In this week’s New England Journal of MedicineGaren J. Wintemute, M.D., M.P.H. considers a huge problem that, for the sake of all of us — and especially our children —  needs fixing:

The United States has become an extreme example of what could well be termed “global gunning.” With less than 5% of the world’s population, we own more than 40% of all the firearms that are in civilians’ hands: 250 million to 300 million weapons, nearly as many as we have people, and they are not going away anytime soon. We have made social and policy decisions that, with some important exceptions, provide the widest possible array of firearms to the widest possible array of people, for use under the widest possible array of conditions.


Dr. Wintemute wants to strengthen existing gun laws:

We should start by requiring background checks for all firearm purchases. When a licensed retailer — gun dealer or pawnbroker — sells a firearm, a background check is performed and a permanent record is kept. But perhaps 40% of all firearms transactions involve private-party sellers, who need not keep records and cannot obtain a background check. I have observed hundreds of these anonymous, undocumented sales; they can be completed in less than a minute.

Not surprisingly, private-party sales are the most important source of firearms for criminal buyers and specifically for persons prohibited by law from purchasing firearms. Such buyers do not volunteer their stories, and savvy sellers know not to ask. Private-party sales are also probably the main reason that the Brady Handgun Violence Prevention Act, which requires background checks for sales by licensed retailers, did not reduce firearm-related homicides.1

Second, on at least two fronts, we should broaden our criteria for denying someone the purchase or possession of firearms. Among persons who purchase firearms legally, those with a previous conviction for a misdemeanor violent crime (e.g., assault and battery) are roughly nine times as likely as those with no criminal history to be subsequently arrested for a violent crime. With two or more such prior convictions, the risk increases by a factor of 10 to 15. Alcohol abuse is a leading risk factor for both interpersonal and self-directed violence, and firearm owners who abuse alcohol are more likely than other owners to engage in violence-related behaviors with firearms.


Dr. Wintemute would also like to see improvements on how to deny gun sales to those who are considered mentally ill.

Judith S. Palfrey, M.D., and Sean Palfrey, M.D. — pediatricians who have known gun violence professionally and personally — argue that even more needs to be done:

We believe that, at a minimum, several specific measures should be taken. First, the ban on assault weapons should be reinstituted. Magazine and ammunition capacity and the tissue-destruction capability of ammunition should be limited. Rather than increasing the number of guns in public places, as was recently suggested by the National Rifle Association, we need to set a goal of reducing the number of guns in our homes and communities. This reduction can be accomplished through tighter consumer-safety regulations, as well as licensure and certification of gun owners. Federal restrictions on the collection of public health data about gun-related injuries should be reversed. Continued emphasis should be placed on limiting children’s viewing of violent material on TV and through video games. Finally, we must dedicate more state and local funding to effective treatment of young people who are identified by parents, schools, and law-enforcement or mental health professionals as being at high risk for committing interpersonal violent acts.


Finally, John T. Walkup, M.D., and David H. Rubin, M.D. remind us of the difficulties ahead in trying to reform mental health care in the U.S., especially as it relates to those who are socially withdrawn and isolated:

Even if early signs were noticed, a mentally ill, withdrawn, isolated young man and his family would face barriers to full engagement in psychiatric treatment. Severely mentally ill people, especially if they are angry and alienated, do not often voluntarily seek treatment, and even those who do may not be fully engaged or cooperative. Young adults 18 years of age or older must consent to treatment; their families, as concerned as they may be, aren’t necessarily able to bring them to a care provider and can’t force them to continue receiving treatment. Moreover, our standards for confidentiality preclude involvement of concerned parents unless it has been specifically authorized by the young person. Also, pursuing care for individuals at risk has become more difficult. Mental health professionals have capitulated to a higher threshold for hospitalization, in part because of standards dictated by insurers; clinicians may also second-guess or fear civil commitment proceedings and so fail to advocate for higher levels of care.

The interface between mental health care providers and these important safeguards of individual liberty can result in delay in, or a complete lack of, a cohesive and comprehensive response to young adults who are experiencing psychiatric difficulties. Particularly, mentally ill young people have the capacity to mask their intent to harm themselves or others.


Here’s something everyone can do today to protect their children from gun violence:

  • Recognize that guns are irresistable to children.  If you have them in your house, your children will find them and want to play with them.
  • Keep your guns locked in an appropriate storage safe. (See the first point)
  • Store your ammunition separately from your guns.  Keep your guns unloaded when stored. (See the first point)
  • Do not keep a gun in your bedside table or under your bed. (See the first point)
  • Make sure all firearms are appropriately registered.
  • If you are a gun enthusiast, teach your family about gun safety early and often.
  • Expect that others in your family or community may not take these same safety measures.  Understanding this will protect your family as much as owning any gun.


There is no doubt that things are about to change in this country.  Gun laws will be added and strengthened.  Mental health care will be improved.  But will these changes be enough?  Only if enough citizens ignore the rantings of the NRA and its members.  Only if Americans treat the paranoid delusions and hatefulness of the anti-government/pro-militia crowd as mental illness on display.  And only if Americans  realize that those who are suddenly experts in the constitution and the second amendment are just pretenders (and that those who are the true law experts are entitled to their opinions — and opinions are all they have).

Are Americans ready to show Hadiya Pendleton’s dad that, in their opinion, enough is enough?

Is it time to heed the opinions of Gabrielle Giffords, herself a victim of gun violence and, along with her husband, Mark Kelly, a gun owner?

Who’s opinions have the most credibility?  Who wants to tell Mr. Pendleton and Ms. Giffords (to their faces) that their opinions are wrong?  Or dangerous?  Or un-American?

In the famous lyrics of Robert Hunter:

One way or another

This darkness got to give.