Jumping to quick conclusions after Newtown would be a tragic mistake

Gun rights advocates are correct: a well armed principal might have reduced the death toll from the tragic elementary school shootings in Connecticut last week. Gun carrying citizens might also have been able to take down the shooters in Aurora and Virginia Tech. To most people, after all, guns are about self-defense, not about committing crimes. As the old saying goes: “There has never been a mass shooting at a gun show.”

On the other hand, gun control advocates are correct to point out that mentally disturbed people like Adam Lanza would not be able to commit massacres if they were prevented from getting their hands on high-powered, semiautomatic weapons. They are also correct to point out that Americans have staggeringly easy access to weapons that far exceed what any sportsmanlike hunter would use during deer season.

In other words, figuring out what to do in the wake of the Connecticut massacre means recognizing the truth in both of these views. It means considering the possibility that the answer to reducing gun violence is a matter of both having more guns and less. To understand what I mean by “both more and less,” I offer two analogies: a straightforward one about airport security, and a more unexpected one about breast cancer screening.

For several decades now, experts have been working to reduce the chances that airline passengers will carry weapons on board airplanes. This strategy has been extremely successful in reducing airplane violence. But these measures have also been extreme – x-rays and metal detectors; long lines and pat-downs. But airport security does not stop with gun control efforts alone. After all, evil people do not need guns to commit violent acts. Organized martial arts experts could overpower airplane personnel with nothing but their limbs. So we have done something else: we have armed pilots and federal marshals with guns while they fly in airplanes. We have created policies that simultaneously decrease and increase the number of guns in airplanes, with a heavy emphasis on restricting guns, out of a recognition that zero guns is not a workable solution.

Of course airports and airplanes are uniquely vulnerable targets. We tolerate extreme gun-control measures in airports because we have become all too familiar with the consequences of allowing evil people to board planes with guns and even box cutters. We take some of the same measures in some schools, with metal detectors being an increasingly common sight on public school grounds. But there are limits to what we should do to restrict guns in our schools. I doubt any of us want TSA agents to replicate their airport security procedures outside of our nation’s elementary schools. What’s more, massacres have not been limited to school sites, but have also occurred in malls, post offices, movie theaters and college campuses. And finally, keep in mind that we have more guns in this country than we have people. We cannot expect even the most extreme gun-control laws to reduce the chance of massacres anytime soon.

Is more guns the solution to this problem?

The idea of arming US citizens with guns to prevent senseless massacres makes sense when we think of individual tragedies:

  • A well armed principal might have stopped Adam Lanza from killing all those children
  • A gun carrying movie theater manager might have been able to take out James Holmes

But this idea falls apart when we think beyond identifiable massacres, and consider the broader implications of a more heavily armed populace. And that is where breast cancer screening offers us guidance.

On The Diane Rehm Show on December 12, several experts debated the pros and cons of breast cancer screening. One of these experts was Dr. Wendie Berg, professor of radiology at the University of Pittsburgh. (In the spirit of full disclosure: I spent two years at Pitt in the early 90s and loved the place.) Berg urged women to get mammograms, with emotionally provocative language: “Women… may not see their child graduate from high school if they are diagnosed with advanced breast cancer.”

In addition to this emotional plea, Berg also appealed to a mathematical argument: “Out of, on average, 11 women who are diagnosed with breast cancer, one of these will have their life saved because of the mammogram.”

Let us accept these numbers for the purpose of discussion. Because even if these numbers are factually correct, they are the wrong numbers to think about when deciding whether mammography is a good idea. The numbers are flawed because they focus only on the population of women diagnosed with breast cancer. By contrast, screening mammograms are given to a much larger population of women, in hopes of identifying those who have silent breast cancer. It is impossible to understand the pros and cons of mammograms without looking at the entire population of women who receive this test.

Gil Welch did just this during this same discussion. Welch is a physician at Dartmouth and an expert on the risks and benefits of cancer screening. (He is an incredibly smart dude and, keeping up with this whole disclosure thing, is someone I’ve known for a couple decades now.) Welch acknowledges that mammograms save lives. Out of 1000 women screened annually for 10 years, approximately 1 will have a life saved because of her mammogram. But what about those other 999 women?

  • A few hundred will be subject to at least one false alarm
    • Leading to anxiety and painful biopsies
  • As many as 10 will receive aggressive treatment for what would have been a harmless cancer

Too often after gun massacres, we think like that Pittsburgh radiologist. We think about the specific identifiable tragedy, the place where we know something bad happened, and we imagine how it could have been a different place if an honest citizen had been armed with defensive weaponry: “If we had had more guns in the hands of responsible professors, the Virginia Tech massacre might not have been so deadly.”

That is the wrong way to think. We need to reason more like Welch – and consider the population as a whole, not just the population unfortunate enough to be in the wrong place at the wrong time. Guns can and do prevent deaths, when used in defense of situations. But more often, guns kill in other ways – through accidents for example. Many more children are accidentally killed by guns they find in the home than by any homicidal maniac.

The same logic is crucial in evaluating well-intentioned policies, such as laws requiring that children be placed in a car seat while flying on airplanes. No doubt, if an airplane has a runway crash, toddlers strapped to car seats will be more likely to survive than those wriggling around on their mother’s laps. But we need to take a broader look before deciding whether this kind of policy would actually save lives. We can’t just think about the population of children, the very rare ones, who are on airplanes that experience runway disasters. We need to think about the entire population of traveling children, many of whom will now be strapped into car seats in their family automobiles because their parents can’t afford to buy them their own seat on an airplane. Highways are much more dangerous, per mile, than airplanes. If we forced parents to buy airplane seats for their toddlers, to make them safer on the planes, we would be killing children, because many of them would be rerouted to the highways with their families, where they are much more likely to die.

In the face of unfathomable tragedies like the Connecticut shooting, it is natural to jump to quick conclusions. That is why gun rights activists quickly imagine a world where well armed teachers defy such assaults.

Thinking that way would be a tragic mistake.

Peter Ubel is a physician and behavioral scientist who blogs at his self-titled site, Peter Ubel and can be reached on Twitter @PeterUbel.  He is the author of Critical Decisions: How You and Your Doctor Can Make the Right Medical Choices Together.

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  • Homeless

    Well, in armed Arizona, Jared Loughner was wrestled to the ground when he dropped his magazine on the ground. Where was that armed hero that saved the day?

  • http://cognovant.com/ W Joseph Ketcherside, MD

    Interesting discussion. You don’t really talk about the actual problem here, which is the lack of mental health treatment in this country. Insurance companies have cut back payment and public funds are unavailable to the extent that mental health facilities have closed for years.

    To use your cancer analogy, this discussion is like arguing over surgery v radiation for lung cancer without paying attention to the smoking that caused the cancer in the first place.

    Americans have had access to guns for centuries, as have people in many other countries. Mass killings like this are becoming more common. The two cities in which handguns are completely illegal – Chicago and Washington DC – have extremely high gun violence rates. Maybe we should spend more time addressing the causes rather than the symptoms.

    • civisisus

      There is no “the” actual problem “Dr” Ketcherside. Please try to keep up, and keep your pernicious one-grating-note ‘pro-guns for everyone’ bilge to your twisted self.

      • http://cognovant.com/ W Joseph Ketcherside, MD

        Excuse me, but I did not say pro-guns for everyone anywhere. And you don’t know me, so you have no basis to assume I am “twisted”. And take the quotes off the “Dr”, I am an MD and earned it. And have taken care of plenty of the results of gun violence.

        I pointed out underlying causes of violence that must be addressed in addition to the discussions of gun control, which alone will not solve the problem. Pretty sure that makes it more than a one-note opinion. Maybe you need to do a little keeping up.

        And try being polite. People don’t listen to opinions from simple-minded asses.

        • civisisus

          I am waaay tired of being ‘polite ‘ with people who want to continue to be polite about large-magazine killing weapons & who insinuate that these devices are essentially the same as a musket used “centuries” ago.

          Let’s do something sensible now – stop making and selling these infernal devices – and then I’ll come back and apologize to you and the rest of ‘polite’ society.

          • http://cognovant.com/ W Joseph Ketcherside, MD

            Let’s do an experiment. Let’s put a couple guns in a house with two people. One is a normal, sane, responsible person. The other is crazy. Which one shoots up the school? Oh yeah, the crazy one.

            Fix the crazy. Let’s do something now. You can wail and moan all you want. Take away guns because you don’t like the shape of their handle. The kid in California shot another kid with a shotgun. Want to take all of those too?

            Quit bitching about the symptom, and start fixing the cure.

            Continue to be a rude and shrill whacko, and we’ll all continue to ignore you.

  • Paul V. Ryan M.D.

    With over 20 dead children, what is there really to discuss?

    Americans may one day awaken to face reality. These sorts of massacres will continue to happen in our country; indeed, they will become almost commonplace unless there is a change in values.

    The United States is composed of a society which values gun ownership before safety; which values a legal “right” to bear arms over the value of any given life, except of course, their own. For decades we have stood by and watched as inner city killings have indeed become a routine matter of daily existence. The Arizona shootings, the Virginia Tech massacre, and now Newton, Connecticut. Where will it stop? It will indeed not stop unless we as a society alter our values.
    The USA (and of course Western society as a whole) is indeed a society that is not awakened to the reality of it own inherent violent consciousness. From the military action in Iraq, where our military caused by even conservative estimates, at a minimum at least 100,000 (likely many more than that) deaths of the citizenry, i.e., women and children. Children as equally innocent as those in Newton. The video games that children play have become more and more violent. There is a huge industry devoted to the development and distribution of weaponry. We should ask ourselves why is there so much apparent surprise and astonishment at another mass killing?
    This is not an issue of mental health treatment. It goes much deeper than that. It reflects a much deeper problem with us that we will continue to allow our culture to place a higher value on arming ourselves and Guns and gun owners will remain. The NRA lobby will get stronger. There will be more and more people killed. The cause of this and all the other senseless killings is of our own making.

  • DonJAustin

    Dr. Ubel provides some very good attention to the need to understand the balanced and comprehensive *value* of measures taken for a given objective – which both the Federal government and the political/activist sphere seem incapable of doing. Too often we hear, for a bad problem, that we “must” to anything and everything that arguably *could* reduce the problem (even if not resolve it) and anyone who says otherwise is in favor of the problem. That is disingenuous and intellectually-bankrupt political and emotional theater at is worst. While we expect that from those directly involved in such tragedies, the rest of us should be more rational and reasoned.

    Unfortunately, after taking us in that direction, Dr Ubel ends by making a completely unsubstantiated closing statement that just lands with a “thunk”. I certainly don’t think I’ve *jumped* to the conclusion he frames. I further object to the skewing of the argument into hypotheses not argued. OF COURSE, just from the premise that armed citizens can stop a massacre, no one is suggesting that guns be handed out like candy bars. Nor is anyone saying that we need to double or triple the number of guns held by citizens. But the other side is very clearly saying that the “good guys”, who currently own and legally carry firearms and possess the skills to use them, should be *disarmed* in many places that have proven to be both dangerous and a target of “EDPs” or emotionally disturbed persons.

    That is, sir, by any historical and reasoned research, a *bad* idea.

  • http://www.facebook.com/people/Natalie-A-Sera/743004321 Natalie A. Sera

    Dr. Ubel said “Gun carrying citizens might also have been able to take down the shooters in Aurora”. Not true. The shooter was wearing body armor and had thrown smoke bombs into the theater. ANYONE who shot a weapon there would more likely have harmed other innocent people than have taken down the Aurora shooter. Adam Lanza also had body armor. The same is true of many other shootings — even the most skilled sharpshooter would have a hard time taking out the shooter when all is chaos, screaming, running bodies, and FAST action. Anyone who thinks differently has seen too many action movies, and not experienced enough real life. Sensible gun control does not mean taking hunting rifles and pistols for shooting ranges out of the hands of sensible people, but it DOES mean permanently banning military-grade assault rifles and limitless ammo. If people want to shoot, let them rent pistols or rifles at a range and buy a limited amount of ammo, the unused part of which must be returned. If they want to hunt, it doesn’t take more than 10 bullets to bring down the one deer they are allowed on their tag. And NO ONE should even be let near a gun without a background check, although many of the mass murderers had no criminal record. We will probably never prevent all gun violence, but we have many opportunities to decrease their frequency, if only we summon up the courage and the will to do it.

  • Molly_Rn

    There was an armed guard at Columbine, but he was having lunch. Your idea is nuts. You would have to have someone armed and ready at every door and constantly on guard, no potty breaks, no eating, no texting.

  • civisisus

    Deciding quickly that we ARE going to take some kind of measured steps to reduce future opportunities for gun violence is neither tragic nor mistaken. We can spend some time deliberating over which measures to implement – but we MUST act, and act now, to constructively diminish opportunities for these horrible and avoidable events.

    Dr Ubel’s essay may be well-intentioned, but his call for plodding deliberation is either poorly expressed or in cynical collaboration with twisted gun fetishists like Wayne LaPierre.

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