The number of Americans killed by firearms since 1968, including suicides, homicides, and accidental shootings, is 1.4 million, more than the 1.2 million killed in all the wars involving our country from the Revolutionary War to the present.
While Americans constitute just under 5% of the world’s population, we account for almost ½ of the world’s civilian-owned firearms, or somewhere between 265 and 300 million guns. Nearly ½ of these are stored improperly in homes with children. The average gun-owning household has 8.2 guns, a number that has doubled over last 20 yrs. One half of all guns in this country are owned by just 3% of the population (who own an average of 17 guns each).
In the United States, gun shops outnumber all Starbucks, McDonald’s, and grocery stores combined. Until recently, one could walk into major retailers like Wal-Mart and Dick’s Sporting Goods and purchase assault rifles and ammunition. Due to inherent weaknesses in federal and state background checks, persons wanting to obtain firearms without oversight can obtain them at gun shows, one of which, ironically, was held the past few years at the Portland Expo Center, in an auditorium right next door to the one hosting KidFest Northwest, a fun and games fair for preschoolers.
Each year, there are 33,000 deaths nationally due to firearm-related violence, suicides, and accidents, easily the highest death toll among industrialized countries. Our firearm homicide rate is 25X higher and our firearm suicide rate 8X higher than in other industrialized countries.
Every day in the U.S. there are 31 homicides, 55 suicides, and 2 unintentional shootings involving guns. 84,000 citizens are injured annually from gun violence. As a physician, I have witnessed and cared for many of these victims. Their wounds are often painful, debilitating, and the afflicted suffer both short- and long-term physical and psychological consequences from their injuries, as do their families and friends. Many of those injured are unable to cover medical costs. Inability to pay medical bills is the number one cause of bankruptcy nationwide and a major contributor to homelessness. The direct + indirect societal costs of gun violence total about $250 billion/year.
There were 271 mass shootings by firearm, in which a perpetrator willfully killed 4 or more people, between 2006 and 2017, with a total of 1,358 victims. This equates to a mass shooting approximately every 16 days, or 22.5 per year, with a mean of 5 victims per incident. Many shooters carried more than one weapon, and most weapons were obtained legally. Mass shootings are now commonplace (think Columbine, Sandy Hook, Orlando, Las Vegas, and Stoneman Douglas High School in Parkland, Florida). School shootings have become so routine that they don’t necessarily lead on the evening news. Since the Parkland shooting, there have been at least 4 mass shootings (2 involving schools), but most people may not know this, so inured are they to the ongoing carnage.
Many of the perpetrators of mass shootings have been consumed by anger, stoked by the poisonous online rhetoric of right-wing hate groups and the openly racist comments of President Trump, whose vilification of immigrants and the poor has gone largely unopposed by complicit congresspersons and the so-called religious right, which seems to have abandoned all semblance of Christ’s biblical message of peace, tolerance, and love. Ironically, while many demonize immigrants and non-Judeo Christians as criminals and terrorists, the majority of mass shootings and domestic terrorist events in the US have been carried out by Caucasian, self-professed Christian, males.
My own experience with guns began in childhood. My brothers and I would play variations of hide-and-seek with toy guns, and particularly enjoyed firing plastic disc pellet guns at each other using badminton racquets for protection. Fortunately, we did not shoot our eyes out, but had our parents known of our dangerous antics, they undoubtedly would have tried to put a stop to them. I have shot a BB gun a few times, which I did not really enjoy, and have been skeet shooting, which was lots of fun.
My Canadian cousins fish and hunt for all their protein, and my cousin’s daughter could kill and dress a moose by the time she became a teenager. They eat what they kill, and I respect them for their connectedness to nature and the way in which they “thank” the animals for their sacrifice. Yet according to the US Fish and Wildlife Service, only about 5% of Americans age 16 and older actually hunt (and not all for food). This is nearly half the percentage of 50 years ago, and is expected to decrease further.
I have tremendous respect for vegetarians, for their healthy, environmentally-friendly, and animal-loving choices. But I also respect those who realize that their non-vegetarian diets require the killing of animals. It is too easy these days, when buying nicely cut and packaged pork chops and roast chickens, to turn a blind eye to the backstory of how those dinner items were produced. I laud those who make food choices based on optimizing ecology and animal welfare when possible, such as choosing organic, free-range meats and chickens raised without artificial hormones and unnecessary antibiotics by companies with good labor standards, rather than animals produced by our mechanized, often unsafe, and certainly unhealthy agricultural system.
I do take issue with those, like the president’s older sons, who kill big game animals, whose populations are decreasing and whose gestational periods are such that each generation can last one or two decades or longer. It disturbs me that someone would derive pleasure from killing another creature, posing triumphantly with its corpse, or mounting its skull or antlers on a wall, possibly as a proxy for true masculinity. And those who deliberately poach endangered rhinos or elephants to sell their horns and tusks for decorative art (supported, in parts of Asia, by the Catholic Church) or for magical potions to supposedly cure disease or enhance virility, should be prosecuted for crimes against nature. While some private big game preserve operators argue that they promote conservation by charging trophy hunters large amounts of money, a portion of which they funnel into breeding programs and land buys, there are more humane and efficient ways to preserve great creatures, which have evolved over millions of years and face myriad threats in the current Anthropocene, our era of mass extinction.
I also understand the desire of gun owners to protect their property and themselves against those who might try to rob, injure, or kill them, especially women who have suffered sexual abuse and assault, which often goes unreported or uninvestigated, as well as those who feel that a gun is their only line of defense against sexual predators. And yet, there is something seriously wrong with a society that needs so many guns for its citizens to feel safe in their homes and on the streets.
Other industrialized countries have lower crime rates than the US as well as far fewer guns. Indeed, well-designed, peer-reviewed research has shown that more guns equals more crime. States with higher levels of household gun ownership have higher levels of firearm crime and do not have lower levels of other types of crime. Firearm assaults are almost 7 times more common in states with the most guns versus those with the least. And studies of local gun control ordinances have shown that that restrictive gun legislation decreases gun violence.
Guns at home are four times more likely to cause an accidental shooting, seven times more likely to be used in assault or homicide, and 11 times more likely to be used in a suicide than to be used for self-defense. People who have access to firearms at home are nearly twice as likely to be murdered as those who do not. Having a gun in the home is also associated with a 3-fold increased risk of homicide; most of these are carried out by someone the victim knows, and women are at especially high risk, especially when there is a history of domestic abuse, be it psychological, physical, or sexual. Restricting access to firearms, especially for those with restraining orders, histories of abusive and/or criminal behavior, and known mental illness decreases the risk of homicide and suicide.
Access to firearms also increases the risk of suicide up to 10-fold, without any increased risk of suicide by other means. Most suicides are impulsive, and crises self-limiting. Suicide attempts involving overdoses are often treatable, indeed many of those who overdose do not intend to kill themselves, and even when they do, they often call 911 and are taken to the emergency room, where most can be saved. Ninety percent of survivors of an attempted suicide do not end up ultimately committing suicide. However, when a gun is handy, the suicide is usually successful, and when not successful leaves the victim in a neurologically-damaged state.
While many believe that gun ownership is a deterrent to crime, in fact it is not. Almost two-thirds of the U.S. population live in homes without guns, and there is no evidence that these individuals are at greater risk of being robbed, injured, or killed by criminals compared with those living in homes with guns. In the miniscule 1% of crimes in which a gun is used in self-defense, it does not decrease the risk of injury or death. Even in the very small percent of cases when sexual assault victims use a gun to try to ward off an attacker, slightly more than 4% of such victims are injured, the same percentage as are injured during or after taking protective action by running away. And while guns in the home decrease the risk of lost property during an attempted robbery by about 1/3, victims using other weapons, such as Mace, favor equally well. Finally, hundreds of thousands of household guns are stolen each year, often ending up in the hands of criminals, who use them to commit violent crimes.
Regulation, polemics, and court decisions regarding access to firearms are based on a fundamental misunderstanding of Second Amendment and the concept of the subordinate clause. This amendment states, "A well-regulated Militia (with a capital M), being necessary to the security of a free State, the right of the people to keep and bear Arms, shall not be infringed." From junior high school English class, it should be clear that the right to keep and bear arms is tied to those who are active in an official Militia (hence the capital M), which when the Bill of Rights was written meant, essentially, the army fighting for the 13 colonies’ independence.
There is no way the framers of the Constitution could have imagined the killing capacity of contemporary firearms. A typical Revolutionary-era musket had a magazine capacity of one round, an effective firing rate of 3 rounds per minute, a muzzle velocity of 1,000 feet per second, and a maximum accurate range of 50 meters. A typical modern-day AR-15 assault rifle has a magazine capacity of 30 rounds, an effective firing rate of 45 rounds per minute, a muzzle velocity of 3,260 feet per second, and a maximum accurate range of 550 meters. Three hundred years ago you could actually see the whites of the eyes of those whom you killed. Now one can fire from a hotel room in Las Vegas at a crowd many football fields away and cause mass carnage.
Today, there are almost 300 active militias (small m), most of which are not preparing to defend the entire nation’s citizens, but rather local pockets of anti-government clans. A large number espouse racist, anti-immigrant and anti-government ideologies. Many consider themselves patriotic, freedom-loving, true Americans, yet simultaneously warn of an impending government takeover of their property. Many are reluctant to pay taxes, the dues we pay for living in a civilized society. 40 states prohibit or limit paramilitary training and unofficial military forces, yet there is no known case of such laws ever being enforced against private militias.
Some gun owners do not trust local law enforcement authorities to protect them. They feel that they have a right to fight back when threatened, which indeed seems entirely reasonable, but this right often includes over-reacting to threats with excessive force. For instance, a 2017 Study of Florida’s 2005 Stand Your Ground Law showed that while both justifiable and unlawful homicides increased substantially after the law took effect, unlawful homicides accounted for most of the increase.
Since the 1990s, the Centers for Disease Control and Prevention has been prohibited, by an act of Congress, from studying gun violence using federal funds. This is a unique prohibition, given the enormity of this public health problem, and since federal grants made up a large portion of gun violence research funds, has stymied many those investigators who hope to learn more to combat an epidemic, which if caused by a virulent bacterium would have the public up in arms (no pun intended) and screaming for a well-funded, urgent research and prevention program. Worse yet, Florida, Mississippi, and Montana have passed laws limiting doctors’ speech in the exam room and prohibiting them from counseling patients about the risks of guns in the home and the importance, when guns are present, of adequate safety measures. Such a blatant intrusion of the government into the privacy of the sacred doctor-patient relationship is antithetical to ethical and professional norms and should worry anyone concerned about the sanctity of the doctor-patient relationship and who hopes to get accurate and complete health information from their physicians. Of note, the Florida law was overturned by the US Appeals Court last year, while the others remain tied up in the courts.
It is beyond comprehension why an average citizen would need armor piercing bullets or assault rifles capable of firing numerous rounds per second. In Florida, where 17 people were recently killed in a school shooting carried out by a 19-year-old armed with an AR-15 rifle, the National Rifle Association has sued to overturn a newly-signed bill that would raise the minimum age for buying rifles from 18 to 21, ban bump fire stocks (which increase the number of rounds one can fire per minute), and introduce a three-day waiting period for gun purchases within the state.
President Trump, who received 5 draft deferments, one for bone spurs (the location of which he later forgot), said that an officer who did not intervene in the Parkland, Florida shooting was a “coward,” that he would have stopped the shooter himself even if he “didn’t have a weapon,” and that “highly trained” teachers should be armed in the classroom. Since his suggestion, there have been 3 separate events involving armed teachers, one in which a troubled teacher shot his gun out of a window, one involving an accidental discharge in an elementary school bathroom injuring the teacher, and one involving a gun safety instructor who fired his weapon into a gymnasium ceiling, causing superficial wounds to a student. When firing their guns, even well-trained, experienced New York police officers hit their suspects only 13% of the time, so between accidents, teachers who feel threatened or lash out with their guns, students who may try to take a teacher’s gun, and the possibility of a dramatically uneven shootout if the attacker has an assault weapon, deaths among students would most likely rise significantly. And given the low salaries of teachers in the US (a sign of how much we really value our children, their intellectual well-being, and their future economic prospects), why would we spend money on arming teachers instead of supporting them in their educational mission?
The National Rifle Association, the chief gun lobby group in the United States, was founded in 1871 by Union soldiers concerned about recruits’ poor shooting skills. Its original mission focused on hunting, conservation, and marksmanship. During Prohibition, the group worked with the Roosevelt administration to pass and later help enforce the National Firearms Act of 1934 and the Gun Control Act of 1938, which regulated machine guns and shotguns, banned some buyers, and required gun dealers to register with the government. Its leader Karl T. Frederick said, "I have never believed in the general practice of carrying weapons. I think it should be sharply restricted and only under licenses."
In the 1960s, the NRA supported the extension and tightening of these laws following the assassinations of President John F. Kennedy, Martin Luther King Jr., and Sen. Robert Kennedy. In the late 1960s, however, widespread concern about rising crime rates and deadly riots in major cities caused rising concern among citizens, who turned in increasing numbers to gun purchases for personal protection. The NRA and its hardliners, especially Harlon Carter, an immigration hawk who headed the Border Patrol in the 1950s, served time for shooting dead a Mexican teenager, and was the first head of the NRA’s lobbying group and later elected to the NRA’s top position, stoked public fears with campaigns that promulgated racism. He spelled out the new group’s approach to gun regulation: "No compromise. No gun legislation."
The 1981 attempted assassination of President Ronald Reagan created a new groundswell for gun control which eventually led to the 1993 Brady Bill, named for Reagan's press secretary Jim Brady, who was wounded in the attempt on the president's life and spent his later years advocating for stronger gun control laws. The Brady Law established a waiting period for gun purchases and other restrictions and was supported by NRA member Ronald Reagan. In 1994, a Democratic Congress enacted a domestic ban on assault weapons, but the NRA managed to insert a 10-year sunset on the law, and when it came due in 2004, the Republican-controlled Congress allowed the ban to expire. Of note, in 1996, following a mass shooting that killed 36 and injured 23 people, Australia restricted the private ownership of semiautomatic and shotguns, required uniform gun registration, and removed self-defense as a legitimate reason to own a firearm. More than one million illicitly held firearms were surrendered (about 1/3 of the guns in the country at the time). There has not been a single mass shooting in Australia since; the odds of this occurring by chance, given historical figures, is one in 200,000.
Today, the large sign on the façade of the NRA headquarters reads only, “… the right of the people to keep and bear arms, shall not be infringed,” conveniently leaving out the dependent clause about a well-regulated militia. The NRA’s current president, Wayne LaPierre said that “socialists” want to take away American’s handguns and semi-automatic rifles so that citizens won’t be able to defend themselves against an attack by the US government, which employs a total of 1,373,650 active-duty personnel; owns 5,884 combat tanks, 41,062 armored vehicles, 1,934 self-propelled artillery guns, 19 aircraft carriers, 63 destroyers, 70 submarines, 2,296 fighter planes, and 947 attack helicopters; maintains a stockpile of 6,800 nuclear bombs, including some that are 80 times more powerful than the bomb the US dropped on Hiroshima during World War II; and operates on a budget of about $600 billion.
Today, the NRA is funded by members’ dues, augmented by million-dollar donations from 22 different gun makers, including Smith & Wesson and Beretta USA, and even $1 of every purchase from some gun and ammunition companies The NRA received up to $52.6 million in industry donations between 2005 and 2013. According to Josh Sugarmann, executive director of the Violence Policy Center, a gun-control organization, "Today's NRA is a virtual subsidiary of the gun industry…While the NRA portrays itself as protecting the freedom of individual gun owners, it's actually working to protect the freedom of the gun industry to manufacture and sell virtually any weapon or accessory."
Thus, what originally began as an advocacy group for firearms training, gun safety, and hunting enthusiasts later morphed into a front group for gun manufacturers. Through advertisements, its cable television channel, and paid pundits, the NRA creates a climate of fear which in turn motivates gun owners and conservatives to vote in higher numbers than those who favor reasonable gun control. The group’s report cards have been credited with the election (or defeat) of many candidates, including incumbents.
In addition to campaign support, the NRA paid $5 million to lobbyists last year. Even candidates who have received remarkably small donations have supported the group’s resistance to sensible gun legislation, despite the overwhelming support of a large majority of Americans.
Some people blame the mentally ill for gun violence. Yet most mentally ill people are not violent, and most violent criminals are not mentally ill. Indeed, mental health care, especially preventive mental health interventions for children, is woefully underfunded and needs to be increased, as does funding into the root causes of violent behavior. But this will not stop the epidemic of gun violence in this country.
Others blame violent movies and video games, and there is some evidence suggesting that these can promote violence. Violent video games are ubiquitous and very popular, a far cry from the Pong and Pac Man entertainment of my youth. Violence in films has more than doubled since 1950, and gun violence in PG-13–rated films has more than tripled since 1985. Since 2009, PG-13–rated films have contained as much or more violence as R-rated films. The acceptance and even glorification of violence in entertainment is troubling, as is why teenagers and young adults would enjoy spending hours each day virtually participating in shootouts, beheadings, eviscerations, and amputations. The makers of violent media bear some degree of responsibility for promoting a culture in which such violence no longer mortifies many, but is instead accepted and even glorified as a means of problem solving.
Our ongoing tolerance of gun violence and gun culture at home is unacceptable. It is heartening to see young people and their parents, who are fed up with school shootings becoming routine, rising up with other concerned citizens against gun violence through the March for our Lives rallies, school walkouts, and town halls where they have demanded that legislators stop taking NRA money, rightly accusing those who do of being complicit in our national epidemic of gun violence. We should all hold our legislators to passing as soon as possible sensible gun control legislation, including outlawing the private ownership of assault weapons; prohibiting convicted criminals, those with restraining orders, and the mentally ill from owning guns; requiring strict background checks and waiting periods for all gun purchases (including those at gun shows); outlawing armor piercing bullets; and adequately funding violence prevention research and mental health prevention and treatment. Indeed, these are reasonable measures supported by a large majority of Americans and even a majority of gun owners and law enforcement officers. And for goodness sakes, let’s stop the nonsensical talk of arming teachers. Schools are facilities for learning and social development and should not be fortresses of fear. It is time to end the war against ourselves. The lives of many, and the livability of our society, depend upon it.
Martin Donohoe, MD, FACP practices internal medicine, is the host of the cable television program Prescription for Justice (https://www.youtube.com/channel/UCJt34I9c5vT2RpZtkg6Im2A), and runs the Public Health and Social Justice website (http://www.publichealthandsocialjustice.org or http://www.phsj.org), where you can find his slide shows, articles, syllabi, and information regarding his book, Public Health and Social Justice (seehttp://phsj.org/public-health-and-social-justice-reader/ for additional ordering information, endorsements, and table of contents.