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Firearm Research Must Not Presuppose Outcome

Published:December 01, 2020DOI:https://doi.org/10.1016/j.amjmed.2020.10.021
      To the Editor:
      In the article by Wen and Sadeghi,
      • Wen LS
      • Sadeghi NB
      Treating gun violence with a public health approach.
      their intention to “treat gun violence with a public health approach” may seem admirable; omitted, however, is the emphasis on the need to appreciate that the platform it cited recognized other factors that affect potential interventions; research outcome will be less subject to “politicization” if it is not assumed that “gun violence can be effectively treated using a scientific approach” because it is not desirable to “reframe gun violence as the public health problem that it is.”
      Presupposing outcomes besmirches the scientific method, particularly because the authors cite a pioneering 2002 “etiologic” framework that was based on the effectiveness of four interventions to prevent impaired driving and to reduce traffic injury and death; they were considered “within the ecological/health promotion framework” and included:
      • Sleet DA
      • Howat P
      • Elder R
      • Maycock B
      • Baldwin G
      • Shults R
      Interventions to reduce impaired driving and traffic injury.
      1) economic interventions, 2) organizational interventions, 3) policy interventions, and 4) health education interventions.
      This commentary articulated the unabashed goal as being “to implement evidence-based interventions” that encompass admittedly societal interventions (ie, gun storage and disposal, background checks, smart guns, age limits for firearm access) while listing “other unanswered questions that directly pertain to medical providers (ie, patient counseling and behavioral health).”
      The appropriate disclaimer against prejudging the outcome of such research is upstaged overtly by articulating the desire “to broaden the scope of possible solutions and to inform a harm-reduction approach involving safety standards for continued firearm ownership.”
      Ignoring the Second Amendment, they dropped all pretense by confessing to justify gun and rifle confiscation (to preclude “continued firearm ownership”) by ignoring the first three criteria in the framework to which they allegedly adhere; they manifest a stance against the National Rifle Association (NRA) and the Gun Owners of America (GOA).
      This is not an insignificant concern, as this author documented in reaction to two (overtly biased) articles in the Annals of Internal Medicine that decried
      • Sklaroff RB
      Physicians, patients, and firearms.
      “slippery-slope rhetoric subtly embedded in (and omitted from) discussion of what is portrayed as inherent in the patient–physician relationship”; for example, specifically advised was supplanting the suggested initial physician query (“Are there any firearms kept in or around your home?”) with “nonpejorative phrasing (that would be) welcoming without being intrusive (‘Would you like to discuss . . . ?’).”
      True then
      • Sklaroff RB
      Curbing firearm violence.
      and true now, “inasmuch as the term ‘gun control’ carries divergent meanings to liberals (restricting firearm access) and conservatives (aiming firearms properly), it is necessary to recognize that editorialization—particularly in a scientific journal—is most effective when devoid of proselytizing.” [The Annals editors subsequently requested editorial review of a related piece.]
      The author is not—and never has been—a gun owner and recalls having touched a patient's handgun once during the past 69 years (except for a BB rifle during summer camp); nevertheless, awareness of political ploys (conjured under the guise of science) cannot go unexposed, particularly noting current urban-class warfare (which has nothing to do with any major purported “public health” parameter) in this volatile pre-election season.

      References

        • Wen LS
        • Sadeghi NB
        Treating gun violence with a public health approach.
        Am J Med. 2020; 133: 883-884
        • Sleet DA
        • Howat P
        • Elder R
        • Maycock B
        • Baldwin G
        • Shults R
        Interventions to reduce impaired driving and traffic injury.
        in: Verster JC Pandi-Perumal SR Ramaekers JG de Gier JJ Drugs, Driving and Traffic Safety. Birkhäuser Verlag AG, Basel, Switzerland2009: 439-456
        • Sklaroff RB
        Physicians, patients, and firearms.
        Ann Intern Med. 2016; 165: 892-893
        • Sklaroff RB
        Curbing firearm violence.
        Ann Intern Med. 2016; 165: 893-894