We need an evidence-based, randomized trial on gun control

For just a moment, let’s take a scientific viewpoint about gun control here and try to leave emotions (and the Constitutional argument) out.

The best type of study to determine whether gun control and/or regulation would be a randomized trial: randomizing a state or country to regulation or not.

Since that’s not going to happen, the next best type of evidence we have to go by is observational, either case-control or cohort studies. The exposure is: gun control regulation. This could be considered dichotomously (yes/no) or continuous (level of regulation from strict to lenient/none).

The outcome is: death by guns. This could be considered in numerous ways: absolute numbers of gun deaths annually; relative numbers of gun deaths adjusting for size of population; number of gun massacres, etc. We could even consider any violent deaths, if you want to be more general.

In a case-cohort study, we’d look at the outcome first (let’s say, massacres) and look backward for the exposure, then calculate an odds ratio that the outcome was significantly associated with the exposure.

In a cohort study, we’d look at the exposure first, looking at level of gun control as a continuous variable. This could be done retrospectively or prospectively. As of now, we could only do this retrospectively. Then look for the outcomes (deaths, massacres, etc.), and determine a risk ratio that the outcome was associated with the exposure.

Either way, the data would indicate that countries with increased exposure (increasing regulation) is associated with a decreased odds/risk of the outcome (fewer deaths, massacres).

Please note that I did not say that increasing regulation caused fewer deaths, just that it was associated with fewer deaths.

Now, I do not have numerical data, so I am only going on what I understand to be true, the empirical data. If those who would not believe this to be true, the best way to deal with this is to show data that decreasing the exposure to gun regulation (i.e., increasing the populace’s ability to acquire firearms legally) is associated with fewer gun deaths.

Therefore, my preference is the following: until evidence (not raw emotions, beliefs, or Constitutional Amendments) that decreased regulation (including eliminating gun zones) results in decreased odds/risk for the outcome (gun death) is found in other countries, then there is no reason to accept the notion that we need to stop advocating for strict gun control. For that matter, stricter gun control has evidential support (even if not emotional support among some) and should be advanced.

If you choose to comment on this in the opposite direction, please think before you do. The anecdotal evidence currently being provided by those who would oppose stricter regulations is purely speculative. I am open to hearing the data to refute the above contention, but it needs to be at least as strong methodologically.

In other words, “case reports” (testimonials by individuals) or “case series” (testimonials by groups, including lobbyists) are weaker forms of evidence scientifically, and I will not consider them as valid as the comparative empirical data I have put forward as an argument.

Ryan Madanick is a gastroenterologist who blogs at Gut Check.

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  • http://www.facebook.com/glen.harness Glen E Harness Jr.

    That’s ok. We won’t consider your data either.

  • JonSanders

    Starting with death as your outcome makes your “study” bogus from the start.

  • JD

    Uh…the “evidential support” link that you provided to the Harvard site states that more guns=more homicides. It does NOT state that stricter gun control = less homicides. There is a huge difference between the two.

    While I agree that more guns means more people die from guns, there is data (including data attained by the FBI) that shows that increasing gun control legislation is associated with in an even further increase in gun related death. It’s fine to have an opinion, but to lecture us about evidence base, and then cite data that is not relevant to your premise, makes you a hypocrite at best, and a moron at worst.

  • http://www.facebook.com/profile.php?id=1370575920 Dave Blackmon

    Well the CDC did a literature review in 2003, unfortunately they were no able to evidence of efficacy with laws (http://www.cdc.gov/mmwr/pdf/rr/rr5214.pdf). Harvard may have some bias built in with the substantial donations given by Michael Bloomberg.

  • http://www.facebook.com/people/Brian-Mckenzie/1419117137 Brian Mckenzie

    Go back to meddling with Health Care. Compare Death/Homicide/Murder Rates of gun Violence for Chicago and Washington DC (both with extreme gun control legislation) to that of Austin Tx, Cheyenne Wy. Or maybe the examples of Soviet Russia, Vietnam, Weimar Germany – all mean nothing to you too for ‘evidence’ Your agenda is showing – go back to making people turn their head and cough.

  • Anon

    First, America is a violent society.
    From glorifying the military (why do we need to fly by Air Force bombers and have Marine riflemen march around at every football/baseball game?) to violence in movies, American culture is plain violent. We have a “Team America, F’ yeah!” mentality that encourages aggression in the guise of defending “freedom”.
    The handguns and shotgun used at Virginia Tech and Aurora are legally available in Canada, but are there are any mass shootings in Canada?
    (Note that for all the hype about “assault” rifles and high capacity magazines, the Aurora shooter’s AR-15 jammed, and he used a plain shotgun to kill. The Newtown shooter’s choice to also use an AR-15 again reflects the fetishization of the U.S. military’s culture of violence.)
    Second, America is a ghetto-tastic society.
    Every major American city has large swaths that look like a Third World Mogadishu. It is shameful. The overwhelming number of gun violence occurs in these areas, committed by African Americans and Hispanics with illegally obtained handguns. No one wants to address the correlation of race, criminality, poverty, and crime because Americans afraid of addressing the real causes. Yet all the talk about gun control is really about disarming law-abiding citizens or making it harder for them to protect themselves.

  • Apathetic_Crusader

    A few things I’d like to address here:

    First, you say that absent evidence proving a lack of gun control results in decreased gun deaths, there is no reason not to advocate for strict gun control. I disagree. You are talking about wielding the power of the state in order to incarcerate individuals, at great expense. As you noted (and casually dismissed), there is a right to bear arms enshrined in the U.S. Constitution as well–I’d no sooner toss it out for lack of evidence that it reduces deaths than I would toss out any of the other rights guaranteed there (speech, freedom of religion, etc). I also suggest that this is not a standard you would apply to anything else in your life. There’s no proof that gay marriage reduces deaths, should it be banned? What about poetry? Can we ban poetry because it doesn’t reduce deaths?

    Second, the metric of “gun deaths” is problematic. I don’t care about gun deaths specifically, I care about deaths in general. Actually, I want to narrow that a little bit–I care about accidental deaths and homicides, but I think people have a right to suicide, and therefore I have a hard time objecting to whatever tool they use. The reason why gun deaths is a problematic metric is that I don’t consider it a win if we eliminate 100 gun homicides a year, but at a cost of an increase of 200 knife homides per year.

    Third, I strongly suggest you take another look at what you’re citing as evidential support. The work that has come out of the Harvard Injury Control Research Center is politically driven and motivated, as opposed to an evidence-based examination of the subject. For example, when discussing the defensive use of firearms, they specifically define this only as instances where someone actually shoots an assailant, despite evidence from previous studies showing that the vast majority of defensive firearm uses involve mere display of the firearm. They say they’re ensuring that we don’t overcount defensive firearm uses by including non-events. I call it cooking the books. In other studies they play fast and loose, trading between homicides and suicides (including suicides and attempting to make it seem as though they are talking about homicides alone), or failing to control for relevant factors such as whether a given firearm was legally owned or not.

    You say that the data would show that increasing regulation would be associated with lower deaths. I am wondering on what basis you make that prediction, given that some of the areas with the toughest gun control actually have incredibly high rates of violence, including firearm violence. In actual fact, the best predictor that has been identified for firearm homicides is not any form of gun control, it’s income inequality. The desperate poverty that exists in many places leads to involvement in criminal activity, which in turn leads to homicides.

    I find this article very problematic–on one hand it demands strong evidence-based argument, and on the other hand it involves sloppy thinking and a failure to actually evaluate the evidence.

  • http://www.facebook.com/diane.white.1297 Diane White

    Leave the constitutional argument out of it? Then it means nothing. End of story.

  • Lisa Corcoran

    Australia has some of the strictest gun control laws in the world. A study at the University of Melbourne found that there was little evidence to suggest that their gun control laws had any significant effects on firearm homicides or suicides. Criminals do not obey laws and have ample access to guns, whether they are “banned” or not.
    Also consider that heroin and cocaine are absolutely illegal in this country yet we still have a massive addition problem. Keeping law-abiding citizens from access to whatever item/substance is bothering you does not solve the problem.

    • Marc

      Australia has a tiny gun harm rate anyway but it has been going down. And they’ve not a massacre since Port Arthur.

  • JD

    For the record, I am a physician, and I hate guns. I am not a gun owner, would never own one, and I think that guns do kill people. However, I do NOT hate gun owners. I hate mass murderers, but that represents a vast minority of gun owners. In any case, I do not think that gun control is a viable solution. I have seen data that suggests that is makes things better, I have seen even more data that it makes things worse. As a physician trained at some of the finest academic institutions in the country (including fellowship) I could never advocate “exposing” my patients to a therapy with that kind of data to support it.

    So….Dr. Madanick, here is some evidence for you. So far, other than this post, there have been 9 comments on your article. All 9 of them state, to varying degrees, that you do not know what you are talking about. There is not a single post that agrees with your analysis. Several of the comments suggest, not to be blunt, that you are an idiot.

    Furthermore, for those 9 comments, there are 37 votes up in favor of them, and only 6 votes down,

    I would suggest that the empircal evidence against you is fairly clear.

    To paraphrase you:

    I am open to hearing the data to refute the above contention, but it needs to be at least as strong methodologically.

    In other words, “case reports” (your single opinion) or “case series” (testimonials by groups, including physicians who use their status to try to influence political issues) are weaker forms of evidence scientifically, and I will not consider them as valid as the comparative empirical data I have put forward as an argument.

    • Marc

      So you think – or know – that there is no association with hundreds of millions of guns in the US and a massive gun death and injury toll and cost? Have you looked at countries such as the UK where handgun control is very strong?

      • JD

        “So you think – or know – that there is no association with hundreds of millions of guns in the US and a massive gun death and injury toll and cost?”

        I actually think and know the opposite. I think that the number of gun deaths in the USA are very associated with the number of guns.

        However, saying that “more guns=more gun deaths” is NOT the same as saying “more gun control=less deaths=the solution”. Gun control only decreases the number of LEGAL guns. It does not decrease, and in fact probably will increase, the number of ILLEGAL guns. Criminals and the insane, the very people who we do not want to own guns, don’t care about gun control laws.

        “Have you looked at countries such as the UK where handgun control is very strong?”

        Yes I have. Take a look at this.

        Here are the top 10 first world/european countries in terms of rates of gun ownership

        1) USA
        2) Switzerland
        3) Finland
        4) Sweden
        5) Norway
        6) France
        7) Canada
        8) Austria
        9) Germany
        10) Iceland

        And here are the top 10 first world/european countries in terms of murder rates:

        1) USA
        2) Albania
        3) Montenegro
        4) Latvia
        5) Liechtenstein
        6) Luxembourg
        7) Finland
        8) Bulgaria
        9) Macedonia
        10) Czech Republic

        Only the US and Finland is on both lists. The only common feature is that the US is first on both lists. So, the association between gun ownership and gun death is only true in the US. By logical deduction, the high rate of gun death in the US has more to do with being American than it has to do with the number of guns.

        • Marc

          Really – you’ve not thought this through at all. First, we can agree that the US has a high degree of inequality and social problems, which lends itself to violence. But so do other countries such as the UK. The big difference is that gangs and drunken youths in the UK do not have widespread access to handguns.

          Then your list also ignores the obvious fact that countries such as France, Finland, Switzerland and others mostly have rifles and shotguns, not handguns, and mostly in rural areas.

          And really – you must recognize that all guns start off as legal. If you’re saying nothing can be done to stem the transfer of weapons to criminals and also to keep guns safer and not misused, as so many are, then you are defeated before you’ve even started.

          • JD

            “The big difference is that gangs and drunken youths in the UK do not have widespread access to handguns.”

            No difference at all. Gangs and drunken youths do not have widespread access to handguns in the USA, either. At least not legally. These groups obtain their firearms by illegal means, including stealing.

            “And really – you must recognize that all guns start off as legal. If you’re saying nothing can be done to stem the transfer of weapons to criminals and also to keep guns safer and not misused, as so many are, then you are defeated before you’ve even started.”

            Boy – you really like to misquote me. I am not saying that nothing can be done. I am saying that gun control laws are not the solution. Now, if you can guarantee gun control laws would stop illegal gun purchases/attainment, I might be in support of them. But history has shown us that it will not work. There are laws controlling drugs….how is the drug problem doing in the US? Abortion used to be illegal too…but all that did was force women into desperate measures and (according to economist Steven Levitt) increase the crime rate.

            So what is there to do? The solution is clearly not a simple as “make guns illegal”. New gun control laws have introduced in the USA for decades, and the degree of gun violence has steadily increased during this time (I can show you data for that). So, exactly what gun control do you propose that has not already been tried and failed?

            The solution, I believe, is going to involve a complete upheaval in our culture, our economic disparity, and our mental health treatments. Clearly not a simple solution. But it is not a simple problem. Unlike you, I recognize that, so I do not just spew out “gun control” as a solution.

          • Marc

            “These groups obtain their firearms by illegal means, including stealing.”

            I’m sure you’d agree that if there are no guns to steal or trafficking and straw sales are made much harder then that’s effective. It certainly is in the UK.

            “The solution, I believe, is going to involve a complete upheaval in our culture, our economic disparity, and our mental health treatments. Clearly not a simple solution.”

            So – is that easier than stopping people like Adam Lanza’s mother from keeping a cache of semi-autos at home rather than kept securely at a shooting range? Is ‘fixing society’ easier than gun registration, compulsory checks on all sales etc?

          • JD

            There IS gun registration, and there ARE compulsory checks on sales. Gun control today is certainly more strict than it was 50 years ago. Yet, the rate of gun violence is far higher today. How can one argue that gun control works, when the strengthening of gun control in this country has been associated with worsening of the problem?

            You keep referring to the UK. I do not accept your premise that gun control has worked there, either. But suppose it did. Who cares? The overwhelming evidence is that in the USA, gun control does not work.

            I am for “no guns”. Gun control does NOT mean no guns. It means no LEGAL guns. Your assumption that gun control would have made it harder for Adam Lanza to obtain a semi auto is based on numerous assumptions, which have never been shown to be true.

            Permit me an analogy. Consider cancer. The “obvious” solution to this problem was to find a cure. And so billions of dollars, as well as significant government intervention, resulted in decades of research to find a miracle drug. Yet, the cancer death rate kept climbing and climbing.

            Was the search for the drug successful? By definition, the answer is no. However, some researchers, instead of jumping on the band wagon an saying “let’s try to cure this”, decided to think about it differently. They said “let’s try to prevent this”. It turns out that screening and education have had a far more positive impact on cancer deaths than “cure research”.

            Advocating for gun control is like advocating for “cure research”. It is well intentioned, and it seems like the obvious and easy solution. However, decades of experience, data, and numerous studies, has shown that in the United States this has been a major fail.

            Is “gun control” a simpler solution? Sure. But who cares if it doesn’t work?

  • DavidBehar

    Switzerland, and Israel. Anti-scientific, left wing wind bags, such as this author must account for their low murder and suicide rates.

    • DavidBehar

      The military guns and high capacity magazines are not for the home invaders. They are waiting for the tyrannical Commie lawyers now in full control of the three branches of government. All are lawyers. Gun control is a Trojan Horse for collaboration with the lawyer enemy of clinical care.

  • Kat

    And which gun laws would have stopped any of the recent killings? People that are killing people will not care how many laws they break. The year of the Columbine Colorado killings had the most strict gun laws under Clinton, and it did not stop those criminals. And even Clinton wanted armed guards in schools back then, just like NRA president Wayne LaPierre today.

  • http://twitter.com/CommunistThug Rules4Radicals

    Chicago can be the quick study here:

    Arguably the most oppressive (and unconstitutional) firearms restriction in the country produces the Murder Capital of the US.

    The Hunger Games ruling class is well protected, however.

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