Hours before a shooting in San Bernardino, Calif., killed 14 people and seriously wounded 22 last December, a group of doctors in white coats brought a petition to Capitol Hill. Signed by more than 2,000 physicians from across the country, the petition asked Congress to lift the 20-year restriction on Centers for Disease Control (CDC) and Prevention funding for gun violence research.
Members of the academic medicine community are speaking out about the need to examine the causes of firearm violence and develop effective prevention strategies. Investigators in academic settings have an important role to play in conducting research that can inform public policy, said Fred Rivara, MD, MPH, professor and vice chair of Academic Affairs at the Seattle Children’s Hospital at the University of Washington.
One week after the Orlando, Fla., massacre in June took 49 lives, the AAMC and 57 national public health, medical, and research organizations signed a letter in support of two Senate amendments that would reduce access to firearms and provide funding for gun violence prevention, including $10 million for CDC research.
Gun violence research was restricted by a 1996 amendment to the Health and Human Services (HHS) spending bill that prohibited the use of CDC funds “to advocate or promote gun control.” But when 20 first-graders and six adults were gunned down in 2012 at Sandy Hook Elementary School in Newtown, Conn., President Obama issued an Executive Order permitting the CDC and other federal labs including the National Institutes for Health (NIH) to resume research and develop prevention strategies.
“When disease and illness bring widespread death, doctors and scientists and public health researchers study the causes so that they can find solutions,” said Senator Ed Markey (D-Mass.), who introduced the legislation in June 2015 that would authorize $10 million annually in CDC funding for gun violence research over the next six years. The CDC’s annual budget includes $386 million dollars to fund research for diabetes, asthma, and flu, but “not one dollar” has been allocated for gun violence, he noted, which causes 33,000 deaths per year—four times more than deaths from asthma and the flu combined.
To date, however, Congress has not appropriated any funding for gun violence research and the restrictive language of the 1996 provision remains intact. Last fall, the bill’s author, Jay Dickey (former R-Ark.), expressed public regrets about the misinterpretation of the amendment. He told news outlets that research could have led to advances similar in impact to highway safety barriers.
“If we want to stop this wave of gun violence, we need better information about what is causing it and what can be done to prevent it.”
Ed Markey (D-Mass.)
According to the most recent CDC estimates, on average 90 people die daily in incidents involving firearms, roughly two-thirds of which are suicides; approximately 70,000 are injured by firearms each year.
"Effective data-gathering and evaluation of evidence-based interventions led to requirements for seatbelts, airbags, and other measures that reduced vehicle traffic fatalities,” said Garen Wintemute, MD, MPH, professor of emergency medicine and director of the Violence Prevention Research Program at University of California, Davis, Health System. This research drove down the motor vehicle fatality rate by nearly 60 percent, he continued. “We should be using the same approaches to address the firearm violence crisis in the U.S.”
In January, Wintemute and other gun violence researchers from Michigan State University, Johns Hopkins University, Duke University, and the University of Pennsylvania joined six U.S. senators for a press conference to address the issue. “Our mission as scientists is to do everything we can to make sure that when the time comes for people to look for the evidence, the evidence is ready,” said Wintemute.
“We can supply the knowledge of prior research; we can serve as individual resources to policy makers and sit at the table with them as they draft ideas. We can design an intervention and figure out if it works.”
Gun violence research is organized into three domains: causes, consequences, and prevention. Questions related to causes include: “What are individual risk factors? What are community level risk factors? What are societal risk factors? What are the social determinants?” Wintemute explained.
The consequences of gun violence, he said, extend far beyond the shooting. Families may lose critical financial support if a working family member is killed or disabled. And in addition to physical injury, there is the psychological fallout. A recent study by Chicago’s Cook County Hospital, a Level-1 trauma center that treats many of the city’s shooting victims, found that 40 percent of patients exhibited symptoms of post-traumatic stress disorder such as anxiety, isolation, anger, and sleeplessness.
“It’s not just the physical or psychological disability that an individual might suffer,” Wintemute added. “There are whole communities where the rhythm of daily life is altered in order to reduce risk of victimization. We are interested in looking at that.”
In addition to helping victims, other research is focused on prevention. Investigators are trying to identify people who are at the greatest risk for homicide and suicide, Rivara said.
Recently, the violence prevention program at UC Davis has received funding from the National Institutes of Health (NIH) and the National Institute of Justice (NIJ) to study connections between alcohol abuse and gun violence.
NIH and NIJ combined with other funding sources have enabled the violence research program at UC Davis to hire faculty, and plans are underway to add post-doctoral fellows to the research team. “At least for us it’s better than it was a few years ago,” said Wintemute. “But this is by no means the case across the country. Things are starting to look up, but compared to the need, the situation is still quite grim.”
Four days after the Orlando shooting California’s State Legislature voted to establish a firearm violence research center at the University of California, the first center of its kind in the U.S. For research advocates, there is still a long way to go. “If we want to stop this wave of gun violence, we need better information about what is causing it and what can be done to prevent it,” Markey summed up. “So let’s give the medical, scientific, and public health community the resources they need. No one should be afraid of science.”
Thursday, September 29, 2016