Today, Explained - A gun policy game-changer

Episode Date: June 16, 2022

America’s gun violence epidemic is a public health crisis. After 24 years of blocked funding, Congress is finally starting to treat it like one. This episode was produced by Victoria Chamberlin, edited by Matt Collette, fact-checked by Laura Bullard, engineered by Efim Shapiro, and hosted by Sean Rameswaram. Transcript at vox.com/todayexplained Support Today, Explained by making a financial contribution to Vox! bit.ly/givepodcasts Learn more about your ad choices. Visit podcastchoices.com/adchoices

Noelle King, on Today Explained this week, we've been doing guns. We've been doing a lot of guns. So many guns. So many guns in this country, something like 400 million. We started the week by talking about the protest movement for better control on these guns. Then, per your request, we talked about the District of Columbia v. Heller, the most important Supreme Court case about the Second Amendment. And yesterday, we talked about the laws. The laws, some of them that work.

But today, Noelle, we're going to talk about DICCI. DICCI. Do you know about DICCI? No, I don't. DICCI is an amendment that prevented this country for over two decades from doing any research into gun violence as a public health problem. Yeah, that sounds very dumb. There's a very odd quirk in our federal government,

and we're going to try and figure out how it came to be and what can be discovered now about this gun crisis that we have now that everyone kind of realized how dumb Dickie was. Get groceries delivered across the GTA from Real Canadian Superstore with PC Express. Shop online for super prices and super savings. Try it today and get up to $75 in PC Optimum Points. Visit superstore.ca to get started.

It's Today Explained. I'm Sean Ramos-Firm, and this is Dr. Megan Ranney. I'm an emergency physician and academic dean of the School of Public Health at Brown University. My second favorite university. And have been a violence prevention researcher for over 15 years. Those of you who listen closely may recognize Dr. Ranney's voice. We had her on the show a few weeks ago to answer listener questions around gun violence in the United States after Yvaldi, but we wanted to have her back to explain her own firsthand experience with this issue. As an emergency physician, I see firsthand

the effects of a bullet on the human body, but also the ripple effects of gunshot wounds on not just their victims, but also on the community and the society around them. I also, as an emergency physician and as a researcher, know that there is nothing that comes through my doors in the ER that can't be prevented. And by approaching firearm injury as a public health problem, it means not being pro-gun or anti-gun any more than I am pro-car or anti-car or pro-pool or anti-pool. I'm about trying to make sure that the gun does not cause harm to humans. And I'm using the same science that we use for every other injury and illness to try to stop people from getting shot and stop having to have them come to the ER.

This is Dr. Ranney's whole thing. The gun problem in the country is a public health problem, and it should be treated that way. But the thing is, it hasn't been treated that way. And the reason... The reason is that for 24 years, we had virtually no federal funding to talk or study firearms as a public health problem. That dates back to 1996, when the infamous Dickey Amendment was passed. The gentleman from Arkansas. It was led by a junior representative from Arkansas, a guy named Jay Dickey. I'd like to generally discuss this issue.

Who created this amendment in the wake of a study showing that folks with a firearm in the home have a higher chance of dying of a firearm injury than folks who don't have a firearm in the home have a higher chance of dying of a firearm injury than folks who don't have a firearm in the home. We have the ownership of guns by itself is what this particular amount of money is going to. It is not a public health threat. This is not a statement on firearms per se, but rather an identification that there is risk. This research study was not all that complex or surprising. It basically showed that if there is a firearm in the house, there is a higher risk of someone in the house dying of gun homicide. Unfortunately, it was interpreted as a shot across the bow around the value of firearm ownership. This is an issue of federally funded political advocacy.

And advocacy organizations, particularly at that point the NRA, mobilized members of Congress to say that research on this topic shouldn't be done. Rather than calling violence a disease and guns as a germ, these people should be looking at the other root causes of crime. Poverty, drug trade, gangs, and children growing up without parental support, and the cruel trap of welfare dependency. And when the Dickey Amendment was passed, the CDC had all of the money that it had been spending on firearm injury removed from its budget. And again, to be precise, the Dickey Amendment

did not ban federal funding of firearm injury prevention research, but it was interpreted that way. Do you know that Congress will not allow the Center for Disease Control to study gun violence? Because the notion is, is that by studying it the same way we do with traffic accidents, somehow that's gonna lead to everybody's guns being confiscated.

What the Dickey Amendment actually said was that the CDC was forbidden from promoting or advocating for gun control. To be clear, the CDC can't promote or advocate for policies anyhow. It was almost a throwaway amendment in many ways, but it was interpreted and the result was the same, which is that federal funding was frozen. Help us understand what isn't being researched in this 24-ish year period where people think the Dickey Amendment says they can't fund research on guns? Gun violence was the least researched of the 30 similar mortality burdens, like sepsis. And the number of people doing research in this area could be counted on basically two hands.

Compare that to the hundreds or even thousands who are doing research on other issues that have similar mortality burdens. It basically destroyed the entire field and meant, as a result, that governments, community groups, and individuals had no evidence on which to implement firearm injury prevention programs. Again, imagine if the American Heart Association was having to work with no data on how to prevent heart disease. How does that happen? So this guy, Dickey, gets this amendment passed that says the CDC can't advocate for a certain policy on guns, which is already the case. And you're saying that that leads to the CDC basically defunding gun research?

Well, it led to Congress basically defunding gun research? Well, it led to Congress basically defunding gun research. Even though the Dickey Amendment didn't say it had to do that? That's correct. And can I tell you the irony is, towards the end of Dickey's life, he actually said that that was a mistake. I was on to other things and worrying about my constituents and I didn't follow through and say we need still need to do research. I didn't do that. The same way that we do research on automobile safety and reducing motor vehicle crashes and trying to reduce the

incidence of motor vehicle deaths. I've gone back through it in my mind to say, what could we have done? And I know what we could have done. We could have kept the fund alive and just restricted the expenditure of dollars. Was this amendment eternal? Does it have an expiry date? You know, again, because the amendment doesn't explicitly ban federal funding of firearm research. There have been, over the years, various attempts to go around it, in particular after Sandy Hook. Lift our national hold on the CDC and allow them actually to study the issue of gun deaths the way we are allowed to study any other cause of death in this country.

The American people support this as well. It took a couple of more years to get those appropriations back. How is this sort of interpretation of the Dickey Amendment finally undone? So starting even a couple of years before Sandy Hook, many of us in medicine had started to work to try to remind folks in medicine, as well as outside of it, that firearm injury is a health and public health problem. We started within our own house, within the American Medical Association, American College of Surgeons, American College of Emergency Physicians, and the American Public Health Association. That work picked up steam after Sandy Hook.

We gradually increased awareness and coalitions around the importance of both talking about firearms as a health problem and doing the research on how to prevent it, the same way that we do for any other injury or illness. So in late 2018, the American College of Physicians published a paper talking about firearm injury as a health and public health problem. And in response to this paper, the NRA sent off a tweet. This tweet from the National Rifle Association said, quote, someone should tell self-important anti-gun doctors to stay in their lane. That NRA tweet set off a firestorm of

response from the health and public health community. Thousands of physicians, nurses, social workers shared stories about how firearm injury is very much in our lane. I mean, Sean. I'm sorry, did you get in a fight with the NRA? So I don't actually call it a fight with the NRA. I have no interest in fighting with them. Let me be clear. The NRA can do what the NRA wants to do. I have interest in advancing the health of my patients and the communities in which I work. But the NRA was directing some ire at you directly?

Yeah, maybe. But we didn't direct our ire back. Our ire was directed at the fact that we were not getting funding to do the research that we know that we need to do. I mean, John, imagine if I told you that we'd done no research on the causes, prevention, or treatment of heart disease or cancer or HIV in 24 years. You would never accept that. And we shouldn't accept it for firearms either. So you guys kind of win this stay-in-your-lane fight? So I would say, rather than the win-lose language, I would say that we reframed Congress's view to the same view that Jay Dickey had at the end of his life,

which is that firearm injury prevention research is not a pro- or anti-gun thing. It's about reducing the burden of injury and death in our communities. But I know this, all this time that we have had, we would have found a solution in my opinion. And I think it's a shame that we haven't. No one in the United States, or virtually no one, wants their loved one to die from a firearm injury. And that's what this work is about.

Okay, I'm not going to use the win or lose language here, but how does one know when they've reframed how Congress thinks about something? How do you know that Dickey's no longer the status quo? Because we succeeded in having $25 million put into appropriations for CDC and NIH in 2019. That was released in 2020. And the first tranche of firearm injury prevention grants were funded September of 2020. A drop in the bucket of what is needed, but a step in the right direction nonetheless. More with Dr. Megan Ranney momentarily on Today Explained. Support for today explained comes from Ramp. Ramp is the corporate card and spend management software designed to help you save time and put money back in your pocket.

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Okay, so Dr. Rainey, where we left off, the federal government is finally funding research on gun violence after this 24-year period of subscribing to something they believe the Dickey Amendment says. You play a pivotal role in this sea change. What are people like you advocating they research with this $25 million in initial funding? That first $25 million led to around 15, 16 grants, which are looking at everything from trying to define the actual numbers of injuries that happen in a community. Yes, we don't even know exactly how many people are injured by a gun every year in the United States. So really simple data questions like that, which are almost unbelievable that we don't know it, through projects like the one that I'm leading, which is a collaboration with 4-H

and 4-H Shooting Sports, which have amazing track records of safety among the kids that participate in their programs, but which don't talk about risk factors for firearm injury. So we're collaborating with them to work with kids to try to talk about risk factors for firearm injury. So we're collaborating with them to work with kids to try to talk about risk factors and empower kids to identify and do something about those risk factors in their communities. Two, projects working with hospitals and emergency departments to help them identify folks at risk and provide appropriate culturally competent counseling to firearm owners. So there's a huge spectrum of projects that are being undertaken with this funding, none of which, to be very clear, have anything to do with promoting or

advocating for gun control. Rather, we are trying to create a science and knowledge around what works and what doesn't. The first big place that we need knowledge is around just that basic data. Just like with COVID, we need to know who's getting hurt, what are the circumstances surrounding their injury, and where do those injuries happen? The second big bucket is around identifying risk factors and protective factors. There are around 400 million guns in private hands in the United States. There are around 45,000 fatal injuries per year, at least in 2020. But that means that most firearms are not used to hurt or kill someone.

So what's the difference? What can we do to increase protection for people who have a firearm in the home, to reduce the risk that they or a family member die from a gun? What can we do to reduce risk among those who live in communities where firearms are prevalent or where firearm injury is prevalent? That's the second bucket of research. The third bucket of research is around what do we actually do? It's around designing programs.

It may be around changing the engineering of firearms. It may be around changing policies. It may be around community interventions or one-on-one change, hospital-based change. There's a whole list of things we could be doing in interventions. And then the last bucket of research is how do we put it in place?

Once we know what works, how do we standardize it and implement it? In some ways, that's the toughest part. Why is it so important that funding on research on the host of issues that you just listed come from the federal government? So for the past 24 years, others have been trying to fill in the blanks.

The little bit of research that has been done has been done with philanthropy or with foundation funds. And many of us have actually done it for free on the side. But that is not adequate to gather the quality of data or develop the large-scale programs that are needed to address this problem, which again, is the leading cause of death for children in America and is among the top causes of death for folks up to about age 44. Imagine if we had tried to address COVID without federal funding. We saw what happened in the early months, right? We didn't have adequate personal protective equipment. We didn't have adequate tests. We would never have gotten those vaccines up and off the ground as quickly as we did if we had not invested billions into Operation Warp Speed and vaccine research. and investigating things like long COVID, which are also of tremendous public health importance. Those federal funds make a difference because they allow groups of researchers, community members, patients to come together and do really high-quality, trustworthy work.

Without those large-scale federal funds, you're not going to be able to create that forward momentum, and you're not going to have the same quality of evidence. And it sounds like just dating back to the mid-90s, when there still was funding on this issue for public health research, that the fear from the NRA and gun rights types was that this kind of research would invariably lead to policy. And hearing you sort of list out all the different areas that we could better understand now, it does seem like, well, when you understand them, when you have the data, you might want to change some policies. Is that invariably where this leads? So policy is always part of the solution to a public health problem, but it is never in and of itself sufficient. Moreover, policy, good policy, should be rooted in the mores of a community

and should be created in a way that it can actually be implemented and enforced. So to me, yeah, policy will be part of it, but only part. And the policies that should be put in place should be ones that have data behind them and that we actually are committed to implementing and enforcing. And the policies surely won't be get rid of all the guns. God, no. First of all, that's not possible in our country. We do have this thing called the Second Amendment. Secondly, again, there are 400 million guns in private hands. And third, can you imagine if we had a policy that said get rid of all the cars or get rid of sex or we tried get rid of alcohol, which wasn't even in the Constitution? Didn't work so well when we tried to ban alcohol. Instead,

we've created policies that mitigate alcohol's harms as best we can. We have a lot more work to do in that front, but there's a lot of federal funding to do it. I'd like to see the same for firearms. When do we start to see the results of this research that's now being done? When do we start to get, you know, groundbreaking revelations? It is likely sometime in the next year that we're going to start seeing results out of some of these studies. It takes a little bit to get stuff up and running, and COVID sure as heck delayed a lot of us. Because you couldn't do as much in-person stuff. But I would expect that we'll start to see results in the next six to 12 months. You mentioned COVID, and it feels

like a reminder that when we're talking about the gun problem in the United States, we're talking about an epidemic. So firearm injury meets all the definitions of an epidemic. It's a growing problem concentrated among certain groups or geographies, although it is distributed across the United States, to be clear. And it's growing at a rate faster than expected. Do you think that idea itself is divisive? We are on a journey to both sides, seeing this as an epidemic. But I will tell you it's a journey I've been on for about a decade. And increasingly, it's one that both sides are on together. Just yesterday, I had a phone call with one of my

community partners, and we talked about how, for firearm owners, there has never been a more important time to talk about firearm injury as a public health epidemic, and that we all need to be on deck to reducing the risk to our kids and our communities, and that this is the way to preserve this constitutional right, is to be committed to changing the patterns of injury and death. There will always be some folks who espouse the extremes, and we're more likely to see that, of course, among the politicians who want to get re-elected and are appealing to a very specific base. But if you talk to the average person, most folks are on board. Dr. Megan Ranney. She kind of got in a fight with the NRA once and won, though she clearly wouldn't call it a fight or pick a winner or loser. She's an emergency physician as well as the academic dean of the

School of Public Health at Brown University, as well as a violence prevention researcher. Our show today was produced by Victoria Chamberlain, edited by Matthew Collette, fact-checked by Laura Bullard, and engineered by Efim Shapiro. The rest of the Today Explained team includes Halima Shah, Avishai Artsy, Hadi Mawaddi, Miles Bryan, Paul Mounsey, and my co-host, Noelle King. Our audio fellow is Tori Dominguez. Our supervising producer is Amna Alsadi. Vox's VP of audio is Liz Kelly Nelson.

We use music by Breakmaster Cylinder and Noam Hassenfeld. We've been talking about this gun problem in America all week, and we've had a whole lot of help from Jillian Weinberger. I'm Sean Ramos from Today Explained as part of the Vox Media Podcast Network and we're distributed on the radio by WNYC Studios. you