THCB

A Well-Armed and Regulated Citizenry, Led by Heavily-Armed Teachers in Body Armor …

Gun rights advocates are correct: a well armed principal might have reduced the death toll from the tragic elementary school shootings in Connecticut last week.

Gun carrying citizens might also have been able to take down the shooters in Aurora and Virginia Tech. To most people, after all, guns are about self-defense, not about committing crimes. As the old saying goes: “There has never been a mass shooting at a gun show.”

On the other hand, gun control advocates are correct to point out that mentally disturbed people like Adam Lanza would not be able to commit massacres if they were prevented from getting their hands on high-powered, semiautomatic weapons. They are also correct to point out that Americans have staggeringly easy access to weapons that far exceed what any sportsmanlike hunter would use during deer season.

In other words, figuring out what to do in the wake of the Connecticut massacre means recognizing the truth in both of these views. It means considering the possibility that the answer to reducing gun violence is a matter of both having more guns and less.

To understand what I mean by “both more and less,” I offer two analogies: a straightforward one about airport security, and a more unexpected one about breast cancer screening.

For several decades now, experts have been working to reduce the chances that airline passengers will carry weapons on board airplanes. This strategy has been extremely successful in reducing airplane violence. But these measures have also been extreme – x-rays and metal detectors; long lines and pat-downs. But airport security does not stop with gun control efforts alone. After all, evil people do not need guns to commit violent acts. Organized martial arts experts could overpower airplane personnel with nothing but their limbs. So we have done something else: we have armed pilots and federal marshals with guns while they fly in airplanes. We have created policies that simultaneously decrease and increase the number of guns in airplanes, with a heavy emphasis on restricting guns, out of a recognition that zero guns is not a workable solution.

Of course airports and airplanes are uniquely vulnerable targets. We tolerate extreme gun-control measures in airports because we have become all too familiar with the consequences of allowing evil people to board planes with guns and even box cutters. We take some of the same measures in some schools, with metal detectors being an increasingly common sight on public school grounds. But there are limits to what we should do to restrict guns in our schools. I doubt any of us want TSA agents to replicate their airport security procedures outside of our nation’s elementary schools. What’s more, massacres have not been limited to school sites, but have also occurred in malls, post offices, movie theaters and college campuses. And finally, keep in mind that we have more guns in this country than we have people. We cannot expect even the most extreme gun-control laws to reduce the chance of massacres anytime soon.

Is more guns the solution to this problem?

The idea of arming US citizens with guns to prevent senseless massacres makes sense when we think of individual tragedies:

  • A well armed principal might have stopped Adam Lanza from killing all those children
  • A gun carrying movie theater manager might have been able to take out James Holmes

But this idea falls apart when we think beyond identifiable massacres, and consider the broader implications of a more heavily armed populace. And that is where breast cancer screening offers us guidance.

On The Diane Rehm Show on December 12, several experts debated the pros and cons of breast cancer screening. One of these experts was Dr. Wendie Berg, professor of radiology at the University of Pittsburgh. (In the spirit of full disclosure: I spent two years at Pitt in the early 90s and loved the place.) Berg urged women to get mammograms, with emotionally provocative language: “Women… may not see their child graduate from high school if they are diagnosed with advanced breast cancer.”

In addition to this emotional plea, Berg also appealed to a mathematical argument: “Out of, on average, 11 women who are diagnosed with breast cancer, one of these will have their life saved because of the mammogram.”

Let us accept these numbers for the purpose of discussion. Because even if these numbers are factually correct, they are the wrong numbers to think about when deciding whether mammography is a good idea. The numbers are flawed because they focus only on the population of women diagnosed with breast cancer. By contrast, screening mammograms are given to a much larger population of women, in hopes of identifying those who have silent breast cancer. It is impossible to understand the pros and cons of mammograms without looking at the entire population of women who receive this test.

Gil Welch did just this during this same discussion. Welch is a physician at Dartmouth and an expert on the risks and benefits of cancer screening. (He is an incredibly smart dude and, keeping up with this whole disclosure thing, is someone I’ve known for a couple decades now.) Welch acknowledges that mammograms save lives. Out of 1000 women screened annually for 10 years, approximately 1 will have a life saved because of her mammogram. But what about those other 999 women?

  • A few hundred will be subject to at least one false alarm
    Leading to anxiety and painful biopsies
  • As many as 10 will receive aggressive treatment for what would have been a harmless cancer

Too often after gun massacres, we think like that Pittsburgh radiologist. We think about the specific identifiable tragedy, the place where we know something bad happened, and we imagine how it could have been a different place if an honest citizen had been armed with defensive weaponry: “If we had had more guns in the hands of responsible professors, the Virginia Tech massacre might not have been so deadly.”

That is the wrong way to think. We need to reason more like Welch – and consider the population as a whole, not just the population unfortunate enough to be in the wrong place at the wrong time. Guns can and do prevent deaths, when used in defense of situations. But more often, guns kill in other ways – through accidents for example. Many more children are accidentally killed by guns they find in the home than by any homicidal maniac.

The same logic is crucial in evaluating well-intentioned policies, such as laws requiring that children be placed in a car seat while flying on airplanes. No doubt, if an airplane has a runway crash, toddlers strapped to car seats will be more likely to survive than those wriggling around on their mother’s laps. But we need to take a broader look before deciding whether this kind of policy would actually save lives. We can’t just think about the population of children, the very rare ones, who are on airplanes that experience runway disasters. We need to think about the entire population of traveling children, many of whom will now be strapped into car seats in their family automobiles because their parents can’t afford to buy them their own seat on an airplane. Highways are much more dangerous, per mile, than airplanes. If we forced parents to buy airplane seats for their toddlers, to make them safer on the planes, we would be killing children, because many of them would be rerouted to the highways with their families, where they are much more likely to die.

In the face of unfathomable tragedies like the Connecticut shooting, it is natural to jump to quick conclusions. That is why gun rights activists quickly imagine a world where well armed teachers defy such assaults.

Thinking that way would be a tragic mistake.

Peter Ubel is a physician, behavioral scientist and author of Pricing Life: Why It’s Time for Health Care Rationing and Free Market Madness and his new book Critical Decisions. He teaches business and public policy at Duke University. You can follow him on his personal blog.

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RichRandom ObserverEdwardHMD as HELLlegacyflyer Recent comment authors
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Rich
Guest
Rich

The medical side of the gun debate is a moot point until after someone is shot. The system, meaning the way society has been changed to a point where parents are almost forbidden to RAISE their children rather and just let them grow up is the bigger problem. Responsibilty for children needs to be given back to parents and taken away from after-care givers and teachers. People need to be educated on what having a child means and not playing Russian Rollette having unprotected casual sex just because it feels good at the time. Governements need to stop socieal engineering… Read more »

legacyflyer
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legacyflyer

I think Random Observer has it right, the question is where the line should be drawn. The NRA wants the line to be drawn very widely, gun control advocates much more tightly.

These kind of issues typically call for some kind of compromise with neither side getting exactly what it wants.

Random Observer
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Random Observer

Gun advocates are using the 2nd Amendment as a smokescreen. The full text says “A well regulated Militia, being necessary to the security of a free State, the right of the people to keep and bear Arms, shall not be infringed.” There is nothing in the text about what kind of arms. Fully automatic weapons have been arbitrarily banned for many years. No citizen is allowed to own a nuclear suitcase bomb or rocket launcher despite those easily fitting in the modern-day realm of 18th century arms (think modern day cannons). The truth is that for whatever reason, the nation… Read more »

Peter1
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Peter1

“Sad to see how nobody calls the NRA on their fallacy.” The NRA through private citizens has done pretty well in the courts. Goggle “Heller” decision. The court ruled against DC and their attempt at gun control, but the Justices stayed away from examining the type of weapons that could be banned. Mostly the NRA has stayed away from the Supreme Court to avoid being surprised by an unfavorable decision. They do better threatening legislators and spending money on campaigns. The last assault rifle ban was nothing but Swiss cheese and was later overturned. Supreme Court never needed to get… Read more »

Random Observer
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Random Observer

Good points. I believe that the NRA has moved public opinion by hiding behind the 2nd Amendment, effectively responding to gun control measures with the notion that the Constitution allows the right to bear arms. In reality they are also proponents of gun control that matches their beliefs (even if one has to take it to the absurd level of no personally owned rocket launchers). The debate needs to be changed not to whether someone can or cannot bear arms, but to what level they can bear arms. I believe majority public opinion is (1) There is a some right… Read more »

EdwardH
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EdwardH

Gun violence injuries are a significant health care issue so is appropriate here. Should the 2nd Amendment allow citizen possession of high-capacity, military/police magazines in legally-obtained long guns or hand-guns where a mentally ill person or a criminal can discharge 30 (Newtown shooter) to 33 (Gifford shooter) rounds within 15 seconds, giving no time to escape or counterattack? The high-capacity magazines appear to enable mass casualties in a very short period of time at a very high cost to society and perhaps could be made illegal to possess, similar to recent the Supreme Court decision upholding restrictions on fully-automatic weapons.

Peter1
Guest
Peter1

“I think we need God’s help. I know I do.” You mean the solution is to pray more? I wonder if the Newtown victims were praying. I guess God was preoccupied solving other world problems. I hope people are fed up with praying, and grieving, and mourning, and burying, and trying to recover. There are about 80 deaths each day (including children) by people who want to solve their problems with a gun. Yet we only get excited if the one time count creeps up to the level of “mass” shooting. The gun nuts seem happy to keep the single… Read more »

MD as HELL
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MD as HELL

Not little “g”.

Peter1
Guest
Peter1

The “little g” denotes a god, not “the God”. Everyone likes to think of their god as the God. If the world was praying to the same god we’d have no religious wars. Maybe The God could make that clear to everyone and settle a lot of unnecessary killing.

I personally don’t believe in any god, but everyone is entitled to their own superstitions.

Merry Christmas MD

MD as HELL
Guest
MD as HELL

I do not belive in government. Merry Christmas, Peter1

legacyflyer
Guest
legacyflyer

Stepping aside for a moment from the gun control debate, I found it interesting to read an explanation of why small kids don’t have to be in “plane seats” while in the air – something that has always mystified me. “The same logic is crucial in evaluating well-intentioned policies, such as laws requiring that children be placed in a car seat while flying on airplanes. No doubt, if an airplane has a runway crash, toddlers strapped to car seats will be more likely to survive than those wriggling around on their mother’s laps. But we need to take a broader… Read more »

DJB
Guest

I really would like to know what it is that gun advocates expect to shoot with their military style automatic weapons. I inderstand that many feel it is an issue of “rights” and that the government shouldn’t take away the rights of the citizen. But we are not living in 1841, when people lived on farms, worried about bears and owned muskets. I work in a city where almost every weekend high vilocity bullets rip through the walls of innocent families. I can imagine the carnage if a homeowner began to shoot back. Is that how to protect the health… Read more »

BobbyG
Guest

I could get along just fine without a 2nd Amendment. No one’s yet come to confiscate my car because owning it isn’t constitutionally guaranteed.

As one commenter tweeted:

“I don’t know what the answer is, but I know I want it decided by frontiersmen who lived 230 years ago.”

John Irvine
Guest

then again, we could go with the French approach …

French psychiatrist guilty over murder by patient

http://www.bbc.co.uk/news/world-europe-20774516

Maggie Mahar
Guest

On Teachers– three thoughts., First, on the idea of arming teachers: Teachers, like all of us, are human beings and thus vulnerable to mental illness. Imagine a 24-year-old 1st grade teacher who has a gun in his desk. One day some combination of his body chemistry, his childhood, genetics, and the pressure of spending 8 hour days, alone, in a room with 24 six-year-olds catches up with him and he snaps. He opens his desk drawer and . . Alternatively, a junior high teacher keeps his gun locked in his desk. He leaves his classroom briefly. An emotionally disturbed 13-year-old… Read more »

Maggie Mahar
Guest

motomed– The problem is that we don’t have :”cures” for such severe mental problems– and often, these shooters show few (if any) signs of being a threat to others, Yes, in the aftermath of a shooting, people may report that they were :strange” or “kept to themselves” but you can’t put someone in a hospital, tie him to a bed and medicate him because he’s odd. Some of these shooters have actually been in therapy, but at these extremes, talk therapy is not going to cure their problems. Typically, the therapist is just as shocked as everyone else. He or… Read more »

Peter1
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Peter1

Maggie, there will never be a gun law that would keep a legal and mentally stable Nancy Lanza (shooters mother) from owning a gun unless the Constitution is amended. Using a tax on guns and ammo will bring in millions for mental health care which in this case may have helped Ms. Lanza get special counciling for her son. Something snapped in that boy’s mind, if he were in therapy he may not have snapped and his mother may have had the information she needed for intervention or even getting the guns out of he house. With all the extra… Read more »

motomed
Guest
motomed

I agree, by no means do I think incidents like this are predictable or preventable, but I also know how hard it is for families to get care for mentally ill loved ones. I can’t tell you how many times I’ve heard someone tell a terrified mother/father/family member “we can’t force them to get treatment unless they make a threat.” Maybe we need to loosen that standard up a little bit? A thoughtful post on standards for involuntary commitment would be nice to see. The issue is far bigger than just being about funding. Peter, As far as taxing guns… Read more »

Peter1
Guest
Peter1

Obviously motored you don’t want any taxes on guns/ammo, no matter what it is for. In fact gun owners do not want to take responsibility for anything that might cost them more. The tax need’nt have to be to large considering the amount of ammo used and guns in circulation. I’d truly like to see punishing taxes (especially on AR rifles and big clips) but that’s not going to happen. You right wingers always cry about unfunded mandates, so put your money where your mouth is and step up with some responsibility. Most of our mental health treatment is done… Read more »

motomed
Guest
motomed

actually in the post you’re replying to I said go for it, as in if it’s reasonable, do it. That is me stepping up and putting my money where my mouth is. I have made it very clear I’m willing to contribute my dollars to this problem, so please stop trying to caricaturize me as something I’m not. The rest of my comment was addressing your desire to make the tax unreasonable. It’s pretty simple, if you make the tax large enough to generate any real revenue, you run the risk of it being determined to be prohibitive and unconstitutional.… Read more »

Peter1
Guest
Peter1

“go for it” That’s a challenge not a discussion point. I’m not the one determining the size of tax but I don’t think it’ll need to be huge to generate a lot of money. But the NRA’s history on this is to oppose any tax. Their view is even small changes to gun control are a foot in the door. Hell they even oppose and lobby against animal protection laws, that’s how rabid they are on anything they deem “liberal”. “This dismissive attitude” Well that’s the pot calling the kettle black. The courts don’t really care if you’re dismissive, they… Read more »

john
Editor

I think we should arm the nurses and the day care center workers – only then will we have attained our full potential as a free society ..

motomed
Guest
motomed

People who have committed mass murder like Jared Loughner, James Holmes, and Adam Lanza had guns. But hardly anyone who has guns commits mass murder.

Peter1
Guest
Peter1

But gun owners want guns to be easily available which means available as well to people with mental illness. What better method exists to get treatment to people who have the potential to buy a gun and kill than to tax the vehicle for their murder. Mental illness treatment is expensive and underfunded, there needs to be a system to pay for it.

What exactly will gun owners take responsibility for?

motomed
Guest
motomed

There are plenty of gun owners who will join you in supporting increased funding for mental health. I’m as libertarian as anyone on health care and would be happy to pay into a government organized system that seeks to care for the mentally ill. The lack of funding for mental health is one of the tragedies of the entitlement society, I guess the mentally ill don’t represent a large enough voting bloc. Gun owners take no more responsibility for this than people who like to enjoy a glass of wine with dinner take for drunk driving deaths. What better way… Read more »

Peter1
Guest
Peter1

But I’m not advocating banning guns or alcohol, you’re intentionally changing the argument. If you haven’t noticed there are taxes on alcohol which help to fund DUI prevention and enforcement and prosecution. Not all people who drink are DUI and we can argue that most drinks are responsible, however all people who buy alcohol pay the same taxes. Taxing guns and ammo is the perfect fit to address a problem that even gun owners must agree they don’t want to see happen. By the way a Libertarian would not support a government system to address mental illness – that would… Read more »

MD as HELL
Guest
MD as HELL

Still looking through the wrong end of the telescope. It eventually comes out that the shooter was identified as “troubled”, or with a history of something that made them, retrospectively, likely to commit the crime they eventually did commit. But even that is looking through the wrong end of the telescope. Eliminating guns would definitely change the mode of violence available to the mass murderer, but it would not eliminate the culprit. Mass murder or serial killer. Pick your poison. Prevention can only get you so far. Now we can have the deterrence debate about the death penalty. Whoops! We… Read more »

Peter1
Guest
Peter1

“Two of the last three posts are on gun control, and not a post yet dedicated to ways to improve mental health care.”

I’ve already offered a solution in another discussion. Mental health care costs money as do measures to prevent guns from getting into the wrong hands. Tax bullets and guns based on their killing power and use that money for mental health and enforcement.