May 27, 1994 John H. Davis, M.D. Editor, Journal of Trauma Department of Surgery D-319 Given Building Univ. of Vermont College of Medicine Burlington, Vermont 05405 I shall note just three of the flaws in the comparison of the costs of treating gunshot and stab wounds with the recommendation of more restrictive gun laws.1 First, Mock et al. compared wounds rather than attacks in calculating what would happen if knives were substituted for guns. Because knife attacks are so much more likely to lead to stabbing than gun attacks to gunshot wounds,2 using the latest figure on handgun-related victimization numbers3 and the costs from Mock et al.,1 applying their hypothesized knife substitution to attacks would produce annually an increase in national medical costs of nearly $200-million. Second, retaining the same number of attacks but having them with knives instead of firearms is not, contrary to the authors' assumption, the "worst-case scenario." The worst-case scenario is dramatically higher numbers of assaults and robberies than occur now. Criminologists have long noted that the nature of guns serves as a deterrent and/or their absence serves as an incentive to assault -- thus a reduction in gun assaults "produced a more than offsetting increase in nongun armed assaults"4 -- and that robbers without guns will tend to go after less affluent, less secure targets, and to hit more of them to achieve the same income.2,4,5 As a result, the no-gun hypothesis would likely see sharp increases in the number of non-gun attacks, not merely the same number as envisioned by Mock et al. Third, that hypothesis has never been thoroughly tested because no gun law here2 or abroad6 has served to reduce the availability of guns to those who would misuse them, except by the most draconian of measures in countries with minimal regard for human rights or due process of law. Some in the public health community have dismissed those criminological sources because their research did not appear in "peer reviewed" medical journals. The post-publication peer review, however, has been impressive. Kleck2 won the 1993 Hindelang Award from the American Society of Criminology (ASC) for "the book published in the past two to three years that makes the most outstanding contribution to criminology," and Kopel's book6 was declared the 1992 book of the year by the Division of International Criminology of the ASC. Paul H. Blackman, Ph.D. Research Coordinator 703-267-1226 Word Count: 367. REFERENCES 1. Mock C, Pilcher S, Maier R: Comparison of the costs of acute treatment for gunshot and stab wounds: further evidence of the need for firearms control. J Trauma 36:516-522, 1994. 2. Kleck G.: Point Blank: Guns and Violence in America. New York: Aldine de Gruyter, 1991. 3. Rand MR: Guns and crime. Crime data brief, U.S. Bureau of Justice Statistics, April 1994. 4. Pierce GL, Bowers WJ: The Bartley-Fox gun law's short-term impact on crime in Boston. Annals, AAPSS 455:120-137, 1981. 5. Wright JD, Rossi PH, Daly K: Under the Gun: Weapons, Crime, and Violence in America. New York: Aldine, 1983. 6. Kopel DB: The Samurai, the Mountie, and the Cowboy: Should America Adopt the Gun Controls of Other Democracies? Buffalo: Prometheus Books, 1992.