Vol. 188 March 1, 2018 St. Valentine’s Day Massacre #2

March 1, 2018

Hub thumbnail 2015St. Valentine’s Day Massacre,
Chicago, Ill. 1929:
7 gangsters killed.

St. Valentine’s Day Massacre, Parkland, Fla. 2018:
17 kids & staff killed.

Firearm safety is a public health issue”
-Massachusetts Medical Society, February 2018

The 1929 massacre was partly responsible for the 1934 Illinois and 1935 Federal laws regulating machine guns. The laws actually did NOT ban the guns, They taxed them! The tax was $200 (about equivalent of $8000 today) and the annual license to own one was also very expensive. It effectively doubled the price of a tommy gun, the gangsters favorite. In 1986 the sale of fully automatic guns was prohibited by federal law “except those already existing in owners hands” that were grandfathered in. (1)

This year’s St. Valentine’s Day Massacre was the 30th mass shooting (more than 4 victims) in 2018 . . . so far. It was also the 17th time a gun had been fired on school grounds in 2018 . . . so far. AND on February 14, 2018 there were 28 additional gun deaths elsewhere in our country. (2)

Just to numb your brain with some more statistics (I know, I know . . .your eyes are already glazed over having read these numbers or others like them so many times), but during the period of 2009-2013 there were 722 per year firearm-related injuries Massachusetts, a state well-know nothing for its extensive of gun regulations . When you subtract the average of 121 suicides per year and 187 unintentional injuries per year some might say, “Only half are homicides. What’s the big push against gun violence.?”

And that’s when you can reframe the conversation into “gun safety”, not gun banning, not gun restrictions. That is the tack the medical profession is taking, and it might prove to be less confrontational to vested interests and more successful than other efforts.  Gun safety measures target preventing ALL of the 722 annual gun injuries. (pun intended).

The American Academy of Pediatrics strongly recommended a few years ago that pediatricians ask about gun safety as part of their usual assessments of household risks during a well visit; i.e. “If you have guns in the house,are they stored safe from the access of children?” One response was Florida legislature passing a law making it a crime for a physician to ask a patient or parent about gun ownership. The law was rescinded by the US Court of Appeals after the AMA brought suit.

In the same Feb. 24 2018 newspaper that Trump called for the arming of school teachers the Associated Press reported that 9,070 pupils (1 in 105 students) had to be physically restrained in Massachusetts school during the 2016-2017 school year.   244 of those incidents resulted in an injury to student or staff. Nationally the U.S. Education Department estimates that figure of physical restraint is at least 22,000 incidences per year. So, let’s just throw a gun into THAT equation! (CCT Feb. 24, 2018)

A relevant model of effective action is the decrease in auto fatalities by passing multiple laws and regulations, technological advances, and public education (Seat belts, airbags, speed limits, car cameras, etc.)

Smart gun technology  now exists to make guns safe, but they would still allow the owner to “repel any invaders of his house . . . or country”,  and might cut the number of gun injuries by 50%. Reducing mass homicides would require more regulation of automatic guns.

Organized Medicine’s new recommendations are to focus on gun safety.
1. Physicians should talk to their patients and families about gun accessibility, storage, and safety in the home.

2. The CDC should be allowed to conduct gun violence research (collect and analyze data)  like in any other public health epidemic.

3. Increase federally funded research on this “urgent health care crisis” of gun violence.

Many physicians belong to the NRA, “and that’s OK”. A physician friend of mine from Massachusetts was interviewing for a medical license by a physician panel in New Mexico. The chairwoman, noting his home state, asked him if he knew about gun control in New Mexico. He pleaded ignorance, and she responded, “A steady hand. Would you like an application to the NRA?”



Vol. 113 November 1, 2014 Threat Levels for Children??

November 1, 2014


Judging by the amount of media output (aka hype) about the perils of the world
our children live in, it does seem amazing that any of us adults survived our own childhood.



I just received a glossy, multi-color, four-page brochure from a leading children’s hospital’s “Injury Prevention Program” listing a whole host of “Fall and winter safety tips for kids”. It provoked some vivid memories of the “dangerous days” of my youth.

Here are some of the “tips” followed by an editorial comment based on my own childhood experiences.

1. “Children should NEVER push or roughhouse while on jungle gyms, slides, seesaws, swings, or other equipment.”
HELLO ?. If you can’t do that how can you determine who is “King of the Mountain”?

2. “Always slide feet first, don’t climb outside guard rails, and don’t stand on swings.”
Sliding head first was much faster, and after three sit-down slides, much less boring.
Billy Almy won the competition for the highest swing only because he was the tallest kid in the class when he stood up. It was certainly not because he was the best leg pumper! No way! Dick Perles was.
And how else could you practice for the rope climb in gym class except on the long, high leg of the tall slide?

3. “Remove all drawstrings from children’s clothing before they enter the playground. Other loose objects like necklaces should also be removed.”
I had no idea then that my hoodie was so dangerous. Without that hoodie drawstring what would I chew on while anxiously watching Billy Almy trying to beat my swing height?  Of course, today’s hoodies are considered a real danger in another way.

4. “There should be only one child on a playground device at a time. More than one child increases their risk of injury.”
See number 1 above, not to mention the seesaw where you could give the other kid a really good rump bump by quickly jumping off your side.

5. “Never let children trick-or-treat alone. Have them walk in groups with a trusted adult.”
We used to go out alone the night before Halloween, “mischief night”, to throw our toilet paper rolls, soap windows, and tip over garbage cans. As we parents grew older with our good neighbor friends, it became increasingly harder to find a “trusted adult”;  one that didn’t mooch a shot of scotch at every other house.

6. “Wear well fitted masks, costumes and shoes to avoid blocked vision or trips and falls.”
I guess that rules out any ET or clown costumes.

7. “During Christmas avoid sharp or fragile decorations for small children”
We always put the star on the top of the tree. Didn’t you?

8, “Avoid toys with pull strings longer than 12 inches and toys that have to be plugged into an electric outlet. Battery operated gifts are less likely to cause burns or electric shocks.”
Strangulation hazard x 2, I guess. BUT, they don’t mention those little lithium batteries that are so easy to swallow and can cause stomach lining burns. Good thing my parents didn’t have to worry about those when I was a kid.

9.“Use sleds you can steer. Always sit up with feet forward – lying flat increases the chance of head and abdominal injuries.”
Oh, now that they’re off the slide you want the kids to lie down! These rules that change with the season could be very confusing to an average kid. As I remember, our toboggans seemed to go willy-nilly where ever they wanted to go. That’s what made them so much fun.

10. “Melting or falling ice or snow can be dangerous for children. Avoid the sides of buildings or structures.”
Oh again, NOW it is safer to walk in the middle of the road!

11. “Children should only skate on public indoor or outdoor rinks.”
Where do we build the fire for the marshmallows?

12. “Cycling should be restricted to off-roads (sidewalks and paths) until age 10.”
Oh, now that the ice has cleared we can go back out into the street… if we are 10 or over.

True that “it’s a sad fact that injury is the number one cause of death and disability among children in the United States”, but the good news is that a whole lot of children are no longer dying from streptococcal infections, whooping cough, pneumonia, measles, congenital heart diseases, croup, etc.

When you look at the actual causes of death by injury to children you get a different impression. “Motor vehicle traffic” accidents is the number one injury killer of children up until the age of 15.  At 15 years “suicide” and “homicide by firearms” makes its appearance in competition for 2nd and 3rd billing. As one parent told me, “My seven year old kid is smart and careful enough to walk the four blocks to school, but I walk with him.  Not because I fear that he will be abducted, but because I fear that some driver talking on a cell phone or texting or adjusting his radio will inadvertently run him down.”

In the 0-4 year old age group “drowning” and “unintentional suffocation” trump “motor vehicle traffic”. That statistic is the basis of the quote that “under the age of 14 a child is four times as likely to drown than to die from a gun shot”, so pool safety (fences, direct visual adult supervision, and early swimming lessons) is key for protection of children.

One result of this well-intentioned brochure highlighting the dangers of schoolyard and playgrounds may be to just increase parental anxiety about local neighborhoods and fear of things that normal kids do.  I think that is unfortunate. Efforts to push safety around pools and other bodies of water, to reduce the number of guns in homes, and to increase the safe keeping of guns that are in homes are better directed ones.

Vol. 84 February 15, 2013 Let’s Treat Gun Owners Like Doctors

February 15, 2013

hubThe number of physicians in the U.S.:  700,000.
Accidental deaths caused by Physicians per year:  120,000.
Accidental deaths per physician:   0.171%
.                                  U.S. Dept. Of Health and Human Services

Number of gun owners in the U.S.:   80,000,000  (Yes, that’s 80 million)
Number of accidental* gun deaths per year: 1,500.
Number of accidental* deaths per gun owner:   0.0000188 %
.                                   Statistics from  FBI
So, statistically, doctors are approximately 9,000 times more dangerous than gun owners .- a popular internet 2011 chestnut

* “Accidental” excludes homicides and suicides. If you count those the number of gun deaths is about 30,000 per year. Between 2003 and 2007 15,000 of those gun deaths were children 19 or younger. (That is about twice the number of children deaths in motor vehicle accidents.) In 2010 there were 6750 U.S. gun deaths among 1-24 year olds. (Twice as many deaths as cancer, 5 times as many as heart disease, and 15 times as many as infectious disease for this age group)

The gun owners I know are very responsible about gun safety. Why make them “pay” for the transgressions of a few with stricter enforcement of regulations and/or creation of new ones?  Why not! We do it to physicians!

In response to a million dollar Medicare scam in Florida that billed sham patients for sham home care services Congress passed a law requiring that EVERY physician had to attest that he or she had met the patient “Face to Face” (F2F) within 30 days of ordering home care services.  Fraudulent actions by less than 0.001% of physicians have burdened all of them with a duplicative, clinically irrelevant, non-reimbursed reporting requirement that is of no use to patient, physician, or home care agency. No big deal you might think, but in reality the absence of the F2F report has delayed millions of dollars of Medicare reimbursement to all certified home care agencies throughout the nation. Hm-m, maybe that was the real reason the law was passed?

In response to “just a few deaths” from automatic weapons in the hands of less than 0.01% of gun owners why shouldn’t we pass some laws to improve gun safety.  Well, we apparently have; about 20,000 of them; laws that is, not gun owners. One problem is that they are not enforced.  The chief enforcement agency, the Bureau of Alcohol, Tobacco, and Firearms (ATF) of the Department of Justice is hobbled… restricted… dare we say “castrated” … as Jon Stewart has.

The ATF, THE federal agency overseeing firearms:

is prohibited from establishing a registry of gun owners (imagine no one keeping a registry of car ownersis prohibited from requiring gun dealers to maintain inventories of their wares

is prohibited from inspecting any gun dealer’s records more than once a year

is prohibited from revealing firearms trace data to anyone other than law enforcement personnel (firearm tracing is done for  firearms used in crimes. One study showed that 57% of guns used in crimes in one state were traced to only 1% of gun dealers.)

is prohibited from requiring gun dealers to respond to police inquiries.

Who made these rules?  Rep. (former) Todd Tiahrt (R-Kansas) put them deep into a 2006 spending bill. The Tiahrt Amendment, as it has become to be known, also permits gun dealers to destroy gun registration applications within 24 hours of completion so as “to avoid any inadvertent errors from being promulgated.”

Why doesn’t the ATF Director complain? Another Congressman, who was the winner of the NRA Defender of Freedom Award for that year, inserted into the 2006 Patriot Act the requirement that the ATF Director ( a mere Bureau chief)  be subject to Senate confirmation; the only Bureau Chief with that requirement. Senate has never done it.  The current part-time ATF Director is a Prosecutor from Minnesota.

Why are Federal laws needed? Massachusetts has some of the most comprehensive gun laws and in 2009 had one of the lowest per capita gun deaths in the country, BUT…in 2011 366 of the 699 guns used in crimes in Massachusetts were traced to sales in other states. One-third of them (133) were bought in New Hampshire and used in Massachusetts.

So we may not need any more laws or regulations for gun safety. We could just repeal the one “Tiahrt Amendment”, and let the ATF begin to do its job
… but maybe physicians should hire the NRA lobbyists to push for repeal of the F2F regulations.

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