Reviving research into US gun violence.

In January, in response to the shooting at the Sandy Hook Elementary School in Newtown, Connecticut, that left 20 schoolchildren and six adults dead, US president Barack Obama issued 23 executive orders to deal with gun violence in America. Among those was an order directing the USCenters for Disease Control and Prevention (CDC) to research the causes and prevention of gun violence, an order directing the US Attorney General to issue a report on new gun safety technology, and an order clarifying that the Patient Protection and Affordable Care Act, the president’s 2010 health reform law, “does not prohibit doctors asking their patients about guns in their homes.” That it was necessary for the president to issue executive orders directing actions in a country that sees more than 31 000 killed from gunshot wounds each year surprised many. But for 17 years, legislation has been on the books banning or severely constraining government initiatives to reduce gun violence and gun related injuries. In his statement announcing his executive actions, Obama denounced in particular efforts to deny federal funding for scientific and medical research into the causes of gun violence. “We don’t benefit from ignorance. We don’t benefit from not knowing the science of this epidemic of violence,” Obama said. For much of the 20th century, gun violence in the US had been considered a law enforcement issue. But in the late 1970s and early 1980s, a series of reports and workshops started to recast the issue as a public health problem and calling for a far broader societal approach. The 1979 US surgeon general report,Healthy People, identified homicide as a important health problem. The report noted that althoughmany factors were involved in the nation’s highmurder rate, including economic deprivation, family breakup, and the glamorization of violence in the media, “Easy access to firearms appears to be the one factor with a striking relationship to murder.” And in 1985 the Institute of Medicine issued an influential report, Injury in America, calling on, among other initiatives, research into the effectiveness of laws and “other measures to reduce firearm homicide.” As part of this shift to a public health approach to violence reduction, the CDC created a Division of Violence Prevention in 1991 and a year later raised the division to center status as the National Center for Injury Prevention and Control (NCIPC). Gun rights advocates, however, denounced the research coming out of the center and other research groups looking in to gun related injuries, which they charged was merely anti-gun propaganda designed to demonize guns. Research funded by the CDC that particularly angered gun rights groups were reported in two papers in theNew England Journal of Medicine in 1992 and 1993. 5 In those papers, Arthur Kellermann and colleagues found that keeping a gun in the home was associated with a 2.7-fold increase risk of homicide for members of the household and a 4.8-fold increase in risk of suicide. “Despite the widely held belief that guns are effective for protection, our results suggest that they actually posed a substantial threat to members of the household,” they wrote. In 1995, gun rights advocates, led by the National Rifle Association, enlisted their supporters in Congress to pass legislation that would have eliminated NCIPC completely. When that effort failed, they instead successfully stripped the CDC of the $2.6m (£1.7m; €1.9m) of its budget slated for gun violence research and forbid the agency “to advocate or promote gun control.” Similar language was put in legislation governing the National Institutes of Health’s budget, and federal funding for public health research into gun violence all but disappeared. Gun rights advocates also moved to pass both state and federal laws seeking to prevent doctors from asking their patients about guns in their homes. Several medical societies, including the American Academy of Pediatrics, the American College of Physicians, and the Academy of Family Physicians, have recommended that physicians counsel their patients about firearm injury prevention, such as the use of gun safes and trigger locks.