If the Centers for Disease Control and Prevention wants to better understand how seat belts help save lives on the road, or the rate at which drug-poisoning deaths kill Americans, or how lead in toys can threaten kids’ health, it’s very well-positioned to do so. After all, the CDC has the broad, vital mandate of “protect[ing] America from health, safety and security threats,” and it’s got an annual budget of $7 billion to work with. It doesn’t just study diseases — it studies any and all threats to human life and health.
But when it comes to what is, statistically, one of the most important public-health threats in the country — guns — this powerful institution is effectively impotent. That’s because the NRA decided that the CDC shouldn’t be allowed to fund gun research, and successfully bullied Congress into codifying this sentiment into law. The American Psychological Association recounts the story: In 1996 the NRA, furious about a 1993 New England Journal of Medicine article on the risks of gun ownership, successfully pushed for the passage of a budget amendment that yanked $2.6 million from the CDC — exactly what it had been spending on gun research — and banned the agency from disbursing any funds toward research that could be construed as supporting gun control. While not an official, outright ban, the CDC has interpreted it that way — its administrators have little appetite for hearings or “investigations” from NRA-funded congresspeople — and since then its gun-related research efforts have dwindled to basically nothing. (Former Representative Jay Dickey, for whom the so-called Dickey Amendment is named, has subsequently expressed regret about his role in this episode.)
This ban has stymied researchers’ ability to answer a plethora of vital questions about guns and public health. The problem is that gun violence is very, very complicated. There’s a popular idea that most instances of gun violence — both suicide and homicide — are a matter of careful deliberation and plotting. In reality, impulse plays a much larger role in these acts than most people think. As a result, the key question that determines whether a given act of violence will occur often isn’t whether someone could conceivably gain access to a gun if they had a lot of time and were willing to go to great lengths to do so, but rather whether they have easy access to one during the moment when they are at the greatest risk of doing something rash and tragic. To the extent gun violence can be summarized in a simple formula, it is: risk factors plus easy access equals tragedy. It’s a formula that applies to all but a small subset of carefully premeditated acts of gun violence.
This is where all the relevant research questions come in: For example, how can we keep people away from guns when they are at their highest risk of suicide? How can we come up with a better system of temporarily preventing dangerously angry people from acquiring them? Can we temporarily disrupt the networks through which young gang members acquire guns? These questions all have empirical answers, but finding out what those answers are requires exactly the sorts of big, ambitious research efforts the NRA has successfully blocked the government from funding.
Dr. Mark Rosenberg, the president and CEO of the Task Force for Global Help and the former head of the CDC’s gun-research efforts, told Science of Us that the CDC restriction has had a deleterious effect on researchers’ ability to understand the problem. “Because we don’t know what works, we as a country are left in a shouting match,” he said. “We get into these totally nonproductive shouting matches because nobody has the evidence … and that’s where we stand right now.”
Dr. Jeffrey Swanson, a psychiatrist and gun-violence expert at Duke, explained that the key to coming up with effective gun-violence interventions is balancing the political reality — broad-based gun bans are basically impossible to pass at this point — with what we know about individuals’ risk factors for committing acts of violence. “Since we can’t broadly limit access to guns in this country, we’re sort of stuck, policy-wise, with trying to figure out who are the dangerous people who are so dangerous we’re going to say they’re above that threshold where we’re going to abridge their second-amendment rights,” he said.
Again, this doesn’t necessarily mean permanently banning their access to guns. Rather, it can be a matter of identifying when certain people are most at risk of harming themselves or others with a gun, and developing policies that take these insights into account. Dr. Harold Pollack, co-director of the Chicago Crime Lab, explained in an email how this logic applies to drug- and gang-related violence. “Our work and others indicate that many potential offenders are not sophisticated about guns, and they are not sophisticated about the underground gun market,” he said. “A scared 20-year-old will get a gun if someone close to him in a relationship of trust helps him to get one. If no one close to him is willing to provide access to a weapon, it becomes much harder for that young person to gain access to a gun. Even if we just slow him down, if it takes him a week rather than a day to get a weapon, that is extremely helpful. That’s six more days we have to intervene to address whatever issue that young man has through less violent means.” So research into gang members’ gun networks, for example, could provide vital insights on how to at least slow the tempo of gun violence in places like Chicago. If policy-makers better understood how guns got passed from person to person, they’d have a better chance of making it just a little bit harder for a given young person to acquire one.
The potential for temporarily barring access to guns is even more apparent when it comes to suicides, which account for more than half of all gun deaths. “I think in the area of suicide, what has become clear is that a lot of suicides are very impulsive,” said Rosenberg, citing studies in which those who survive suicide attempts are asked about their thinking at the time they tried to kill themselves. In many cases, there are only five minutes between when someone decides to kill themselves and when they actually attempt to do so. Per the aforementioned formula, easy access to guns matters a great deal. Could there be straightforward ways to temporarily bar severely depressed people — at least those at a heightened risk of suicide — from purchasing guns?
So where could all this potential research lead? One possibility — albeit a remote one, at the moment — is that it could spur new laws to help mitigate the damage done by guns. Another is that it could help researchers better evaluate one of the biggest, most important gun laws on the books: the 1968 Gun Control Act.
In an Annals of Epidemiology article published in May, Swanson and some colleagues argued that this law takes the wrong approach given what we know about gun violence. The statute, they explain, places restrictions on gun ownership by and sales to certain individuals; specifically, “the exclusion covers anyone who has been determined by an authoritative legal process to be dangerous or incompetent to manage their own affairs due to a mental illness and also covers criminally accused individuals found incompetent to stand trial or acquitted by reason of insanity.”
This law assumes a tight correlation between severe mental illness and violent acts, but the authors argued that things are more complicated than that. Yes, certain combinations of psychiatric symptoms — “delusions, suspiciousness, and extreme anger,” for example — are linked to a heightened risk of committing a violent act. But having a diagnosis of mental illness, on its own, only marginally increases this risk. (Conditions like depression are however, significantly correlated, on their own, with higher risks of suicide, which accounts for more than half of all gun deaths.) The law’s effectiveness is also premised on the idea that people with severe mental disorders will end up in an institution and therefore under state supervision. In 2015, though, we’re decades into a messy de-institutionalization experiment that has left many severely mentally ill people in shelters or on the streets (or in prison, though access to guns isn’t an issue there) — and therefore not subject to the law.
Plus, as Swanson pointed out, the law doesn’t restrict gun purchase or ownership from people who who are temporarily held as a result of some crisis or incident — which authorities can generally do for up to 72 hours without the state declaring the person incompetent to manage their own affairs — but who don’t end up being formally committed to an institution (though a handful of states have passed laws to cover this loophole). “Here you have someone where you know they have been in a mental-health crisis, they might not be suicidal, but they do not have by that very fact anything that would disqualify them under federal law or any state law from buying a gun,” said Swanson. “So they can walk out of the hospital and go to a gun store and end their own life or do something to someone else.” This law also, of course, has no effect on the 9 percent of “individuals in the United States [who] self-report patterns of impulsive angry behavior and also possess firearms at home” — numbers reported in a study published earlier this year.
Here’s what this all comes down to: Just because meaningful gun control isn’t possible now doesn’t mean it won’t be in 5 or 10 or 20 years. But in the meantime, while the political side of the equation remains mired in dysfunction, it’s vital for researchers to build a solid, evidence-based foundation for future reforms — whether those reforms come in the form of state-level changes or a revision of the 1968 language.
The NRA might be powerful, but it isn’t powerful enough to have shut down gun research everywhere. Plenty of other institutions and organizations are producing valuable insights about the public-health dimension of gun sales and ownership.
But they aren’t the CDC. Rosenberg explained that when you restrict a study to one city or one neighborhood, there’s only so much you can learn — guns cross borders effortlessly within the U.S., which makes it difficult to fully and rigorously assess a given policy at the local level. If Chicago passes a tight gun-control ordinance, it doesn’t change the fact that right outside the city limits, buying guns is just as easy as before. “You need to find two places that are roughly comparable,” he explained, one where a new policy goes into effect and the other — a control city or state — where it doesn’t.
Ideally, then, public-health studies about guns “are large-scale studies. You need enough people in the study, and you need it to go over a long enough period of time to have enough examples, both where you’re doing your intervention and where you’re not.” In many cases, the CDC has both the budget to run the best version of these studies, and the bird’s-eye perch to coordinate between, say, various local sheriffs’ offices, city governments, and universities on major research undertakings. Almost none of this is happening, and it’s impossible to quantify the damage this lack of research has done to our understanding of a major public-health threat. By now, we could have been tens of millions of dollars deeper into gun research that undoubtedly would have saved many lives.
It’s unfortunate the NRA — and an obsequious Congress — had other ideas.