WITH YOUNG Americans being gunned down at a rate far beyond anything seen in other developed countries, it would be hard to imagine a more fitting activity for a U.S. government agency concerned with the public's health than firearms research. Over the past decade, the agency I head, the Centers for Disease Control and Prevention, has been doing exactly that. One result has been to modestly advance knowledge about this important subject. Another has been to put us within target range of the National Rifle Association.
The NRA has targeted not just the CDC's research on firearms, which amounts to a mere $2.5 million a year, but the whole center where that work is conducted or funded. In what might be likened to a shotgun assault, the NRA has been pressing Congress to abolish the National Center on Injury Prevention and Control. This despite the fact that 95 percent of the research funded by the center has nothing to do with firearms, but with unintentional injuries, such as those caused by auto accidents and fires, and with the prevention of child abuse and other forms of violence.
Of the two arguments the NRA has made for abolishing the Injury Center, one is that it duplicates work of other federal agencies. Precisely this question has been investigated by both the General Accounting Office and the inspector general of the Department of Health and Human Services, and both have judged this charge to be without foundation. Of course, avoiding duplication requires constant vigilance, but for the moment maybe this can be left to Congress and conscientious public servants.
What ought to be of wider concern, is the second argument advanced by the NRA -- that firearms research funded by the CDC is so biased against gun ownership that all such funding ought to cease. Here is a prescription for inaction on a major cause of death and disability. Here is a charge that not only casts doubt on the ability of scientists to conduct research involving controversial issues but also raises basic questions about the ability, fundamental to any democracy, to have honest, searching public discussions of such issues.
To understand the full import of what the NRA is asking, it helps to know something about the public-health problem firearms represent today and the current state of gun research. Realizing the dimensions of the gun problem requires only picturing a bar graph comparing this country's national homicide rates for males aged 15 to 24 with those of other countries. The bar representing the United States approaches the length of a pencil; the bars for other developed countries are on average about the size of a pencil's eraser.
From 1988 to 1991 the rate of homicide among American males in this age group was 37.2 per 100,000; in the developed country with the second highest rate, Italy, it was 4.3 per 100,000. In other words, the homicide rate among young American males was almost nine times greater than in the second highest developed country. Even the rate for young American white males was more than three times greater than the rate found in Italy.
When homicides, suicides and accidents are added up, firearms account for close to 40,000 deaths a year in the United States -- about the same number of Americans as were killed in the entire Korean War. Nearly as many people are killed with guns as die from motor vehicle accidents; but, while vehicular deaths have been declining, those from firearms rose 60 percent between 1968 and 1991. In the latter year firearms-related injuries were the eighth leading cause of death of Americans under 65. For those aged 10 to 34, guns are the second leading cause of death, and they account for one of five deaths among U.S. teens. Given the size of the problem, one would expect substantial research to be devoted to it. In fact, research is scanty. As Franklin E. Zimring of the University of California School of Law in Berkeley has noted in the journal Health Affairs, "Much more money has been spent on newspaper advertisements about gun control than on research addressing the relationship of firearms and violence."
What makes this all the stranger is that a considerable amount of research will probably be needed to make much headway on this problem. Experts agree that there is no simple solution to firearms deaths any more than there was a simple way of achieving the major reduction in motor-vehicle deaths that has occurred in this country over the past 25 years. While Americans drive twice as many miles today as they did 25 years ago, the number of highway fatalities has actually declined, not because of any single intervention but because of substantial resources invested in a whole variety of measures. As Prof. Zimring puts it, "In addition to seat belts, we have better emergency treatment, safer roadways, airbags, breakaway lampposts and padded dashboards. The design, evaluation, and introduction of these various safety measures have become a significant enterprise in U.S. government and industry."
He adds: "By contrast, the design of methods to reduce the risks associated with firearms in America is literally nobody's business."
What kind of research and development will it take to effect a reduction in firearms deaths comparable to what has been achieved on America's roads? More likely than dramatic breakthroughs, Prof. Zimring writes, is that "knowledge will accumulate as a result of multiple and redundant evaluations. This is precisely the kind of research effort that is unattractive in academic and medical research and unlikely to be sustained without systematic governmental or foundation funding."
Over the past decade, the main source of government funding for firearms research has been the CDC, and, as I said, even that has been decidedly modest. It is some measure of the scarcity of funding that in the most recent review of outside research proposals at the National Injury Center, 149 applications were submitted in all categories, including firearms. Of these, 29 were judged excellent to outstanding, and nine were funded. In other words, more than two-thirds of the proposals that were excellent or outstanding had to be turned down because of a lack of money to fund them.
Yet, in the midst of 40,000 gun deaths a year, we have the NRA expressing outrage at the waste of taxpayers' dollars for firearms research. What can account for this?
Clearly, the modest amount of research that has been carried out has produced results that are not to the NRA's liking. A number of studies, for example, have cast doubt on the value of guns in protecting owners against crime. Emory University's Arthur Kellermann and Associates, a group that has become a particular target of the NRA, found that the presence of a gun in the home is much more a risk factor for homicide than a protection against it. Duke University's Philip Cook found that only 3 percent of victims were able to deploy a gun against intruders when they were at home; recalling that half of all households have guns, he concluded that it is "quite rare for victims to be able to deploy a gun against intruders even when they have one handy." Interestingly, those most vociferous in attacking such research, such as the authors of several articles that appeared recently in the Journal of the Medical Association of Georgia, have published virtually nothing in the way of original findings of their own -- and, in fact, have not even applied for research grants for that purpose. This is not to say that the questions they raise about others' work have no merit or should not be pursued. No one working in this field would deny that what we don't know about firearms use is far greater than what we do know. But acknowledging this is a far cry from impugning the motives of those who do research, and the latter seems to be the way we live now.
In a letter to all U.S. senators, the NRA charges the CDC with "promoting a clearly political campaign against gun ownership." But everything about the way this research has been funded and published would seem to belie that charge. The grant process in the Injury Center -- and throughout the CDC -- closely resembles that of the National Institutes of Health, the largest supporter of biomedical research in the world. As is the case at the NIH, grant applications to the Injury Center are reviewed by experts drawn from a pool of hundreds of scientists from across the country, in a process known as peer review. Even if the leadership of the center was disposed to promote a "clearly political campaign against gun ownership," as the NRA claims, peer review would make it extraordinarily difficult, if not impossible, to do so.
The NRA's harshest attacks have been directed against scientists whose research has received wide attention through publication in such leading journals as the New England Journal of Medicine, the Journal of the American Medical Association and the American Journal of Public Health. But any original research published in those journals must survive the most rigorous process of peer review.
Thus, the work that most outrages the NRA has passed muster among scientists at least twice -- when it was funded and when it was published. If such work can be merely "political," as the NRA purports to believe, then our society would seem to be in deep trouble indeed, perhaps more than the NRA can imagine. It was undoubtedly his sense of the recklessness of the NRA assault that stirred Jerome Kassirer, the editor of "The New England Journal of Medicine," to characterize it in a recent issue as "an attack that strikes at the very heart of scientific research."
Because it typically focuses on human behavior, research on the prevention of disease, injury and disability often broaches matters that are controversial and on which people feel strongly -- subjects such as firearms, AIDS and other sexually transmitted diseases, smoking, job safety, environmental hazards. If scientists cannot look deeply into such matters without having their characters impugned, research will be inhibited, and ultimately the public will suffer.
There is a sense, too, in which the NRA attack is disturbing beyond its potential effects on science and public health. We seem in this country to have arrived at a moment of deep distrust about all kinds of things. Scientists have not been immune, and individual cases of misfeasance have received widespread attention. But what the NRA is alleging goes well beyond that, suggesting a kind of systematic cheating.
Of all people in our society, few are more dedicated to intellectual probity -- to seeing things as they are -- than scientists; it is, in fact, their life's work. If we question the honesty of scientists who give every evidence of long deliberation on the issues before them, what are our expectations of anyone else? What hope is there for us as a society?
The tragedy of firearms research was summed up two years ago by Dr. James Mercy and CDC colleagues in Health Affairs. "The gun-control debate has become so polarized," they wrote, "that neither side really seeks to understand the other. As a result, there is no middle ground and very little constructive dialogue. By reframing the debate, public health can help to engage many more people in this critically important issue."
This is not an issue that will be resolved by bumper stickers. The purpose of the CDC in its firearms research has always been to develop a body of knowledge that can be the middle ground to which Mercy alludes, that can provide the basis of constructive dialogue and reasoned action on a highly complex problem. The CDC would welcome the efforts of any group that shares these goals, and would be glad to work with them.
Meanwhile, honest scientists ought to be allowed to get on with their work. David Satcher is the director of the Centers for Disease Control and Prevention.