Guns, Germs, and Science: Public Health Approaches to Gun Control

by David B. Kopel

Presentation for the Tenth Annual Alumni Day Program

College of Public Health

University of Oklahoma

Health Sciences Center at Oklahoma City

Friday, October 14, 1994

Childrenís Hospital of Oklahoma

Nicholson Tower, 5th Floor

Oklahoma City, Oklahoma

 

 Good morning. Thank you for inviting me.

Traditionally, the gun issue in America has been studied by scholars in the two fields of my own expertise: law, and criminology. Legal scholars have studied issues such as the meaning of the Second Amendmentís guarantee of "the right of the people to keep and bear arms," as well as parallel provisions in state constitutions.

Criminologists have studied data regarding the legitimate protective use of guns and the criminal misuse of guns, and various strategies for reducing the latter without interfering with the former. Twenty-five years ago, both law and criminology had very little of substance to add to the gun debate. But in the last two decades, there has been an explosion of scholarship regarding the gun question. And the scholars have come to a surprising degree of consensus.

In the field of legal scholarship, the primary question has been answered: the Second Amendment was plainly intended to guarantee a right of individuals to possess arms. The essential purpose of this guarantee was not to protect sporting uses of guns, but to facilitate resistance to criminal governments, which was seen as simply a larger case of resistance to individual criminals. One interesting piece of new scholarship argues that an individual right to own handguns for personal protection can be found in the federal Ninth Amendment. Nicholas J. Johnson, Beyond the Second Amendment: An Individual Right to Arms Viewed through the Ninth Amendment, 24 Rutgers L.J. 1 (1992).

It was generally expected that the deterrent effect of widespread citizen possession of arms would deter potential tyrants, and thus make unnecessary the actual use of firearms in revolution.

There are still plenty of legal questions to be resolved regarding the boundaries of the Second Amendment. But as to the question of original intent, the debate is well-settled. Indeed, there is not a law professor in this country who in the last 25 years has published anything in a law journal claiming that the Second Amendment was not intended to protect an individual right.

Within the field of criminology, there has also been a growth of scholarship. The criminologists have not been as unanimous in their answers as have been the legal scholars -- partly because the legal scholars had one clear question to answer first, and once the historical documents surrounding the creation of the Second Amendment were studied, the answer became obvious.

But criminological research has in the last two decades suggested that the most extreme forms of gun control -- such as prohibitions on handguns, or extremely rigorous gun licensing systems -- are not effective, and perhaps even counterproductive.

The criminologists also point out that guns are used quite frequently for lawful defensive purposes, and in that capacity, provide a major public safety benefit.

In the last decade, especially in the last five years, the legal and criminological scholars looking at the gun issue have been joined by researchers in the public health and medical fields, with much of the research being funded by the federal Centers for Disease Control.

Most of these researchers tell us that "Violence is a disease," that "Guns are a disease vector," and that we should start looking at gun control as a public health issue, rather than a legal or criminal issue. Indeed, we are told that the gun control debate is now ended, since the "scientific" public health approach has supplied all the answers.

I have to tell you how strange these phrases sound to many people who are trained in law or criminology. Imagine, if you would, that the direction of this inter-disciplinary crossing was reversed. What if criminologists and law professors started getting involved in medicine?

Suppose, for example, that I was here to tell you that it is time to start thinking of communicable disease as a criminal and legal issue, rather than a public health issue, and this is time to recognize that "Disease is a crime."

In support of this new, "legal" approach, I might point out that while the public health approach has made important progress in reducing communicable disease, the public health approach has succeeded in wiping out entirely only a few diseases, such as smallpox. In the 1960s, the Centers for Disease Control promised that measles in America would be eradicated entirely within four years, yet a quarter of a century later, measles is still with us.

I would further point out that disease endangers the person who is diseased, just as does drug abuse, which is currently treated as criminal problem. Communicable diseases, being communicable, also endanger other people far more directly than does drug use, or most other forms of non-violent crime.

In many cases, a person who comes down with a communicable disease could have prevented the disease through proper precautions, ranging from inoculation to hand-washing. Moreover, persons who are carriers of communicable diseases have often consciously disregarded a risk they pose to innocent people -- for example by coming to work even though they know they are sick.

If we can characterize the level of violence in American society as "epidemic," then we could certainly say that the total, overall level of communicable diseases, including everything from the flu to chicken pox to AIDS is also epidemic. More properly, chicken pox and violence might be described as having high endemic levels, but we should not be too concerned with technical details when public safety is involved.

Accordingly, my modest proposal for "Treating disease as a crime" would impose criminal penalties, including fines and imprisonment, on people who have communicable diseases.

The most severe criminal penalties would be applied to people whose misconduct inflicts a large number of people with a dangerous disease.

Lesser punishments would apply to persons who infect only themselves with minor diseases through negligence, rather than recklessness. A person who catches a cold because he failed to wash his hands often enough would only spend a week in jail.

For persons who catch diseases through no fault of their own, administrative fines, but no jail time would be imposed, much as we currently impose fines on businesses which inadvertently violate highly technical environmental regulations.

Of course my modest proposal to treat disease like a crime would also include all the enforcement tools currently available to law enforcement. For example, if you know you have a cold, and you drive to work anyway, thereby endangering your co-workers, your automobile will be forfeited as an instrumentality of crime. As with current drug-related forfeitures, disease-related forfeitures will up to the discretion of the police, with essentially no judicial review.

At first, my modest proposal will encounter substantial resistance, even within the law enforcement community. But eventually the National Institute of Justice will start funding millions of dollars of research designed to reduce communicable disease by treating it as a crime.

The research will never be published in serious journals of epidemiology or public health. But the new research will be published in highly-regarded legal journals, such as the Harvard Law Review.

The new criminal disease research will rarely make reference to previous medical research. Indeed, it will recycle half-baked ideas for disease reduction that have already been studied and disproven in the medical journals.

But the Harvard Law Review and the Yale Law Journal have a lot of prestige, and a much better public-relations machine than does the American Journal of Epidemiology. Newspapers and the electronic media -- which already take a sensational, salacious, and short-sighted approach to covering the crime issue -- will eat up and regurgitate the press-releases from the Harvard Law Review detailing the latest set of factoids and hysteria cooked up by law professors with federal grants trying to write articles about communicable disease.

So after a few years, and a few tens of millions of dollars of federally-funded research, most of what the general public hears in a "scientific" way about disease control will come from articles about Rubella in the Harvard Law Review, and studies of Syphilis in the Journal of Contemporary Law.

Predictably, the American Medical Association and other Washington lobby groups will try to resist the campaign to treat disease as a crime. These counter-efforts will be dismissed by the mainstream media. After all, the AMA -- unlike the Harvard Law Review and the federal government -- is obviously biased on the disease issue. Doctors collectively make billions of dollars when diseased people are given medical treatment, rather than put in prison, where they belong. The AMAís objections to treating disease as a crime deserve no more serious analysis than the NRAís objections to treating violence as a disease.

If you find my modest proposal to treat disease a crime to be rather disturbing -- and I hope you do -- then perhaps you can sympathize a little with the legal scholars and criminologists who are disturbed by the current campaign to treat violence as a disease.

And in any case, it is time for the "violence as a disease" theory to undergo a much more rigorous analysis than it has thus far received.

Even if we accept that violence is a disease, the public health solution is far less obvious than the gun prohibition movement and some of its public health allies would suggest. Their analysis simplistically echoes the words of Dr. Katherine Christoffel of the American Academy of Pediatrics: "Guns are a virus...They are causing an epidemic of death by gunshot, which should be treated like any epidemic -- you get rid of the virus."

Let me suggest that sensible public health policy does not support this conclusion so readily.

Flies are a disease vector for polio. Yet the CDCís rigid fly control programs of the early 1950s proved ineffective against polio. Are guns in America, like flies, already so numerous that attempting to reduce their numbers significantly enough to reduce the violence-disease rate is likely to be an exercise in futility? Much, but not all, criminological researchers suggests that the answer to this question is "yes."

CDC can get caught up in programs that fit with the political wishes of the White House or Congress, but which have little scientific validity. The rat control programs of the 1960s are one example. Another is the Times Beach, Missouri, evacuation in early 1980s, which forced hundreds of people out of their homes because of alleged dioxin contamination, for what turned out to be unscientific, politically-driven reasons. The evacuation was the work of Dr. Vernon Houk, who later became a leader in the CDCís gun prohibition efforts.

For something to be a genuine disease vector, there must be some association between prevalence of disease vector (guns) and the disease (violence). In fact, there is a strong correlation. But the correlation is an inverse one. Regions and population groups with the most guns have the lowest levels of gun violence. Periods when the per capita gun supply is rising rapidly, such as the early 1980s, have been periods of falling violence.

Serious research about a source of disease must consider the disease may have a pharmakopic effect. The evidence suggests that firearms do. The latest, most in-depth research suggests that firearms are used as often as 2.5 million times a year for self-defense against criminal attack. Defensive use usually involves simply brandishing or referring to a gun, rather than firing it.

Finally, the "public health" campaign to outlaw guns because of the allegedly successful gun control policies of other nations ignores the potential criminogenic effect of those controls.

The chart below sets forth crime and suicide rates for several nations, per 100,000 population. (The table is taken from the author's book The Samurai, the Mountie, and the Cowboy, at 407. In the book, the Japanese burglary figure is incorrectly reported as "2351.2." The error occurred because the author's draft listed the figure as "251.2," and when the author marked page proofs to substitute a "3" for the "5" in the burglary figure, a production error resulted in the "3" being inserted but the "5" not being deleted. The author regrets any confusion caused by the error.)

Country Homicide Suicide Total Death Rape Robbery Burglary
Japan .8 21.1 21.9 1.6 1.8 231.2
England & Wales 1.1 8.6 9.7 2.7 44.6 1639.7
Scotland 1.7 10.2 11.9 4.4 86.9 2178.6
Canada 2.7 12.8 14.5 10.3 92.8 1420.6
Australia 2.5 11.8 14.3 13.8 83.6 1754.3
New Zealand 1.7 10.8 12.5 14.4 14.9 2243.1
Switzerland 1.1 21.4 22.5 5.8 24.2 976.8
United States 7.9 12.2 20.1 35.7 205.4 1263.7

 

While the United States has much more violent crime than the other nations (including crimes such as rape, which rarely involve guns), the United States anomalously has less burglary. In terms of burglaries perpetrated against occupied residences, the American advantage is even greater.

In Canada, for example, a Toronto study found that 48% of burglaries were against occupied homes, and 21% involved a confrontation with the victim; only 13% of U.S. residential burglaries are attempted against occupied homes. Similarly, most Canadian residential burglaries occur in the nighttime, while American burglars are known to prefer daytime entry to reduce the risk of an armed confrontation. A study of an unnamed "northern city" in Ontario for the years 1965-70 also appears to show a relatively high level of burglary against occupied residences. The study reported that 12.2% of burglaries were daytime, 69.5% were nighttime, and 18.3% were unknown. It is certain that no person was home for the "unknown burglaries" since if someone had been home, the time of entry would be known. A large percentage of the nighttime burglaries may have involved a person at home, since most people are at home at night. Peter Chimbros, A Study of Breaking and Entering Offenses in "Northern City" Ontario, in Crime in Canadian Society 325-26 (Robert A. Silverman & James J. Teevan Jr., 1975). After Canada's stricter 1977 controls (which generally prohibited handgun possession for protection) took effect, the Canadian overall breaking and entering rate rose 25%, and surpassed the American rate, which had been declining. A 1982 British survey found 59 percent of attempted burglaries involved an occupied home (again compared to just 13 percent in the United States).

In the Republic of Ireland, where gun control is also severe, burglars have little reluctance about attacking an occupied residence. Claire Nee and Maxwell Taylor, Residential Burglary in the Republic of Ireland: Some Support of the Situational Approach, in Whose Law and Order? Aspects of Crime and Social Control in Irish Society 143 (Mike Tomlinson, Tony Varley, and Ciaran McCullagh eds., Belfast: Soc. Ass'n of Ireland, 1988).

Why should American criminals, who have proven that they engage in murder, rape, and robbery at such a higher rate than their counterparts in other nations, display such a curious reluctance to perpetrate burglaries, particularly against occupied residences? Could the answer be that they are afraid of getting shot? When an American burglar strikes at an occupied residence, his chance of being shot is equal to his chance of being sent to jail. Accordingly, a significant reduction in the number of Americans keeping loaded handguns in the home could lead to a sharp increase in the burglary rate, and to many more burglaries perpetrated while victim families are present in the home.

Epidemiologists in particular, and public health researchers in general, have excellent quantitative skills, traceable in part to Pierre Charles-Alexander Louis and his methode numerique, which pioneered the use of statistics in medical research. Most criminologists have similar quantitative skills, but very few legal researchers do.

But precise measurement, even though apparently scientific, is not always so. Phrenology, a highly-regarded "science" of 19th-century, produced elaborate measurements of the shape of peopleís heads. These shapes supposedly were associated with certain traits, such as lack of intelligence ("low-brow") or criminal propensity. Today, we recognize that the phrenology data is of no scientific value. In regards to firearms, the public health research, like phrenology research, too often tells us more and more about less and less.

An example of the contribution that the public health community can contribute to the gun control debate is Lois Fingerhutís research regarding teenage homicide rates, the most detailed research ever regarding the topic. Nationally, the overall homicide rate is 9 or 10 per 100,000 population, a rate that has varied little over the past 25 years. For teenagers of all combinations of races and genders in rural areas, the homicide rate is close to zero. Interestingly, these teenagers are the ones with the readiest access to firearms.

But for Black males aged 15 to 19 in core urban areas, the homicide rate is an incredible 160.

Fingerhut suggests that the solution to this problem is gun control; as I will detail in a little bit, I think that there are more effective solutions. People may differ as to how to respond to this awful death rate, but everyone should be grateful to Ms. Fingerhut and the CDC for providing us with important data detailing the immensity of the problem. As the CDCís William Farr put it, "The death rate is a fact; anything beyond that is an inference."

Unfortunately, the product of public health research about guns is too often bad data. A good example of bad data is the claim of Dr. Arthur Kellermann in a study released last fall that claims that the presence of a gun in the home raises the risk of murder by 2.7 times.

The study fails to adequately address the cause and effect relationship. Do guns cause people to be murdered, or are people already at risk of being murdered more likely to buy guns?

We can see the cause-and-effect issue by looking carefully at Kellermannís own odds ratios. The Kellermann article, which produced the widely-circulated risk ratio for gun ownership, reports an ever higher risk ratio (4.4) for renting rather than owning the place where you live. Does this mean that you suddenly become safer when your apartment building goes condo? Of course not.

Likewise, are you safer when you get rid of your gun?

Not necessarily.

One of the confounding factors not reported in the Kellermann article is whether the crime victim is a criminal. Criminals are at much higher risk of being murdered than the population in general. And criminals may be more likely to own guns. So perhaps the connection between apartments, handguns, and homicide is that each of these elements may be associated with criminality, relative to the general population.

The possibility that Kellermann has reversed cause and effect is supported by his findings regarding "controlled" access security systems. Such security systems produced a higher crude odds ratio than did gun ownership. Does this mean that a cautious homeowner should, after getting rid of handguns, convince his landlord to get rid of the security guard in the apartment lobby? To the contrary, the presence of security guards in the lobby (like guns in the home), may simply be a reflection of the dangers faced by people who are at risked of being murdered, and who are taking sensible steps (through armed security guards, and through personal armament) to protect themselves.

The Kellermann article also highlights the weakness of the case-control method when taken beyond the confines of disease. Letís apply the studyís case-control methodology to something else. Letís compare 200 students, all of whom scored double 800s on the SAT, with 200 socioeconomically similar students who did not score so high. We find that the high-scoring students are about three times more likely to own a chess set than the lower-scoring students. Accordingly, we claim that "persons who own chess sets are three times more likely to score an 800 on the SAT than are persons who do not own chess sets."

I hope that the SAT chess study would not convince high school students to run out and buy chess sets, in the hopes of improving their SAT results.

We donít know of the students with chess sets actually played chess much. Even if they did play chess a lot, we donít know if chess helped build verbal analogy skills and other skills with lead to SAT success, or if people who are already smart and likely to do well on the SAT are simply more like to enjoy chess sets, or be given chess sets as gifts.

If we just substitute "being murdered" for "scoring an 800 on the SAT," and substitute "gun" for "chess set," we have the study that supposedly proves that owning a gun increases the odds that youíll be murdered.

Finally, a study which only looks at dead people is not a very good measure of the protective benefits of gun ownership.

In short, the medical gun prohibition literature is frequently suffers from the same defect which the sociologist Herbert Blumer found in so much sociology: "To select (usually arbitrarily) some one form of empirical reference and to assume that the operationalized study of this one form catches the full empirical coverage of the concept or proposition..."

Not all of the federally-funded "guns are germs" studies are as flawed as the study we just discussed. But most of them are. The article handout by Doctor Suter dissects most of the famous guns and health articles.

The medical scholarship does a reasonably good job of quantifying firearms deaths. But the literature is so full of ignorant statements about how guns function, hostility to the notion that guns might sometimes have a pharmakopic effect (the victimís gun serving as a "remedy" to the criminalís gun), vicious denunciations of gun owners, and a complete incomprehension as to why anyone would actually own a gun as to be of very limited value in formulating gun control policy. There is no effort to enter the world of the gun owner, to see guns as gun owners see them. Accordingly, the medical literature regarding guns is generally as flat and sterile as would be research about wines written by a hard-shell Baptist preacher whose lips have never tasted a drop. As Blumer observed, "the scholar who lacks firsthand familiarity is highly unlikely to recognize that he is missing anything."

There is another problem with the medical intervention in the gun issue. Too often, it is based on an appeal to authority, rather than to logic. Doctors--unlike lawyers, Congress, and used car salesman--enjoy great credibility in the eyes of the American people. But the further that doctors stray from medicine, the greater the risk of destroying that credibility.

When criticized -- whether by Dr. Paul Blackman of the National Rifle Association -- or by eminent sociologists such as James D. Wright of Tulane University -- or by physicians such as Doctor Suter, the response of the gun prohibition movement and its public health allies is generally to attack the motives of the critic, rather than to answer the criticism.

This sort of response is inappropriate for several reasons.

First of all, it is antithetical to the scientific method. If an article suffers from fundamental statistical flaws, those flaws do not disappear simply because the NRA points them out.

Secondly, the most prominent public health scholars on the gun debate, such as Doctor Kellermann, or Doctor Christoffel from the American Academy of Pediatrics, are themselves ideologues and political activists. I do not think that this fact disqualifies them from producing research that should be carefully considered.

Most of the people in the legal academy who write about legal control of obscenity, for example, have passionate views about freedom of speech, sexual freedom, or feminism. Nobody in the legal academy would suggest that Catherine MacKinnon, who believes deeply in radical feminism, or Alan Dershowitz, who believes deeply in freedom of speech, should not have their writings considered carefully simply because they are passionate about what they are writing about.

Thus, it is simply childish for researchers who are subject to criticism to attempt to deflect that criticism by sneeringly pointing out that the critic believes in the Second Amendment.

Moreover, personalization of the issue tends to raise rather than settle questions about the desirability of gun control. Both sides of debate have people for whom research has confirmed their previous intuitions, for or against guns. But there is also a class of scholars who started studying the gun issue and were strong supporters of one viewpoint, but who revised their views in light of the evidence.

Every scholar who has "switched" has "switched" to the side that is skeptical of controls.

Indeed, most of the prominent academic voices who are gun control skeptics -- including law professors Sanford Levinson and William Van Alstyne, and criminologists Gary Kleck and James Wright -- are people who when they began studying guns were supporters of the gun control agenda. I do not know of a single scholar who has published a pro-control article who started out as a skeptic of gun control.

This suggests how heavily the weight of the evidence is distributed, once people begin studying the evidence. Rather than taking my word, study the research yourself.

In the long term, a little recognition of medicineís limits might be in order. Even in the field of actual communicable disease, there is a great deal that science cannot answer. The Centers for Disease Control is the descendant of the Malaria Control in War Areas unit of the U.S. Public Health Service. Despite intensive malaria-control efforts, such as draining swamps, and spreading DDT over vast areas, the Malaria Control unit made little progress against malaria until the disease essentially disappeared in 1945, for reasons which even today are not understood.

Even classic medical problems involving communicable diseases may not be entirely solvable through medical approaches. Sexually transmitted diseases, including the old-fashioned ones, remain a very serious public health problem, despite decades of hard work by the public health community.

How much more so may public health prove unable to solve problems further afield?

Several centuries ago, physicians treated wounds by caring for the weapon that caused it. By the armarium urguentum, prescribed for gunshot and other wounds in 1622, "If the wound is large, the weapon with which the patient has been wounded should be anointed daily; otherwise, every two or three days. The weapon should be kept in pure linen and a warm place but not too hot, nor squalid, lest the patient suffer harm"

Today, it would seem absurd to deal with gunshot wounds by treating the gun rather than the wound. But prestige organs of the medical establishment such as the New England Journal of Medicine and the Journal of the American Medical Association claim to have found the solution for the public health problem of woundings: remove guns from society.

Like the armarium urguentum in its time, this view is widely accepted among public health professionals of this time. As in the 17th century, a focus on the object that seemed to "cause" the distress -- the weapon -- was a solution that missed the real cause of the distress. The distress of a wound, and the distresses of a violent society, have causes more profound than physical objects.

The focus on objects rather than the people can lead public health to absurd results. Consider, for example, the public health involvement in the nuclear war debate during the 1980s.

Traditionally, the risks of nuclear war and how to reduce them had been considered a diplomatic or military issue.

Public health made useful contributions to the nuclear debate. A famous 1962 article in the New England Journal of Medicine documented the widespread presence of strontium 90 in childrenís teeth. This research proved to be a major spur to the Nuclear Test Ban Treaty the next year.

But the public health contribution to the nuclear issue was often an unhelpful focus solely on the nuclear arms themselves (just as modern public health focuses on the guns). Physicians for Social Responsibility promoted unilateral American nuclear disarmament as the supposedly scientific response to nuclear danger. This was simply philosophical pacifism masquerading as science. Dr. Helen Caldicott, predicted in 1984 that nuclear with the USSR was "a mathematical certainty" if Ronald Reagan were re-elected.

Dr. Caldicott's scientific conclusions notwithstanding, the world survived Mr. Reagan's re-election. With the threat of nuclear war receding, pacifists are turning their attention away from disarming the American government, and towards disarming the American people. Like Physicians for Social Responsibility, which found no moral distinction between a nuclear weapon owned by the American government and one owned by a Communist dictatorship, domestic pacifists consider a firearm owned for protection to be as illegitimate as one owned for crime. The pacifist elements of the medical community today promote the disarmament of law-abiding, mentally healthy Americans, and they wrap their moral claim in the cloak of "science."

History showed that the core of the nuclear problem was a political one. When the political system in USSR changed, the threat of nuclear war vanished dramatically. The way to eliminate nuclear terror was to remove the terrorists who were running the Soviet Union.

In regards to gun violence in America, the core problem again involves human behavior, not inanimate weapons.

Gun crime is falling for most population groups, but it is soaring for inner-city minority males, bringing the overall rate up.

In a way, the current evidence regarding gun misuse vindicates one of the critics of Dr. Louis Pasteur. In 1880, Pasteur discovered that he could make chickens sick by injecting them with cholera germs. But a few years later, Max von Pettenkofer (a Professor of Hygiene in Munich) drank a cup of pure cholera germs, with no ill effect. Pettenkofer is credited with establishing that germs by themselves do not cause infection; there must also be a susceptible population and a suitable environment. In the case of inner-city male minority teenagers, there is plainly a population and environment susceptible to the "disease" of gun violence. Yet the medical research about the disease looks almost exclusively at guns, and pays little attention to the factors that have made one particular portion of the population immensely more susceptible to the violence disease than every other part of the population.

Until we begin the social reconstruction that will change the lives of the poor in Americaís inner cities, nothing will change about the gun problem.

The inner cities already have the strictest gun laws in U.S.

Nearly a century of prohibition, starting with the Harrison Narcotics Act in 1911, has not deprived inner city teenagers of easy access to cocaine, even though cocaine has to be grown on another continent. How can it be seriously asserted that any set of controls, including prohibition, will deprive them of guns?

What we have to do is deprive them of the inclination to use guns in a criminal manner, and that is a much more difficult enterprise than passing gun control legislation.

The energy spent on the gun debate would be far better focused on a discussion of how to help the inner cities. Gary Kleck favors a massive jobs program. I think that it is more important to make drastic changes in the welfare system, a system that subsidizes illegitimacy, the number one correlate of criminal behavior.

We must also re-think the "drug war" which has inflicted so much violence in our cities, and which burdens the criminal justice system so heavily that enforcement of the laws against violent crime is emasculated.

We need to start reforming the dysfunctional government school system. Some people would suggest that the government schools need more money, while I believe that the parents and students who are stuck in this dysfunctional system need the power to choose their own schools, through a voucher system. A good school may be the last hope to rescue a child from a dysfunctional family before he begins a criminal career that will lead to his own death, and the deaths of several other people.

However these debates on how to help the inner cities are resolved, these are the debates that we must begin having if we are serious about reducing the disease of gun violence.

Gun control sometimes plays an what Ivan Ilich calls an "iatrogenic" role in distracting popular attention from the conditions which allow crime to flourish. Kleck summarizes: "Fixating on guns seems to be, for many people, a fetish which allows them to ignore the more intransigent causes of American violence, including its dying cities, inequality, deteriorating family structure, and the all-pervasive economic and social consequences of a history of slavery and racism...All parties to the crime debate would do well to give more concentrated attention to more difficult, but far more relevant, issues like how to generate more good-paying jobs for the underclass, an issue which is at the heart of the violence problem." Gun control distracts the public and the legislature and the medical community from the more difficult tasks of confronting the culture of poverty.

We are now reaping the consequences of 30 years spent talking about guns rather than doing something effective about poverty and hopelessness. If we really want to reduce the disease of violence, it is time for us to start acting.

Notes

[The 17 endnotes from the original text are not included in the html text.]

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