The vacuum in gun violence research in America is slowly being filled by independent organizations.
The latest to accept the responsibility for studying one of our most pressing public health crises is Kaiser Permanente, the giant health-care system, which last week announced a $2 million program to study how to prevent gun injuries and deaths.
With more than 12 million members and a presence in communities with 65 million residents, says Bechara Choucair, the organization’s chief community health officer, “we feel a responsibility to address public health issues, and gun violence is one of those issues.”
Firearm-related injuries caused 30,000 deaths in 2016, the latest year for which statistics are available. Kaiser Permanente physicians treated 11,000 gunshot injuries in 2016 and 2017 combined.
“Whether firearm-related injuries and deaths are coming from suicides, homicides or accidents,” Choucair told me, “we feel we’re particularly well-positioned to understand what role health-care systems can play to help prevent them.”
Kaiser Permanente’s effort appears to be unique among nonacademic medical institutions. But it may be uniquely situated to perform the sort of clinical studies that have been sorely lacking in U.S. gun violence research. The system is known for its ability to conduct clinical research among its huge patient base, including research into cardiac and cancer treatment.
In turning its sights on firearms violence, Kaiser Permanente will be helping to fill a gap created by federal agencies’ fears of the National Rifle Association. In 1996, the NRA strong-armed Congress into eliminating the $2.6 million it had appropriated for gun violence research by the Centers for Disease Control and Prevention. Congress then passed a measure drafted by then-Rep. Jay Dickey (R-Ark.) forbidding the CDC to spend funds “to advocate or promote gun control.” (Dickey later would publicly regret his amendment.)
The Dickey Amendment didn’t technically ban any federally funded gun violence research. The real blow was delivered by a succession of pusillanimous CDC directors, who decided that the safest course bureaucratically was simply to zero out the whole field. The result was to reduce gun violence research to an uncharted desert.
Non-federal institutions have recently moved to fill in the blanks. One is UC Davis, which has established the Firearm Violence Research Center with a five-year, $5-million grant.
The center’s director, Garen Wintemute, welcomes Kaiser Permanente’s initiative. “In this field, a $2 million research commitment will make a difference,” he told me by email. “One possibility that I find particularly exciting: Kaiser would be an ideal setting for research on how best to integrate firearm violence prevention into patient care.”
The $2 million may be just a start — a “down payment,” says David Grossman, a physician and expert in gun injury prevention at Kaiser Permanente in Washington state who will be co-leader, with Choucair, of the system’s task force on firearm injury prevention. Physicians know how to treat firearm injuries when they present at the hospital and have a good idea of which groups are most at risk. Therefore, Grossman said, the research will focus on interventions that physicians can perform for patients in high-risk groups, such as those vulnerable to abuse by intimate partners where “there is a firearm in the picture.”
“As clinicians, we’re seeing those folks,” Grossman told me. “We have an opportunity to help and intervene, and we’d like to know how we can be most effective.”
Grossman already has some experience in learning how intervention can reduce injury and death. In 2011, before joining Kaiser Permanente, he studied what happened after gun safes were installed in rural native Alaskan households, 95 percent of which owned guns. The study found that the ratio of homes with unlocked guns fell from 93 percent to 35 percent in a year, a trend the study team conjectured would lead to reduced gun-related injuries and deaths in the community.
The system’s doctors also have experience intervening to address chronic conditions such as alcoholism or motor vehicle injuries. “As a family physician, I’ve counseled thousands of patients over the years how to quit smoking or prevent car accidents,” Choucair says.
“There are decades’ worth of research that tell us how to screen for these issues, who to screen for these issues, what type of questions to ask, and if somebody screens positive, what are the types of interventions you need to do to address these issues. The reality is that when it comes to firearm injuries, we don’t have that body of research. We’re hoping that $2 million will start to fill in the gaps.”
One other difference: the political component. Few areas of American life are as touchy as gun ownership. It’s not unheard of for gun-happy state legislators to try to limit doctors’ abilities even to ask patients about guns in the home, an example of how politics can infiltrate the clinical office.
The system’s initiative will step lightly around politics, Choucair says. “It’s really, really important that we are leaving the policy debates to policymakers,” he says. “This is truly about science; this is not about politics.”
There are opinions, and there are facts. First, some facts.
It used to be that pregnancies were divided into trimesters and the state could not regulate abortion in that first trimester, could regulate it in the second only to protect the health of the mother, and could regulate or limit it in the third to protect the welfare of the fetus. That was the holding in Roe v. Wade.
Then, Pennsylvania became the battleground in the abortion debate with Planned Parenthood v. Casey, in which the Supreme Court eliminated the trimester framework, finding it flawed. It reiterated a woman’s right to choose, but made this important distinction, which was missing from the sterile posture of Roe: “The very notion that the state has a substantial interest in potential life leads to the conclusion that not all regulations must be deemed unwarranted.”
And so was born the concept of viability. For the first time, even though it continued to agree that a pregnant woman had a “liberty” interest in not being pregnant, the law gave dignity to the fetus and started to establish parameters by which this dignity — this “life” — should be recognized and protected by the government.
So these are facts: Women can have abortions, with some legal restrictions. While my opinion is that they should be legally prevented from aborting a child; my opinion is not a fact.
But if we acknowledge that women can have abortions in some circumstances, we also have to accept that they can be prevented from having them in others. And that is what brings us back to Pennsylvania.
Last week, the state House of Representatives fast-tracked a bill that would ban abortions based on a diagnosis or suspicion that the fetus has Down syndrome. The bill was moved out of the chamber’s Health Committee on Monday, and the House will likely vote on it this week.
Abortion rights groups are apoplectic. Newspapers have published op-eds opposing the bill as a grotesque infringement on the “woman’s right to choose,” as if no one had ever read Planned Parenthood v. Casey or understands the “fact” that women do not have unlimited choices when it comes to being “un-pregnant.”
Planned Parenthood has, predictably, come out full force in opposition to the bill. But I think the saddest part is that some parents of Down children have actually come out publicly against the bill, too, which strikes me as supremely inhumane. Just my opinion, of course. Here are some more of them:
To hear that a woman who has given birth to a child with Down is still willing to allow other children to be denied a future because she doesn’t want to infringe on another mother’s “choice” is a perfect example of the way society has dehumanized unborn life. It is the same principle at play when someone says, “I am personally against abortion but I don’t want to deny another woman that right.” Sorry to shatter your carefully crafted illusion, my open-minded friend, but you are not then personally against abortion. You just won’t have one yourself.
Those who try to turn the mother into a victim by lamenting society’s lack of resources for the disabled are so breathtakingly hypocritical, or naive, that I have to wonder if they even believe their own words, or are simply spouting a script prepared for them generations ago by Justice Oliver Wendell Holmes, who wrote the majority decision in Buck v. Bell, the case that authorized the sterilization of the “mentally impaired.” He stated in one chilling passage, “Three generations of imbeciles are enough.”
For the woman or man who thinks it’s OK to abort a fetus that would grow into what we once called “Mongoloid,” Holmes’ reasoning makes sense.
I believe the real reason people oppose this bill is because they are afraid to open Pandora’s Box. Once the lid comes off, it will reveal the stark barbarity of abortion taken to the extreme: a desire to eliminate the random imperfections and inconveniences of life. Just like Justice Holmes and his fear of imbeciles.
My friend Kurt Kondrich shares that opinion. He is the father to beautiful Chloe, who was diagnosed with Down in utero. He observes, “It is time to stop the ultimate form of bigotry: terminating individuals who do not meet the cultural mandate for perfection.”
I am thrilled that Pennsylvania is poised to turn our opinions into incontrovertible fact.
President Donald Trump’s missile strike against Syria will enable him to declare victory and applaud his own resolve.
But the attack won’t have much effect, because it isn’t connected to a clear, coherent strategy.
The missile strike will accomplish one narrow goal: It will reaffirm the international norm against using chemical weapons. That’s a good thing.
But it won’t change much on the ground. It won’t alter the course of Syria’s seven-year war, which Bashar Assad is winning with help from Russia and Iran. It won’t even protect Syrian civilians from future chemical attacks. It’s mostly about us — and mainly about the president’s irritation that his “red line” has been ignored — not about them.
At the most basic level, Trump’s missile strike will be aimed at punishing Assad for dropping chemical weapons on a neighborhood full of children, and deterring him from doing it again. But the Syrian president, “Animal Assad” in Trump’s tweets, is willing to absorb the punishment. He proved that after the U.S. missile strike against a Syrian airbase last year.
That attack was intended to deter, too, but Assad resumed using chlorine gas after a few months. For the Syrian leader, the chance to eliminate pockets of opposition and demoralize his enemies by suffocating their children is worth the risk.
An effective deterrent would require a much larger action than last year’s pinprick strike. Trump would need to promise that future attacks will be met with a continuing, escalating campaign against Syrian military assets.
But that would draw the U.S. more deeply into the Syrian war, a step Trump has resisted, just as Barack Obama did. In 2011, Obama declared that Assad must go, but he never found a way to enforce that wish at an acceptable cost. It was his greatest foreign policy failure.
Then, as now, the U.S. had clear interests in Syria’s fate, well beyond the war’s terrible cost in human lives. Assad’s brutal rule has helped spawn terrorist opposition groups, including Islamic State, which briefly ruled much of Syria and Iraq. An Assad victory could turn Syria into a permanent base for Iranian military units on Israel’s northern border. (The country is already a base for Russia’s navy on the Mediterranean.)
Now it’s Trump’s turn to grapple with a no-win situation. American interests haven’t changed, but there is one new factor: About 2,000 U.S. troops are in eastern Syria, finishing up the war against Islamic State, also known as ISIS.
The U.S. military is wrestling with a problem: Once Islamic State is defeated, what happens to the desert territory that pro-American forces have gained?
Last year, Defense Secretary James N. Mattis and then-Secretary of State Rex Tillerson announced a strategy of sorts. U.S. forces will remain in eastern Syria to help those local forces establish a provisional government, in a de facto American protectorate.
“What we are going to do is hold that territory and get it back in local leaders’ hands,” Mattis said a few weeks ago, “and assure that ISIS 2.0 doesn’t rise in the middle of all of that and derail everything we’re fought for.” At that point, he said, it will be up to the United Nations to restart its sputtering Geneva peace negotiations and produce a “post-conflict plan for the way ahead.”
But there’s a flaw in that strategy: President Trump doesn’t like it, especially if it means a long-term commitment. “I want to get out — I want to bring our troops back home,” Trump said recently. “It’s time. We were very successful against ISIS.”
Trump reportedly told Mattis that U.S. troops could stay in Syria for now — but only for “months, not years.” Meanwhile, he ordered the State Department to halt reconstruction aid to the area.
That’s not going to work. Trump has suggested that Saudi Arabia or other Arab governments could take the mission over, but the Saudis are inexperienced and unready. The Assad regime will do its best to undermine any effort to establish a competing government in its eastern provinces. And the United Nations has been trying to negotiate a peace agreement without success since 2012.
Just as Obama found, there are no easy choices in Syria, let alone easy victories. Trump will declare his missile strike a win, but don’t believe it. No strategy, no success.