In Chicago, a pediatrician named Katherine Kaufer Christoffel was horrified to find an 18-month-old child with a BB in the brain. She called the Consumer Product Safety Commission and discovered that BB guns like all firearms weren't subject to regulation as consumer products. Christoffel would go on to create the HELP Network, a broad coalition of medical and professional organizations intended to expand the base of medically oriented gun-violence activism.
Meanwhile, the National Rifle Association which had a great deal invested in framing the gun issue as a crime problem, and whose members were readily moved to anger by descriptions of their handguns as "disease agents" was starting to pay attention to this medical and scientific flank attack.
A prominent public health researcher named Arthur Kellermann remembers getting a note from Paul Blackman, the research coordinator for the NRA's Institute for Legislative Action. He didn't save it, but now wishes that he had. "It said something to the effect of, 'Dear Art: With publication of your last study, you have graduated from the public health file to your own, named file at the NRA headquarters.' "
Home Is Where the Hearts and Minds Are
What are the health risks of keeping a gun in your home?
Home is primal territory in the polarized gun debate, the locus of deeply held beliefs and feelings on both sides. To one side, the home is a refuge, to be protected and defended from a predatory world, and the handgun is the defensive weapon of choice. To the other side, it is a place where people unnecessarily and tragically shoot their family members or themselves.
The polarization appears so stark that a key point is often forgotten: On this and other aspects of the broader gun debate, a large number of Americans still occupy the uncommitted center. These are the people who can, in different circumstances, be persuaded both that gun ownership should be protected and that guns should be more strictly controlled. They're the same people who, once convinced of smoking's health risks, supported the legal and legislative strategies that have given the tobacco companies such grief. If these folks were to start seeing guns less as icons of freedom and more as lethal viruses or dangerous consumer products, they could and surely would exert enough pressure to break the political stalemate over gun control legislation.
That's where Arthur Kellermann's question comes in. It packs an emotional wallop that could sway those uncommitteds. And the NRA can see this as well as anyone.
Kellermann, who now runs Emory University's department of emergency medicine and directs the school's Center for Injury Control, is a tall, angular Tennessee native who speaks with a warm drawl that seems slightly at odds with his Type A intensity. On April 2, 1984, he was 29 years old and headed for a master's in public health at the University of Washington, to be followed by an emergency medicine career ("I liked the idea of making a difference and making it in a hurry," he once told an interviewer). Then, sitting in the UW student center, he heard a news report about the shooting death of soul singer Marvin Gaye, who had been killed by his own father on the day before his 45th birthday.
"We've got all these guns in people's homes," he remembers thinking at the time, "a number of them for protection, but when I hear news stories it's usually about a suicide or an accidental shooting or a family homicide. Surely somebody has looked at guns in the home as a protective or risk factor for a health outcome, the way we have looked at cigarettes and smoking or chemicals and liver disease."
But no one really had.
Kellermann read a long paper summarizing the criminological literature on guns, but found no answers. There was nothing significant in the medical literature, either. So he went to work on the question himself.
In collaboration with King County Medical Examiner Donald Reay, he studied all the gunshot deaths that occurred in the county which includes Seattle and its environs over a six-year period. Out of a total of 743 deaths from firearms, they found, 398 took place in the home where the gun was kept. Of these, more than 80 percent were suicides, 13 percent were homicides and 3 percent were accidents. Homicide victims were most often shot by family members and roommates. Seven of the 398 deaths were later determined to be in self-defense, and two more involved intruders shot while attempting entry. This meant that there were a whopping "43 suicides, criminal homicides, or accidental gunshot deaths involving a gun kept in the home for every case of homicide for self-protection."
Kellermann and Reay published the study in 1986, in the prestigious New England Journal of Medicine, under the title "Protection or Peril?" They carefully noted its limitations, pointing out, among other things, that nonlethal firearms injuries were not included, that their data "do not include cases in which burglars or intruders are wounded or frightened away" and that "cases in which would-be intruders may have purposely avoided a house known to be armed are also not identified." A complete analysis of the risks and benefits of keeping a gun in one's home, they wrote, "would require that these figures be known."
Nevertheless, they suggested, "it may reasonably be asked whether keeping firearms in the home increases a family's protection or places it in greater danger." And they concluded that, "given the unique status of firearms in American society and the national toll of gunshot deaths, it is imperative that we answer this question."
"Protection or Peril?" hit a nerve. But Kellermann knew it hadn't really settled anything. So he proposed to the CDC which had not funded his initial work that he use a case control study to look at the same basic question.
Case control involves matching "cases" in this instance, homicide victims killed at home with "controls," carefully selected individuals from the same neighborhood who are demographically similar to the victims. The study's design was neutral, Kellermann says: If having a gun turned out to reduce a person's risk of homicide, the case control methodology was fully capable of detecting this. He and nine colleagues spent six years on the study.
In the meantime, he published a number of other papers in the firearms field. The one that got the most attention was a 1988 comparison of crime rates in Seattle and neighboring Vancouver, B.C., two cities that were "eerily similar," as Kellermann puts it, except that Vancouver had more restrictions on guns. Funded in part by the CDC and written with eight other researchers, it found that while the cities' overall crime rates were roughly the same, "the rate of assaults involving firearms was seven times higher in Seattle."
The early '90s were heady years for the gun violence researchers. Spurred in part by concern over a dramatic rise in youth homicide, people outside the public health universe were finally starting to take notice. In 1992, the CDC converted its injury division into a full-fledged "center" to increase the visibility of its work. Meanwhile, annual deaths from firearms injuries in America were reaching a 30-year peak, climbing to 39,595 in 1993.
Kellermann's case control study was published in the New England Journal of Medicine on October 7, 1993. Much more sophisticated than his earlier work, it was both more persuasive and more complicated to explain. But there was no change in the bottom line: Keeping a gun around the house was "strongly and independently associated with an increased risk of homicide."
Cut to a movie theater in Atlanta, sometime in the winter or spring of 1996. Kellermann and his wife had just settled into their seats when Paul Newman popped up on the screen. The actor was seated at the breakfast table, newspaper in hand.
"West Monroe, Louisiana," Newman read. "Matilda Crabtree, 14, jumped out of a closet and yelled 'boo' to scare her parents and was shot to death when her father mistook her for a burglar. Matilda was supposed to be sleeping at a friend's house, but decided to sneak home and play a joke on her family. Her last words were, 'I love you, Daddy.' "
Newman's blue eyes disappeared and these words appeared on the darkened screen: "A gun in the home triples the risk of a homicide in the home."
That's my number! Arthur Kellermann thought. He looked at his wife and said, "He didn't acknowledge me, but it's there!"
The Best Defense
Here's our proof! the gun controllers chorused happily. And they sent spokesmen like Paul Newman out to trumpet it.
It's a conspiracy to ban guns! the anti-controllers howled. And in the battle for the uncommitted center, they deployed a single, potent number of their own.
Two and a half million.
That's the number of times a year, according to Gary Kleck, a criminologist at Florida State University, that Americans use a gun in self-defense.
If the 2.5 million figure is true, Kleck says (and in fact he considers the estimate conservative), it would suggest that guns are used to defend people far more often than they're used in the commission of crimes. And if that's true, Arthur Kellermann's estimates about the risks of keeping a gun for defensive purposes are open to serious doubt.
Kleck and Kellermann are joined at the hip in the gun debate. Kellermann says he's uncomfortable with the fact that "the media tend to portray us as Zippy and his evil twin or vice versa," but there are good reasons why their work is linked. Because if you're going to argue that having a gun in your home puts your life in jeopardy, you've surely got to ask if it might not also save your life.
Gary Kleck shows up to be interviewed at his cramped FSU office wearing a bluejean jacket with a tiny peace symbol clamped to its pocket. He is 47, with thick, graying hair and a tidy beard. He's got a new book out, called Targeting Guns, with an angry chapter in which he lashes out at the public health research on firearms.
"It is angry, and I didn't even bother to kind of paper it over with the usual bland academic tone," he says. "Because I am outraged, and I hope the outrage will have some impact."
Among his many charges: Public health researchers such as Kellermann fail to address the possibility that there's a two-way relationship between gun availability and violence, which leads them to confuse cause and effect. They demonstrate "unprofessional bias" in interpreting their results, and often display a "lack of simple common sense."
Kleck is particularly scornful of the Seattle-Vancouver comparison (he is far from alone here, even among criminologists who are otherwise supportive of Kellermann), which he calls "the most technically primitive study of guns-violence links ever published in a professional journal."
(continued on Page 5)