Correspondence
Support for New Policies to Regulate Firearms
N Engl J Med 1999; 340:234-236January 21, 1999
- Article
To the Editor:
Even if one accepts the results of Teret et al. (Sept. 17 issue),1 showing that there is strong public support for strategies to regulate firearms, why are they deemed to support new policies to regulate firearms as consumer products? If the public overwhelmingly endorses measures such as childproofing, personalization (devices that permit firing only by an authorized person), magazine safeties (devices that prevent firing after the magazine or clip is removed), and loaded-chamber indicators (devices that show whether a handgun is loaded), isn't this in fact evidence that governmental regulation is unnecessary? After all, if Americans really want guns with such devices, and are willing to pay for them, why shouldn't the market provide them?
Why the call for action on the part of policy makers? If this study purports to be news, isn't it also news to domestic gun manufacturers? It seems to me that if Teret et al. want to see regulations on firearms enacted, they must first make an argument that the market has failed.
In his accompanying editorial, Dr. Hemenway argues that the success in reducing motor vehicle injuries in the United States “provides insight into methods that could reduce firearm injuries,”2 and indeed, it may. Fatality rates calculated according to the number of miles driven dropped dramatically over the 60-year period preceding the enactment of the National Traffic and Motor Vehicle Safety Act in 1966.3 Furthermore, as Trebilcock has stated, “proponents of the 1966 Act made no serious market failure argument for its enactment; the Senate Commerce Committee, after lengthy hearings, reported that it did not have the foggiest notion as to the truth of the proposition that `safety does not sell.'”3
Finally, just how effective such regulations would be is open to question. According to Trebilcock, “a stream of empirical studies . . . have generally found few if any safety gains from regulation in numerous safety contexts. Those safety gains that were realized have often entailed costs disproportionate to their benefits.”3
3 ReferencesFrederick Paola, M.D., J.D.
University of South Florida College of Medicine, Tampa, FL 33612-47991
Teret SP ,Webster DW ,Vernick JS , et al. Support for new policies to regulate firearms -- results of two national surveys. N Engl J Med 1998;339:813-818
Full Text | Web of Science | Medline2
Hemenway D . Regulation of firearms. N Engl J Med 1998;339:843-845
Full Text | Web of Science | Medline3
Trebilcock MJ . Review of: Requiem for regulators: the passing of a counter-culture? The struggle for auto safety. Yale J Regul 1991;8:497-510
To the Editor:
Teret et al. raise interesting and timely possibilities for regulatory policies for firearms. If, indeed, public opinion is well represented by their survey results, then it would seem that legislators now have further reason to consider firearm-safety policies. As Hemenway points out in his editorial, the public health victory in reducing deaths and injuries from motor vehicle accidents probably had more to do with legislating vehicle safety than with driver education.
Firearm manufacturers, distributors, and retailers should be under some legal pressures to provide safer products. Given that some modifications could be made to firearms, that the industry is aware of these modifications, and that the public, including gun owners, desires these safety modifications, class-action suits initiated by well-intentioned lawyers and relatives of victims of unintentional gunshot wounds might create the necessary incentives for the industry to provide safety features.
Firearm-related deaths and injuries involving children or caused by persons with criminal, psychiatric, or drug-abuse histories seem tragically unnecessary when there appears to be public consensus about enhancing the safety of firearms and of their distribution.
Craig N. van Roekens, M.D.
University of California at Berkeley School of Public Health, Berkeley, CA 94701To the Editor:
Antigun public health researchers often compare the large but declining rates of motor vehicle fatalities with the rates of gun-related deaths, ignoring the fact that the relative rates of motor vehicle–related morbidity and medical costs1 are vastly larger than those associated with firearms.2,3 They then go on, as David Hemenway did in his editorial, to credit — generally without documentation — public health measures for the decline, dismissing the role of law enforcement's decades-old crackdown on unlawful driving practices.
Public health researchers are divided on how to address the fact that motor vehicle–related deaths are almost exclusively accidental, whereas firearm-related deaths are overwhelmingly intentional. Some researchers assert as an article of faith that the same initiatives as are aimed at accidents would apply to criminal and suicidal violence.4 Others simply use a bait-and-switch tactic in which they use the large number of gun-related deaths as a basis for declaring an emergency but then acknowledge, as Hemenway did, that proposed gun-control measures “may not substantially reduce gun-related crime, but . . . could decrease the number of deaths and injuries that occur each day as a result of unintentional gunshots.” With accidents accounting for just 3 percent of gun-related deaths, the most popular of the regulatory policies endorsed by Teret et al. were aimed at protecting young children, who account for only 5 percent of accidental and 0.2 percent of total firearm-related deaths.
The data, however, undermine the claim that reforms modeled on those designed to reduce motor vehicle injuries are needed for guns. Hemenway notes that in the past 40 years, highway-safety initiatives have resulted in a decrease of over 75 percent in motor vehicle fatalities per mile. Although a precise, similar comparison with respect to guns is not possible, analysis of figures on the stocks of motor vehicles1 and guns5,6 from 1955 to 1995 shows a 68 percent drop in accidental motor vehicle fatalities per 100,000 motor vehicles and an 84 percent drop in gun-related accidental deaths per 100,000 firearms.
6 ReferencesPaul H. Blackman, Ph.D.
National Rifle Association of America, Fairfax, VA 22030-74001
Accident facts, 1997 ed. Itasca, Ill.: National Safety Council, 1997.
2
Max W ,Rice DP . Shooting in the dark: estimating the cost of firearm injuries. Health Aff (Millwood) 1993;12:171-185
CrossRef | Web of Science | Medline3
Cherry D ,Annest JL ,Mercy JA ,Kresnow M ,Pollock DA . Trends in nonfatal and fatal firearm-related injury rates in the United States, 1985-1995. Ann Emerg Med 1998;32:51-59
CrossRef | Web of Science | Medline4
Rosenberg ML ,O'Carroll PW ,Powell KE . Let's be clear: violence is a public health problem. JAMA 1992;267:3071-3072
CrossRef | Web of Science | Medline5
Kleck G. Targeting guns: firearms and their control. New York: Aldine de Gruyter, 1997.
6
Thurman R . Firearm business analysis. Shooting Industry 1998;42:32-49
To the Editor:
The article by Teret et al. concerning the regulation of firearms should be seen in context as the blatant political treatise that it really is, as opposed to the scientific paper it pretends to be. The Journal has a disclosure policy with respect to potential bias arising from research sponsorship. Readers should be informed that the Joyce Foundation that sponsored the study openly and unambiguously solicits funding proposals that will support an obviously political antigun “public health” agenda. In this sense, it is much like the tobacco industry's soliciting of research that will prove tobacco “safe.”
Peter H. Proctor, Ph.D., M.D.
4126 S.W. Freeway, Houston, TX 77027Author/Editor Response
The authors reply:
To the Editor: Dr. Paola comments that if consumers truly wanted safer guns, gun manufacturers would alter their products, and therefore, government regulation is unnecessary. The behavior of gun makers belies this assertion. The design changes that manufacturers have made in handguns in the past several years tend to increase the lethality of the gun rather than its safety.1 Gun makers have not routinely included existing safety devices such as loaded-chamber indicators and magazine safeties in all handguns. In fact, in at least one instance, they developed a safety device (the grip safety, which one manufacturer claimed rendered its revolver inoperable by children under eight years of age), sold about a half-million handguns with this device, and subsequently discontinued the use of the device without substituting any other child-resistant mechanism.2
This disjunction between the design of guns and the public's preference for safer guns is precisely the evidence of market failure to which Dr. Paola refers. Furthermore, if a gun is made safer, it is made safer not only for the buyer but also for those who do not choose to buy guns, some of whose lives would be saved as a result.
Dr. Paola may prefer to allow the gun makers to remain unregulated, but the findings of our survey quite clearly show that the public disagrees with him. As we pointed out in our article, the vast majority of the public, and even gun owners, want increased government regulation of guns as consumer products. The premise of this strong preference for regulation is that it will save lives. Dr. Paola disagrees with this premise, citing a book review as a reference, but well-designed studies have demonstrated that the regulation of consumer products, including automobiles, can save lives.3,4
Dr. Blackman misunderstands or misstates the possible safety benefits of the policy options discussed in our article; he incorrectly assumes that only the number of fatal, unintended injuries to young children will be decreased. But many of the policy options that were the subject of the poll (e.g., personalization of guns) would also apply to gun-related suicides and homicides involving adolescents and adults.
Dr. Blackman states that from 1955 to 1995, the rate of gun-related accidental deaths per 100,000 guns decreased by 84 percent. If he had examined all gun-related deaths instead of only accidental deaths, he would have found that from 1955 to 1995, there was a 27 percent increase in the number of all gun-related deaths per 100,000 guns.
4 ReferencesStephen P. Teret, J.D., M.P.H.
Daniel W. Webster, Sc.D., M.P.H.
Jon S. Vernick, J.D., M.P.H.
Johns Hopkins School of Hygiene and Public Health, Baltimore, MD 21205-19961
Wintemute GJ . The relationship between firearm design and firearm violence: handguns in the 1990s. JAMA 1996;275:1749-1753
CrossRef | Web of Science | Medline2
Robinson KD, Teret SP, Vernick JS, Webster DW. Personalized guns: reducing gun deaths through design changes. 2nd ed. Baltimore: Johns Hopkins Center for Gun Policy and Research, 1998.
3
Robertson LS . Automobile safety regulations and death reductions in the United States. Am J Public Health 1981;71:818-822
CrossRef | Web of Science | Medline4
Rodgers GB . The safety effects of child-resistant packaging for oral prescription drugs: two decades of experience. JAMA 1996;275:1661-1665
CrossRef | Web of Science | Medline
Author/Editor Response
Drs. Paola and Blackman question the benefit of safety regulations in general and automobile regulations in particular. Yet the author of their only relevant reference accepts as best evidence “the Brookings Institution's comprehensive empirical evaluation of the safety gains from [National Highway Traffic Safety Administration] motor vehicle standards . . . [which] finds that the standards may have reduced fatalities as much as 40 percent.”1,2 As opposed to Blackman, Trebilcock voices concern about any “reorientation of auto safety regulation from science and planning to the old and, scientifically speaking, discredited approach to traffic safety of crime and punishment.”2
A new Institute of Medicine report on injury prevention devotes an entire chapter to “the comprehensive approach that has been utilized successfully to promote motor vehicle safety and [recommends] steps that could be taken to implement a similar effort to reduce firearm injuries.”3 Government has the responsibility to protect consumers by helping to ensure the safety of many potentially dangerous products — for example, food, drugs, cars, and planes. The Consumer Product Safety Commission ensures that there are minimal safety standards for such things as the amount of “kickback” of chain saws and the flammability of children's sleepwear. A government agency should also be responsible for ensuring that guns do not go off when dropped4 and that they have loaded-chamber indicators and other safety devices.
Government also has the responsibility to help ensure the public's safety. Guns pose a risk to public safety when they are used recklessly or in crimes. Many reasonable firearm initiatives could reduce the risk to the public, such as laws allowing the purchase of one gun per month (which reduce gun running) and the use of personalized firearms (which reduces unauthorized use of guns).
Dr. Blackman seems ready to dismiss policies aimed at reducing unintentional deaths caused by firearms among very young children, since they account for only 5 percent of such deaths. Similar reasoning would mean the elimination of most proven safety measures, such as child-safety seats or rollover standards for motor vehicles, since they are factors in less than 5 percent of motor vehicle fatalities.
Some of the reported drop in the rate of unintentional gun-related deaths is a statistical artifact caused by changes in classification5 and more accurate determinations of suicide and homicide. The real decrease has been good news and is probably the result of a reduction in exposure (gun use declines with urbanization) and better medical care. More might be known about ways of preventing firearm-related injuries if Dr. Blackman's organization had not successfully lobbied to reduce federal funding for scientific research on firearms.
5 ReferencesDavid Hemenway, Ph.D.
Harvard School of Public Health, Boston, MA 021151
Crandall R, Gruenspecht H, Keeler T, Lave L. Regulating the automobile. Washington, D.C.: Brookings Institution, 1986:75.
2
Trebilcock MJ . Review of: Requiem for regulators: the passing of a counter-culture? The struggle for auto safety. Yale J Regul 1991;8:497-5103
Institute of Medicine. Reducing the burden of injury: advancing prevention and treatment. Washington, D.C.: National Academy Press, 1999.
4
Larson E. Wild West legacy: Ruger gun often fires if dropped, but firm sees no need for recall. Wall Street Journal. June 24, 1993:A1.
5
Ikeda RM, Gorwitz R, James SP, Powell KE, Mercy JA. Fatal firearm injuries in the United States 1962-1994. Violence surveillance summary series no. 3. Atlanta: National Center for Injury Prevention and Control, 1997.
