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Last night I attended a panel discussion on reducing firearm violence reduction. One of the three speakers was a colleague, an emergency room doctor who is also internationally known for his research on reducing the deaths and injuries from firearms. The other two were a married couple who lost their daughter in a gun massacre 12 years ago, and have become a force for change in mental health care and gun laws. I’m familiar with the research in this area. But one simple fact stunned me. Our congressman, John Garamendi, is a progressive Democrat re-elected by an 8-point margin. His mail, however, is running 9 to 1 against gun control legislation. Our panel said: “Write letters – they matter!”

Ready to write letters and make a difference? Read on.

Our panel laid out facts and demolished myths about reduction of gun violence. Here is a short summary.
•    Some 40% of firearm sales are private, undocumented and unchecked. They are the most important source of guns for criminals and others prohibited from owning guns. Most crimes use newly acquired guns, not older ones. Requiring background checks on all transactions would reduce their availability. And 90% of Americans, including over 70% of NRA members, support this proposal.
•    Current law prohibits sales to felons, but people convicted of misdemeanor violent crimes are also at high risk of future violent crime (10-15 fold higher risk if 2 or more violent misdemeanors.) Alcohol abuse also increases the risk of firearm violence substantially. We could expand the list of people who cannot legally buy guns.
•    High-capacity magazines make the casualty numbers higher. If Jared Loughner had only 10 bullets loaded, an 8-year-old girl would still be alive.
•    City- and state-level regulation is insufficient. Chicago gun crimes are committed with weapons bought outside the city. A third of the cars in Nevada gun show parking lots have California plates. But there is enough evidence from local efforts to show that regulation does have an impact.

The evidence supports the proposals of President Obama’s special panel. They may not eliminate gun violence, but they will reduce it substantially. And the majority of Americans support these common-sense, constitutionally sound proposals. Even Justice Scalia has stated that some regulation of the right to bear arms is both permissible and wise. Our audience asked, “So what is standing in the way? What can we do to help?”

Our panel, and the congressional aide in the audience, told us that Congress needs to hear our voices. Not just petitions, not just demonstrations, but our letters and our phone calls – to our own representative and senators, and to the leadership.

I know that DailyKos readers are enthusiastic and articulate writers – I’ve been reading your diaries and comments. Let’s turn that talent and energy to writing letters – and get all your family and friends to write. If you live in my district, write to Congressman Garamendi! Call your own representative’s office, and find out what they are hearing, and write to them! Write to your senators! Write to Nancy Pelosi and Harry Reid! Just for the heck of it, write to John Boehner and Mitch McConnell!

All you need to tell them is that you want them to vote for gun violence prevention proposals – background checks, ammunition limits, more mental health care and health research - now. Send email – snail mail is delayed for physical inspection.

And write back and let the rest of us know that you’ve written.

Originally posted to Laurel in CA on Wed Feb 20, 2013 at 11:43 AM PST.

Also republished by Repeal or Amend the Second Amendment (RASA) and Shut Down the NRA.

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Comment Preferences

  •  I would support federal standards for (1+ / 0-)
    Recommended by:
    Patrick Costighan

    gun control/safety/whatever, though it's hard to believe there could be enough consensus. Perhaps a 'minimum' set federally, and then more by the states that is allowed legally?

    Agree on magazine sizes. I don't think clip/magazine sizes are covered in the 2nd as written, though I think an onerous restriction that would result in making a huge % of factory-level legal guns illegal wouldn't pass the muster.

    Not sure on misdemeanors overall. Can you just do it for misdemeanor drug offenses (alcohol included)?

    I see what you did there.

    by GoGoGoEverton on Wed Feb 20, 2013 at 11:51:36 AM PST

    •  You can be quite specific on offenses (5+ / 0-)

      You can be very specific about types of offenses. For example, you can include misdemeanors such as threatening violence with a gun, but exclude non-violent stuff. You can also allow a pathway back to being allowed to purchase a gun. This has been proposed, for example, for mental health issues. There is an article on the latter in this week's New England Journal of Medicine.

      •  I think you mean brandishing. (0+ / 0-)

        I don't think there's making threats with a weapon is a misdemeanor in any jurisdiction.

        We probably could expand the list of misdemeanants prohibited, and I do like that you've thought of a pathway for recovering rights.  On the other hand, you might want to consider prohibiting not simply possession, but manner of possession, ownership, etc. for particular violations.  A subject might be able to keep at home for defense, but not carry, for example.

    •  We already have some. (0+ / 0-)

      I would prefer federal preemption of state law on this for new production firearms produced or imported in numbers greater than 5,000 (to allow for the import of small lots and to allow smaller manufacturers to test the market).  Require the firearm to have passed military or police acceptance testing and the results provided or pass a drop test (not fire when dropped on to a rubber mat on concrete from a reasonable height.  

      Here is an example of such a test:  http://www.northamericanarms.com/...

      Here is a discussion of it:  
      http://thefiringline.com/...

      "7.7 Drop Safety

      The combination of the automatic firing pin safety with the forced retraction of the hammer to its safety notch keeps the weapon dropsafe.

      Has the weapon been dropped, it must undergo examination in the armory.

      Repeated drops, particularly on the hammer, may fatigue parts and destroy them in case of further drop related stress.

      The hammer therefore has a deformation spur that will be deformed or broken off in case of a drop."

      There is no reason today that all new production firearms are not drop safe.  

      As for changing a disqualifying conviction.  I would definitely like to address that too and allow prohibited persons to earn the right back eventually.  

      Under capitalism man exploits man, under communism the roles are reversed.

      by DavidMS on Wed Feb 20, 2013 at 03:34:19 PM PST

      [ Parent ]

  •  also (6+ / 0-)

    just show them the polls. by large margins, the public supports ALL of the president's proposals, and even (by a smaller margin than the rest) an assault weapons ban. even in states like mi, nc, pa, co, or, and even in texas!

    The cold passion for truth hunts in no pack. -Robinson Jeffers

    by Laurence Lewis on Wed Feb 20, 2013 at 11:54:36 AM PST

  •  What do you propose limiting them to? (2+ / 0-)
    Recommended by:
    DavidMS, noway2

    During the Columbine shooting, one of the users just carried more ten round magazines for his carbine. I'd be curious to see what you recommend.

    Republicans cause more damage than guns ever will. Share Our Wealth

    by KVoimakas on Wed Feb 20, 2013 at 12:29:57 PM PST

    •  Recommendations from Johns Hopkins summit (6+ / 0-)

      In early January, Johns Hopkins University convened a summit of experts on gun violence reduction, and they published a book - "Reducing Gun Violence in America". You can order the book for $8 from the university, to get the full story.

      Their recommendations, however, are summarized here:
      http://hub.jhu.edu/...

      They suggest a limit of 10 rounds. It won't prevent all deaths, but they argue persuasively that it would reduce the numbers.

      I'd encourage you and others who are interested to read further. The book represents a serious effort by a group of first-rate researchers and clinicians who want to make changes, based on evidence, that will reduce harm. As my colleague says, he wants to stop people from showing up in his ER with bullet holes in them.

      •  You know how pro-gun control people (2+ / 0-)
        Recommended by:
        DavidMS, noway2

        automatically discount anything from the NRA or from the pro-gun extremists like LaPierre?

        Yeah...I feel the same way when I see shit like this:

        The event's two keynote speakers, New York City Mayor Michael Bloomberg and Maryland Gov. Martin O'Malley, both used the occasion to announce significant gun reform proposals.
        "Guilt" by association doesn't quite fit it.

        Though I will say this, after reading the list of stuff at the bottom of your link, there are a few things I will agree on.

        A few. A lot of what they propose is still horseshit.

        Republicans cause more damage than guns ever will. Share Our Wealth

        by KVoimakas on Wed Feb 20, 2013 at 01:51:47 PM PST

        [ Parent ]

      •  ordered the book (1+ / 0-)
        Recommended by:
        Laurel in CA

        I already knew about the summit and had read that bullet point list of their recommendations---some of which I agree with, some I don't care one way or the other, and honestly, many I don't see as justified---but didn't know the findings had been gathered into a book.

        But now that I know, I plan to read it to learn about the arguments behind the recommendations. My wife will want to do the same.

      •  Argue persuasively? (0+ / 0-)

        As best as I can tell, Webster and Vernick just say that limiting magazines will save lives, but offered no substantiating data.  To date,  people have only argued for limiting magazine capacity by appealing to conventional wisdom born out of lack of experience and a dubious extrapolation out of the Tuscon incident.

    •  what about all the other (1+ / 0-)
      Recommended by:
      Glen The Plumber

      thousands of shootings? We can all play the selective proof game.

  •  A person gets shot every 5 minutes & we are still (2+ / 0-)
    Recommended by:
    Glen The Plumber, Laurel in CA

    arguing about whether there should be background checks on ALL firearm sales?  This is incomprehensible.  How many more people must get shout ant die before we fight to free Congress from the NRA's control and pass sensible firearm regulations?

    Thanks for the diary.

    Then they came for me - and by that time there was nobody left to speak up.

    by DefendOurConstitution on Wed Feb 20, 2013 at 01:22:52 PM PST

    •  Saying we need more laws against murder (2+ / 0-)
      Recommended by:
      happy camper, Patrick Costighan

      makes about as much sense as saying we need to worship the sun god to make sure that it will rise in the morning.

      Your statement relies an assumption and it should be intuitively obvious that it is false.  It assumes that murders are legally buying weapons and will go through background checks.  It is a good thing that criminals will follow all these new laws that you are calling for.

  •  Can you explain this? (1+ / 0-)
    Recommended by:
    KVoimakas
    Some 40% of firearm sales are private, undocumented and unchecked.
    How is that number calculated, across the entire country, if there is no documentation or checking?

    Seriously. WTF.

    It's safe to trust a sane person with the keys to nuclear weapons, but it's not safe to trust an insane person with the cleaners under the kitchen sink. The answer is not more gun control, it's people care.

    by JayFromPA on Wed Feb 20, 2013 at 02:14:29 PM PST

    •  Data from studies by careful researchers (1+ / 0-)
      Recommended by:
      Glen The Plumber

      It is, as you surmise, difficult to study phenomena for which administrative data are not collected routinely. The NRA has tried hard to block any data collection or research. But it is not impossible, for scientists who are careful, thoughtful, determined and knowledgeable about the subject.

      The 40% figure, and a link to documentation and references for it, can be found in a news release today from UC Davis, based on research by the Violence Prevention Research Center. Here's a link to the news release: http://www.ucdmc.ucdavis.edu/...

      The full report is long, detailed and technical, intended as a research document. It is not necessarily user-friendly for a general reader. But as a professional in medical and epidemiologic research with 40+ years of experience, I can assure you that the methods are appropriate and the investigators highly qualified and respected in this area.  

      I hope that's sufficient to help you get started at understanding the science behind the numbers.

      •  That data is 19 years old! (2+ / 0-)
        Recommended by:
        noway2, happy camper
        It is widely
        reported that approximately 40% of all firearms transactions occur directly between
        private parties. This estimate comes from the National Survey of Private Ownership
        of Firearms in the United States, for which data were collected in November-December
        1994.
        1994!
        Does it mean anything to you to realize that there are people just receiving their college degrees that weren't even out of diapers at the time that this data was collected?
        This estimate comes from the National Survey of Private Ownership
        of Firearms in the United States, for which data were collected in November-December
        1994.9 Respondents reported acquiring 251 firearms in the two years prior to the survey.
        Of these, 59.8% were obtained at a gun store, pawnshop, or other licensed retailer.
        Another 29.6% were acquired from a member of the family, a friend, or acquaintance;
        3.9% at a gun show or flea market; 2.8% through the mail; and 3.8% from other sources.
        Family and other people you know by name?!?! YOU INCLUDE THEM?!?!

        I don't know about your ability to parse this logic, but there is also no determination that a private sale did not have a nics check.

        It may interest you to know that I bought a handgun, face to face private sale, and it still went through a background check. So not only is your 40% number flawed in the implications by three quarters, IT IS ALSO BASED ON DATA SO DAMN OLD THAT PEOPLE HAVE BEEN BORN AND GROWN TO VOTE FOR OBAMA BETWEEN THEN AND NOW.

        The use of this data is disgusting. It is oily used car salesman sleazy. Even karl rove knows that when he is manipulating people he needs the most current numbers there are. Jeez.

        It's safe to trust a sane person with the keys to nuclear weapons, but it's not safe to trust an insane person with the cleaners under the kitchen sink. The answer is not more gun control, it's people care.

        by JayFromPA on Wed Feb 20, 2013 at 05:46:53 PM PST

        [ Parent ]

        •  More recent data also exist (1+ / 0-)
          Recommended by:
          Glen The Plumber

          You raise some good questions, and I'll try to comment, although I would not claim to have Dr. Wintemute's long-standing expertise in the area. The information all comes from the published report, which provides extensive references, so I won't cite further references.

          First, as the technical report points out, the data from 1994 are indeed old, but they are quite consistent with reports both before that time and as recently as 2004. (My grandson was born then and, although he campaigned for Obama, he's still quite a few years shy of being eligible to vote for him.) I am well aware of the dangers of extrapolation, but I'm also very cautious about inferring major changes in processes that appear to be stable in other ways.

          Second, the laws pertaining to private party sales vary considerably from state to state. Some states, e.g. CA, require background checks even in private-party sales. How these are conducted varies. Some states process the transaction through a licensed retailer; in only 3, though, can the seller initiate the check directly. So yes, it is quite possible that some of these are documented. My error, not in the report! What fraction, though, is uncertain.

          Finally, it's very helpful to have thoughtful feedback, comments, and even corrections. I'm a big supporter of the peer review process - as a participant on both sides, again for many years. But I generally find the discussion benefits from a measured and temperate tone, that assumes reasonable good will on the part of the participants, and avoids invective. Just a suggestion, of course.

          •  And yet (1+ / 0-)
            Recommended by:
            noway2

            I've gotta head out the door, but go click through to the pdf and as I recall reading last night, the 04 study was from unpublished data.

            And the reason for the invective is because in my view easily 90% of the people on this site that call for new legislation have not done anywhere near the research to be anything more than armchair quarterbacks that scream at the tv.

            And having you claim that the data was all good but complicated, so to basically trust you... and then for me to see such glaring third grade reasoning problems... well why should I trust any of the people calling for gun control?

            It's safe to trust a sane person with the keys to nuclear weapons, but it's not safe to trust an insane person with the cleaners under the kitchen sink. The answer is not more gun control, it's people care.

            by JayFromPA on Thu Feb 21, 2013 at 03:24:26 AM PST

            [ Parent ]

            •  I hope you will advocate for funding new research (0+ / 0-)

              Your concern that people are citing old data is shared by the researchers. The NRA has blocked federal funding and release of data, as well as federal funding of research (one reason the 2004 report is based on unpublished data, although collected by the agency by same methods as in past.) The research community uses data collected at the state level for those states, like CA, that do collect and make the data public, and on research funded by foundations.

              Your passion on this front suggests that you would be a strong advocate for collection and release of accurate data and for federal funding of careful peer-reviewed research on firearms and firearm safety - would you consider writing a letter to your representative in support of better data and/or new research?

              •  How did the NRA block funding? (0+ / 0-)

                Couldn't be statutory, or otherwise an executive order rescinding the "ban" would be insufficient. So that leaves a previous executive order.  I doubt President Clinton issued one, and I can't find anything of the sort from the Bush Administration.  Also, why did President Obama wait four years before lifting this so-called ban if he could do so by mere executive order?  And what about state funded research into firearms and violence?  Certainly California has a vested interest in providing law enforcement and public health authorities with good intelligence on firearms?

                I think there's a far less nefarious reason for the paucity of firearms injury research: it's very, very hard to get conclusive results.  Not just because of lack of resources (this research is no more expensive than national polling done all the time), but in the lack of uniform coding standards for a variety of data pertaining to mortality and injury and firearms retail.  Add to that a nigh inscrutable secondary firearms market, and you've got the recipe for research that is overly thin on substance in the aggregate, or makes for rough generalization in the deep.  

                Of course, that's not a very useful point of view for pounding on our new set piece villains.

                •  JAMA gives a good summary of the barriers (1+ / 0-)
                  Recommended by:
                  WakeUpNeo

                  There are, in fact, federal laws that were designed to block effective federal firearms data dissemination and research. An editorial in J Amer Med Assoc, 13 Feb 2013, gives a good summary of the barriers to national-level firearms research in this country:
                  http://jama.jamanetwork.com/...

                  The President has acted to ameliorate some of the effects by executive action, but the laws on the books retain a substantial inhibitory effect.

                  State-level data and support exist in some states, like CA, but others have policies that are even more restrictive than those at the national level.

                  An even more appalling proposal, in my mind, is the FL law described in this editorial. It would interfere with the ability of pediatricians to advise parents effectively on accident prevention for children. The law is currently on hold, thanks to a federal judge, but similar laws have been proposed in other states.

                  I would not go so far as to describe the people and groups who propose, pass and support these laws as "villains" - I try pretty hard not to resort to personal attacks in such discussions. But I would certainly say that they are creating barriers to effective research and healthcare delivery for a major public health problem. I disagree with their approach and find its impact dismaying.

                  •  Re: (0+ / 0-)

                    Kellerman's op-ed cites two Congressional actions.  One is the 1996 appropriation that zeroed out CDC injury center funding I mentioned earlier.  The other is the 2011 Consolidated appropriations act forbidding expenditure in promotion of gun control (redundant, since federal law already prohibits extending grants for the purposes of lobbying).  Kellerman suggests that the careers of grant issuers "are at risk" if they choose to fund firearms injury research, but last I checked that's not a firing offense.

                    Kellerman, by the way, is not a disinterested academic here.  He was rightly criticized for poor auditability of his crowning contribution and failure to control for several obvious confounding factors (including, a failure to distinguish between victims killed by their own weapons and those killed by firearms brought in from the outside).

                    The Florida law against speaking firearms safety with patients is intrusive, and a severe and obtuse overreaction to what was a very clear case of discrimination by one doctor.  Rather than addressing the issue at hand, discrimination, by giving patients a cause of action against such trespasses, the state sought to criminalize speech.  That's horrendous on its own, but it is not in anyway related to the breadth and quality of firearms research.  You're not going to collect data from off hand, very personal and very private conversations between doctors and patients.  You need objective measures--actual records of injuries and circumstances--and coding, and the obstacle their is money and coordination.

                    •  As I recall.... (0+ / 0-)

                      It's been a while since I read the florida law in the raw, so I won't use whole phrases.

                      However, it DOES include an exemption for doctors who are acting in good faith to ask about gun safety.

                      My primary support for the florida law is that it makes use of the very same pillar of civil society upon which also rests the right to get your birth control pills or have an abortion.

                      The concept of which I speak is simple: When you enter into a position in which you are licensed by the state and will interact with the general public, your choice to take on that role also means you may not discriminate amongst the general public in any way.

                      Pharmacists make the effort to go to school, and are licensed by the state, and so their personal religious beliefs are to be set aside and they may not obstruct any person from their right to birth control prescription or plan b or whatever.

                      Doctors make the effort to go to school, and are licensed by the state, and so their personal gun beliefs are to be set aside and they may not discriminate against any patient who has one revolver or one hundred ar15s or whatever.

                      The florida law had an exemption for good faith efforts in service to gun safety, and is only intrusive to those authoritarian doctors who feel they must supplant their gun views over the views of the patient.

                      It's safe to trust a sane person with the keys to nuclear weapons, but it's not safe to trust an insane person with the cleaners under the kitchen sink. The answer is not more gun control, it's people care.

                      by JayFromPA on Thu Feb 21, 2013 at 04:19:10 PM PST

                      [ Parent ]

                      •  I agree in principle (0+ / 0-)

                        Also, I was wrong.  The law doesn't criminalize speech; but it imposes professional penalties for violation.

                        In practice, this went way overboard.  I don't care if my doctor is an anti-gun prick so long as he sees to his duty to care for my medical needs.  If he discriminates against patients who reject his advice on the matter or even decline to speak on it, he should be held civilly liable for that overt act.  But even then I don't need to collect his M.D. and license.  

          •  No one's replicated NSPOF in the past 20 years. (0+ / 0-)
        •  Re: (0+ / 0-)

          That might be a little strong.  Data is certainly old, cross-sectional, and uniquely coincides with a peak in violent crime.  On the other hand, it's not incredible.

          The problem is when people generate soundbites barely connected to the original data and conclusions.  That 60 percent of buyers purchased from "stores" in 1993 is read as "40 percent of gun buys never involve a background check." That's obviously wrong--seventeen states require background checks for all private transfers except for family members.  Even new legislation contemplates a family member exception, so you're now talking about 18 percent of transfers.

      •  It isn't from careful researchers (2+ / 0-)
        Recommended by:
        happy camper, Patrick Costighan

        It is a figure that the Brady Bunch pulled out of their backside.  Undoubtedly they are also counting the estimated black market sales in this figure too.

    •  National Survey of Private Ownership of Firearms (1+ / 0-)
      Recommended by:
      JayFromPA

      It's a 1994 survey.  Here's a 1997 summary prepared for the feds:

      https://www.ncjrs.gov/...

      Cook and Ludwig found that purchases from "stores" accounted for 60 percent of transfers.  The reader is left to assume that the remaining 40 percent are by definition "private, undocumented and unchecked" (at least by public authorities).  Of course, that's not true since at least seventeen states jurisdictions actually require private transactions to go through an FFL for a background check.  We're also discounting people who also submit Form 4473 on their own accord.  And under DiFi's background check, you'd only expand the share of transactions triggering background checks from 60 percent to 78 (family members are exempted).

  •  This is a social issue, not a gun issue. (2+ / 0-)
    Recommended by:
    Utahrd, noway2
    Current law prohibits sales to felons, but people convicted of misdemeanor violent crimes are also at high risk of future violent crime (10-15 fold higher risk if 2 or more violent misdemeanors.) Alcohol abuse also increases the risk of firearm violence substantially. We could expand the list of people who cannot legally buy guns.
    We don't add even more restrictions on alcohol in order to reduce alcohol abuse or alcohol related crime.
    So why should we believe that adding even more restrictions on guns will result in a reduction of gun abuse or gun crime?

    It's safe to trust a sane person with the keys to nuclear weapons, but it's not safe to trust an insane person with the cleaners under the kitchen sink. The answer is not more gun control, it's people care.

    by JayFromPA on Wed Feb 20, 2013 at 02:22:37 PM PST

    •  We do in fact make restrictions for alcohol abuse. (1+ / 0-)
      Recommended by:
      Glen The Plumber

      We have restrictions on use of alcohol in the context of driving: if you drive while drinking, you can lose your driver's license or even your car. Is there a good way to separate drinking and gun use? I'm not sure. I would certainly support keeping guns out of bars - doesn't the idea of intoxicated people with guns seem a little dangerous to you?

      As for why we think that added restrictions on guns will result in a reduction of gun violence, I suggest you read the book "Reducing Gun Violence in America" - you can order for just $8 from Johns Hopkins. It does a great job of summarizing actual evidence, not just opinions, for what has been tried and found to work. Their recommendations are evidence-based. That's my standard for medicine and public health policy.

      •  I wrote "even more restrictions". (1+ / 0-)
        Recommended by:
        noway2

        No person under 21 can purchase alcohol.
        No person under 21 can purchase a handgun, already exist.

        Restrictions on where it's allowed to drink.
        Restrictions on where it's allowed to carry, already exist.

        Restrictions on the transfer (resale) of alcohol.
        Restrictions on the transfer of guns, already exist.

        Restrictions on who can possess (read: be holding/using) alcohol - it's a family thing.
        Restrictions on who can possess (read: be holding/using) guns - it's a family thing, already exists.

        To purchase alcohol, you have to prove your eligibility.
        To purchase a gun, you have to prove your eligibility.

        We ALREADY HAVE restrictions on guns that are fairly close to the level of restrictions on alcohol, but we still end up with drunk drivers that kill people.

        My exact words were:

        We don't add even more restrictions on alcohol in order to reduce alcohol abuse or alcohol related crime.
        Would you care to address the point I actually made?

        It's safe to trust a sane person with the keys to nuclear weapons, but it's not safe to trust an insane person with the cleaners under the kitchen sink. The answer is not more gun control, it's people care.

        by JayFromPA on Wed Feb 20, 2013 at 05:19:48 PM PST

        [ Parent ]

        •  Laws and enforcement vary considerably by state (1+ / 0-)
          Recommended by:
          Glen The Plumber

          And we have seen improvements over the years in the rate of alcohol-related fatalities in driving, with the establishment of national standards, more effective enforcement, and a shift in national culture. So a change in restrictions on alcohol and driving has made a difference, over a number of years. The argument for changing the policy was supported  by data showing better driving outcomes in states that had more restrictive policies.

          How does this apply to drinking and alcohol? Some states allow firearms anywhere, including in bars; some states have proposed laws under consideration that would allow this. So there are in fact some differences in restrictions. There are also differences in enforcement of existing rules. There are a number of studies that suggest a much higher risk of firearm injuries and death associated with alcohol use. Thus we have   what my world calls "natural experiments" to look at, and the results indicate that guns and alcohol are a volatile, risky mix.

          Surely it is worth at least opening the question of whether there are ways we can reduce the number of casualties, given that we know alcohol is a well-established risk factor. The physicians have made some suggestions. Do you have other ideas? What will work to attain the goal, as my colleague puts it, of having fewer people showing up in his ER with bullet holes?

          •  Re: Guns and Alcohol (0+ / 0-)

            It's a matter of common sense not to drink and shoot; however, research in this area tends to lump together a number of events that are only loosely tied together by the common presence of alcohol and guns.  For example, you have Wintemute finding that gun owners drink more than non-gun owners, yet concealed carry permit holders are less likely to commit crimes, up to and including homicide.  Alcohol use, gun ownership and injury is also confounded by suicidal behavior; while firearms owners are at elevated risk of attempting suicide, the research does not distinguish between general firearms owners and people who've acquired the device expressly to destroy themselves.

            These confounding factors make it more difficult to evaluate the likely effectiveness of a set of policy choices.  Banning guns in restaurants or bars does nothing to prevent a law-abiding citizen from purchasing a revolver, a handle of Scotch, and drinking himself stupid while playing a game of Russian Roulette.  On the other hand, a policy of educating firearms retailers and private sellers on detecting buyers potentially contemplating suicide might have an impact.

            •  Even more important, primary care providers (0+ / 0-)

              And an even more effective deterrent to firearm suicide (or homicide) might be to educate primary care providers in assessing risk, including depression and alcohol abuse, and ascertaining whether the at-risk patient had a firearm available. But of course the FL law and others like it would put up substantial barriers to discussing the presence of firearms in the household, and thus barriers to trying to reduce the direct risk to the patient or others in the household.

              We try to teach our medical students about these risk factors, starting early in their medical school careers. We teach them to look for signs of depression, alcohol abuse, intimate partner abuse, and so on, all of which are risk factors for the patients' health, but far more so if there is a gun in the house. But I also have to warn them that in some states, discussions of firearm risks and safety with their patients are a moving target for legal action. To quote one, "Boy, that's dumb."

              •  Re: (0+ / 0-)

                FL law, as dumb as it is, ain't the problem.  It is inoperative as it works it way through the courts, after all, but even then it's not necessary for the physician to determine if an at-risk patient owns firearms.  The authorities will have to determine that one way or another.  That said, I have no problem with asking the question or being asked, but you'll have to deal with people who will prove recalcitrant or even outright lie.  In the end, might be better to assume all your patients are armed.  The authorities, if and when they respond, certainly will.

                The obstacles, whatever they may be, will lie in detecting suicidal tendencies, reporting suspicions to the authorities, and prodding the authorities into action.

                •  Reporting is not the goal of the docs. (0+ / 0-)

                  I think you are misinterpreting the goal of medical practice. The idea is that physicians are trying to identify health risks - including those for gun accidents, suicide, and homicide. Then they try to change the behaviors to reduce the risks as much as possible. Guns in a house with children should be kept secured so that there is no chance the kids can get at them. Someone with clinical depression is better off selling the gun, or handing it to a reliable family member or friend for safekeeping. Someone living in a house with an armed and abusive intimate partner might need to be persuaded to leave.

                  We've managed, slowly, to convince most parents that kids should be in car seats or booster seats in cars. The death and injury rates have dropped as a result. Thirty years ago, this was called by some an unwarranted intervention in personal choices, but I expect the kids whose lives were saved would not complain about the imposition of a car seat for a few years. We are gradually convincing smokers that it is a really bad idea to subject their kids to secondhand smoke. The evidence from 20 years of serum continine studies of NHANES population-based samples of non-smokers, including kids, suggests we have made an impact, though about 5-10% of kids are still being subjected to passive smoking.

                  Eventually, if the FL law and others like it are blocked, and if the discourse can focus on more on health and safety and less on demonizing people who point out the risks to people in households with guns, physicians may be able to have an impact on how gun owners and their families deal with those risks. Maybe my colleagues will then see fewer kids showing up shot by guns left lying around, and gun suicides, and murder-suicides of couples. Don't you think that is a goal worth seeking?

                  •  Re: (0+ / 0-)

                    I don't think that's a goal worth seeking (because I think your advice is based on dubious findings over questionable data), but that doesn't really matter. I see no reason to threaten doctors with professional sanction for simply spouting old fishwives' tales about guns.  I can always say "thanks, but no thanks Doc, that's none of your business."  If someone else prefers to heed their advice, that's their call.  So long as a physicians attend to their duties, as opposed to discriminate against their patients like this joker, I'm perfectly fine.

                    Reporting dangerous psychiatric conditions may not be the "goal" of docs, but it's certainly one of their responsibilities.  And you don't need to necessarily know whether a patient has a firearm in order to do that.  If the authorities have any brains, they're going to assume a patient's armed when they arrive to investigate regardless of what you say.

                    •  The goal is to avoid preventable deaths. (0+ / 0-)

                      I don't know what is dubious about the fact that children who have access to loaded guns are more likely to fall victim to gun accidents than those in households without guns at all or where guns are secured. Or what is dubious about the fact that people who attempt suicide with a gun are far more likely to succeed than those who attempt suicide with pills. These are well-established medical facts.

                       California law protects confidentiality of the patient-doctor interaction with only a few exceptions. Those include a reasonable suspicion of child abuse or elder abuse, a reasonable suspicion that the patient may present a danger to others, and a reasonable suspicion that the patient is likely to harm himself unless preventive measures are taken. Keeping a gun in the house is not considered child abuse, at this time, nor can I believe that you would want it to be so. Depression is not reportable; even suicidal ideation would not be generally reportable unless there were grounds to think someone had intention of carrying it out.

                      The American Academy of Pediatrics has as a standard of care that the physician ask a parent whether the family has guns in the house, and if so, to advise that they be secured away from the child. It is a common-sense recommendation, but you are free to ignore it. So is the depressed patient whose doctor suggests that he ask his sister to keep his gun locked up safely while he undergoes treatment for depression. You are also free to decide that you don't want to discuss it with the doctor. You are even free to change doctors altogether until you find one who doesn't think loaded weapons pose a danger to children, or to depressed patients, or to people in abusive relationships. Maybe you can even find medical practices and hospitals where patients and staff are all welcome to show up armed.

                      •  Re: (0+ / 0-)

                        It's dubious in the sense that it relies on data that fails to control for a variety of home conditions and event factors, up to and including whether or not the child was injured by a gun that actually belonged to a household member.  But that's not the real egregious part; it's common sense that children--especially small children--and guns don't mix well.  What's really offensive is the advice given, which ranges from disarm (which at least has the benefit of being effective) to storing guns and ammunition separately in locked locations (which dangerously engenders a measure of false security).  First thing I learned as a gun owner was to keep my firearms and ammunition within a few feet of me at all times in all permissible locations, or otherwise securely stored in real gun safes or .  The idea is that your weapons and ammunition should be on your mind as much as possible, as much as you think about where your wallet is (hopefully more so).  And that's just for the sake of safe shooting (it amazes me how many people let ammunition sit forever; you're supposed to check it at least twice a year, and rotate out older ammunition just as frequently).  It's a rule of thumb built on a house of cards containing both empirical and anecdotal experience, but it's the precautionary principle taken to a feasible extreme.

                        I am no doctor or psychologist.  I can't tell you where the line should be drawn on what should and shouldn't be reportable, but at some point physicians and policymakers need to get together and work out the appropriate balance.  It may come to nothing; maybe we're already doing everything we could and should do in terms of standards.  In that case, the failing is in actual implementation.  Again, I'm no expert in that area and I'm willing to hear what people have to say.

          •  That's a false assumption. (0+ / 0-)

            Just because you go into a bar doesn't mean you are drinking.

            Two words: Designated driver.
            Obviously a designated driver would be a person who enters a bar, but is not drinking. So the assumption falls flat there.

            Two other words: Business lunch.
            Obviously a 'bar' in the middle of a bunch of corporate buildings is going to be used for lunches by those office workers.
            Before I gave it a thumbs down, my tivo picked up a couple episodes of this show "Bar Rescue". The episode I saw was about a pirate bar in the middle of a bunch of high rise corporate offices that was renovated into a business lunch place - and the place got packed with people having non-alcoholic lunches or coworker gatherings after the workday ended.

            Two yet other words: General socialization.
            There are other things to to in bars than drink. Even the most alcohol-centric still have things like music and pool tables. I've had plenty of really fun times just hanging out with friends in a booth at a "bar" without any drinking at all.

            Furthermore, go research the raw quantity of horrible events like newtown. I don't recall which show it was, and don't know where they got their numbers, but one of the msnbc shows pointed out that the raw number of events has stayed flat for many years even while population grows and also while gun ownership grows. As I recall, the raw quantity was about 20 per year... ~20 per year in the 90's... ~20 per year in the 2000's, still ~20 per year even last year. What that means in relation to population growth is that the rate of these newtown style events is dropping. WooT!

            The best suggestions I have stem from your acknowledgement that enforcement varies and from observations about anger.

            We live in a world of selective enforcement - go five mph over the limit and you are pretty much not going to get a ticket. That's selective enforcement, and it has infused into our lives to the point where we no longer notice it.

            About anger... When someone who has anger management issues loses their temper, violence happens. The angry husband either shoots the wife, or punches her teeth out, or cracks her ribs with a bat. Gun control takes away the gun, but doesn't stop the violence - Whoop-de-fucking-do she's still toothless!

            The problem with the very concept of gun control as proposed by people like Dianne Feinstein is that it doesn't properly identify the prime mover. The mentality of prohibition and banning and confiscation of DiFi as applied to domestic violence would prohibit baseball bats but do nothing to cure the angry husband of his management issues, and the beaten wife would still have her teeth punched out.

            It's safe to trust a sane person with the keys to nuclear weapons, but it's not safe to trust an insane person with the cleaners under the kitchen sink. The answer is not more gun control, it's people care.

            by JayFromPA on Thu Feb 21, 2013 at 05:02:06 PM PST

            [ Parent ]

            •  Gun violence carries higher risks. (0+ / 0-)

              People who attempt suicide with guns are far more likely to complete the act than those using pills, say.

              People who try to kill someone with a gun are far more likely to succeed, and indeed to kill multiple people if that is the aim, than those who use knifes, fists, baseball bats, or whatever.

              Guns, especially those equipped with bullets designed to cause maximum damage, are more lethal, both short range and at a distance.

              The comparison with a baseball bat is, frankly, rather silly. I have a baseball bat in  my house. I am not worried that my 8-year-old grandson will get hold of it and do major damage to himself or his sister by accident. I'd feel considerably differently about a gun.

              As for the "some people in a bar don't drink" argument, I'm more worried about the ones who are drinking. And armed. Which would not, alas, be the empty set, so to speak. The idea of a bunch of armed people with blood alcohol levels high enough to need a designated driver is not a cheerful one, even less so if they are accompanied by a bunch of armed designated drivers to keep the armed drunks in line. Maybe this is a failure of my imagination.

      •  And it has been proven that a lot of habitual (2+ / 0-)
        Recommended by:
        happy camper, Patrick Costighan

        repeat drunk driving offenders have no license, no insurance, often don't even own their own car, have been in and out of jail several times.  There isn't one damned law that stops them, except perhaps the one about committing vehicular homicide at the end before they go away for a long time.

  •  This is a mistaken understanding of reality. (3+ / 0-)
    High-capacity magazines make the casualty numbers higher. If Jared Loughner had only 10 bullets loaded, an 8-year-old girl would still be alive.
    Loughner's gap between magazines was because he was fumbling the overlarge object in his hands.

    The standard size magazines are well suited to being changed quickly, with only one hand, and by feel alone. The overlarge magazine requires a different grip which reduces dexterity and eyes to guide the end into the pistol. The overlarge size of the thing introduces delays.

    The overlarge magazines use overlarge springs, which introduces the problems of spring tension. Springs exert their force unequally through their range of compression, and this makes long springs unsuitable at the short end of the range when calibrated for the long end of the range, and calibration of the materials for the middle of the range makes for malfunction prone when at the edges.

    It's safe to trust a sane person with the keys to nuclear weapons, but it's not safe to trust an insane person with the cleaners under the kitchen sink. The answer is not more gun control, it's people care.

    by JayFromPA on Wed Feb 20, 2013 at 02:32:20 PM PST

  •  "Most important source" my ass. (1+ / 0-)
    Recommended by:
    43north

    LCPGV, via ATF,  counts 26,000 straw purchases over a two year period.  Reported theft/loss from FFLs alone amounted to 75,000 firearms gone in a three year period.   The figure for all theft/losses is an order of magnitude higher.

    Also, current federal law prohibits considerably more people than just felons from possessing firearms, including those convicted of misdemeanor domestic violence.  You could always argue that there are more people you'd like to see covered (like, maybe, everyone), but why buy trouble?

    You do know that Reno is only 15 miles away from California, right?  And is it really that insightful to point out that firearms are rarely purchased where they are used (gun shop shootings are very rare)?  There are hundreds of millions of firearms in country, enough that it would take 500 years to steal them all at current theft/loss rates.  There's an even larger international supply as well; and Americans have an historically open border when it comes to contraband.  

  •  An interesting discussion, but... (0+ / 0-)

    I've written my letters, and a number of my friends have written theirs. Even my 97-year-old father, who taught artillery in WWII and is by no means a novice in the gun world, wrote his letter.  Thank you!

    I found the comment discussion interesting. I'm pleased that at least some folks were moved to try to read the medical literature, even if they disagreed. The degree of passion about gun violence prevention is unsurprising, but the tone was occasionally disappointing. The 8% of Americans who oppose universal background checks might be more persuasive to the rest of us if they did not so often sound as if they were angry, suspicious, hostile, armed to the teeth, and ready to shoot on sight.

    And now, I really do have to leave this and return to other things, caring for the aged, teaching the young, and helping the homeless.

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