[This was the written text supposedly supplied attendees at an American Academy of Nursing (?) conference on violence held in November 1993 at the Washington Hilton Hotel; the oral presentation was shorter and involved a debate with Arthur Kellermann, with a moderator objectively wearing a ban-handguns button.] Over the past two decades, criminologists have learned a great deal about firearms and violence.* Unfortunately, the public health response has largely been to ignore the findings or miscite them in the rhetorical push to have the medical community pretend it has proven the widespread availability of firearms to be a problem, with educational and legislative solutions obvious. While some of the public health production of data have proven interesting, virtually all of the analysis has been pointless, misguided, and dishonest. The criminological findings are, in some ways, disappointing. The most thorough studies by James D. Wright and his colleagues, first at the University of Massachusetts1,2 and then at Tulane,3,4 along with the massive literature review and original research by Gary Kleck5 at Florida State University, are all disappointing to a society wishing for simple answers to firearms related violence. Briefly, they have not found firearms availability related to criminal violence, homicide, or suicide. And virtually no gun law has any impact on violent crime, or gun use in violent crime. Kleck found some approaches to punishing unlawful carrying of a firearm somewhat beneficial, and some differences in law or gun availability might affect slightly gun use in suicide but not the overall suicide rate. Guns are frequently used for protection, and using a gun for protection reduces the likelihood the crime will be completed or that the intended victim will be injured. In short, although Wright and Kleck still support some restrictions on firearms, they found no reason to find ownership of guns, or handguns, by ordinary citizens to be a problem, and no reason to believe gun laws would curb the problem. Some of this should be obvious to persons looking at trends in gun or handgun ownership and misuse. Most of the increase in suicide in recent decades occurred with firearm and handgun ownership by households stable; there was no increase in homicide and suicide following the rise in household ownership of handguns. The recent increase in homicide came at a time when the firearms market was in the doldrums. More significantly, during the 1980s, for most age, ethnic, and gender groups, firearms-related deaths declined -- including deaths among women and domestic homicides, even as there were widespread reports of gun manufacturers targeting women. Most of the recent increase in youth suicide has been less than that in Europe, and most of the increase in homicide has been among persons with traditionally the lowest levels of gun ownership and facing the most restrictive gun laws: young, inner-city blacks and Hispanics.6 These data and the failure of gun laws are largely ignored in the rhetorical public health approach to firearms and violence exemplified by the Centers for Disease Control and Prevention (CDC), and its leading spokesmen, Mark Rosenberg and James Mercy, who believe that if they can demonstrate that firearms are involved in morbidity and mortality -- they are -- then the epidemiological approach proves that any and all proposals will be effective in solving the endemic problem of violence in America, which they call epidemic.7 One problem with the public health approach is a reliance upon unscientific and deceitful methods. Criticism of public health research on firearms is rebutted not with factual material but with an assertion that the critic is biased. One example: "Coming from an official spokesman for the National Rifle Association [NRA], Blackman's invective is no surprise. Kleck's and Wright's long-held views on the issue of gun control are also well known, and their criticism was predictable."8 As it happens, Wright's long-held views were as an advocate of restrictive gun laws whose mind was changed by his research;9 and Kleck remains a supporter of restrictive gun laws and has been criticized for that by the NRA.10 Neither gibe is a scientific response. A more imaginative effort at ad hominem criticism occurred when public health researchers wished to suggest that the theory that, absent a firearm, a potential suicide would simply use a different method, was flawed.11 They first cited a letter to the New England Journal of Medicine where the substitution theory was enunciated -- with a citation to a medical journal article12 -- but the author's affiliation was not given, and then cited a paper by the author, where the substitution theory was not mentioned, but the NRA could arguably be listed as the "publisher." This leads to mention of a related unscientific attitude in public health research, the miscitation of sources. A study which found that a restrictive gun law was followed by a change in the method of suicide but no change in the rate12 was cited11 to support the opposite conclusion. Two surveys -- one of which asked nothing about firearms accidents, and the other of which asked about accidents but not where they occurred -- were cited as suggesting "that guns kept in homes are involved in unintentional deaths or injuries at least as often as they are fired in self-defense."13 This followed a study which cited two FBI sources for the proposition that "Less than 2 percent of homicides nationally are considered legally justifiable."14 Neither source reported that figure. The FBI did not then report data on the number of homicides police thought might be legally justifiable, and still does not collect data on the number determined by prosecutors or others to be legally justifiable. When a source is attempted to be given for the assertion that gun manufacturers' 1980s targeting of a women's market was followed women's gun-related deaths is at an all-time high, a statement popular with the CDC's Mercy,15 the source cited is a 1987 work, with data ending in 1982, showing women's gun-related deaths to have peaked in the 1970s.16 Almost all firearms studies in the public health literature includes citations of materials which do not say what they are purported to have said, or, worse, say something different. The irony of the assertion that Wright's views on "gun control" were "well known" is that, in a previous publication, the same authors had miscited him to support the proposition that "restricting access to handguns could substantially reduce our annual rate of homicide."17 Mercy's activities also exemplify the problem of public health professionals using rhetoric in place of science. Two examples he likes to make are between the number of firearm-related deaths which occur in America in a two-year period with the number which occurred in Vietnam battlefields, and to the number which occurred in the 1980s versus the numbers of AIDS-related deaths during the 1980s.15 The first, in addition to neglecting the fact that the America's mission was ancillary, and the vast majority of casualties were Vietnamese, ignores the key element of rates per 100,000. America's presence in Vietnam rarely exceeded 600,000, with an annual death rate in excess of 1,000. America's population hovers around 250,000,000. And the AIDS comparison includes years before AIDS was identified and was just beginning its epidemic growth; AIDS now exceeds suicide and homicide as a cause of death in the U.S. The CDC rhetorically notes that firearms, or homicides and suicides exceed natural causes as a cause of death for adolescents and youth adults -- something to be expected, since, once children escape the killers of infancy and childhood, external causes remain the leading expected cause of death until ailments of middle age come on. In fact, the real change over the past decade has not been that young adults are not killed by natural causes, but that persons aged 25-44 increasingly are, by AIDS. Similarly, the CDC rhetorically notes that firearm-related deaths, for the first time, exceeded motor-vehicle deaths in two states, suggesting this was because of an increase in firearm-related deaths,18 especially in follow-up citations. The data in the report indicate that Louisiana accomplished that feat in 1974. More importantly, (a) other data indicate that, nationally, the fall in firearms accidents was greater for that period than the fall in motor-vehicle accident.19 And (b) the data -- comparing accidents with motor vehicles to accidents, suicides, and homicides involving firearms -- actually showed that, particularly in Texas, both firearms and motor vehicles saw significant decreases, it was merely that the decrease was so much faster for motor vehicles that they fell below firearms. Perhaps more importantly, since some of the rhetoric is obviously just that, is the deliberate skewing of data, either with or without some ostensible other reason. Perhaps the most important single skew is the limitation in the vast majority of public health studies related to firearms -- where any actual benefits from or harms involved with firearms are measured -- to mortality data. Mortality data are chosen because they are the available data rather than because they are the right data. The result is to skew matters so that firearms seem more relevant to public health than to criminology. After all, only fractions of a percent of crimes involve guns; even violent crimes involve firearms only about 13% of the time. But switch from percentages to rankings as a "cause" of death, and firearms rise to greater significance. Similarly, it is possible to pretend firearms are more dangerous to people and to health-care costs than motor vehicles once morbidity is ignored in favor of mortality. The result, however, is to exclude from consideration the use of firearms in non-fatal ways either in violent crimes, accidents, or for sport or protection. Other skewing of data also occurs. Much of the rhetoric regarding children and firearms- related deaths is achieved by redefining children to include persons up to the age of 19 and excluding persons 0-1.20 The obvious reason is the tiny number of firearm-related deaths among infants, and the high numbers of deaths from natural causes. Later, in reporting trends in gun- related deaths, the lead author began her study with 1985 because showing an entire decade would show a sharp decline in firearm-related deaths between 1980 and 1985.21,22 Similarly, because, while firearms are now involved in about two-thirds of homicides nationally, but in only one-quarter of those involving children,23 homicide victims under 13 were excluded from a study of homicides in the home.24 It would not have taken many children's homicides in homes without firearms in the three counties studied, plus a few false denials of a gun's presence in the homes of controls, for the crude odds ratio for gun ownership to fall below the level of significance. In the same authors' earlier and similar study of suicide, about 30% of suicides were excluded because they occurred outside the home and such suicides were reported by the authors to be less likely to involve guns.11 Those studies were also skewed against firearms by rhetorically ignoring risk factors measured and found to be far greater, but keeping firearms as the focus in the title, in the press, and in educational and policy recommendations.11,24 In the suicide study, firearms as a risk paled compared to tests of illicit drug use, living alone, and domestic violence. In the homicide study, firearms came in fifth of six factors tested for the adjusted odds ratio, behind illicit drug use and domestic violence.* Other factors were either not checked at all or were ignored in the calculations. With one-third of the suicide study above the age of 60, no question of physical health was asked. And, while the question of treatment for depression or mental illness was asked, it was not included in the factors for which crude or adjusted odds ratios for suicide were calculated: In fact, the odds ratio, if calculated, would have been about 25 times higher for depression than for firearms ownership. In the homicide study, factors ignored included family upbringing at a time when even the media are noticing, as criminologists long have, the importance of one-parent families as a risk factor, and whether socialization is by peers or family. The entire "case control" approach, justified on the grounds it is useful for studying events which rarely happen* is misleading as a means to learning about homicide, or suicide. By its very nature, selecting controls similar to persons who die from homicide or suicide means selecting persons largely unrepresentative of society at large or even of the unrepresentative counties chosen. The homicide study, for example, involved persons less affluent and less educated than the counties in general, and the population studied was 62% black while the counties studied were 25% black. It was a study of very high risk individuals compared to high risk individuals, not a study comparing homicide victims to ordinary gun owners. In addition to ignoring the risk of domestic violence, much of the public health research ignores the glaring difference among various ethnic groups, preferring to focus on the firearm, even to the point of deception. A famous comparison of homicide in Seattle and Vancouver17 pretended that firearms explained the difference between the two cities' homicide rates. In fact, with three- fourths of each city's population comprised of non-Hispanic whites, their homicide rates were virtually identical -- insignificantly higher in the restricted Canadian city. Vancouver's lack of blacks and Hispanics compared to very high homicide rates among Seattle's ethnic minorities, including a high homicide rate in Seattle's volatile Asian community, while Vancouver's stable Asian community recorded lower homicide rates than their whites. Unscientifically, the authors "are disinclined to calculate a summary odds ratio stratified by race."25** Similar distorted reasoning occurred when the authors turned to suicide in the two cities.26 The authors pretended that suicide rates were generally higher in the gun-restrictive Canadian city overall and for most ethnic and age groups. Finding a difference among 15-24 year olds, however -- and ignoring the fact for part of that age group, the Canadian gun law was then more lenient -- the gun law should be credited with reducing the suicide rate below that of Seattle. They were essentially saying that a gun law could cause one slice of a pie to be smaller without affecting the size of the whole pie. One of the only efforts to test the effects of a gun law similarly deliberately distorted data to reach a conclusion.27 While most scientists will compare cities to cities, these researchers compared the numbers of homicides in a city, which was rapidly losing population, to those in the surrounding suburbs, which were growing. Perhaps worse, the model used disguised the fact any chart on the homicides would have shown, that the rate of homicide fell before the Washington, D.C., gun law went into effect, and then was stable, rose slightly, fell for a brief time, and then skyrocketed.28 The model used essentially averaged pre-law with post-law homicides to take advantage of the fact that the homicide rate had been quite high in the early 1970s before falling until the year (1976) the gun law was enacted. When challenged with the assertion that homicide dropped during the two years before the law took effect, between 1974 and 1976,29 the authors dishonestly asserted that the critic had said that the drop in homicide began in January 1974, thus suggesting that January 1974 is 24 months before October 1976.30 The authors had checked no other possible factors to explain what they perceived as a drop in homicide; they assumed it must have been the gun law, even though other factors certainly existed in Washington, D.C., including increased efforts to enforce federal gun laws in the District in the mid-1970s.31 Some of the problems with public health research on firearms is the making of illogical leaps from data to conclusion. Although there have been massive experiments around the country with a variety of restrictive gun laws, no honest effort has been made to study their actual effects. The Vancouver/Seattle comparisons17,26 simply assumed the gun laws were the primary differences between the two cities, or the two metropolitan areas, an assumption which is unjustified. A more thorough effort did find both lower levels of handgun ownership and handgun involvement in homicides in Canadian provinces than in bordering American states, but no significant differences in homicide rates, except where two cities unlike anything in Canada -- New York and Detroit -- were in the state bordering a Canadian province.25 But that was not a test of law but availability. The general leap from virtually all public health research on firearms is from asserting guns are involved in morbidity and mortality to concluding restrictive gun laws offer a solution, regardless of the content of the law. Thus, with most reports indicating military-looking guns used in 0-4% of gun-related crimes in most jurisdictions where data are available, and in less than 1% of homicides,5,32 recommendations for bans on so-called "assault weapons" are all but universal in public health literature. Similar support is voiced for the Brady Bill, which would impose a five- business-day waiting period with optional police background check before dealer transfers of handguns to persons at least 21 years old in the states which do not already have a background check -- roughly 30% of the US population. Where such checks occur, about 1-2% of sales are stopped, rightly or wrongly, to persons who might or might not use the handgun to commit a crime, find another means of obtaining a handgun, obtain a rifle or shotgun, or use another weapon to achieve the same result. With handguns involved in about 10% of violent crime,33 the Brady Bill is aimed at a small fraction of a percent of violent crime, none involving adolescents. Doubting the bill would work at all, Kleck's calculations suggest that if it did, perhaps 50 homicides annually would be affected in a nation with 24,000 such incidents annually.5 Sometimes, the illogical leap goes beyond the assumption that firearms-related violence justifies any and all experiments. The New England Journal of Medicine recently suggested that "gun control" experiments which were tested and failed would provide justification for still more restrictive gun laws.34 Others believe they have proven harm merely by showing access to a firearm, even if there is no mortality, morbidity, or other harm from such access.35,36 Another believed it had demonstrated a problem requiring legislative and educational correction based not on harm from "latchkey" children's access to firearms -- as might be demonstrated by showing disproportionate amounts of accidental deaths or gun-related delinquency from such children -- nor even from proof of actual access to firearms by those children, but by demonstrating that guns were often present in the homes of "latchkey" children.37 There may be a problem, although the number of latchkey children appears to be rising as the number of gun-related accidents with children is falling. But the study did not demonstrate that in any way. Had they, their solutions might or might not have made sense. Part of the problem with public health professionals is an appalling ignorance of firearms, ballistics, and firearms owners. A recommendation that pediatricians teach their patients about the risks of gun ownership is undermined by pediatricians' ignorance of the fact regarding those risks38 and a demonstrated preference for gun owners to learn from gun organizations and non-owners to learn from law enforcement.39 Recommendations regarding safety features on firearms tend to follow discussions on the numbers of suicides and homicides involving firearms, while accidents represent a small and diminishing percentage of the misuse of guns in America.16,19 And all such recommendations ignore the fact that such devices could be counterproductive if not retrofitted to all guns,40 and that gun owners not only will not have old guns retrofitted but would remove unwanted safeties put on at the factory.6 Similarly, gun owners would not tolerate ammunition ineffective for protection. Less lethal weapons will be developed for law enforcement, and, when effective, will, in all likelihood, be adopted by large numbers of gun owners without need for legislation or public health advocacy.* Another problem deals with ignorance or indifference of criminological and other findings as to what constitutes a risk factor.41 Part of this is owing to the inappropriate methodologies. Case control, for example, requires assuming certain factors to be risk factors -- ethnicity, age, gender, perhaps income or education -- which prevents further measurement. Other factors recognized by criminologists have been ignored in most public health studies, including family structure and values, influences of peer groups and the mass media, unemployment, and the like. Sometimes the ignorance leads to pretending a major discovery has been made when the criminologically-obvious was happened upon. Kellermann et al.24 recently discovered that homicides in the home generally involve persons who know one another, rather than strangers, and that intruders are rarely involved. To criminologists, it would be mindboggling that anyone might think otherwise, with burglary-related homicides always a small percentage of homicide and, otherwise, it being obvious that people in one's home are persons one knows. Domestic violence is generally recognized but belittled both for homicide and suicide. In one article, women were advised against having a gun for protection, because, when a woman kills with a gun, she is five times more likely to kill a family member or intimate acquaintance than a stranger.42 (The ratio was approximately the same when women killed with a knife and minimally lower when they killed by some other means.) There was no suggestion that the killings were other than self-defensive, a view supported by criminological literature: "Moreover, it seems clear that a large proportion of spousal killings perpetrated by wives, but almost none of those perpetrated by husbands, are acts of self-defense....women kill male partners after years of suffering physical violence, after they have exhausted all available sources of assistance, when they feel trapped, and because they fear for their own lives."43 Comparable to the five-to-one ratio, a study of rape found it 3.5 times more likely to be by a non-stranger.44 Thus, domestic self- defense is bemoaned as something women should try to avoid by avoiding firearms ownership. Incredibly, mental illness and depression have been ignored or denied in suicide studies. Kellermann et al.11 asked about history of mental illness or depression in a widely-publicized suicide study, but the odds ratio was not calculated. And the CDC's leading spokesmen have denied its relevance to recent increases in suicide, without citation 45 or, it would seem, justification.46 And public health advocates -- while espousing redesign of guns aimed exclusively at accidents, particularly those involving children -- generally dismiss firearms safety education as unproved, potentially counterproductive, and meaningless where such a small percentage of firearms-related deaths involve accidents.16,47,48,49 The proliferation of unscientific anti-gun advocacy research in public health is likely to continue. For one thing, a Gresham's Law is at work. While criminologists may learn from criminologists,50 such research is apt to be sneeringly dismissed as contrary to common sense.51 Competent medical and public health researchers might prefer to go into fields where honesty and competency is highly regarded, leaving the fame and fortune of gun research to the biased and incompetent. Peer review then works to enforce Gresham's Law, as standards steadily decline. Katherine K. Christoffel really is the peer of Arthur Kellermann.* It normally takes but one peer reviewer to blackball an article; thus, even if some anti-gun reviewers would accept research viewed as pro-gun, it would likely be blackballed by another, who would reject any article conflicting with preconceived ideas. One peer reviewer blackballed an article suggesting some legislative remedy would not keep guns out of the hands of children, arguing that it was not enough to say what would not work; the article would have to say what would work to be worthy of publication. That approach is not similarly applied to experiments to see if a particular drug will aid in the treatment of a disease. (Private communication*) The news media can be counted on to exacerbate the situation by dutifully ignoring all of the caveats which are perfunctorily included in anti-gun public health research, as well as corrections of the most egregious of errors. When a study found that, among suicidal adolescents, firearms in the home doubled the likelihood of suicide,52 two times became 75 times for the CDC,53 and the requirement that the adolescents be suicidal was ignored by the popular press.54 And, while Kellermann and Reay14 noted that a study was preliminary and not necessarily accurate with regard to anyplace but the metropolitan area covered, it is constantly cited as if it were definitive -- although the more cautious, while still treating it as definitive, will voice it more as "one study found...." The situation is not likely to improve anytime soon. So long as available data are accepted instead of the data actually needed for scientific study, and so long as higher praise comes for more highly biased studies, there is little incentive to scientific research. Neither the medical profession nor public health professionals should be expected to insist upon competency and honesty in firearms research. Most of them are too busy doing their jobs and keeping up with relevant literature to be bogged down in shoddy research which is simply ignored or dismissed as unworthy of being read. A certain irony exists in the fact that medical personnel are among the leading lights of anti-gun advocacy, since gun, and handgun, ownership tend to rise with affluence.5 And, while some workers in inner-city hospitals wish their patients were disarmed by law, others see more and more reason to arm themselves. And one of the reasons some restrictive gun laws are not enforced with enthusiasm by police, prosecutors, and the courts, is that violators all too often turn out to be persons who have never been a threat to society, who have no prior arrest records, and may just be nurses who have to travel to or through unsafe neighborhoods on their way to work.55 Recommendations for the nursing community would be: (1) Demand better research of public health professionals, incorporating the lessons learned from criminology. (2) Evaluate the feasibility of increasing reporting from emergency rooms on details regarding firearm-related morbidity and mortality without hampering treatment to patients. (3) Work with the NRA to get schools in each nurse's area to adopt the NRA "Eddie Eagle" firearm safety program. (4) Nurses interested in developing their own personal safety strategy should be advised to inquire about the availability in their areas of NRA's courses on the subject, by telephoning: 1-800-861-1166. REFERENCES 1. Wright JD, Rossi PH, Daly K. Under the gun: weapons, crime, and violence in America. New York: Aldine, 1983. 2. Wright JD, Rossi PH. Armed and considered dangerous: a survey of felons and their firearms. New York: Aldine de Gruyter, 1986. 3. Sheley JF, McGee ZT, Wright JD. Gun-related violence in and around inner-city schools. AJDC 1992;146:677-682. 4. Wright JD, Sheley JF, Smith MD. Kids, guns, and killing fields. Society 1992;84- 89(Nov/Dec). 5. Kleck G. Point blank: guns and violence in America. New York: Aldine de Gruyter, 1991. 6. Blackman PH. Children and firearms: lies the CDC loves. Paper delivered at annual meeting of the American Society of Criminology, New Orleans, 1992. 7. Blackman PH. Criminology's astrology: the CDC approach to public health research on firearms and violence. Paper delivered at annual meeting of the American Society of Criminology, Baltimore, 1990. 8. Sloan JH, Rivara FP, Kellermann A. Correspondence: firearm regulations and rates of suicide. N Engl J Med 1990;323:136-137. 9. Wright JD. Second thoughts about gun control. Public Interest 1988;91:23-39. 10. Blackman PH. Book review: Gary Kleck. Point blank: guns and violence in America. Criminologist 1993;18(3):16. 11. Kellermann AL, Rivara FP, Somes G, Reay DT, Francisco J, et al. Suicide in the home in relation to gun ownership. N Engl J Med 1992;327:467-472. 12. Rich CL, Young JG, Fowler RC, Wahner J, Black NA. Guns and suicide: possible effects of some specific legislation. Am J Psychiatry 1990;147:342-346. 13. Kellermann AL, Reay DT. Correspondence: firearm-related deaths. N Engl J Med 1986;315:1484. 14. Kellermann AL, Reay DT. Protection or peril?: an analysis of firearm-related deaths in the home. N Engl J Med 1986;314:1557-1560. 15. Cotton P. Gun-associated violence increasingly viewed as public health challenge. JAMA 1992;267:1171-1174. 16. Wintemute GJ. Firearms as a cause of death in the United States, 1920-1982. J Trauma 1987;27:532-536. 17. Sloan JH, Kellermann AL, Reay DT, Ferris JA, Koepsell T, et al. Handgun regulations, crime, assaults, and homicide: a tale of two cities. N Engl J Med 1988;319:1256-1262. 18. CDC. Firearm-related deaths -- Louisiana and Texas, 1970-1990. MMWR 1992;41:213-221. 19. National Safety Council. Accident facts, 1993 edition. Chicago: NSC, 1993. 20. Fingerhut LA, Kleinman JC. Firearm mortality among children and youth. NCHS Advance Data No. 178 (Nov. 3, 1989). 21. Fingerhut, LA. Firearm mortality among children, youth, and young adults 1-34 years of age, trends and current status: United States 1985-1990. CDC Advance Data 231 (March 23, 1993). 22. Fingerhut LA, Kleinman JC, Godfrey E, Rosenberg H. Firearm mortality among children, youth, and young adults 1-34 years of age, trends and current status: United States 1979-1988. CDC Monthly Vital Statistics Report 39 (Supplement)(March 14, 1991). 23. U.S. Dept of Justice Federal Bureau of Investigation. Crime in the United States, 1992 (Uniform Crime Reports). Washington, D.C.: Government Printing Office, 1993. 24. Kellermann AL, Rivara FP, Rushforth NB, Banton JG, Reay DT, et al. Gun ownership as a risk factor for homicide in the home. N Engl J Med 1993;329:1084-1091. 25. Centerwall BS. Homicide and the prevalence of handguns: Canada and the United States, 1976 to 1980. Am J Epidem 1991;134:1245-1260. 26. Sloan JH, Rivara FP, Reay DT, Ferris JAJ, Kellermann AL. Firearm regulations and rates of suicide: a comparison of two metropolitan areas. New Engl J Med 1990;322:369-373. 27. Loftin C, McDowall D, Wiersema B, Cottey TJ. Effects of restrictive licensing of handguns on homicide and suicide in the District of Columbia. N Engl J Med 1991;325:1615-1620. 28. Government of Washington, D.C., Office of Criminal Justice Plans and Analysis. Homicide Report. April 1992. 29. Blackman PH. Correspondence: effects of restrictive handgun laws. N Engl J Med 1992;326:1157-1158. 30. Loftin C, McDowall D, Wiersema B, Cottey TJ. Correspondence: effects of restrictive handgun laws. N Engl J Med 1992;326:1160. 31. Kleck G. Interrupted time series designs: time for a reevaluation. Paper delivered at the annual meeting of the American Society of Criminology, New Orleans, 1992. 32. Kleck G. Assault weapons aren't the problem. New York Times, Sept. 1, 1992. 33. Rand MR. Handgun crime victims. U.S. Dept of Justice, Bureau of Justice Statistics Special Report, July 1990. 34. Kassirer JP. Guns in the household. N Engl J Med 1993;329:1117-1119. 35. Weil DS, Hemenway. Loaded guns in the home: analysis of a national random survey of gun owners. JAMA 1992;267:3033-3037. 36. Callahan CM, Rivara FP. Urban high school youth and handguns: a school-based survey. JAMA 1992;267:3038-3042. 37. Lee R, Sacks JJ. Latchkey children and guns at home. JAMA 1990;264:2210. 38. Webster DW, Wilson MEH, Duggan AK, Pakula LC. Firearm injury prevention counseling: a study of pediatricians' beliefs and practices. Pediatrics 1992;89:902-907. 39. Webster DW, Wilson MEH, Duggan AK, Pakula LC. Parents' beliefs about preventing gun injuries to children. Pediatrics 1992;89:908-914. 40. General Accounting Office. Accidental shootings: many deaths and injuries caused by firearms could be prevented. Report to the chairman, subcommittee on antitrust, monopolies, and business rights, Committee on the Judiciary, United States Senate, 1991. 41. Nettler G. Killing one another. Criminal careers, vol. 2. Cincinnati: Anderson Pub Co, 1982. 42. Kellermann AL, Mercy JA. Men, women, and murder: gender-specific differences in rates of fatal firearms violence and victimization. J Trauma 1992;33:1-5. 43. Wilson MI, Daly M. Who kills whom in spouse killings?: on the exceptional sex ratio of spousal homicide in the United States. Criminology 1992;30:189-215. 44. National Victim Center and the Crime Victims Research and Treatment Center. Rape in America: a report to the nation. Washington, D.C., April 23, 1992. 45. Rosenberg ML, Mercy JA. Introduction, 3-13. In Rosenberg ML, Fenley MA. Violence in America: a public health approach. NY: Oxford, 1991. 46. O'Carroll PW, Rosenberg ML, Mercy JA. Suicide, 184-196. In Rosenberg ML, Fenley MA, eds. Violence in America: a public health approach. NY: Oxford, 1991. 47. National Committee for Injury Prevention and Control. Injury prevention: meeting the challenge. NY: Oxford, 1989. 48. Kellermann AL, Lee RK, Mercy JA, Banton J. The epidemiologic basis for the prevention of firearm injuries. Ann Rev Pub Health 1991;12:17-40. 49. AAP Committee on Adolescence. Policy statement: firearms and adolescents. AAP News 1992(January):20-21. 50. Nettler G. Criminology Lessons. Cincinnati: Anderson Pub Co, 1989. 51. Menken M. In reply. Arch Neurol. 1993;50:346-347. 52. Brent DA, Perper JA, Allman CJ, Moritz GM, Wartella ME, Zelenak JP. The presence and accessibility of firearms in the homes of adolescent suicides: a case-control study. JAMA 1991;256:2989-2995. 53. Rosenberg ML, Mercy JA, Houk VN. Guns and adolescent suicides. JAMA 1991;266:3030. 54. Reeves R. Give gun control a chance. Baltimore Sun, September 25, 1992. 55. Blackman PH. Carrying handguns for persons protection: issues of research and public policy. Paper delivered at the annual meetings of the American Society of Criminology, San Diego, 1985. *There has also been massive research on the intentions of the framers of the Second Amendment, and of similar state constitutional protections of the right to keep and bear arms, making it clear that an individual right for sane, non-felonious adult citizens to own commonly- owned types of guns was expressly what was intended, and that the "militia" reference was to the persons who might be expected to protect the nation in case of an emergency, not any organized body of soldiers. And the Fourteenth Amendment was intended to apply that guarantee against infringement by the states. SP Halbrook. That every man be armed: the evolution of a constitutional right. Albuquerque: Univ. of New Mexico Press, 1984. A right to bear arms: state and federal bills of rights and constitutional guarantees. Westport, Conn.: Greenwood Press, 1989. S Levinson. The embarrassing Second Amendment. Yale Law J 1989;99:637-659. It is understandable that the medical community would not be concerned with constitutional law; it is unclear why MDs and MPHs feel comfortable pretending expertise on the matter in medical journals. *An interesting aspect of this for the CDC is that, in speaking to the 1992 annual meeting of the American Society of Criminology, the CDC's Mercy told his audience that firearms research was a high priority for the CDC but that domestic violence research was not. *Thus, were the Kellermann et al. study of homicide's findings accurate,24 gun ownership would raise the annual risk of household homicide to one in 15,000. **They are similarly disinclined to report other information. They assert that handguns explain the difference in firearm-related homicide in the two cities, although pictorially, their chart makes the relative difference between the cities' rifle/shotgun homicides look similarly different in size. Requests for the data have been routinely ignored. The significance is that, while handguns are sharply restricted in Canada, rifles and shotguns were relatively unrestricted in both jurisdictions. Interestingly, the authors assumed there were dramatically higher levels of gun ownership in Seattle than in Vancouver -- largely based on comparing protective handgun ownership in Seattle to sporting handgun ownership in Vancouver, and using a peculiar test which presumes that firearm availability among the general public can be determined by measuring firearm misuse in suicide and homicide. However, a survey by Gary A. Mauser in British Columbia, and Gary Kleck's analysis of two decades of national social surveys suggests that gun ownership levels in the two cities might be similar, and, indeed, that gun ownership might even be higher in the Canadian city. (Private communication) *As has been demonstrated with tear/pepper gas and "stun guns," however, their production will be followed almost immediately for calls for their restriction on the grounds they could also be used by criminals, and the lobbies for any new products are generally poorly organized. *Christoffel recently refused admission to a conference she was holding because its purpose was to "use a public health model to work toward changing society's attitude toward guns so that it becomes socially unacceptable for private citizens to have handguns," and the registrant "does not share these beliefs, and, therefore, does not meet the criteria for attendance at the meeting." (Letter to Edgar Suter, MD, September 28, 1993) CDC grant recipient Kellermann and CDC representatives Rosenberg and Mercy were welcomed at the conference. *Occasionally a scholar whose research is perceived as pro-gun will be asked to peer-review anti-gun research, presumably when its flaws are so obvious to the editor that even the lower standards for gun research are not met, and as a way to demonstrate fairness in the selection of peer reviewers. And occasionally research perceived as pro-gun has been published because the editor ignored efforts of peer reviewers to blackball research for reaching the "wrong" conclusion.25