The CDC's Framing of Homicide and Suicide As 'Public Health' Issues Provides Cover for Biden's Gun Control Agenda
The agency returns to a research area where it has caused much controversy in the past.
As director of the Centers for Disease Control and Prevention (CDC), Rochelle Walensky has a lot on her plate right now—perhaps too much, given her history of misrepresenting COVID-19 research, promoting dangerously mixed messages about vaccination, issuing confusing and scientifically dubious advice, and laying claim to vast powers that Congress never gave her. But Walensky's pandemic-related duties did not deter her from publicly switching focus to a highly contentious subject that has always spelled trouble for the CDC: gun violence.
"Something has to be done about this," Walensky told CNN last week. "Now is the time. It's pedal-to-the-metal time."
Although that metaphor suggests hasty action, Walensky emphasized that she is not calling for new gun controls. "I'm not here about gun control," she said. "I'm here about preventing gun violence and gun death."
In Walensky's view, the CDC needs to investigate the causes of gun-related deaths so that public policy will have a stronger empirical basis. "I swore to the president and to this country that I would protect your health," she said. "This is clearly one of those moments, one of those issues that is harming America's health….We haven't spent the time, energy, and, frankly, the resources to understand this problem because it's been so divided."
Walensky's disavowal of restrictionist motives and her lip service to finding common ground with "the firearm-owning community" would be more reassuring if it weren't for two facts. First, CDC-sponsored research in the past typically has served an anti-gun agenda that aims to reduce homicide and suicide by limiting access to firearms. Second, President Joe Biden has consistently used "public health" rhetoric to give his preexisting gun control ambitions a scientific patina.
Beginning in 1997, responding to complaints from the National Rifle Association (NRA), Congress prohibited the CDC from spending taxpayer money on gun violence research. That ban was lifted in 2018, and Walensky is taking advantage of the new leeway by funding studies aimed at "understanding the root causes of gun violence," as CNN puts it.
CNN presents the NRA's opposition to CDC research in this area as politically motivated interference with science. But as Don Kates and two other gun policy scholars noted in a 1997 Reason cover story, the studies funded by the CDC were controversial precisely because they seemed designed to promote a political cause.
"Contrary to [the] picture of dispassionate scientists under assault by the Neanderthal NRA and its know-nothing allies in Congress, serious scholars have been criticizing the CDC's 'public health' approach to gun research for years," noted Kates and company. They described some of that criticism:
In a presentation at the American Society of Criminology's 1994 meeting, for example, University of Illinois sociologist David Bordua and epidemiologist David Cowan called the public health literature on guns "advocacy based on political beliefs rather than scientific fact." Bordua and Cowan noted that The New England Journal of Medicine and the Journal of the American Medical Association, the main outlets for CDC-funded studies of firearms, are consistent supporters of strict gun control. They found that "reports with findings not supporting the position of the journal are rarely cited," "little is cited from the criminological or sociological field," and the articles that are cited "are almost always by medical or public health researchers."
Further, Bordua and Cowan said, "assumptions are presented as fact: that there is a causal association between gun ownership and the risk of violence, that this association is consistent across all demographic categories, and that additional legislation will reduce the prevalence of firearms and consequently reduce the incidence of violence." They concluded that "incestuous and selective literature citations may be acceptable for political tracts, but they introduce an artificial bias into scientific publications. Stating as fact associations which may be demonstrably false is not just unscientific, it is unprincipled." In a 1994 presentation to the Western Economics Association, State University of New York at Buffalo criminologist Lawrence Southwick compared public health firearm studies to popular articles produced by the gun lobby: "Generally the level of analysis done on each side is of a low quality. The papers published in the medical literature (which are uniformly anti-gun) are particularly poor science."
Kates et al. described Arthur Kellerman, then director of Emory University's Center for Injury Control, as "the CDC's favorite gun researcher," and his studies give you a sense of the agency's research agenda. In a 1993 New England Journal of Medicine article, for example, Kellermann and his colleagues reported that "keeping a gun in the home was strongly and independently associated with an increased risk of homicide." Specifically, the risk factor was 2.7, leading to the popular gloss that "keeping a gun in the home nearly triples the likelihood that someone in the household will be slain there."
Kates and his collaborators explained some of the problems with that conclusion. More on that here.
In a 1998 study published by The Journal of Trauma and Acute Care Surgery, Kellermann and his coauthors reported that "guns kept in homes are more likely to be involved in a fatal or nonfatal accidental shooting, criminal assault, or suicide attempt than to be used to injure or kill in self-defense." Specifically, they said, "The number of unintentional shootings, criminal assaults, and suicide attempts involving a gun kept in the home exceeded the number of self-defense and legally justifiable shootings by a ratio of 22 to 1. Guns kept in homes were four times more likely to be involved in an unintentional shooting, seven times more likely to be used in a criminal assault or homicide, and 11 times more likely to be used in an attempted or completed suicide than to be used to injure or kill in self-defense."
One glaring problem with this study is that Kellermann's team limited its analysis to cases in which guns were used to "injure or kill" someone. As scholars such as the Florida State University criminologist Gary Kleck have been pointing out for decades, counting only shootings vastly underestimates the use of guns for self-defense, which according to survey data typically involves nothing more than brandishing a weapon to deter an attacker.
Given this history, it would be understandable if gun rights advocates were concerned that the CDC's renewed interest in firearm deaths could serve mainly to produce anti-gun factoids. Walensky is keen to reassure them.
"We cannot understand the research [on] firearm violence, firearm injury, without embracing wholeheartedly the firearm-owning community," Walensky told CNN. "My job is to understand and evaluate the problem, to understand the scope of the problem, to understand why this happens and what are the things that can make it better—to research that, to scale that up, to evaluate it and to make sure that we can integrate it into communities….Oftentimes [there] will be escalating events that occur that might lead to a suicide or a homicide, and what we really need to do is understand the root causes of that. The firearm injury is probably the most distal part of what happens. It is the end event. What are the 10, 12, 15 things where we could have intervened before that singular event?"
CNN mentions a couple examples of CDC research grants that gun control skeptics might view as unobjectionable. "In one of those projects, gun stores in Colorado have developed a suicide awareness program," it says. "Another project in Vermont educates children about how to safely use and store guns." But other CDC grants raise the possibility that the agency is back in the business of supplying fodder to gun control supporters.
One study aims to "understand disparities in firearm mortality and to conduct innovative and more sensitive and precise evaluations of the effects of policies designed to improve firearm safety." Its findings "will be used to inform how firearm ownership varies across populations, communities, and time and how this variation relates to differential firearm homicide and suicide risk among subgroups."
Another study will "examine whether personal firearm ownership moderates [i.e., affects] the impact of individual and community opioid-related harm on individual firearm suicide risk." It also will "examine whether firearm availability moderates the impact of community opioid-related harm on firearm suicide rates."
I do not mean to prejudge the quality and usefulness of studies like these. They may shed light on important issues that are unresolved by the existing literature. But the history of "public health" research on guns is cause for skepticism.
Biden compounds that skepticism by using "public health" as an all-purpose rationale for gun laws he has long favored. The president argues that his proposals—including constitutionally and empirically questionable policies such as prohibiting "assault weapons," limiting magazine capacity to 10 rounds, requiring background checks for virtually all firearm transfers, and suspending people's Second Amendment rights to prevent them from committing suicide or homicide—are well-validated responses to a "gun violence public health epidemic." Violent crime, he says, "is actually a public health crisis."
This framing, which Walensky obviously supports, implies that homicide and suicide are analogous to communicable diseases caused by deadly microbes that spread from person to person without conscious human choice. In fact, they result from deliberate decisions. The analogy shifts the focus from targeted policies that might change the factors underlying those acts to broad restrictions that impinge on the rights of many peaceful, law-abiding people.
Consider the "red flag" laws that Biden favors, which authorize courts to suspend the Second Amendment rights of people who are deemed a threat to themselves or others. A 2020 RAND Corporation review found no scientifically sound studies indicating that such laws prevent either mass shootings or violent crime generally. It found "inconclusive evidence" that they prevent suicides, which the available data indicate is the justification for a large majority of gun confiscation orders. But even if we accept the estimates regarding suicide, they suggest that 90 to 95 percent of people whose guns are seized would not have killed themselves had they retained their firearms.
Is a 5 percent risk of suicide a good enough reason to suspend someone's Second Amendment rights for a year (or for up to five years, as California allows)? Civil libertarians are apt to be skeptical. But to public health specialists, preventing five or 10 deaths for every 100 interventions may look like an appealing proposition.
More generally, the model red flag legislation produced by Biden's Justice Department evinces an almost complete lack of concern for the serious due process issues raised by depriving people of the constitutional right to armed self-defense based on suspicions about what they might otherwise do. From a civil libertarian perspective, that attitude is hard to fathom. From a public health perspective, which sees reducing deaths as the overwhelming priority, this system is more likely to make sense, especially if the analysis ignores the potentially lethal consequences of preventing people from using guns in self-defense.
Biden's "public health" rhetoric applies a quasi-medical, pseudoscientific veneer to policies that should be critically examined on their merits. It implies that contentious measures are beyond serious debate, because public health experts know how to control epidemics, and their wisdom should not be questioned. Just as politicians cited the threat posed by COVID-19 to justify sweeping restrictions on millions of Americans, whether or not they were actually infected by the coronavirus, Biden cites the threat posed by violent crime to justify broad interventions that affect millions of Americans, whether or not they pose any sort of danger to public safety.
Perhaps Walensky's approach will be different. But the fact that an infectious disease specialist takes it for granted that people with that sort of training have as much claim to expertise in this area as criminologists and sociologists gives one pause. Does treating homicide and suicide like contagious diseases provide new insights, or does it conceal the underlying reality? Given Walensky's readiness to fight actual diseases with population-level restrictions on behavior, it seems likely that she is sympathetic to similarly broad interventions against gun-related deaths.
