Friday, January 18, 2013

Sure as shooting

There are two reasons not to talk about gun control in the immediate aftermath of the Newtown atrocity, and opposition by the National Rifle Association and its adherents is neither of them.

The first is that addressing gun control right after innocents are shot might in some way seem exploitative. The second is that no imaginable degree of stringent gun control could fully exclude the possibility of an unhinged adult shooting a kindergartener.

But both of these objections are as porous as the sands of our shores battered by Hurricane Sandy. And a consideration of those shores readily reveals why.

With regard to exploitation, there was no thought of it as post-Sandy ruminations turned to how we might best prevent or at least mitigate the next such catastrophe. It was not exploitative to look around the world at strategies used to interrupt storm surges, divert floodwaters, or defend infrastructure. Those reflections continue.

Similarly, it's not exploitative when my clinical colleagues and I speak to our patients in the aftermath of a heart attack or stroke about what it will take to prevent another one. In fact, these exchanges have a well-established designation in preventive medicine: the teachable moment.

It is opportunistic, but in a positive way: There is an opportunity to do what needs to be done. Admittedly, it's better to talk about preventing heart disease, or the drowning of Staten Island, or of New Orleans, or the shooting of children, before ever these things happen. But the trouble tends to be: Nobody is listening then.

We are constitutionally better at crisis response than crisis prevention. We'll get back to the Constitution shortly.

It's not exploitative to talk about what matters when you have people's attention as opposed to when you don't; it's strategic opportunism, pragmatism, and good sense. It is, of course, a damn shame that we only seem to focus our attention on disaster prevention in the immediate aftermath of disasters, public or personal. But if that is our nature, those wanting to get anything done are well advised to proceed accordingly.

As for the second argument: It's true, no degree of gun control short of eliminating guns from the planet could guarantee that a lunatic will never again shoot an unarmed innocent. But that no more obviates discussion of sensible gun control than the fact that no degree of shoreline protection can guarantee we will never again suffer any damage from a monster storm. In defending ourselves, and our children, from monster storms or monstrous people, we are foolish to make an unattainable perfect the enemy of the good we can do.

And there is, clearly, good we can do.

Other than in the hands of military and law enforcement personnel, semi-automatic and assault weapons, and the gear that goes along with them, as in the Aurora, Colo. shooting, serve the purposes of carnage and devastation almost exclusively. Access to them should be regulated accordingly.

As for the Constitution: This really has nothing whatsoever to do with the Second Amendment, and certainly doesn't infringe on it. The Second Amendment doesn't say anything about what kind of "arms." We are left, as a modern society with weapons unimagined in the days of our Founding Fathers, to figure that out for ourselves.

I will leave other Second Amendment arguments, including specific reference to a "well regulated militia," to the Constitutional scholars; I do not pretend to be one. Sensible arguments for gun control sidestep Constitutional concerns entirely.

However we interpret the right for private citizens (having nothing to do with a well regulated militia, for what it's worth) to bear arms, we are left to decide: What arms? We seem to agree that private citizens should not bear nuclear arms. I suspect most of us agree they should not bear chemical or biological weapons capable of destroying entire populations, either. Private citizens don't get to bear the launch codes for missile silos.

It would be surprising news to me if even the most ardent defenders of the Second Amendment felt that private citizens should be able to have a personal nuclear arsenal. And, assuming not, then we all agree: We have to draw a line somewhere. What arms?

We might far more constructively address the question of where to draw the line once we acknowledge that, but for the truly radical and deranged, we all agree there is a line somewhere. Once we've done so, my contribution to the debate would simply be my own standby: Epidemiology should trump ideology.

In other words, things matter because of their effects. If everyone had an Uzi, but no one ever got shot, who would care? The reason for us to care about who has what guns is how they wind up being used.

I have written about gun control before. And, predictably, I have received a deluge of rather uncomplimentary correspondence each time. I expect a bumper crop this time, too. I have taken advantage of such exchanges to ask the more gregarious among my verbal assailants to tell me about any situation in which a semi-automatic weapon was used for self-defense. Most don't seem to know of any, although of course anybody can track down evidence for anything somewhere in cyberspace.

The premise underlying ever-more-potent weapons for personal defense is, of course, fundamentally flawed; it is subject to the arms race principle. If more potent guns are in circulation, then both sides get them. Yes, the good guys can get them, but so can the bad guys. That might invite the good guys to argue for more potent "arms" still, but then, of course, the bad guys get those, too. The more potent the arms, the greater the collateral damage.

The first question for us all, NRA members and die-hard pacifists alike, is: Why do we care? Anyone who wants guns for all just because they like guns, and the consequences be damned, is a damn fool, and doesn't deserve our attention. But frankly, neither does the pacifist who just hates guns, and doesn't care if they are truly useful for self-defense. Let's agree about what matters: consequences.

If we can manage that, then the second question is: What is the interpretation of "arms" in our right to bear arms that best protects us all, including children in kindergarten classes? If we don't have the data, then an analysis should be commissioned to get them. And we should all then embrace the best answer an unbiased analysis can generate. If we do have the data, and yes, I think we do, then we should all pay attention to them.

If we and our children truly are safer for having semi-automatic weapons in everybody's hands, then we should all get our hands on them. But if not, then we shouldn't. We would still have the right to bear arms, of course, just not the ones used preferentially to take an entire classroom of kindergarteners out of the loving arms of their parents, forever.

Something bad could have happened in Newtown without semi-automatic firepower. But it would have been much less bad.

Even if we were less inclined to climate change denial, we would still have to acknowledge that there have always been hurricanes, they've always been potentially destructive, and we can't prevent them. But we can examine the defenses at our disposal, and determine how to use them to produce the best possible outcomes.

We should look to guns as we look to our shores. In both cases, if what we truly care about is protecting the innocent, then sure as shooting, there are lines to be drawn in the sand.

David L. Katz, MD, FACP, MPH, FACPM, is an internationally renowned authority on nutrition, weight management, and the prevention of chronic disease, and an internationally recognized leader in integrative medicine and patient-centered care. He is a board certified specialist in both Internal Medicine, and Preventive Medicine/Public Health, and Associate Professor (adjunct) in Public Health Practice at the Yale University School of Medicine. He is the Director and founder (1998) of Yale University's Prevention Research Center; Director and founder of the Integrative Medicine Center at Griffin Hospital (2000) in Derby, Conn.; founder and president of the non-profit Turn the Tide Foundation; and formerly the Director of Medical Studies in Public Health at the Yale School of Medicine for eight years. This post originally appeared on his blog at The Huffington Post.

Labels: David Katz, guest post, health policy, politics, public health

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Friday, January 18, 2013

Sure as shooting

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