More on my call for an assault weapon ban…
From Randy Flick
Friends and colleagues forgive me for being slow to respond to the discussion around this most important of issues. As many of you are aware, I wrote an open letter to the membership during my tenure as president of SPA in response to the massacre at Marjorie Stoneman Douglas High School. That letter was reposted along with a very thoughtful response from the current board leadership after the most recent event at Uvalde, Texas.
What you may not know is that I began my career more than 25 years ago at Johns Hopkins as both a critical care-anesthesia fellow and a student at the Hopkins School of Hygiene where I spent countless hours at the Baltimore City coroner’s office poring over the records of children killed with firearms during what was the most violent period ever in American cities. I am also a gun owner and have been all my life. My children all own firearms and target shooting is something we do together whenever we can. With that background let me address some of the issues raised by Dr. Donohue (a former resident and a very good one at that) in his response. It is important that I do so point by point and call out some of the typical arguments he employs which unfortunately will require an uncomfortably high word count. One of the problems in the gun debate is the lack of nuance and nuance takes more than a few words to convey. So please bear with me as I go through the arguments posed by my friend and colleague, Dr, Donahue.
I have inserted my comments into the text of Dr. Donahue’s post to make it easier for the reader.
From Brian Donahue
Myron, it has been a pleasure to receive your daily pediatric anesthesia articles of the day. I have greatly enjoyed the academic challenges and insights you have provided, and I have always looked forward to the discussions involving my colleagues. I use past tense because your daily e-mails took a very sharp political turn today, to which I respond now. Although I find it distasteful that you use your fine academic forum as a platform to advance a clearly political agenda, I will save this discussion for another time. My hope here is that you actually read this letter in its entirety and take the time to consider its arguments.
I have read Dr. Yaster’s original post, the APSA letter and Dr. Donahue’s response in their entirety. As someone that has been around for a while, I suspect Dr. Donahue knows that every agenda is political to one extent or another. The difference lies only in what is at stake.
In this discussion the stakes are high. The life and death of Children is an issue of public health no different than motor vehicle crashes, drowning, poisoning or any of the other trauma deaths that I studied as a student of public health 27 years ago. Each of those issues had and continue to have political ramifications. As some recall there was a very spirited political debate around the requirement for seatbelts and airbags in cars. Many of the same types of arguments were made by the opponents to those efforts at prevention as Dr. Donohue makes now. We all know how effective and unobtrusive those interventions have been and how many lives they have saved.
Suggesting that we should not address firearm injury as political issue is disingenuous and is an old tried and true means of shutting down thoughtful discussion.
For the record, I am not a member of any gun lobby, I’ve never been a member of the NRA, nor have I ever contributed to anyone’s political campaign or any political action committee. I share every bit of your passion and sorrow in response to mass shootings. Like you, in my role as an anesthesiologist, I have very graphically witnessed the tragedies of gun violence. Like you, I agree that any act of violence in our society is a serious moral stain, worthy of condemnation, investigation, and cohesive efforts at prevention. Like you, I would love to see something effective done.
We would all love to see something done and Dr, Yaster has suggested that it be an assault weapons ban. Dr. Donahue offers no solutions only states very clearly that addressing gun ownership and use cannot be part of whatever we do.
The busy reader may wish to stop here. You know all you need to know based on the above statement (full context is below). If you have time feel free to read on.
For the record, I am not a member of any gun lobby, I’ve never been a member of the NRA, nor have I ever contributed to anyone’s political campaign or any political action committee. I share every bit of your passion and sorrow in response to mass shootings. Like you, in my role as an anesthesiologist, I have very graphically witnessed the tragedies of gun violence. Like you, I agree that any act of violence in our society is a serious moral stain, worthy of condemnation, investigation, and cohesive efforts at prevention. Like you, I would love to see something effective done.
We all share your concern but concern, like thoughts and prayers, will not bring those kids back to their families and will not prevent the next mass shooting.
In response, you issue a call to ban “assault weapons.” This term captured my attention, because there really is no standard definition from policy makers, gun enthusiasts, physicians, or even gun manufacturers regarding what an “assault weapon” is. My guess is that you’re referring to the popular AR-15 rifle, which fires a 223 / NATO 556 round. For the purposes of this letter I assume this is what you mean.
Agree, assault weapons are difficult to define but disagree that there is no standard definition. There was, of course, a definition of assault weapons contained within the previous assault weapons ban. We can have a debate around whether the definition was appropriate or not, but we cannot deny the simple fact that a definition was in place and could be reinstated in some form. This argument represents a very common theme…. Let’s call this; the perfect is the enemy of good argument.
It goes something like this; because we cannot perfectly define what an assault weapon is, we shouldn’t even try. In order to do something, it must be perfect, or we should do nothing at all. If that is how we approach all public health policy we would be essentially powerless to legislate or improve the safety of the drugs we take, the food we eat, the water we drink and the consumer products we use every day. Imagine for a moment that we took that approach to airline safety. More than 10 years as an FDA advisor taught me that legislation is messy business that rarely if ever even comes close to perfectly defining either problems or solutions. Perfect is indeed the enemy of good….or it is your friend if your goal is to end discussion or block action.
Now, being a man of science, Dr Yaster, I think you may be interested in some facts regarding this weapon. First, the round fired from it is the same diameter as a 0.22 round, considerably smaller than the 9mm or 45-calibur handgun rounds carried by most law enforcement officers. Second, the firing power and lethality of this weapon is far less than that of my grandfather’s 30.06 deer hunting rifle, which has been available to citizens for more than a century and has never raised the political concerns we are observing today.
See comments below regarding Grandpa’s deer rifle
Third, outside of the military, no AR-15 rifle sold today is available as fully automatic, which means the weapon rapidly fires rounds as long as the trigger is pulled. Rather, the AR-15 rifle is semi-automatic, which means each round requires a separate trigger pull, the exact same mechanism used in handguns. Therefore, contrary to your claim, it has no more capacity for “rapid fire” than handgun does.
I don’t see anything in any of the statements that confuses automatic and semi-automatic firearms although this is a common mistake made by commentators on the left often undercutting whatever points they wish to make. Yes, indeed an AR- 15 cannot fire more rapidly that a semi-automatic handgun although I am not sure how that matters in this discussion, but I may have missed something.
This rifle is popular today not because it is “killing machine” (it is clearly less lethal than many other weapons available), but because it is very reliable, durable, accurate, easy to service and clean, has multiple options for accessories, and has standard replaceable parts. So, it seems a bit of an exaggeration to make unsubstantiated emotional appeals to how deadly these weapons are. It also clouds the issue of whether restricting them will have a significant impact on violent crime.
Completely agree. I have spent many hours at the range with an AR-15. Enjoyed it immensely. I am sure Dr. Donahue and the reader would agree the weapon was originally designed to be deadly….to people.
Let’s address some of the “facts” but lets recall the words of Mike Huckabee who said, “Facts can be slippery things but trying to change them to suit a political agenda never works. Americans are too smart for that”.
Dr. Donohue is being a bit slippery in his presentation of the facts. He is presenting facts, but not all the facts, and only the facts that tend to support his political position. He is by no means alone in this. Let’s call this the Cherry-Picking argument.
Indeed, we are all scientists of one sort or another and those who have a modicum of understanding of firearms and ballistics know that discussions of the “firing power and lethality” are subject to broad interpretation based on context and nuance. Let me emphasize that the cherry picking of “facts” is a disease that affects all parties in this discussion (including me of course). Both sides make statements that too often have a loose connection with a nuanced understanding of differences in how firearms operate and what factors are important in determining the likelihood of causing grievous bodily harm and or death.
Yes, it is true that the 5.56 round is the same as a .22 cal. round and yes, it is also true that 9 mm and .45 caliber rounds are larger, even much larger, than the typical 5.56 mm standard NATO round (I use “typically” very intentionally as the AR-15 can be chambered for a wide variety of calibers including 9 mm). These facts, as Dr. Donohue knows very well, are cherry picked and intended to confuse the uninitiated. He also knows that the size and or weight of the round (bullet) is a secondary factor in lethality. Lethality is mostly a function of energy dissipated by the projectile in the target. In this case, the body of the 9- or 10-year-old child. Kinetic Energy is a simple function of the formula that Dr. Donohue I assume recalls and we all learned in undergraduate physics (K.E. = 1/2 m v2) ).
This is, of course, where the cherry picking comes in. Dr. Donohue has focused the least important factor in the equation, mass, rather than by far the most important factor, velocity. The typical muzzle velocity of a 9 mm handgun is roughly 1/3 that of the standard NATO 5.56 round (1200 v. 3000 fps). I am no math wizard but if one plugs those numbers in the formula the answer is obvious. Please be mindful there are many other factors that determine how energy is dissipated in soft tissue.
Fourth, please understand that the weapons ban which ran from 1994-2004 had little or no effect on criminal activity, firearm deaths, or lethality of gun crime. In fact, gun violence actually decreased once the ban expired in 2004, because there are numerous other factors that contribute to crime statistics. Fifth, handguns continue to be used in the great majority of all gun crimes, so any ban on rifles is unlikely to be successful in accomplishing what we all would like to see.
Okay, let’s call this argument by misdirection or maybe obfuscation.
Interesting and true at least to the extent that firearm deaths did indeed decline after the assault weapons ban was allowed to lapse. Firearm deaths had been on the decline in the U.S. from the mid-nineties until the past few years when gun death rapidly increased. It is also true that gun death is a very complex issue, and it is important to point out that mass shootings especially those like that seen at Sandy hook, Parkland or Uvalde are a very small part of the problem. Something that my friends on the left often forget. If one wishes to understand gun violence and especially why violence decreased in the 90’s I might suggest reading the work of Steven Levitt at U. of Chicago.
We are, in this discussion, focused not on gun death but an assault weapons ban (That was the title of the PAD authored by Dr. Yaster). We can discuss the broader issue later.
Dr. Donohue has changed the subject to an area that fits his narrative better when he states, “the weapons ban which ran from 1994-2004 had little or no effect on criminal activity, firearm deaths, or lethality of gun crime” The question is not whether criminal activity, or firearm death or lethality of gun crime (not sure what the last one means) were affected by the assault weapons ban. Rather it is whether an assault weapons ban could have saved the life of even one child who was dropped off at school by their parents on the last day of school in Uvalde Texas. Let’s remind ourselves that regardless of our politics we are first and foremost physicians and advocates the health and safety of children. That is our moral obligation. Let me say that again…it is our moral obligation which of course transcends our politics.
There are of course data on the number of mass shootings over time which is a better (by no means perfect) approximation of the problem under discussion. I leave to all of you to decide whether the ban was impactful or not. It is by no means clear keeping in mind that the overwhelming majority of these mass shootings were handgun related.
It might be even more instructive to look at the number of school shootings or more precisely the number of deaths associated with school shootings. See below
If these weapons are banned, I surmise that there will again be little or no effect on violent crime, which will be frustrating and disappointing.
Here, Dr, Donohue, is once again obfuscating. To be clear no one believes that an assault weapons ban will have a discernable impact on the rate of violent crime in the United States.
It may save the life of a child.
Justifying such an ineffective, politically charged ban as “a step” is disingenuous, and does not justify the wasted time, effort, and resources spent to no avail. If these weapons are banned, I also surmise that politicians will seize the opportunity to arrogantly gloat about how they pushed forward this “important legislation” and will castigate their opponents for being sold out to the gun lobby, and obviously not caring about children. Such grotesque misrepresentation of equally concerned citizens who simply disagree about policy, is again disingenuous and will only further polarize our country, keeping us from coming together to the real problems behind gun violence, pushing the solutions to these problems even further from our reach. What are these problems? The issue cannot be guns, or access to guns, because the guns have always been there.
Not sure what to say here… I will simply display the relevant data. Most scientists would conclude that correlation between gun ownership and gun death is pretty strong.
But, I could be mistaken. The reader can judge for themselves.
Once again if we focus on the issue at hand, mass shootings using an assault weapon, the picture is somewhat different. The number of AR-15 imported or manufactured in the U.S. is now well over 2 million per year roughly 10 times that in 2004. It is now the most common rifle manufactured in the United States. No surprise it is involved in mass shootings.
That is not to say it is the cause of mass shootings.
If you’re my age, you probably recall kids in high school with hunting rifles (like by grandfather’s rifle, more powerful than the AR-15) in their cars or trucks parked in the school lot, and not a single thought was given toward shooting up the school. I estimate some 40% of my high school classmates in Wisconsin went deer hunting every fall. We have had guns in our culture since before our nation was founded, but only in recent decades have we witnessed the atrocious increases in gun violence, particularly against our children.
As an avid hunter in my youth, I can easily conjure the images described by Dr. Donohue. Unfortunately, the facts presented are not quite complete. In recent decades gun violence has declined dramatically. Until about 2016-18 homicide rates in the U.S. were at their lowest level since the early 1960’s having declined steadily from the mid 1990’s. Hard to reconcile that with a declining society and lax law enforcement unless these cultural phenomena appeared suddenly in 2016-18. Those on the left should also consider that homicide rates move up and down independently of household firearm ownership which has been fairly steady. That said homicide rates (nearly all related to firearms) are vastly higher in the U.S. relative to other wealthy countries and correlate highly with rate of gun ownership (see previous). The data on homicide rates are below but before we go there let’s pause and talk about the power of grandpa’s rifle.
In all likelihood grandpa’s rifle was a bolt action 30.06 firing a .30 cal round at a muzzle velocity of between 2500 and 3500 FPS roughly similar to that of the AR-15 with a 16 in barrel chambered for 5.56 and firing a standard NATO round (approx. 3000 fps). Whether those numbers equate to grandpa’s rifle being more powerful or not you can judge but please keep in mind there are a variety of factors (e.g., bullet type) that impact energy transfer. What really matters is that the energy transferred to the body of a 9-year-old little girl sitting at her desk at school is enormous and differs insignificantly when compared to that of a 30.06 round from grandpa’s deer rifle. I think we call this a distinction without a difference. That said, the comparison to grandpa’s gun is important as it highlights the difference between large capacity semiautomatic firearms like the AR-15 and what grandpa carried out to the deer stand which was probably bolt action rifle having a capacity of 3-5 rounds contained in a non-detachable magazine. Tougher to kill 19 little kids with that rifle.
What we are observing is a society in decline, an unraveling of civic order, likely arising from a general disregard for the lives and properties of others. I think you’ll agree that in our lifetime we have witnessed increased illegal drug use, fatherlessness, erosion of the family, crises in education, and increased rebellion and purposelessness among our youth, all of which are serious social problems and contribute in major ways toward violence.
Nope I can’t agree at least with most of this. Lots to unpack here.
Let’s call this; argument by distraction. This is not really an argument rather these are talking points intended to provide a litany of reasons why it must be true that: “The issue cannot be guns, or access to guns, because the guns have always been there”. Yes, indeed there are lots of other factors that impact mass shootings of little children but let’s not single out guns as the factor that is NOT important in the discussion.
Anyway, as I said, lots to unpack here so let’s take them one by one
1. Illegal drug use. Agree, drug use and drug related crime is clearly an important factor in violent crime, and we should agree to do more to address this. Although I don’t recall that is has been a factor in school shootings. Also, illegal drugs were a problem that has been around for a while especially in the past decade and did not seem to prevent the homicide rate from declining to its lowest levels in 50 years. Nonetheless it is very important problem.
2. Fatherlessness. This I presume would be measured by the number of children living in a single-family home. Children living in single family homes has declined steadily although not dramatically for the past 25 years. By the way, some of those homes are headed by a father (15- 20%).
3. Erosion of the family: see above
4. Crisis in education. Although I am not sure what this refers to; the literacy rate in the U.S. is over 90% and stable. Educational attainment is 88% for high school and 40 % for college. These figures are on a long term steady upward trajectory.
5. Rebellion and purposelessness in youth: Youth and teenage unemployment is at near-historic lows and more 60% of high school graduates enroll in college. Seems like purposeful activity. Certainly not on the decline. As a child of the 60’s I can recall when rebelliousness was a real thing.
More recently, we have witnessed political violence in the form of riots, property damage, theft and looting, arson, assaults on law enforcement, and attorneys general and judges who are soft on crime.
Agree, unfortunately those on the extreme of both sides seem not to be able to remain peaceful. Civil unrest has occurred in a variety of settings from the streets of Minneapolis to the halls of our capitol. Our nation’s leader(s) should consistently condemn rather than promote violence and encourage thoughtful discussion. Such condemnations have been unfortunately too little too late if they occur at all.
We even have politicians calling for and justifying violence against their opponents or their opponents’ supporters. Violence is glorified in our entertainment, music, video games, and social media. While I cannot propose a simple solution to all these problems, they need to be part of our conversation on violent crime, if we are to have any hope for consensus or problem resolution.
Again, lets touch on a couple of these because they are typical distractors used in these discussions.
1. Violent video games. Violent video games are a world -wide phenomenon most prevalent in Japan… Enough said.
2. Violence in social media. We agree although I might suggest another term…intolerance. Social media is a challenge that cuts both ways and like reasonable gun control there should be thoughtful limits on free speech as there are limits on all rights enumerated in the constitution or provided for by legal precedent or legislation.
Banning one particular rifle may make us feel like we’ve “done something,” taken “a step,” but it hasn’t been effective in the past, will further polarize our already fractured society, waste time and resources, and distract us from the more significant contributory issues.
An assault weapons ban is not one particular rifle it is a class of firearm that has specific characteristics that were defined in the previous assault weapons ban. If you are interested there is a Wikipedia article for that.
Lest we forget we all take our shoes off every time we go through security at the airport because one guy tried and failed to put a bomb in his shoe. Is that a waste of time?
Dr. Donohue has made an argument against the reinstatement of an assault weapons ban that may be compelling if one ignores some of the missing facts, talking points, misdirection obfuscation etc. At the core of the argument there is always a kernel of truth that I will address momentarily.
What we have witnessed in these posts is a sample of what goes on around the country at the dinner table, at the bar or in the lounge at work every day. Each side in the debate goes to their respective corner to spout a long litany of practiced talking points that create a great deal of heat and very, very little light.
Notably absent from Dr. Donohue’s post is a set of policy alternatives. If not an assault weapons ban what is it you suggest we do? Shall we continue, as it appears you suggest, to stand by and watch more children die in their classroom? Do nothing because the proposed solution is not perfect and will not stop all those with a desire to kill children?
Allow me to propose solutions for discussion debate and consideration. They are by no means perfect or comprehensive and they, as suggested by Dr. Donahue, address more than assault weapons. As Dr. Donohue correctly points out addressing assault weapons will not move the needle appreciably… except maybe for a few kids in grade school.
1. Rather than banning assault weapons, instead ban magazines with a capacity greater than 10-15 rounds (maybe even less – remember grandpa and his 30.06). Easy to define and easier to enforce than an assault weapons ban. As Dr. Donahue points out, there is no great benefit in trying to restrict the sale of AR-15. Especially since unlike in the 90’s there are now millions of assault weapons in circulation. Doing so would indeed create a volatile social environment and further inflame tensions.
2. Raise the age of firearms (all firearms) purchase to 21 years. Most school shooters are young white men whereas disproportionately handgun homicide is carried out by young black men. The common denominator is young men. Make the owner of the gun criminally liable for injuries resulting from the use of that weapon.
3. All sale or transfer of firearms should include a background check. This is a no -brainer.
4. A national Red flag laws with mandatory reporting and liability for failing to do so.
5. Firearms manufacturers should be liable for the products they produce just like everyone else.
6. Repeal the Dickey amendment which was enacted in 1996 to prevent research on the public health impact of gun violence.
Let me close with two quotes:
Justice Scalia wrote: “Like most rights, the right secured by the Second Amendment is not unlimited. It is not a right to keep and carry any weapon whatsoever in any manner whatsoever and for whatever purpose.”
Kimberly Rubio, the mother of Alexandria Rubio one of the victims stated so eloquently;
“to some guns are more important than children”.
Let’s all agree that the lives of children are more important than guns
From BW
Myron, did you post Donahue's private email to you on a public forum? That's sub-optimal. He's on point with what he said. Several other pediatric anesthesiologists I know agree with Brian. In addition to his points, why do you think schools are targets? Because they're no gun zones and murderers therefore target them. In TN, there was a massive shooting attempt at a church - the gunmen was shot by attendees before doing damage, 4 of which had their guns pointed at him. "Hard school zones" in some states, where some of the teachers carry, are not targets. This is personal to me as I lost a friend at a mass school shooting, and if I had been there with a gun, the shooter may have killed me but no one else. I hope going forward this will be a forum for pediatric anesthesia discussion, not politically charged topics. I should note I'm not a republican.
From Myron
BW: Just to clarify….Brian sent me his email to be posted in the PAAD in response to my call for an assault weapon ban. It was posted in its entirety without any editing on my part. Indeed, I’ve been encouraging our readers to respond to all of the PAADs and have tried to make a reader response a regular feature of the PAAD.
From Elliot Krane
Your first correspondent, Dr. Donahue, was bold sending his take on the massacre of children in Texas – surely he knew that his would be the only voice against further regulation of firearms. (He also seems to know way too much about firearms and ammo to support his contention of not being a gun enthusiast, but that is not the point here.)
Growing up in Arizona I have fired both 22 caliber and 30-odd-six rifles as a youth and have seen the wounds they produce in deer (or venison, as we call it on a plate)…small entrance wounds and sometimes exit wounds, but you can still identify the genus of the animal shot and strap it to the hood of your car for all to see on your drive home from the mountains.
The children in Texas did not resemble those deer as far as I can tell from the descriptions in the press. One child could only be ID’d by her new green Converse sneakers received as a gift only one day before. Other children were so mangled as to required DNA analysis from their corpses and their parents in order to ID their remains. Others were literally decapitated by the destructiveness of the ammunition. These were not the wounds of hunting rifles or handguns. They were the result of a rapid fire military grade weapon, high capacity magazines and high velocity explosive ammunition designed to cause maximum injury and destruction. If someone hunted with one of these weapons they’d have to bring their prey home in a barrel.
But Dr. Donahue makes some valid points: Fewer than 1% of gun deaths are from mass shootings; the majority of gun deaths are suicides, and the most others accidents, and single victim homicides. But I’ll still take a reduction of 1% of deaths because mass shootings are so horrific by their targeting of the innocent, vulnerable and the minorties — children in schools and movie theaters, Black patrons of a grocery store, gay men in a bar, Blacks in churches and Jews in synagogues. Clearly these are driven by hatred and bigotry, yes, catalyzed by the general decay of societal norms, as well as violent computer gaming and pernicious social media, and the effect of these on vulnerable disenfranchised young adult males: all the more reason to keep these weapons out of the hands of the public.
With 4,000,000 guns in private hands already, I argue that the 2nd amendment has now been fulfilled, the public is armed to the teeth, militias have their arsenals, and not another gun need be sold ever again. But if not that, then at least assault rifles, which are easy to define, and have no place in civilian hands any more than other military grade hardware.