Intended for healthcare professionals


Reducing gun deaths in the United States

BMJ 1999; 318 doi: (Published 01 May 1999) Cite this as: BMJ 1999;318:1160

Personalised guns would help—and would be achievable

  1. Stephen P Teret, Professor and director,
  2. Daniel W Webster (steret{at}, Assistant professor
  1. Johns Hopkins School of Public Health, Center for Gun Policy and Research, Baltimore, Maryland 21205, USA

    The United States has again suffered tragic losses from gunfire within a school. As happened in Mississippi, Kentucky, Arkansas, Pennsylvania, and Oregon, the students and faculty of the Columbine High School in Littleton, Colorado, became targets for young people carrying firearms, this time comprising an arsenal capable of killing 15 (including the assailants themselves) and wounding many more. The shooting on 20 April has been described as one of the deadliest school massacres in the nation's history. What are the options for preventing future massacres—in a nation that has steadfastly resisted the option adopted by other countries of severely restricting the ownership of guns?

    Gunfire in the United States now claims 34 000 lives annually. The citizens' stockpile of guns is measured at about 200 million. In the aftermath of schoolhouse slayings we have become accustomed to the litany of suggestions for prevention. These include calls for less violence on television and in movies and video games, the strengthening of family values, involvement of churches, construction of recreational facilities, and early identification and counselling of troubled youths. Though reducing exposure to media violence and teaching children to behave non-violently may be valuable, they alone will not eliminate school shootings. There are 52 million school aged children in the United States. Even if behavioural interventions were 99.9% effective in this population, over 50 000 children would remain candidates for committing the next school based killings—if they could find an operable firearm.

    One common thread throughout all incidents of school shootings is the firearm. With a gun in hand, schoolchildren are capable of mass murder. Without the gun, most children lack the strength, skills, and cunning to plan and execute multiple killings.

    When mass shootings have occurred in other countries, the policy response has been to ban and sometimes buy from citizens the type of guns used in the killings. In Colorado the policy question that was scheduled for vote in the legislature was whether it should be made easier for citizens legally to carry concealed weapons. In fact, one Colorado legislator commented after the shootings, “I would feel safer knowing that there was a teacher at my kid's school who was a concealed weapons permit holder who could intervene in a situation like this.”1 Against this background, some gun policy experts have come up with suggestions for prevention.

    The most essential strategy for preventing these incidents, and other types of fatal shootings, is to make firearms unavailable to or inoperable by children. Strategies to make guns unavailable to children have limited success. Laws requiring safe storage of guns and the use of trigger locks will deter some, but not enough, children from using a gun. An evaluation of the safe storage laws that were passed in 12 states in the United States suggested that the laws were associated with a 23% reduction in rates of fatal, unintentional shootings of children aged 14 and under.2 But a reanalysis of the data suggests that the reduction in deaths was attributable largely to the experience in one state and that there was no consistent beneficial effect in the other states (DW Webster, M Starnes, unpublished). The use of trigger locks also presents potential problems. Placing or removing a trigger lock on a loaded handgun can cause the gun to discharge, endangering the holder of the gun and others nearby. Gun owners must also be vigilant to store the gun with the trigger lock in place.

    The most effective method for reducing tragedies caused by children with guns is to require that all firearms be personalised and childproof so that only an authorised user can operate the gun. Use of personalised guns would be possible only after the owner activated the gun with a fingerprint, or by pressing buttons in a prescribed sequence, or through some other means of rapid identification. The technology to do this exists and is already used in other products—for example, in elevators in residential buildings, restrooms in office buildings, and motor vehicle ignition switches. One leading American producer of handguns, Colt's Manufacturing, promises to have personalised handguns for police on the market soon. This company's product development has been assisted by funding from the US federal government.

    Personalised guns will not only reduce the likelihood of homicidal shootings by children; they will also prevent some youth suicides and unintended deaths that occur when children find guns. Recently in Philadelphia young children playing outdoors found a loaded handgun; one child pulled the trigger and fatally shot another. In a society that prides itself on making medicine bottles that cannot be opened by young children, we still permit handguns to be made that can be readily discharged by the very young. The safe design of guns is not regulated by the government.

    A consequence of the legislative abdication of effective gun regulation is the current wave of lawsuits being brought by both cities and individual citizens in the United States against gun manufacturers. Many of these lawsuits allege that the manufacturers' failure to use existing safety technology in their guns constitutes corporate negligence for which the manufacturers are liable. The exposure to liability may well be the influence that breaks the stalemate in the longstanding gun debates in the United States.

    Polls show that the American public favours redesigning guns so that they will be a safer consumer product. While the public still strongly resists the banning of handguns, laws compelling gun makers to produce childproof handguns are favoured by 88% of the general population and even 80% of the gun owning population. Laws requiring new handguns to be personalised are favoured by 71% of the general population and 59% of gun owners.3

    The question therefore is when will the legislators in the United States catch up with the opinions of their constituencies and have the courage to challenge the well financed and highly vocal gun lobby? Requiring the safer design of guns will not reduce the rage that is present in some young people, but it may well reduce its lethality.


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