Guns, Germs, and Science: Public Health Approaches to Gun Control

by David B. Kopel

This article is a revised version of a lecture delivered at the Alumni Day Program, at the

University of Oklahoma College of Public Health, October 14, 1994.

Traditionally, the gun issue in America has been studied by scholars in law and criminology. Legal scholars have studied issues such as the meaning of the Second Amendment's guarantee of "the right of the people to keep and bear arms," as well as parallel provisions in state constitutions.

In the field of legal scholarship, the primary question has been answered: the Second Amendment was plainly intended to guarantee a right of individuals to possess arms. The essential purpose of this guarantee was not to protect sporting uses of guns, but to facilitate resistance to criminal governments, which was seen as simply a larger case of resistance to individual criminals.⁽¹⁾

There are still many legal questions to be resolved regarding the boundaries of the Second Amendment. But as to the question of original intent, the debate is well-settled. Indeed, there is not a law professor in this country who in the last 25 years has published anything in a law journal claiming that the Second Amendment was not intended to protect an individual right.

The criminologists have not been as unanimous in their answers as have been the legal scholars. But criminological research has in the last two decades suggested that the most extreme forms of gun control -- such as prohibitions on handguns, or extremely rigorous gun licensing systems -- are not effective, and are perhaps even counterproductive. The criminologists also point out that guns are used frequently for lawful defensive purposes, and in that capacity, provide a major public safety benefit.

In the last decade, especially in the last five years, the legal and criminological scholars looking at the gun issue have been joined by researchers in the public health and medical fields, with much of the research being funded by the federal Centers for Disease Control and Prevention. Most of these researchers tell us that "Violence is a disease," that "Guns are a disease vector," and that we should start looking at gun control as a public health issue, rather than a legal or criminal issue. Indeed, we are told that the gun control debate is now ended, since the "scientific" public health approach has supplied all the answers.

These phrases sound strange to many people who are trained in law or criminology. Imagine, if you would, that the direction of this inter-disciplinary crossing was reversed. What if criminologists and law professors started getting involved in medicine? Suppose, for example, that I told you that it is time to start thinking of communicable disease as a criminal and legal issue, rather than a public health issue, and it is time to recognize that "Disease is a crime."

Treating Disease as a Crime

In support of this new, "legal" approach, I might point out that while the public health approach has made important progress in reducing communicable disease, the public health approach has succeeded in wiping out entirely only a few diseases, such as smallpox. In the 1960s, the Centers for Disease Control promised that measles in America would be eradicated entirely within four years, yet a quarter of a century later, measles is still with us.

I would further point out that disease endangers the person who is diseased, just as does drug abuse, which is currently treated as criminal problem. Communicable diseases, being communicable, also endanger other people far more directly than does drug use, or most other forms of non-violent crime.

In many cases, a person who comes down with a communicable disease could have prevented the disease through proper precautions, such as inoculation or hand-washing. Moreover, persons who are carriers of communicable diseases have often consciously disregarded a risk they pose to innocent people -- for example by coming to work even though they know they are sick.

If we can characterize the level of violence in American society as "epidemic," then we could certainly say that the total, overall level of communicable diseases, including everything from chicken pox to AIDS, is also epidemic. More properly, chicken pox and violence might be described as having high endemic levels, but we should not be too concerned with technical details when public safety is involved.

Accordingly, my modest proposal for "Treating disease as a crime" would impose criminal penalties, including fines and imprisonment, on people who have communicable diseases. The most severe criminal penalties would be applied to people whose misconduct inflicts a large number of people with a dangerous disease. Lesser punishments would apply to persons who infect only themselves with minor diseases through negligence, rather than recklessness. A person who catches a cold because he failed to wash his hands often enough would only spend a week in jail. For persons who catch diseases through no fault of their own, administrative fines, but no jail time would be imposed, much as we currently impose fines on businesses which inadvertently violate highly technical environmental regulations.

At first, my modest proposal will encounter substantial resistance, even within the law enforcement community. But eventually the National Institute of Justice will start funding millions of dollars of research designed to reduce communicable disease by treating it as a crime.

The research will never be published in serious journals of epidemiology or public health. But the new research will be published in highly-regarded legal journals, such as the Harvard Law Review.

The new criminal disease research will rarely make reference to previous medical research. Indeed, it will recycle half-baked ideas for disease reduction that have already been studied and disproven in the medical journals. But the Harvard Law Review and the Yale Law Journal have a lot of prestige, and a much better public-relations machine than does the American Journal of Epidemiology. Newspapers and the electronic media -- which already take a sensational, salacious, and short-sighted approach to the crime issue -- will eat up and regurgitate the press-releases from the Harvard Law Review detailing the latest set of factoids and hysteria cooked up by law professors with federal grants trying to write articles about communicable disease.

So after a few years, and a few tens of millions of dollars of federally-funded research, most of what the general public hears in a "scientific" way about disease control will come from articles about rubella in the Harvard Law Review, and studies of syphilis in the Journal of Contemporary Law.

If you find my modest proposal to treat disease a crime to be rather disturbing -- and I hope you do -- then perhaps you can sympathize a little with the legal scholars and criminologists who are disturbed by the current campaign to treat violence as a disease. In any case, it is time for the "violence as a disease" theory to undergo a much more rigorous analysis than it has thus far received.

Disease Vectors

Even if we accept that violence is a disease, the public health solution is far less obvious than the gun prohibition movement and some of its public health allies would suggest. Their analysis simplistically echoes the words of Dr. Katherine Christoffel of the American Academy of Pediatrics: "Guns are a virus...They are causing an epidemic of death by gunshot, which should be treated like any epidemic -- you get rid of the virus."

Flies are a disease vector for polio. Yet the CDC's rigid fly control programs of the early 1950s proved ineffective against polio.⁽²⁾ Are guns in America, like flies, already so numerous that attempting to reduce their numbers significantly enough to reduce the violence-disease rate is likely to be an exercise in futility?

CDC can get caught up in programs that fit with the political wishes of the White House or Congress, but which have little scientific validity. The rat control programs of the 1960s are one example.⁽³⁾ Another is the Times Beach, Missouri, evacuation in early 1980s, which forced hundreds of people out of their homes because of alleged dioxin contamination, for what turned out to be unscientific, politically-driven reasons. The evacuation was the work of Dr. Vernon Houk, who later became a leader in the CDC's gun prohibition efforts.

For something to be a genuine disease vector, there must be some association between prevalence of disease vector (guns) and the disease (violence). In fact, there is a strong correlation. But the correlation is an inverse one. Regions and population groups with the most guns have the lowest levels of gun violence. Periods when the per capita gun supply is rising rapidly, such as the early 1980s, have been periods of falling violence.

Serious research about a source of disease must consider whether there is a pharmakopic effect. The evidence suggests that firearms are pharmakopic. The latest, most in-depth research suggests that firearms are used as often as 2.4 million times a year for self-defense against criminal attack. Defensive use usually involves simply brandishing or referring to a gun, rather than firing it.⁽³⁾

Finally, the "public health" campaign to outlaw guns because of the allegedly successful gun control policies of other nations ignores the potential criminogenic effect of those controls.

The chart below sets forth crime and suicide rates for several nations, per 100,000 population. ⁽⁴⁾

While the United States has much more violent crime than the other nations (including crimes such as rape, which rarely involve guns), the United States anomalously has less burglary. In terms of burglaries perpetrated against occupied residences, the American advantage is even greater.

In Canada, for example, a Toronto study found that 48% of burglaries were against occupied homes, and 21% involved a confrontation with the victim; only 13% of U.S. residential burglaries are attempted against occupied homes. Similarly, most Canadian residential burglaries occur in the nighttime, while American burglars are known to prefer daytime entry to reduce the risk of an armed confrontation.^(5,6)A British survey found 59 percent of attempted burglaries involved an occupied home.⁽⁷⁾

Why should American criminals, who have proven that they engage in murder, rape, and robbery at such a higher rate than their counterparts in other nations, display such a curious reluctance to perpetrate burglaries, particularly against occupied residences? Could the answer be that they are afraid of getting shot? When an American burglar strikes at an occupied residence, his chance of being shot is equal to his chance of being sent to jail.⁽⁶⁾ Accordingly, a significant reduction in the number of Americans keeping loaded handguns in the home could lead to a sharp increase in the burglary rate, and to many more burglaries perpetrated while victim families are present in the home.

Phrenology and Guns in the Home

Epidemiologists in particular, and public health researchers in general, have excellent quantitative skills, traceable in part to Pierre Charles-Alexander Louis and his methode numerique, which pioneered the use of statistics in medical research.⁽²⁾ But precise measurement, though apparently scientific, is not always so. Phrenology, a highly-regarded "science" of 19th-century, produced elaborate measurements of the shape of people's heads. These shapes supposedly were associated with certain traits, such as lack of intelligence ("low-brow") or criminal propensity. Today, we recognize that the phrenology data is of no scientific value. In regards to firearms, the public health research, like phrenology research, too often tells us more and more about less and less.

An example of the positive contribution that the public health community can make to the gun control debate is Lois Fingerhut's research regarding teenage homicide rates, the most thorough research ever regarding the topic.⁽⁸⁾ For teenagers of all combinations of races and genders in rural areas, the homicide rate is close to zero. Interestingly, these teenagers are the ones with the readiest access to firearms.

But for Black males aged 15 to 19 in core urban areas, the homicide rate is an incredible 160. Fingerhut suggests that the solution to this problem is gun control; people may differ as to how to respond to this awful death rate, but everyone should be grateful to Ms. Fingerhut and the CDC for providing us with important data detailing the immensity of the problem. As the CDC's William Farr put it, "The death rate is a fact; anything beyond that is an inference."⁽²⁾

Unfortunately, the product of public health research about guns is too often bad data. An example of bad data is article by Dr. Arthur Kellermann and others claiming that the presence of a handgun in the home raises the risk of death by 3.4 times.

First of all, Doctor Kellermann will not let other let other researchers see his data. This seems to be a gross deviation from appropriate scientific standards. If critics will never have the opportunity to see one's data, then it possible to massage the data into all sorts of conclusions.

Moreover, the study fails to address the cause and effect relationship. Do guns cause people to be murdered, or are people already at risk of being murdered more likely to buy handguns?

We can see the cause-and-effect issue by looking carefully at Kellermann's odds ratios. The Kellermann article, which produced the widely-circulated risk ratio for handgun ownership, reports the exact same risk ratio for renting rather than owning the place where you live. Does this mean that you suddenly become safer when your apartment building goes condo? Of course not.

Likewise, are you safer when you get rid of your handgun? Not necessarily.

The possibility that Kellermann has reversed cause and effect is supported by his findings regarding controlled access security systems. Such security systems produced a higher crude odds ratio than did handgun ownership (2.3 vs. 1.9). Does this mean that a cautious homeowner should, after getting rid of handguns, convince his landlord to get rid of the security guard in the apartment lobby? To the contrary, the presence of security guards in the lobby (like handguns) in the home, may simply be a reflection of the dangers faced by people who are at risked of being murdered, and who are taking sensible steps (through armed security guards, and through personal armament) to protect themselves.

The Kellermann article also highlights the weakness of the case-control method when taken beyond the confines of disease. Let us apply the study's case-control methodology to something else. Let us compare 200 students, all of whom scored double 800s on the SAT, with 200 socioeconomically similar students who did not score so high. We find that the high-scoring students are about three times more likely to own a chess set than the lower-scoring students. Accordingly, we claim that "persons who own chess sets are three times more likely to score an 800 on the SAT than are persons who do not own chess sets."

I hope that the SAT chess study would not convince high school students to run out and buy chess sets, in the hopes of improving their SAT results.

We don't know of the students with chess sets actually played chess much. Even if they did play chess a lot, we don't know if chess helped build verbal analogy skills and other skills with lead to SAT success, or if people who are already smart and likely to do well on the SAT are simply more like to enjoy chess sets, or be given chess sets as gifts.

If we just substitute "being murdered" for "scoring an 800 on the SAT," and substitute "handgun" for "chess set," we have the study that supposedly proves that owning a handgun increases the odds that you'll be murdered.

Finally, a study which only looks at dead people is not a very good measure of the protective benefits of gun ownership.

"I must be right. I'm a doctor."

There is another problem with the medical intervention in the gun issue. Too often, it is based on an appeal to authority, rather than to logic. Doctors--unlike lawyers, Congress, and used car salesman--enjoy great credibility in the eyes of the American people. But the further that doctors stray from medicine, the greater the risk of destroying that credibility.

When criticized -- whether by Dr. Paul Blackman of the National Rifle Association -- or by eminent sociologists such as James D. Wright of Tulane University -- or by physicians such as Dr. Edgar Suter, the response of the gun prohibition movement and its public health allies is generally to attack the motives of the critic, rather than to answer the criticism.

This sort of response is inappropriate for several reasons. First of all, it is antithetical to the scientific method. If an article suffers from fundamental statistical flaws, those flaws do not disappear simply because the NRA points them out.

Secondly, the most prominent public health scholars on the gun debate, such as Dr. Kellermann, or Dr. Christoffel from the American Academy of Pediatrics, are themselves ideologues and activists. I do not think that this fact disqualifies them from producing research that should be carefully considered.

Moreover, personalization of the issue tends to raise rather than settle questions about the desirability of gun control. Both sides of debate have people for whom research has confirmed their previous intuitions, for or against guns. But there is also a class of scholars who started studying the gun issue and were strong supporters of one viewpoint, but who revised their views in light of the evidence.

Every scholar who has "switched" has "switched" to the side that is skeptical of controls.

Indeed, most of the prominent academic voices who are gun control skeptics -- including law professors Sanford Levinson and William Van Alstyne, and criminologists Gary Kleck and James Wright -- are people who when they began studying guns were supporters of the gun control agenda. I do not know of a single scholar who has published a pro-control article who started out as a skeptic of gun control. This suggests how heavily the weight of the evidence is distributed, once people begin studying the evidence.

In the long term, a little recognition of medicine's limits might be in order. Even in the field of communicable disease, there is a great deal that science cannot answer. The Centers for Disease Control and Prevention is the descendant of the Malaria Control in War Areas unit of the U.S. Public Health Service. Despite intensive malaria-control efforts, such as draining swamps, and spreading DDT over vast areas, the Malaria Control unit made little progress against malaria until the disease essentially disappeared in 1945, for reasons which even today are not understood.⁽²⁾

Even classic medical problems involving communicable diseases may not be entirely solvable through medical approaches. Sexually transmitted diseases, including the old-fashioned ones, remain a very serious public health problem, despite decades of hard work by the public health community.

How much more so may public health prove unable to solve problems further afield? The focus on objects rather than people can lead public health to absurd results. Consider, for example, the public health involvement in the nuclear war debate during the 1980s.

Traditionally, the risks of nuclear war and how to reduce them had been considered a diplomatic or military issue.

Public health made useful contributions to the nuclear debate. A famous article in the New England Journal of Medicine documented the widespread presence of strontium 90 in children's teeth. This research proved to be a major spur to the Nuclear Test Ban Treaty.

But the public health contribution to the nuclear issue was often an unhelpful focus solely on the nuclear arms themselves (just as modern public health focuses on guns). Physicians for Social Responsibility promoted unilateral American nuclear disarmament as the supposedly scientific response to nuclear danger. Philosophical pacifism was masquerading as science. Dr. Helen Caldicott, predicted in 1984 that nuclear with the USSR was "a mathematical certainty" if Ronald Reagan were re-elected.

Dr. Caldicott's scientific conclusions notwithstanding, the world survived Mr. Reagan's re-election. With the threat of nuclear war receding, pacifists are turning their attention away from disarming the American government, and towards disarming the American people. Like Physicians for Social Responsibility, which found no moral distinction between a nuclear weapon owned by the American government and one owned by a Communist dictatorship, domestic pacifists consider a firearm owned for protection to be as illegitimate as one owned for crime. The pacifist elements of the medical community today promote the disarmament of law-abiding, mentally healthy Americans, and they wrap their moral claim in the cloak of "science."

History showed that the core of the nuclear problem was a political one. When the political system in USSR changed, the threat of nuclear war decreased dramatically. The way to eliminate nuclear terror was to remove the terrorists who were running the Soviet Union.

In regards to gun violence in America, the core problem again involves human behavior, not inanimate weapons.

The Search for Real Solutions

Gun crime is falling for most population groups, but it is soaring for inner-city minority males, bringing the overall rate up. Until we begin the social reconstruction that will change the lives of the poor in America's inner cities, nothing will change about the gun problem.

The inner cities already have the strictest gun laws in U.S. Nearly a century of prohibition, starting with the Harrison Narcotics Act in 1911, has not deprived inner city teenagers of easy access to cocaine, even though cocaine has to be grown on another continent. How can it be seriously asserted that any set of controls, including prohibition, will deprive violent youths of guns?

What we have to do is deprive them of the inclination to use guns in a criminal manner, and that is a much more difficult enterprise than passing gun control legislation.

The energy spent on the gun debate would be far better focused on a discussion of how to help the inner cities. Gary Kleck favors a massive jobs program. I think that it is more important to make drastic changes in the welfare system, a system that subsidizes illegitimacy, the number one long-run correlate of criminal behavior.

In addition, we need to start reforming the dysfunctional government school system. Some people would suggest that the government schools need more money, while I believe that the parents and students who are stuck in this dysfunctional system need the power to choose their own schools, through a voucher system. A good school may be the last hope to rescue a child from a dysfunctional family before he begins a criminal career that will lead to his own death, and the deaths of several other people.

However these debates on how to help the inner cities are resolved, these are the debates that we must begin having if we are serious about reducing the disease of gun violence.

Gun control sometimes plays an what Ivan Ilich calls an "iatrogenic" role in distracting popular attention from the conditions which allow crime to flourish.⁽¹⁰⁾ Kleck summarizes: "Fixating on guns seems to be, for many people, a fetish which allows them to ignore the more instrangient causes of American violence, including its dying cities, inequality, deteriorating family structure, and the all-pervasive economic and social consequences of a history of slavery and racism...All parties to the crime debate would do well to give more concentrated attention to more difficult, but far more relevant, issues like how to generate more good-paying jobs for the underclass, an issue which is at the heart of the violence problem."⁽¹¹⁾ Gun control distracts the public and the legislature and the medical community from the difficult tasks of confronting the culture of poverty.

We are now reaping the consequences of 30 years spent talking about guns rather than doing something effective about poverty and hopelessness. If we really want to reduce the disease of violence, it is time for us to start thinking about how to strengthen families and foster individual responsibility, and it is time to abandon the unscientific crusade against guns.

References

1. Space limitations prevent a full listing of the more than fifty law journal articles in the last fifteen years that have examined the Second Amendment. Among the more prominent articles are: Van Alstyne W, The Second Amendment and the Personal Right to Arms. Duke L J 1994; 43:1236-1255; Amar A. The Bill of Rights and Fourteenth Amendment, Yale L J 1992; 101:1193; Cottrol R, Diamond R. The Second Amendment: Toward an Afro-Americanist Reconsideration, Georgetown L J 1991;80: 309; Levinson S. The Embarrassing Second Amendment, Yale L J 1989; 99:637-659; Levy L, Original Intent and the Framers' Constitution. 1988.

2. Etheridge E. Sentinel for Health: A History of the Centers for Disease Control. 1992.

3. Kleck G, Gertz M. Armed Resistance to Crime: The Prevalence and Nature of Self-Defense with a Gun. J Crim L & Criminol 1995; vol. 85: (forthcoming).

4. Kopel D. The Samurai, the Mountie, and the Cowboy: Should America Adopt the Gun Controls of Other Democracies? 1992. The figures are from 1983 in Carol Kalish, International Crime Rates, Bureau of Justice Statistics Special Report (Washington: Department of Justice, May 1988).

5. Okihiro N. Burglary: The Victim and the Police. 1978; U.S. Bureau of Justice Statistics, Household Burglary, January 1985; Rengert G, Wasilchick J. Suburban Burglary: A Time and a Place for Everything. 1985; Conklin J, Robbery and the Criminal Justice System. 1972; Chimbros P. A Study of Breaking and Entering Offenses in "Northern City" Ontario, in Silverman R & Teevan J. Crime in Canadian Society. 1975.

6. Kleck G. Crime Control Though the Private Use of Armed Force. Soc Probs 1988; 35: 1-21.

7. Mayhew P, Residential Burglary: A Comparison of the United States, Canada and England and Wales. Natl Inst of Just. Wash. 1987.

8. Fingerhut L, Ingram D D, Feldman J F. Firearm and Nonfirearm Homicide Among Persons 15 through 19 Years of Age: Differences by Level of Urbanization, United States, 1979 through 1989. JAMA, 1992; 267: 3048-53.

9. Kellermann, A L, Rivara F P, Rushforth N B, Banton J G, Reay D T, Francisco J T, Locci A B, Prodzinski J, Hackman B A, Somes G. Gun Ownership as a Risk Factor for Homicide in the Home. New England Journal of Medicine, 1993; 329: 1084-91.

10. Ilich, I. Medical Nemesis: The Expropriation of Health. 1976.

11. Kleck G. Guns and Violence: An Interpretive Review of the Field. Social Pathology, 1995; 1: 12-47.

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