10 May 2019
Dear Interested Readers,
I Am Not Sure How Much More I Can Take
In November 2017 the New York Times columnist Nicholas Kristof published an opinion piece entitled, “How To Reduce Shootings.” He began the article by pointing out how different our problem with guns is compared to the rest of the world. Since there are more than 300 million guns in our country, at least one for every man, woman and child that lives here, we have a problem that is very different than in any other country. Japan, for example, has about one gun for every ten residents and experiences less than ten gun deaths a year. Even more upsetting is the fact that we have 3 murders per 100,000 people which is six times as many gun related homicides as they do in Canada where there are only 0.5 murders with guns per 100,000. When we start looking at the data from the perspective of all gun related deaths the number jumps to 10.5 per 100,000. When you begin to analyze the data, the problem takes on the appearance of a public health issue, and that was Kristof’s point. Kristof’s thesis was that we treat gun violence, gun control, and gun ownership as political issues when we should treat gun related deaths as a public health problem.
Kristof uses multiple charts and graphs that are worthy of an article in the New England Journal of Medicine to bolster his point. The “fewer guns equals fewer deaths” chart is a valuable piece of data. Hawaii has the lowest percentage of households with a gun at about 20%. It also has one of the lowest death rates per 100,000. Over 80% of households in Wyoming have guns and they have one of the highest death rates at over 16 per 100,000. The same trends hold true for state regulations. The more heavily a state regulates gun ownership, the lower its death rate from guns.
Kristof has no illusion that we will ban guns anytime soon. The NRA is too powerful, and gun ownership is a cultural issue in many families. Kristof grew up on a farm in Oregon where about 50% of households have at least one gun. He participated in gun ownership and gun safety programs offered by the NRA in his youth, and thinks that the programs made a difference, but now the programs are mostly a presentation of NRA political propaganda.
Kristof points out that cars kill many people. We don’t ban cars, but we have dramatically reduced the number of automobile related deaths through automobile regulations. He suggests that we should regulate guns the way we regulate cars. He points out that the rate of auto related deaths per 100 million miles driven has been reduced by 95 percent since 1921. States like Connecticut that have increased gun laws and regulations have seen gun related deaths fall. In states like Missouri where gun regulations have been repealed, the gun related deaths have increased.
Kristof gets very specific about the changes in regulations that would lower the death rates while allowing responsible people to continue to enjoy their second amendment rights. They are:
- Background Checks
22 percent of guns are obtained without one.
- Protection Orders
Keep men who are subject to domestic violence protection orders from having guns.
- Ban Under-21s
A ban on people under 21 purchasing firearms (this is already the case in many states).
- Safe Storage
These include trigger locks as well as guns and ammunition stored separately, especially when children are in the house.
- Straw Purchases
Tighter enforcement of laws on straw purchases of weapons, and some limits on how many guns can be purchased in a month.
- Ammunition Checks
Experimentation with a one-time background check for anybody buying ammunition.
- End Immunity
End immunity for firearm companies. That’s a subsidy to a particular industry.
- Ban Bump Stocks
A ban on bump stocks of the kind used in Las Vegas to mimic automatic weapon fire.
- Research ‘Smart Guns’
“Smart guns” fire only after a fingerprint or PIN is entered, or if used near a particular bracelet.
Kristof’s final point is that there is more bipartisan agreement about appropriate regulation than most of us realize. As the chart below which I have lifted from the article demonstrates, an amazing 93% of households that own guns agree with 96% of households that don’t have guns that there should be universal background checks. 72% of gun owning households agree with 89% with households that don’t own guns that there should be a Federal mandatory waiting period on all gun purchases. The fact that we can’t move forward with the level of agreement that exists is a manifestation of a lack of political courage of our Congress in the face of objections orchestrated by the NRA.
One of the saddest realities in our collective experience with gun violence is that it seems that until the last week and a half shootings that had fewer than ten victims almost went unnoticed. The shooting at the University of North Carolina Charlotte on April 30th and the shooting earlier this week at the STEM high school in Denver drew our attention even though there were only two deaths in Charlotte and one in Denver. What you probably know that is new in each instance was that a brave young man sacrificed himself to thwart the shooter or shooters.
Kristof responded to the deaths of the two young men by writing once again about our collective ineptitude when it comes to preventing school shootings and other gun related deaths. His piece begins:
Politicians fearful of the National Rifle Association have allowed the gun lobby to run amok so that America now has more guns than people, but there is still true heroism out there in the face of gun violence: students who rush shooters at the risk of their own lives.
Let’s celebrate, and mourn, a student named Kendrick Castillo, 18, just days away from graduating in Highlands Ranch, Colo., who on Tuesday helped save his classmates in English literature class from a gunman.
“Kendrick lunged at him, and he shot Kendrick, giving all of us enough time to get underneath our desks, to get ourselves safe, and to run across the room to escape,” Nui Giasolli, a student in the classroom, told the “Today” show. Kendrick was killed, and eight other students were injured.
At least three boys in the class — one of them Brendan Bialy, who hopes to become a Marine — tackled and disarmed the gunman. “They were very heroic,” Nui said. Bravo as well to the police officers who arrived within two minutes of the shooting and seized the two attackers.
The courage of those students in Colorado echoes last week’s bravery of Riley Howell, a student at the University of North Carolina at Charlotte. Riley, 21, charged a gunman there and continued even as he was shot twice. As he tackled the gunman he was shot a third time, in the head, and killed, but he ended the shooting.
Kristof draws an obvious comparison between our usual lack of legislative or administrative response to a shooting versus what happened in New Zealand after its mass shooting in March.
When New Zealand experienced a mass shooting in March, it took the government of Prime Minister Jacinda Ardern just 26 days to tighten gun laws and ban assault rifles. In contrast, America has had 53 years of inaction since the University of Texas tower shooting in 1966 claimed 17 lives. Sandy Hook … Las Vegas … Parkland — so many dead; so little done.
Since 1970, 1.45 million Americans have died from guns — suicides, murders and accidents. That’s more than the 1.4 million Americans estimated to have died in all the wars in American history going back to the American Revolution.
This should also make us all cringe: In a typical year, more American children ages 4 and younger die from firearms (110 in 2016) than police officers do in the line of duty (65 in 2016).
That last point underlines for me Kristof’s original idea that gun violence is a public health issue. It is also a pediatric issue. But he has more points to make about what we could do, but don’t do. He repeats some of the suggestions that he made in his November 2017 article:
Some 22 percent of guns are still acquired in the U.S. without a background check; a person wanting to adopt a rescue dog often undergoes a more thorough check than a person buying an assault rifle.
Safe storage of guns — in gun safes or with trigger locks — prevents children and others from accessing firearms. Voluntary gun buybacks would reduce the pool of firearms out there. We should also invest in “smart gun” technologies that require a code or fingerprint to fire. We need more “red-flag laws” that make it more difficult for people to obtain guns when they present a threat to themselves or others.
And tell me: Why do we bar people on the terrorism watch list from boarding planes while still allowing them to purchase guns?
Kristof finishes with logic that is hard to deny.
Every day in 2017, the last year for which we have figures, an average of 107 people died in America from guns. We’re not able to avert every shooting, but we can save some lives. We need not have the courage of the students who charged gunmen; we just need to demand action from our members of Congress and state legislators.
That’s the best way to honor heroes like Kendrick Castillo and Riley Howell, by making such heroics less necessary in classrooms around America.
If a majority of Americans agree that we want to do impactful things that reduce gun violence, what is holding us back? I think that the answer is the same as the other political issues that chronically trouble us. If we want universal healthcare coverage, if we want to diminish global warming, if we want a workable immigration policy, if we want to repair our infrastructure, if we want to end the national destructive force of outrageous debt for a college or graduate degree, if we want economic equity in opportunity and compensation for women and minorities, if we want fairer elections without distortion from powerful individuals and corporations, we must go to the polls in 2020 and elect a president and a Congress with margins that enable resolution of these long term problems. I have had enough, and I do not want to watch the further violation of norms of civil behavior by those who have been elected to our highest offices and the continued erosion of the values that a majority of Americans still claim to respect.
Before these last shootings I was planning to write this letter about David Brooks’ new book, The Second Mountain: The Quest for a Moral Life. But, the shootings intervened. I am not crazy enough to think that my opinion adds up to more than one vote, but I also believe that one voice and one vote can make a difference if it is joined with other votes that are associated with similar votes. I keep looking for some common denominator for all the issues that move me. Brooks comes very close to speaking for me in his book. He spends a lot of time differentiating between happiness and joy. He wrote a column this week that is an extract of the first 50 plus pages of his book. If you want to read it click here.
I was originally attracted to his book as a potential asset in the attempt to understand the epidemic of burnout in healthcare, and I will expand and explain that concept in some future posting, but I also found wisdom in the book that I think tracks closely to the the questions that frustrate us like our inability to manage gun violence.
Early in the book, in Chapter 6 on page 46, which is really page 69 since there is a 23 page introduction that discusses joy from every conceivable angle, Brooks discusses “the soul” in a way that startled me. I have bolded what I think connects to the values that I believe drive most clinicians, and the values that should drive our demands to free us all from the specter of gun violence. Brooks writes:
“The other more important part of the consciousness is the soul. Now, I don’t ask you to believe in God or not believe in God. I’m a writer, not a missionary. That is not my department. But I do ask you to believe that you have a soul. There is some piece of your consciousness that has no shape, size, weight, or color. This is the piece of you that is of infinite value and dignity. The dignity of this piece doesn’t increase or decrease with age; it doesn’t get bigger or smaller depending on your size and strength. Rich and successful people don’t have more or less of it than poorer or less successful people.
The soul is the piece of your consciousness that has moral worth and bears moral responsibility. A river is not morally responsible for how it flows, and a tiger is not morally responsible for what it eats. But because you have a soul, you are morally responsible for what you do or don’t do. Because you have this essence inside of you, as the philosopher Gerald K. Harrison put it, your actions are either praiseworthy or blameworthy. Because you have this moral piece in you, you are judged for being the kind of person you are, for the thoughts you think and the actions you take. Because each person has a soul, each person is owed a degree of respect and goodwill from others. Because each person has a soul, we are rightly indignant when that dignity is insulted, ignored, or obliterated. Slavery is wrong because it insults the fundamental dignity of a human soul. Rape is not just an assault on a collection of physical molecules; it is an insult to a human soul. It is an obscenity. Obscenity, the philosopher Roger Scruton teaches, is anything that covers up another person’s soul.”
Gun violence is an obscenity. The fact that every person does not have access to adequate healthcare is an obscenity. When we allow the future of our children to be traded for current excess profits for a few, we are participating in an obscenity. In retrospect, every doctor or nurse that I have encountered, whose care was worthy of emulation, seemed to intuitively understand the concept of the worth of every soul, and sought to do everything they could to address the concerns that patients presented them. I fear that one reason we have not been able to eliminate gun violence is that we only respond to the souls we see in the moment. We are always hearing after the fact about the souls that are lost to gun violence. It is too late to protect the souls of the teachers and children lost in Newtown, or those enjoying a night out in Orlando, or a concert in Las Vegas, or gathered for Bible study in Charleston, or sitting in class in Parkland High, or worshiping at The Tree of Life in Pittsburg, and too late to protect Kendrick Castillo and Riley Howell who were both anticipating graduation. We do not know the names of the next souls who will need to decide in the flash of a few milliseconds whether to give up their own life to yet another shooter to protect others, or to dive under a table and hope that they will be one of the lucky survivors when the horror is over.
Public health problems are best managed prospectively when possible, and as expeditiously as possible when a crisis is occurring. Inaction almost always leads to the loss of more souls, and that is a moral failure. We have waited far too long to act. We have already rationalized away many souls. How many more will be lost before we find the strength to say, “Enough of this obscenity!” Collectively, by our inaction, we have been, and will continue to be, complicit agents in the perpetuation of an obscenity until we find just a little of the courage that Kendrick Castillo and Riley Howell had in abundance, or some of the wisdom that seems to be easy to find in New Zealand.
Beautiful Places, Thin Places
After a weekend visit with my son and his wife in Albuquerque, my wife and I spent some time with friends in Santa Fe. Whenever I go to New Mexico I am hoping to do a little fly fishing. Several years ago I bought a book of beautiful outdoor scenes entitled 49 Trout Streams of New Mexico by Raymond C. Shewnack and William J. Frangos. Over the years I been fortunate enough to fish a few of the suggested streams. My buddy Harry in Santa Fe is the perfect outdoor partner. He is a Vietnam veteran who served as a combat medic while he was Ranger in the 101st Airborne. He was awarded three Purple Hearts and multiple other medals for combat injuries and bravery while administering care to wounded soldiers under fire on missions into the jungle in 1970-71. After earning degrees in forestry and management he spent almost forty years working for the National Parks Service at sites from the Atlantic to the Pacific. Needless to say, he is a great guy to guide any venture into the wild.
Harry thought we ought to go to Fenton Lake State Park which is in the Jemez Mountains about an hour west of Los Alamos. Fenton Lake is the result of a small dam on the Rio Cebolla which is a beautiful trout stream. Today’s header shows the little Rio Cebolla downstream from the lake as it runs through a beautiful meadow surrounded by majestic ponderosa Pines. I would call the Rio Cebolla a creek. Further downstream cattle were grazing along the stream. Harry knows the area well because the National Park Service managed Bandelier National Monument and Valles Caldera National Preserve that lie between Los Alamos and Fenton Lake. If you were a fan of “Longmire,” the long running A&E/Netflix television series based on the modern western crime novels of Craig Johnson, the area may look familiar because it is where many of the outdoor scenes were filmed. The set for Longmire’s cabin sits at the edge of the Valles Caldera, and the Caldera is the familiar view from Sheriff Longmire’s front porch.
I am sad to report that I caught no trout in the few hours that we had to fish on Monday, but I did feel close to nature. Whether you are in the desert where you can see to what seems to be the far edge of the world, or in the mountains among the ponderosa pines and the meadows, it is easy to feel that you are in one of those “thin places” where the spiritual world comes very close to our troubled world. It is good for the soul to spend a little time in a thin place. I hope that you know where to find one.
Be well, take good care of yourself, let me hear from you often, and don’t let anything keep you from doing the good that you can do every day,
Gene
