Editor’s note: This commentary is by Christopher Barsotti, MD, who practice emergency medicine in Bennington. He is a member of the American College of Emergency Physicians, a fellow of the American Academy of Emergency Medicine, and he participates on the advisory board of the National Medical Council on Gun Violence. He lives in Pownal.
[V]ermont is in the midst of a public debate about proposed legislation to restrict firearm access among individuals with known risk factors for violence. Between stories of personal tragedy and battle cries against tyranny, discussions about guns and public health are highly emotional – almost by definition. In the latest round, data has been used to validate sentiment: Vermont is the “safest state,” and therefore gun regulation is a “solution in search of a problem.”
As an emergency physician, my practice guidelines are necessarily based on evidence. Incomplete data leads to spurious conclusions, and clinicians must be careful to look at data quality when we interpret evidence. Policy that concerns individual and public health deserves the same cautious, empirical approach, but this has not been the case when it comes to measuring gun violence.
… the abused woman whose husband put a handgun on the kitchen table “for effect” when he beat her; the out-of-control kid who grabbed an unsecured gun and faced down his parents when he was mad; the mentally unstable man who scared the hell out of his neighbors with an impressive array of high-capacity firearms …
The scale of gun violence is commonly measured in terms of completed, reported and classified violence: homicide, aggravated assault, suicide, etc. Given what’s at stake when it comes to guns in the hands of the wrong people, perhaps it’s best to look at the data and decide for yourself. Vermont crime data is available through the Vermont Domestic Violence Fatality Review Commission Report, the Vermont Crime Information Center, the FBI Uniform Crime Report and the Centers for Disease Control. The most recent year with comparative data is 2012, and here is the number of people who died by homicide in Vermont: 13, 7, 8 or 9. Each database reports a different number, and even within Vermont’s own data, there is a variation of 85 percent. Which data do you trust, and does anyone know how many people died by homicide in Vermont in 2012? Given the extreme variation in a single metric that seems fairly straightforward (homicide), what does this mean for our reported rates of aggravated assault, suicide, etc.? Is Vermont the safest state? I have no idea, because this degree of inconsistency indicates a systemic problem with the data, and makes it impossible to draw reliable conclusions.
Additionally, violence is notoriously under-reported, as one can see through (de-identified) examples from a single Vermont emergency room: the abused woman whose husband put a handgun on the kitchen table “for effect” when he beat her; the out-of-control kid who grabbed an unsecured gun and faced down his parents when he was mad; the mentally unstable man who scared the hell out of his neighbors with an impressive array of high-capacity firearms; the woman who tried to shoot herself with a long gun, but jerked the stock when she pulled the trigger, missed and blew a hole through her apartment wall; the heroin addict who dropped a handgun out of his pocket before passing out on the gurney; the kid who could have been a school shooter, but someone got worried and brought him in for treatment; the woman who overdosed on pills after witnessing the shooting death of a loved one. These are all examples of violence with a gun, but no one is counting.
They are also problems in search of a solution.
Safest state? It all depends on the data you choose to report, how you spin it, and the dangerous realities you either don’t know about or choose to ignore.”
