Blog | Thursday, February 14, 2013

Gun control and numerical nonsense

I have expressed my support for gun control emphatically, here and elsewhere, and in so doing given myself up for human target practice. I expected nothing else.

Once more into the breach, even so.

There are, of course, some valid concerns and challenges raised by those who oppose gun control. I don't mind admitting that. For one thing, nothing worthwhile as having fewer gun-related deaths in the U.S. is worthwhile is ever easy. For another, I acknowledge that a disagreement doesn't require that everyone on one side of the argument be a moron. Perspectives and priorities can differ, even among decent, intelligent people.

And, frankly, a comprehensive plan to reduce gun violence, including bans and restrictions on certain kinds of weapons and ammunition and body armor, enforced regulation of sales and interstate commerce, buy-back and amnesty plans, background checks, better mental health screening and care, stiffer fines and sentences, a massive enforcement initiative, etc., would be challenging to conceive, and harder still to implement. Not impossible, mind you, just hard.

So I concede there are challenges, including the need to keep reasonable arms accessible to reasonable people for reasonable use. We left-leaning public health types love civil liberties, and America, and the genius of our Constitution too, you know.

But there are some truly vapid arguments against gun control. And salient among these is: "The assault-style weapons and high-capacity magazines you want to ban account for only a tiny proportion of gun-related deaths, and a vanishingly tiny proportion of all deaths." This is an all but constant refrain for the anti-gun-control chorus. I've heard it many times, usually in the context of being called names that would make my poor mother pass out.

But as noted, this is utterly vapid, nihilistic nonsense. A non sequitur. And here's why:

Against the backdrop of prevailing epidemiology, not many die in plane crashes. So if our sole concern is the total number of cause-specific deaths, plane crashes are just no big deal. We have no more reason to do anything about them than we do about assault weapons used in massacres.

In fact, if this is a numbers game, strictly, then the next time you are boarding a plane and wondering what was done after the last calamitous plane crash to make it less likely to recur, that answer really ought to be: "Not a damn thing, of course. Have a nice flight."

It doesn't end there. Not many people died on September 11. Not in the grand scheme of death. More than one million people die prematurely in the U.S. every year, and more than 80% of those premature deaths are due to chronic diseases. So September 11 was really miniscule compared to tobacco; or eating badly; or lack of exercise. Or guns. Or car crashes. Or texting while driving.

So why the fuss? If we are not concerned with who dies, or how, or at whose hands, if it's all about how many, then our response to September 11 has been wildly exaggerated. More of our military personnel have died in our response to September 11 than were killed on that day that lives in infamy. If it's about the numbers, we are doing something very wrong.

So, of course, it clearly is not just about the numbers. And here's a numbered list of reasons why:

1) One death is a lot if it's yours, or that of someone you love.

2) What most of us really can't stand is not risk, or vulnerability, we are all going to die, after all, but helplessness. It is human nature, our constitution, if you will, to fear and revile risks we don't control, those imposed on us, like a Kevlar-clad lunatic bursting into my lab, or my kids' school. I feel in charge of my steering wheel, even though my car is far more likely to be the death of me than a gun. That doesn't change our thinking, we don't want dangers imposed on us. That, too, is a libertarian concept.

3) A focus on numbers ignores circumstance, context, and choice. People choose many behaviors that invite some degree of danger. First-graders in their elementary school classroom, or people attending a movie, have done no such thing

4) A numbers game ignores the motivation of mass murderers. The real intent of the Newtown attack and the September 11 attack is not measured in the body counts, appalling as they are. It is measured in the psychological aftermath, it's an assault on our culture and society. The perpetrators of massacres are people who want to, and do, make history. Not so for every hoodlum with a Saturday night special. Assault weapons in the wrong hands are used to assault not just individuals, but our way of life. The very notion of security and liberty, beautifully conjoined, is in their crosshairs.

5) Numbers-based arguments lead toward a slippery slope. They invite us to ignore all causes of death, no matter what we might do about then, that don't climb above some arbitrary statistical threshold. Since my day job is focused on the leading causes of death in modern society, cardiometabolic diseases, I suppose I should welcome this thinking, since it would divert all relevant resources to me and others like me, and the work we do. But I don't welcome it. It's absurd. It would mean no firemen, because after all, how many people die in fires in the grand scheme of things? It would mean no lifeguards. No crossing guards. No child safety caps. No guardrails. No Coast Guard. Maybe no police at all. It's nihilistic, dysfunctional, dystopian nonsense.

What matters about massacres resides in the nature of the menace, not the casualty count in epidemiologic context. I am an epidemiologist, and readily acknowledge that not everything that counts can be counted.

In the current, intensifying debate about gun control, all valid arguments should be heard. A numbers-based argument is not among them. What matters here is what is being assaulted, and that was never just a number.

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.