The Washington PostDemocracy Dies in Darkness

The reasons we don’t study gun violence the same way we study infections

(J.J. Alcantara/The Washington Post; iStock)
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Three decades ago, a pair of researchers wrote in one of the country's leading medical journals about a common cause of death and injury in the United States that received very little federal funding.

“A thorough review of research awards for 1983 failed to identify a single research project on the topic of firearm injuries,” the authors wrote after scouring a database of the research funded by the National Institutes of Health.

Meanwhile, they noted that cholera, diphtheria, polio, congenital rubella syndrome and rabies had, collectively, received 19 research awards from NIH. There were 17 cases of any of those diseases in the United States in 1982 and nine deaths; in contrast, gun injuries caused 33,000 deaths and were estimated to have caused close to 200,o00 injuries.

A new analysis in the Journal of the American Medical Association suggests that little has changed over the past three decades. There were close to 34,000 gun deaths in 2014, more than half of which were suicides. If public health issues were funded based on their death toll, gun violence injuries would have been expected to receive about $1.4 billion in federal research funding over about a decade — compared with the $22 million that it actually got, the study found. The researchers didn't limit their analysis to NIH; they used a database that contains projects funded by multiple federal agencies.

“I think a good parallel can be drawn to motor vehicle accidents,” said David Stark, medical director of the Institute for Next Generation Healthcare at the Icahn School of Medicine at Mount Sinai, who led the study. “Those kill about the same number of people, but that has been decreasing substantially. … All of that really starts from essential public research that determines the proximate causes of accidents — and it's only with research that you can start to develop plans and policies and initiatives.”

Why the diseases that cause the most harm don’t always get the most research money

Relative to the number of deaths it causes, gun violence is the least-researched major cause of death — as measured by the number of papers published. It is also the second-least-funded cause of death, after falls, compared with its death toll. The graph below shows how much funding different conditions receive compared to their mortality rate. It's expected that the more deadly a disease or condition is, the more funding it will receive — and the general pattern holds. But there are outliers; HIV falls way above the average line, showing it receives more funding than would be expected based on its death toll. And gun deaths are far below the line — as well as short of other injury-related deaths, such as motor vehicle deaths and poisonings.

There are a few reasons for the gun violence research disparity. First, there are legislative restrictions on gun research. For two decades, the Centers for Disease Control and Prevention has been prevented from allocating funding that could be used to advocate for or promote gun control. Although that doesn't explicitly exclude all research on gun violence, it is said to have had a chilling effect on funding.

“Precisely what was or was not permitted under the clause was unclear. But no federal employee was willing to risk his or her career or the agency's funding to find out,” physicians Arthur L. Kellermann and Frederick P. Rivara wrote in an opinion piece in the Journal of the American Medical Association in 2013. “Extramural support for firearm injury prevention research quickly dried up.”

Similar restrictions have been extended to the National Institutes of Health, although the agency has continued to fund research.

Aside from political pressure, there is a more philosophical one in which injuries are treated differently than disease. Injuries are a public health issue, but the debate over gun research often becomes mired in a debate over whether a person who intentionally wants to hurt himself or another person will do so, with or without a firearm. Research is also often driven by where researchers see the biggest scientific opportunity to come up with a cure or therapy, and infections or cancer may simply be easier to study than gun violence using traditional tools.

One of the complications of a study like this is that it uses broad categories to look at spending trends. For example, if the majority of gun violence is suicides, it might make more sense to study suicide, regardless of whether it involves a firearm. But suicide, too, has been chronically underfunded compared with its health burden. The number of deaths annually from breast cancer are now about the same as suicide. But breast cancer research received $699 million in NIH research funding in 2016; suicide and suicide prevention received $73 million.

Read more:

This doctor says violence is contagious, and we should treat it like a disease

Why this gun control study might be too good to be true