Common sense gun policy reforms for the United States

BMJ 2012; 345 doi: (Published 21 December 2012)
Cite this as: BMJ 2012;345:e8672

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Ever since our own Scottish tragedy in Dunblane in 1996 I have been interested in the US approach to guns and gun control.

I should point out that I have visited the US on many occasions. I have family and friends there and I love to visit. I have never, ever been threatened or felt intimidated whilst visting there so I have no axe to grind.

But I do agree that guns and gun violence has to be seen as a public health issue. And that is what I do not understand. If there were a automobile or a toy or a piece of DIY equipment that was killing 30,000 Americans every year it would be banned immediately and no-one would bat an eyelid. So why is it so different for guns?

I know about the Second Amnendment of 1791 but surely those who agreed to that then could never have envisaged the types and proliferation of guns that we have now. All they had then were basic flintlocks. And in any case surely the Constitution could be re-amended if there was a democratic will to do so.

Guns are designed for one purpose and one purpose only - killing things. Whilst this may be appropriate (e.g. for culling excessive populations of wildlife or for protecting commercial animals and crops against vermin) I can see little role for a virtual "free-for-all" in gun ownership. Likewise there can be almost no jutification at all for anyone owning a hand gun as the sole purpose of hand guns is to kill fellow human beings.

In the UK most people have never seen a real gun. Less than 0.2% of the population hold a gun license and these are almost always shotgun and single shot rifle licenses for farmers, gamekeepers, etc. Hand guns and hand gun ownership are essentially illegal as are all automatic weapons. Semi-automatics are severely restricted and nothing more than 0.22 calibre is allowed.

In Scotland the devolved Government is now making moves to restrict or even ban the general sale of air pistols and rifles to the public.

Almost everyone living in the UK supports these measures and no politician would dare oppose them in public at least.

And it shows - we have a gun homicide rate of about one in a million. When a gun homicide occurs in Scoland it is often still in the news 2 or 3 years later.

But I am not smug. Scotland has pockets of extreme violence. The main city Glasgow is a good example so let's compare it to an equivalent US city.

Baltimore on the east coast of the USA has a population of about 700,000. It's an old port which has seen tough times in a post-industrial decline and which is blighted by poverty, gangs, violence and drug and alcohol addiction.

The homicide rate in Baltimore is about 10x that of Glasgow on the west coast of Scotland - an old port which has seen tough times in a post-industrial decline and which is blighted by poverty, gangs, violence and drug and alcohol misuse.

But whereas knife crime in Baltimore is not a huge issue (most homicides involve firearms) there are 6000 recorded stabbings each year in Glasgow. That's a stabbing rate of 86 per 100,000 citizens. But most people who are stabbed don't die.

Now imagine, if you will, we had in Glasgow the liberal guns laws of the US. Even if only half of these stabbings in Glasgow were converted to shootings that were fatal Glasgow would still have a homicide rate 10x that of Baltimore.

I think this kind of thought process puts a lie to the notion that in the US liberal gun laws are not a major part of the problem.

But I am not naive enough to assume that this is the only significant issue. In 1999 I was lucky enough to be given the chance to do a sabbatical studying the provision of primary care in rural areas which allowed me to spend a number of weeks in New Mexico. I was pondering the issue of gun violence in the US with one of the local Directors of Public Health there at the time and we came to similar conclusions:

(1) that the liberal US gun laws are part of the problem is a no brainer

(2) but the issue was more complicated than simply banning guns (though obviously fewer guns would mean fewer opportunities to use guns)

(3) one of the major issues then (which, of course, may no longer be the case?) was the very poor provision in the US of primary preventive mental health services. When I outlined to my US colleague the system that operates in my remote community he said they had nothing similar to offer.

In my remote community we have 5 community psychiatric nurses, including 3 with addictions training and one with special role for dementia; we have social work mental health officers; we have educational and clinical psychology services all locally based; and we have a visiting team of psychiatrists (Consultant and Specialist Registrar) who visit every 3 weeks to hold clinics locally.

In my time I have seen several young men who could have gone on, without intervention, to have caused havoc and I wouldn't have been surprised if one or more had gone on to kill. But they didn't because they were identified, subjected to intervention and continually supported from the day it became evident there was a problem.

Perhaps this is an issue in the US even today. And I am not the only one who thinks that. If you haven't done so already would strongly urge you to read the following article written by a mother in the wake of the terrible events in Newtown:

We need to hear such voices at this time.

Competing interests: None declared

Stephen McCabe, GP

none, Portree Medical Centre, Skye

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Action on guns is necessary in the UK, too.

Think of the films, computer games and music glorifying guns, violence and war. We may choose not to watch or listen to such entertainment, but we – and our children – cannot avoid their all-pervasive advertising (especially hoardings in public spaces). It’s not only the James Bond films themselves glorifying a man with a gun: the marketing also does.

The fetish for guns in entertainment and advertising must be challenged. The education secretary’s plan to instil the "military ethos" into children through the involvement of former soldiers in schools [1] looks even more inappropriate.

1. Hamilton C. Ex-soldiers to visit schools and pass on military ethos. Independent 2012 Dec 06.

Competing interests: None declared

Alex C W May, independent researcher

N/A, Manchester M13 9DP, UK

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American citizens have a right to bear arms; their constitution prioritises an individual's right over the community interest in a way that could not happen in Britain where adherence to the Human Rights Act 1998 aims to achieve the correct balance between the rights of an individual and the rights of society. The reform of gun laws in the US is urgently needed but as gun ownership is an individual right it is embedded at the very heart of the American constitution and is likely to represent a significantly more complex issue to resolve than might be perceived by many in the UK.

Competing interests: None declared

Sarah Thornton, Lawyer

None, York

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It is a human tragedy that what we create to protect ends up killing us or our dear ones leaving behind a scar so deep that only the families who lost their dear ones will carry them for a long time. Assault weapons and assault weapon manufacturers are so powerful that to think of bringing a policy for Gun control makes even a great president at a loss as to how he could go about avoiding such tragedies in future. National Rifle Association president comes out with a statement that it is not gun control but gun trigger that will save lives by employing armed security personnel in schools all over USA. It is the tragedy of democracy for it is a double edged weapon. What is that one can do as an individual citizen- as an ordinary human being like us- devote time for our children; if our children have some inherent flaw in their traits genetic or acquired- take it seriously - take the child for proper counseling and intimate to the family physician about the child with such behavioral abnormality. Let us not forger,
A touch from the mother during infancy, growing up in an environment of joint family, helping to grow with other children in a positive way, restricting the exposure of the child to violent movies or gaining access to assault weapons and constant vigil on the child development are key issues that every parent must look into. Apart from that assault weapons must be kept in a safe and secure place locked securely and away from the hands of adolescents. The Media must downplay these acts of very grave tragic events though done with a view to share the tragedy and newsworthiness of reporting or broadcasting them. Because there are few in the Viewers with such personality disorder who may get activated by viewing such events.
The DNA of every individual is not complex. But it becomes complex by the environemntal factors-call it a variation of epigenetics-as environgenetics.
Parents "give love and affection to your children, be with them when they want you, including breastfeed them, create a bonding that will help the child grow well with balanced emotional feelings." There is no use in finding factors outside of you for what had made Adam the monster he was from a tender infant.

Competing interests: None declared

dhastagir s sheriff, Professor

Faculty of Medicine, Benghazi University, Benghazi, Libya

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Guns are an important part of American history, particularly in stories about “cowboys and Indians”. Sadly, these stories falsely portray cowboys, settlers, soldiers, and guns as good, but Native Americans, tribes, teepees, and bows-and-arrows as bad. Of course, these stories cover up the lies and exploitation perpetrated by a young, exuberant America that didn’t understand or practice civil rights. To be fair to America, neither did the rest of the world. Nevertheless, these self-serving stories are canards that can be dispelled by the insightful words of Sioux Chief Sitting Bull who aptly said about Americans, “The love of possessions is a disease with them...If you have one honest man in Washington, send him here and I will talk to him."

Competing interests: None declared

Hugh Mann, Physician

Retired, Eagle Rock, MO, USA

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