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Physicians and Guns

I guess it should come as no surprise to anyone, the increasing number of articles in conventional medical journals about the health consequences of gun ownership. After all, each year more than 30,000 people are killed by a gun and another 70,000 are wounded. Add up the past decade and you get nearly one million gunshot victims. Picture Chicago’s Soldier Field, filled and refilled with people–17 times–to give you a visual on one million human beings.

While you’re visualizing, fill two of these stadiums with children. Anybody who denies we have a major health crisis on our hands is simply bonkers.

The medical abbreviation for a gunshot wound is GSW, something I wrote myself dozens of times during rotations at Cook County (now Stroger) Hospital. “18 y/o BM GSW L chest DOA.” I doesn’t take much imagination to figure it out. And given that the current US population is roughly 313 million, if we project based on one million GSW victims over the past decade it means that at least one in every 313 of us will be shot over the next decade.

Of the roughly 30,000 to die this year by a GSW, the majority will be suicides (57%), followed by homicides (35%), with the remaining 5% “accident,” “police intervention,” or “undetermined.” The vast majority of that gun-homicide number is made up of young men, but as Chicagoans we know this too well, living as we do in the murder capital of the US.

Many of those listed as homicides start out wounded and can’t be saved
I got a taste of this during my first night on surgical call at Cook County when I was a medical student, lowest man on the surgical team. A 20-something kid had been shot during a gang fight, the bullet entering the right side of his abdomen and travelling through his intestines, liver, and spleen before exiting on the left. My job in the operating room was to keep a tight grip on the retractor, a curved metal device that does just that, retracting abdominal muscles so the surgeon gets a large visual field in which to make his repairs.

Holding a retractor is both tedious and exhausting. You can’t see anything interesting because the surgeons are standing in front of you. It’s exhausting because you have to pull constantly, keeping the tension on, and within minutes you feel your biceps throbbing. If you ease up on the tension, the surgeon loses his field and lets you know fast by whacking your knuckles with whatever metal object is nearby. So you stand perfectly still and pull. It’s hot as hell under the bright OR lights and everybody’s pouring sweat. It’s only in the movies that a nurse dabs perspiration from the surgeon’s forehead. At County, he wiped his sweaty forehead on the shoulder of the medical student next to him, which was me.

We started at 1 am and closed the poor guy up, still alive, at 8 am. Seven straight hours of surgery and I still had the whole workday ahead. About a third of the way through the operation, at 3 am or so, I abandoned any thought of being a surgeon, knowing then that I’d be an internist. Our patient actually survived for a couple of weeks before dying of surgical complications. The entire time he was in the hospital a policeman sat in front of his door, ready to take him to Cook County Jail if he survived.

The medical costs of guns are staggering
In addition to the agonizing grief of losing a family member to gun violence, the raw costs are currently tagged at $33,000 for a fatality and $300,000+ for a GSW. These numbers reflect a combo package of medical, police, legal, transport, and the like, and adds up to about $12 billion a year.

Since the vast majority of victims have no health insurance, taxpayers pick up the tab. Also, the GSW price tag doesn’t include any of the multitude of person-hours spent caring for the GSW victim, both by family and medical professionals.

A recent article in The American Journal of Medicine dispels the NRA-promulgated myth that guns make our nation safer, whether by protecting our homes or our borders from marauding and rapacious Canucks. To remind you, the majority of gun fatalities are suicides (57%), followed by homicides (38%). The remaining 5% are a combination of police intervention, accident, and “undetermined.” In other words, if you wake up one morning, buy yourself a gun, and at some point actually pull the trigger, the odds are you’ll use it to blow your own brains out.

But what about the “safety and protection” issue?
Here’s a quick personal gun story. I write these health tips from a small cabin located at the dead end of dirt road in rural Illinois. I rarely see my neighbors, but when we do get together guns are a frequent discussion topic (small-town and rural dwellers own more guns per capita than city dwellers). My neighbors are all nice guys, and all utterly astonished that I’ve never owned a gun, aside from my childhood Daisy Red Ryder air rifle, which mysteriously disappeared from my room during its first week of ownership, my parents never confessing to anything.

“How are you going to protect your home?” my neighbors ask.

“Against what?” I ask. “Wild turkeys? Deer?

They remind me there’s a state prison down the road. It’s a maximum security prison and looks every inch of it. No one has been known to escape.

I pipe up cheerily, “I’ve got it! The gun will protect me against the skeet you guys are always shooting. Must be hundreds of them. Dangerous (clay) birds, those skeet.”

Sadly, earlier this year one of these neighbors had a psychotic break, which I fortunately missed. He suddenly became paranoid and was walking through the area threatening his friends with his very loaded gun. He was talked into dropping the gun (“the state troopers were set to blow him away,” I was told) and was promptly hospitalized. But you can imagine how this story could have ended tragically.

Guns do not make nations safer
The medical article I linked to above neatly brings to an end the cliche that guns make nations safer. First, researchers listed 27 developed countries according to the number of guns per person. This ranged from a high of 88 guns per 100 people (the US, of course) to a low in Japan, with 0.6 guns per 100 people. The European countries were all mid-range, averaging 30 guns per 100 people.

Then the researchers compared the gun ownership rate with the firearm-related homicide rate per 100,000, and again, the US was highest (10.2 people per 100,000, totaling  30,000+ deaths annually) and Japan the lowest, with just 0.6 people killed per 100,000.

Europeans seem to handle their guns better than we do here, with just one gun death per 100,000

The conclusion could not be more obvious: a country’s high gun ownership rate makes it a dangerous place to live. That seems so rational, but it’s exactly the opposite of what the NRA endlessly tells its huge membership and our elected officials.

What’s interesting is how the crime rate figures into this. Although you might assume that citizens are prompted to buy guns by a nation’s high crime rate, overall the US crime rate is average, pretty much on a par with low gun-ownership countries like Switzerland and Portugal.  Like my rural neighbors, people in the US apparently think that because our crime rate is much higher than it actually is, it’s worth arming ourselves to deal with our baseless fear of  “them…out there.”

And we’re killing ourselves in the process.

Be well,
David Edelberg, MD  


Leave a Comment

  1. Addie says:

    If guns made us safer, what was the history of the American West all about? We are not going back to Dodge City. The Second Amendment can no more be used to take us back than it could be to keep us there. This is an interesting post from a physician’s point of view. I may ask permission to quote you in upcoming weeks. The CDC in decades past treated gun violence as a public health issue. It funded proposals to change public policy and legislation on weapons possession. Bush II revoked that funding. Obama reinstated it. Currently many nonprofits, including the American Bar Association where I work, are doing or preparing to do NIH funded gun violence research on which to base upcoming Federal and State legislation. The problem on the far Right is its blindness to the far Left, also armed, also dangerous, but suspiciously (terrifyingly) quiet in contrast to the bar room brawls the Right orchestrates. But it is others, working quietly behind the scenes with no fanfare and no credit, for the social good. We need to keep these quiet researchers and behind the scenes policy advocates in our thoughts to stay our course.

  2. William Geldernick says:

    Do you propose that citizens completely subject themselves to a “benevolent” superstate? Where all criminals (including lawless use of economic oppresion) are prosecuted according to the law? When the dollar crashes and there is price inflation of 200-500% and unemployment of 30% as in Spain or 50% as in Detroit, shall we relegate our safety to the “few”? I suggest to you that your normalcy bias blinds you to envisioning such a world. That’s okay, we have history to draw upon. Consider Mao of China who, for the collective slaughtered 110 million valueless individual citizens. And thanks to today’s money manipulaters, China owns most of our debt and paper on property in the form of CDOs. But the chinese are not the villans, amoral libertine lawmakers who favor commerce above humanity are. And this IS the world we live in today.

  3. John Pearson says:

    Thank you for this needed dose of sanity.

  4. Russ Verkest says:

    Dr. David,
    Everyone has a right to their personal opinion, so I respect you for expressing yours. You have a platform to speak from, right or wrong. But here is the truth: Guns do not kill people! People kill people! Take away the guns, and they will find another weapon to kill with. How about spending your influence on the root cause, and not the symptom? If you are old enough to remember the movie, 1984, you should agree that the Big Brother mentality didn’t work then, didn’t work in Nazi Germany, Didn’t work in the USSR, and still won’t work. Perhaps your next article can focus on why people kill and what you recommend to help the root causes of the GSWs. Thanks!

  5. Cathy says:

    I’m with John~ once again Dr. E. is spot on . So thankful for your insight, intelligence, & compassion.

  6. IngKoe says:

    Russ’s argument (and that of many other gun proponents), that “people kill people” is of course correct since guns don’t walk around and start shooting people. But it doesn’t change the statistics unfortunately.

    I believe there is also an important psychological factor – having a gun readily available will most likely alter how people act in emotionally difficult situations. Having a firearm readily available when you are distressed, angry, etc. will most likely increase the chances in you using that firearm. Having a firearm readily available will potentially alter the way you think and go about “resolving” a difficult situation – it will automatically be an option.

    For example, say you were fired by a boss you already hated for years. There is no prospect of getting a new job any time soon and you get home. You are enraged and come up with a variety of scenarios on how to get back at your former boss. If you possess a firearm, then one of the scenarios will probably include the firearm. Would you not have one, then it would probably not occur to you to use it. Yes, you could go out and buy one (assuming you have a permit), but by the time you get it, you will have hopefully already calmed down (the main purpose of the waiting period when buying firearms).

    Yes, you could also use a knife or similar, but it’s a heck of a lot easier to pull the trigger from a few feet away than it is to approach somebody with a knife.

    What Dr. E. pointed out are statistics, and they unfortunately don’t lie. We should also not forget the fact that we have a lot of mentally ill people in this country (a subject Dr. E. has touched in the past I believe) and a relatively easy way to obtain guns (not only because we have so many of them) for them. Most of us know that most mentally ill people are not getting the treatment they should.

    There was a time when owning a gun was indeed sensible and necessary. A time when many people hunted. A time when there were no cars or airplanes. A time when people needed to defend their house because there was no police, or it would take them hours to come. A time before telephones. It was during those times that the constitution was written. But times have changed.

    I don’t think there is anything wrong with owning a gun, if the country you life in has a safe way of distributing those guns to law abiding citizens that are mentally stable. Unfortunately this is not the case in the U.S. And what’s happening on a day to day basis is just out of control.

  7. James says:

    Thanks again Dr. E.
    Unbelievable the power the gun lobby has in this country.
    We’re sadly at the point these days where it’s not even that surprising when someone opens fire on innocent people, and we can’t even get some mild, sensible legislation through on background checks etc.
    Beyond sad.

  8. Jinnie King says:

    My first husband committed suicide….wait for it, wait for it…with an EXTENSION CORD. He hung himself from a rafter in our basement. Let’s ban extension cords, knives, pharmaceutical drugs too (overdosess). Getting rid of guns is not going to solve murders, homicides, suicides.

    Effective immediately I will no longer be a patient of Whole Health Chicago. It’s too bad that you can’t keep your politics to yourself. I will miss Dr. Kelley.

  9. Dr. R says:

    Jinnie. Our health tips are written to inform, educate, and create dialogue. As you can see from the other comments, there are some sharp disagreements. This blog is an opportunity to air those differences, have a discourse about a particular topic and try to understand other perspectives. Our opinions are often formed by our life experiences; yours and Dr. Edelberg’s are very different and that’s fine.

    I hope that you will reconsider remaining a patient at WHC particularly since you obviously have a good relationship with Dr. Kelley.

  10. William Geldernick says:

    You are all forgetting, based on your normalcy bias, that the world is growing increasingly chaotic. I’d rather be independent in self defense than dependent on any of your opinions or God forbid, a grid locked confused house and senate that can still somehow manage to monitor us all, pass laws restricting our freedoms, and IGNORE enforcing laws that have created such economic disparity and oppression. You trust these people?! Then I submit to you that you are willfully blind. I love my community, the police (I have family that are police) and I have to tell you that I love my family and neighbors enough to say that in such a real world, not an imaginary Orwellian world of “eloi”, I’m prepared to execute proper emergency judgement to save mine or my family’s life. Wake up you intellectually dishonest people!

  11. Jann Knutson says:

    When I was 17, I was held up at gunpoint by a junkie who needed a fix. He demanded money,and i had used the last of my cash on the bus. I started talking to him, and still don’t know exactly what i did or said that caused him to lower that gun, and leave me alive. I do know that it certainly could have ended differently, and that the laws that are meant to protect us from gun violence do not go far enough. Stronger background checks, to help weed out people with mental illness or addictions would help us all to be safer. As one who has looked down the barrel of a gun, and lived to tell about it, I feel it to be my duty to the many who can no longer speak, to do so.

  12. Addie says:

    Jinnie, Some political arguments are totally useless and destructive, some are constructive and benefit people no matter which side prevails. Gun control arguments are always constructive. I would only stop seeing a doctor who disagreed with me, if I felt his opinion affected the quality of my treatment. Otherwise, you’re just shooting yourself in the foot!

  13. William Geldernick says:

    Gun control arguments are NOT always constructive if they ignore all the facts.

  14. Old School Liberal says:

    Ok, I imagine JFK would be well esteemed in this particular forum; a man who resisted and wanted to end wars and appealed to the UN for complete disarmament in reverence of Eisenhower who said the greatest threat was the military industrial complex. I guess this debate boils down to necessary use of force. Some would say lethal force is never necessary. I think we can all agree that the world is less than ideal, I’m just trying to get some of you to consider that there may be abnormal situations where lethal force is necessary AND moral in self defense held accountable by the law. JFK and all who have been violently wronged, rest in peace…

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