Correspondence

The Attack on the National Center for Injury Prevention and Control

N Engl J Med 1996; 334:191-194January 18, 1996

Article

To the Editor:

In regard to your editorial (Sept. 21 issue)1 on the National Center for Injury Prevention and Control (NCIPC), no one disputes the need to perform research with a valid purpose such as identifying ways of improving public health, but when there is such a bias in the work and the statistical information is so flawed as to be obvious to anyone with any reasoning ability, then the research has no value and should neither receive public funding nor be reported in respected medical journals such as the New England Journal of Medicine. Vicious attacks on groups that point out such bias and errors in research methods only demonstrate your pettiness and the absence of hard data on which to base your opinions.

As long as the NCIPC pursues such a biased political and social agenda, it should certainly be abolished until or unless it becomes dedicated to truly honest scientific research. Supporters who wish to achieve by federal regulation and intervention what rational people with common sense can so easily recognize as faulty public policy do not deserve either their current positions or the respect of our profession.

Ronald D. Weddle, M.D.
4004 Mary Jo Blvd., Bardstown, KY 40004

1 References

1
Kassirer JP. A partisan assault on science -- the threat to the CDC. N Engl J Med 1995;333:793-794
Full Text | Web of Science | Medline

To the Editor:

I am writing to suggest that there is a misunderstanding of fact and intent in your editorial with regard to Doctors for Integrity in Policy Research (formerly Doctors for Integrity in Research and Public Policy) and its criticism of the activities of the NCIPC.

Complaints made by our organization do not stem from partisan politics but are a collective expression of the independent conclusions of more than 500 physician members in academia and the private sector. The purpose of our organization is to safeguard the civil liberties of Americans from the effects of faulty policy research.

We have a deep respect for the traditional aspect of the Centers for Disease Control and Prevention (CDC). We also strongly support legitimate research on firearms and violence. Our complaint is very straightforward: we believe that there are many instances in which the NCIPC and its sponsored researchers have abandoned scientific rigor and objectivity in the conduct of research on firearms and violence. In a publicly funded agency charged with providing recommendations for public policy, this practice is unacceptable: public health could be adversely affected by research that served a preordained agenda instead of the truth. We have catalogued elsewhere the general and specific bases for this opinion.1,2

Concerned as you are by the ties of our group to the gun lobby (there are none; we are independent and supported by members' dues), we wonder whether you find acceptable the political activities of the NCIPC in the national gun-prohibition movement. In one of many examples, funds granted by the CDC for use in studying farm injuries were diverted for the sponsorship of a conference on firearms policy (“Handgun Injuries: A Public Health Approach,” at the University of Iowa, January 29, 1992) featuring NCIPC scientists at the highest level along with political activists such as Sarah Brady.

So egregious has been the bias in statements and activities of NCIPC personnel and some of their associates that those in other disciplines have extensively documented serious examples of such bias.3 Lawmakers, too, are beginning to notice; legislation introduced this year will forbid the NCIPC to engage in some of its current activities.

Like you, we are hopeful that the future will bring more public exposure of this issue. We are as anxious as you not to see the integrity of the CDC threatened; indeed, it is for this reason that we are intolerant of the lack of science within the NCIPC.

William C. Waters, IV, M.D.
Doctors for Integrity in Policy Research, Atlanta, GA 30339

3 References

1
Suter EA. Guns in the medical literature -- a failure of peer review. J Med Assoc Ga 1994;83:133-148
Medline

2
Suter EA, Waters WC IV, Murray GB, et al. Violence in America: effective solutions. J Med Assoc Ga 1995;84:253-261
Medline

3
Kates DB, Schaffer HE, Lattimer JK, Murray GB, Cassem EH. Guns and public health: epidemic of violence or pandemic of propaganda? Tenn Law Rev 1995;62:513-596

To the Editor:

The CDC has provided funding (grant R49/CCR903697-06) for a newsletter published by the Trauma Foundation, a San Francisco group that lobbies against gun ownership. The newsletter exhorts readers to “organize a picket at gun manufacturing sites” and “work for campaign finance reform to weaken the gun lobby's clout.”1 In addition, senior staff members at the NCIPC have advocated restrictive licensing so that only police, the military, and guards would be allowed to have guns. In the same publication the authors advised the outright prohibition of gun ownership.2

The most ardent opponents of gun ownership, if they are rigorously honest, must be concerned about these developments. For if they continue, the door is open to all manner of federally funded political action, always brought under the banner of public health.

Responsible gun owners have called for their elected representatives to withdraw funding for the NCIPC. Their action derives not from machinations of the National Rifle Association but from righteous stewardship of their own tax money. Taxpayers should not be compelled to pay for political action they do not support. It is, after all, their money.

Timothy Wheeler, M.D.
Doctors for Responsible Gun Ownership, Upland, CA 91785-1931

2 References

1
Trauma Foundation. Injury Prevention Network Newsletter 1995;11:17-17

2
Mercy JA, Rosenberg ML, Powell KE, Broome CV, Roper WL. Public health policy for preventing violence. Health Aff (Millwood) 1993;12:7-29
CrossRef | Web of Science | Medline

To the Editor:

The idea that the gun-control laws sometimes violate the Second Amendment or state analogues of the Second Amendment, as I note in an article published in the Journal of the Medical Association of Georgia, 1 which you cite in your editorial, is not my invention. Courts have invalidated 21 gun-control laws on the basis of the right-to-arms clauses in state constitutions and have invalidated 2 gun-control laws on the basis of the Second Amendment itself. These latter cases are cited in another article that you criticize; the same article cites the huge corpus of legal scholarship showing that the Second Amendment guarantees an individual right, as well as the substantial criminologic literature suggesting that severe gun-control measures such as those you favor would be ineffective and counterproductive.2

The Journal of the Medical Association of Georgia published an issue that contained articles both for and against gun control as a medical “cure” for violence. Instead of confronting the issues raised by the skeptics, you simply attack the authors ad hominem and applaud the successful efforts to oust the journal's editor. Ironically, although the journal is attacked because it presented diverse viewpoints on the gun issue, the CDC — which never even acknowledges that reasonable people may differ on gun control — is held up as a model of science.

A serious scientific inquiry into the gun issue might begin with a review of the numerous scientific flaws in the antigun studies reported in the New England Journal of Medicine or funded by the CDC (or both).2,3 As I observed in my article, when scientific errors made by the CDC and its gun-prohibitionist allies are pointed out, the typical response is “to attack the motives of the critic, rather than to answer the criticism.”

Critics of the CDC's low-quality research are not opposed to federally funded scientific study of the gun issue. The National Institute of Justice has been funding high-quality research on violence prevention since long before the CDC began to imagine that guns are germs. Unlike CDC grantees, researchers who receive grants from the National Institute of Justice are required to make their data available to other researchers. This requirement is an important protection against scientific fraud.

David B. Kopel, J.D.
Independence Institute, Golden, CO 80401-3134

3 References

1
Kopel DB. Guns, germs, and science: public health approaches to gun control. J Med Assoc Ga 1995;84:269-273
Medline

2
Suter EA, Waters WC IV, Murray GB, et al. Violence in America: effective solutions. J Med Assoc Ga 1995;84:253-263
Medline

3
Kates DB, Schaffer HE, Lattimer JK, Murray GB, Cassem EH. Guns and public health: epidemic of violence or pandemic of propaganda? Tenn Law Rev 1995;62:513-596

To the Editor:

What you and other left-wing ideologues fail to recognize is that the American people have been awakened to the heretofore surreptitious funding of radical anti-American causes, and that this funding is going to cease. What you refer to as the “gun lobby” is 70 million Americans who own guns. An even greater number of Americans are thoroughly fed up that their earnings are confiscated by the government and turned over to organizations that are working to destroy their freedom.

It is particularly galling to see the CDC come under the control of those who are seeking to destroy our freedom. The CDC is an invaluable resource and service organization for both the medical profession and the public. As such, it has a responsibility to preserve its integrity by remaining objective, honest, and competent. I am confident that this foray into the political arena will not be permitted to continue.

The antigun campaign by the NCIPC does represent a duplication of work performed by other agencies and organizations. The chief difference is that those agencies and organizations have collected data in an objective, scientific manner, whereas the NCIPC has resorted to lies and distortions in its campaign. This can hardly be considered scientific research, except perhaps by some of the revisionists who have crept into academia. It is interesting to note that the NCIPC has never advocated a ban on corn pickers, power take-off drive lines, or farm augers. The CDC has similarly never recommended the removal of aspirin from all homes where children reside, although aspirin poisons thousands of children every year.

There is good reason why the right of self-defense by individuals was delineated early in the Constitution. The long history of abuse by governments and tyrants was reviewed at length in the writings of the framers of the document, all of which are readily available to anyone who is interested in the matter. Throughout history, tyrants have disarmed their subjects for only one reason: control. This pattern was most recently repeated by Adolf Hitler, in the 1930s. It is ironic that the Gun Control Act of 1968 was taken virtually verbatim from the German Firearms Act of 1937. Those who are fervently attempting to disarm the American people today are motivated by the same evil intent that drove Hitler or simply by ignorance of historical facts.

Donald E. Waite, D.O., M.P.H.
Michigan State University, East Lansing, MI 48824

To the Editor:

Your editorial on the fate of the CDC and the NCIPC is very useful in calling attention to an extremely important agency and its urgent problems. More should be said about the way to deal with these matters; I want to focus on some positive things.

The precarious position of the NCIPC is somewhat similar to that of the National Institute of Mental Health (NIMH), which grew, in terms of its budget and influence, to a size just about equal to that of the National Institutes of Health. But the NIMH also made enemies, in large part because it marginalized organizations and persons with ideas that did not agree with the agency's methods and goals in all particulars, including many people with “conservative” ideas about social and mental health problems.

A strident and single-minded approach that focuses on gun control as the principal means of dealing with violence may be self-defeating. Many people are appalled by the violence in our society but have legitimate doubts about the efficacy of gun control as a preventive measure. This perspective should be neither ignored nor minimized.

It is well known that even where guns are not controlled, it is illegal for a young person to carry a gun. The NCIPC should focus on this age group in order to learn more about the phenomenon and use its expertise to help communities deal more constructively with the problem of youths carrying guns, as well as violence. The NCIPC should also focus more of its resources and bring the public health perspective to bear on gun trafficking. In addition, it may be desirable to establish a system of surveillance of violence in schools to help track this epidemic. These problems are bigger than law enforcement and could benefit from a public health perspective. In addition, attention to these matters by the premier public health agency promoting injury prevention would broaden its political support and bring more influential friends to its side.

Jack Susman, Ph.D.
University of Maryland, College Park, MD 20742

To the Editor:

I was amazed at your courage in publishing your editorial. From here on the west coast of Canada, one feels (and is) impotent watching the struggle your country is going through in relation to the firearm problem. Please take this letter as support and encouragement. Help us all on this continent by not faltering in your efforts, for as your country goes, so goes mine in a few years. I have written a similar letter of support to Allan Rock, our minister of justice. The same enormous profits are supporting a minority but frightening opposition to a proposed gun-control bill, and it may be defeated. He also needs all the help it is possible to give. Good luck.

Julius L. Stoller, M.B., Ch.B.
888 West 8 Ave., Vancouver, BC V5Z 3Y1, Canada

To the Editor:

Thanks for the editorial supporting the NCIPC. The attack on this agency is unconscionable and is motivated by the basest political and selfish interests. It is imperative that medical leaders speak out against efforts at intimidation and repression. Keep up the good work; you are a model for the rest of us.

Robert Blake, M.D.
University of Missouri, Columbia, MO 65212

Author/Editor Response

Dr. Kassirer replies:

Reports on studies of violence submitted to the New England Journal of Medicine are put through the same scrutiny in our peer-review process as all other epidemiologic studies. Not surprisingly, these reports, like those on vitamins, drugs, and other interventions, have their critics. Though none of the studies on violence are perfect, each adds to the cumulative evidence that more guns yield greater risk. They are all in the public domain for anyone to evaluate for themselves.

Several of our correspondents argue not only that the epidemiologic studies supported by the NCIPC are flawed but also that it is inappropriate for the center's staff to engage in political activities. The latter may be so, but that is no reason to attempt to eliminate an agency that contributes so much to preventing injuries of all kinds. It is hard to escape the conclusion that physicians who have urged the elimination of funding for the NCIPC wish to foreclose epidemiologic studies that could be used to undermine progun policies.

Dr. Waters, in his official reply from the Doctors for Integrity in Policy Research, tells us that his organization receives no money from the National Rifle Association but does not mention that his physician coauthors (including the chair of Doctors for Integrity in Policy Research and the president of Doctors for Responsible Gun Ownership) advertise their organizations in publications of the National Rifle Association,1 that they have displayed their ideas on the association's page on the World Wide Web,2 or that the National Rifle Association distributed publications by Doctors for Integrity in policy Research widely.3 Dr. Waters also chooses not to answer whether his organization investigates integrity in research on subjects other than guns. In addition, his comment about the documentation of serious bias by people in “other disciplines” is misleading: three of the five authors of the paper to which he refers4 are his coauthors on another paper.5

The opposing arguments about the interpretation of the Second Amendment have been well aired, and I will not review them here. Needless to say, numerous distinguished scholars and jurists have rejected the interpretation of the National Rifle Association and other gun advocates.6,7 I continue to believe that the First Amendment, not the Second, is the law that protects us against the abuses of government.

For the record, here is a distillation of my published views. I have proposed that physicians should evaluate the data on firearms themselves, and if they agree that the risks outweigh the benefits, they should speak out and recommend legislation to control firearms.8 I suggested that, as models for society, physicians should not keep guns themselves.8 I admonished physicians' organizations to speak out on the risks associated with guns.8 I urged physicians to support design standards for guns, locks on guns, registration of firearms, licensing of gun owners, and legislation banning guns in schools.9 I supported the passage of the Brady bill and an assessment of its impact.9 I maintained that private ownership of automatic and semiautomatic weapons has no redeeming social value and that these weapons should be banned.9,10 Most recently, I urged Congress to continue the support of scientific studies of injuries, including those related to firearms.11

Jerome P. Kassirer, M.D.

11 References

1
Baker JJ. Gun control is bad medicine. American Rifleman. February 1994:40, 41, 76-9.

2
Wheeler T. Letter to the editor of the California Journal via the Internet. Upland, Calif.: Doctors for Responsible Gun Ownership, May 31, 1995.

3
Memo from NRA Public Affairs office to teleconference participants. Fairfax, Va.: National Rifle Association of America, June 13, 1995.

4
Kates DB, Schaffer HE, Lattimer JK, Murray GB, Cassem EH. Guns and public health: epidemic of violence or pandemic of propaganda? Tenn Law Rev 1995;62:513-596

5
Suter EA, Waters WC IV, Murray GB, et al. Violence in America: effective solutions. J Med Assoc Ga 1995;84:253-263
Medline

6
Henigan DA, Nicholson EB, Hemenway D. Guns and the Constitution: the myth of Second Amendment protection for firearms in America. Northampton, Mass.: Aletheia Press, 1995.