“If guns don’t kill people, why do we give people guns when they go to war? Why not just send the people?”

Ozzy Osbourne

About 6 weeks ago, I sat at the foot of my son’s bed listening to him describe how rumors of a potential active shooting threat spread at his middle school. 

I remembered as a young boy at a little league practice, hearing about Laurie Dann, who shot 6 children in a nearby suburb elementary school.  It was 1988, she was mentally ill, and she had a handgun.  I remember distinctly because my father came in the middle of practice, who never “taking chances.  Laurie took her own life, ending the spree.  But in sleepy Winnetka, this was unheard of.  Kids meantime were constant victims of violent gang and gun violence not 30 minutes away where my father taught elementary school at Dorothy J. Howe elementary school (Go Jets).  The Latin Kings, El-Rukns, and all the other sets that waged constant warfare and cost thousands of people their lives, their kids’ lives and destroyed their right to live their lives in peace. 

For many years, the flow of weapons into the state of Illinois came through Indiana.  The Chicago Skyway was a gunrunner haven where they would simply load up in Indiana and weigh their sedan trunks in one city and simple pay the 80-cent toll and sell right out of that same trunk 30 minutes down the road. 

Chicago was and is not the only city that knows gun violence with some areas of Los Angeles, San Francisco, Atlanta, Oklahoma City, Cleveland, Pittsburgh, and countless others where gunfire is a regular occurrence.  The epidemic of school shootings, similar to Laurie Dann’s horrid rampage became catapulted into the national consciousness with Columbine in 1999.  Eric Harris and Dylan Klebold acquired multiple guns and explosive devices and about 2 months before graduation, laid siege to Columbine High School in Littleton, Colorado.  It is important to know how they acquire the guns. 

According to the Violence Policy Center: “…a friend of Klebold and Harris, bought the shotguns and the Hi-Point 9mm Carbine at The Tanner Gun Show in December of 1998 from unlicensed sellers. Because Anderson purchased the guns for someone else, the transition constituted an illegal “straw purchase.” Klebold and Harris bought the TEC-DC9 from a pizza shop employee…who knew they were too young to purchase the assault pistol, but nevertheless sold it to them for $500.” and also verified by the Denver Post a few days after the shooting.  They were not loser, loners or the trench coat mafia.  This was also notable for pre-dating social media by decades.

The Columbine shooting, it turns out, was only the appetizer and the main event was the homemade bombs they left.  99 devices were found.  In their writings, they were inspired by Timothy McVeigh.  It was timed to coincide with the Oklahoma City bombing and also the siege on David Koresh’s followers in Plano, Texas. 

At Columbine, an unlicensed seller and straw purchase put the firearms in the hands of these two young men.  So, would them having the gun constitute the moment of the crime or when they pulled the trigger.  Seeing as both methods are illegal, it would seem the shooting is the fruit from the poison tree of the act of illegally acquiring the firearms.  The argument might be different if they had somehow acquired the firearms legally (they were both 18).  That is an argument many use to distract from the question of what actually happened versus a hypothetical. Some argue to “stick to the facts” when it comes to potentially curb what is seen as a constitutional right to bear arms.  It would seem here the facts are these two got their guns illegally, and thought that illegal act, murdered 12 high schoolers and wounded twice as many more, not to mention traumatized a generation.

Within a few months of Columbine, a large number of high schools were practicing active shooter drills, and some installed metal detectors.  Policies changed.  The national tenor of going to school changed.  Many regard Columbine as the watershed moment and model for many subsequent school shooters.  Some of the responses were constructive, many were not. 

We are transported forwards to Uvalde in 2022, where dozens of “good guys with guns” (the police) waited an hour and 14 minutes before going in because they were afraid of being wounded.  A former student, an 18-year-old man, fatally shot 19 students and 2 teachers and wounded 17 others at Robb Elementary in 2022.  Here, another person shoots up a school, and could have been confronted by law enforcement, who instead stood by while children were slaughtered.  They had lots of guns, training, and the authority and legal justification to use deadly force, and stood by. 

“What is an assault weapon” is a common refrain used to derail a discussion on firearms.  It is an honest question, asking to define something for the purposes of discussion.  The thing of it is, its pretty much been answered.  So, the frequent (mis)use of Socratic dialogue techniques to try to confuse and fire off chaff on a discussion that needs happen.  But this points to a larger question:  Why are we so hesitant to do the work and find out what can reduce the violence. Further, as gun enthusiasts themselves point out, not every school or mass shooter uses semi-automatic rifles, and many times it is a hand gun. It is interesting to note that when the assault weapons ban was enacted in 1994, legal scholars seemed to know what they were talking about.  (Department of Justice, 1994; see also Pub. L. 103-322, 1994)

A tweet from the National Rifle Association (NRA) account on X told doctors “to stay in their lane” in 2018 when physicians called for more firearm regulation.  The post is still up, and was summarily “ratioed” by angry parents, doctors, and advocates, the most prominent being Fred Gutenberg, whose daughter was killed in Marjorie Stoneman Douglas school in Florida.  One would think gun violence, and the death and disability is the essence of what we strive to prevent and treat.  Seems like a bad idea, both now and 6 years ago.   

Some gun advocates have suggested that guns promote freedom, citing the second amendment as mandamus.  In my time debating arguments on firearms, some have stated that the Holocaust would not have happened if the Jews had had guns.  During the Warsaw Ghetto Uprising when on April 19, 1943, the last 60,000 Jews were being cleared to go to the concentration camps.  A group of about 700-750 people had smuggled weapons, ammo, and grenades to fight back.  Suffice it to say the 2000 Nazis had a tactical advantage and the Jews were buried in rubble from fires, or poisoned by has as they tried to make it out through the sewers.

It was not just from the sheer number of Nazi soldiers and their artillery, but because also their ideology had such a hold on the Europe, and stemmed from hundreds of years of antisemitism.  Guns cannot cure centuries of bigotry and hatred, because no matter how many guns they got, the people that hated them would have made sure they had more than they did. 

The inherent terror on the side of concerned people against firearm regulation is that the information may lead to restrictions on firearms.  There is no way to know unless we do the work.  Large, well-funded studies can elucidate what, if anything can work.  It is possible many in the pro lobby might find themselves vindicated but perhaps instead it is the fear that more regulation instead of less will be shown to statistically to reduce many types of gun-related death and disability.

The NRA was founded in 1871, in order to improve soldier marksmanship after poor accuracy during the Civil War 10 years ago.  The NRA worked with the federal government in the 1930s and 1940s to create new gun laws, due to the rise in the US of gun violence and with the advent of the Thompson Submachine Gun and gangster/bootlegger violence during prohibition. In 1968, the Gun Control Act of 1968 required serial numbers and firearms and prevented ownership of a gun by those who have been committed for mental health reasons or with history of drug use.  The NRA changed stance in the 1980s, becoming more of in favor of gun ownership deregulation.  The NRA lobby has historically opposed the study of firearms, working through efforts aimed at more pro-gun members of Congress.  The NRA has also gone so far as to grade how pro-firearm a political candidate is.

Some studies have been done, but large retrospective studies have not enjoyed government funding.  Of the studies available, RAND has published a meta-analysis this year.  The publication of 152 studies showed 52 of the 144 policy effects examined.  It found: “Across all of the 18 policies that we examined, only three—child-access prevention laws, concealed carry laws, and stand-your-ground laws—had evidence that we classified as supportive, our highest evidence rating, for an effect on a particular outcome. Specifically, there is supportive evidence that child-access prevention laws reduce firearm self-injuries (including suicides), firearm homicides or assault injuries, and unintentional firearm injuries and deaths among youth. In addition, we found supportive evidence that stand-your-ground laws increase firearm homicides and supportive evidence that shall-issue concealed carry laws increase total and firearm homicides.”

https://www.rand.org/research/gun-policy/key-findings/what-science-tells-us-about-the-effects-of-gun-policies.html.

The RAND meta-analysis also openly admitted weak or scan evidence in certain areas studied due to methodological issues as well as the heterogeneity of gun laws available for study. 

“Importantly, however, where we conclude that evidence for a policy is weak, that does not mean that the policy is ineffective; the policy itself might well be quite effective. The absence of evidence about a law can result from the law not having been studied or studied well, which may reflect shortcomings in the contributions that science has made to policy debate, the absence of available data on key outcomes, or a variety of other methodological challenges facing gun policy evaluation researchers. “

But one very important salient point should not be forgotten: “Still, even relatively small effects of gun policies are important to the people and communities affected. Even a 1-percent reduction in homicides nationally would correspond to approximately 2,500 fewer deaths over a decade.”  So it begs the question:  why throw the baby out with the bathwater? 

Any neurosurgeon who has treated a gunshot wound understands what it physically looks like in a human brain or spine injury.  Having had that simultaneously satisfying and chilling sound of bits of shrapnel clink into a basin – I have had my share of chilling moments when I realized as I was closing up, that this person would never be the same and any semblance of their pre-gunshot life would be a blessing.  We need to agree to fund the work to see what will work.

What is important in our role as neurosurgeons is not to tell people what do with their guns, but to show them how guns affect people, and the wounds and death they inflict, treat, and support the victims of gun violence.  Further, we should as physicians and some of us as scientists should never fear what the objective data show.  And finally, if we get results that we do not like, even if it shows nothing works, it is not time to attack the methodology but to think long and hard what to do next.  We need to understand even a small delta, even if something helps reduce deaths by 3-5%, represents thousands of lives saved.  We should do the research, look at the information we get, and not attack results we do not like.

For Disclosure:  Our family donates to Mothers Demand Action, a PAC subgroup of Everytown USA. https://momsdemandaction.org/

Giffords Foundation: https://giffords.org/

Resource on the history of gun violence in the last 150 years in the United States, “Long Shadow:” Podcast https://podcasts.apple.com/us/podcast/long-shadow/id1577471264?i=1000652587604

NRA website: https://home.nra.org/

National Association for Gun Rights: https://gunrights.org/

National Sports Shooting Foundation: https://www.nssf.org/