March 6, 2003
Dr. Edgar Suter's letter regarding Coben & Steiner's "Hospitalization for firearm-related injuries"
31 January 2003
Letters to the Editor
American Journal of Preventive Medicine
K. Patrick, MD, MS
San Diego State University
5500 Campanile Drive
San Diego, CA 92182-4710
619-594-7344
619-594-5613
Submitted By E-mail Only: ajpm@mail.sdsu.edu
Re: Coben JH, Steiner CA. Hospitalization for firearm-related injuries in the United States, 1997. Am J Prev Med (2003 Jan) 24(1):1-8
Dear Editor:
We wryly recall the late Sen. Edward Everett Dirksen's "pretty soon we'd be talking about big money" quip as we note that the much-vaunted $802 million estimate of 1997's gun injury medical costs represents 0.064% of America's $1.25 trillion in annual total medical costs. Apparently, neither the authors nor the peer reviewers noticed that this already minuscule fraction represents a 60% decrease from the last published estimate of gun injury medical costs. [1]
That minuscule percentage highlights another conceptual flaw in Coben's methodology. Where in medicine would we settle for a risk-without-benefit analysis? Doctors have themselves estimated that we kill 180,000 people each year (five times annual gun deaths, the equivalent of three jumbo-jet crashes every two days).[2] Would we leave the analysis of American physicians at that sensational factoid without considering the benefits physicians provide? We think not. When we last visited this issue,[3] we noted, with detail and citation, that every one of the relevant 15 studies found that annually 400,000 to 4 million Americans use guns to defend themselves. Using the methodology of gun ban advocates Max[1] and Nieto,[4] we calculated that the economic benefits of defensive gun usage was potentially $4.5 billion annually. Lives saved, injuries prevented, property protected, and medical costs averted are the benefits from guns far outweighing the purported detriment.
Another factor is invariably overlooked in tallying the benefits of gun ownership. As many as one-third of a billion people died at the hands of government in the twentieth century,[5] dwarfing all tallies of private crime. We doubt that anyone can convincingly refute that America's high rate of individual gun ownership has played a fundamental role in protecting Americans from deadly genocidal tyranny and planned wartime invasions. What is that worth in lives and money?
Finally, for the last 10 years as the proportion of the crime-prone 15-25 age cohort has fallen in the US population, so too has violent crime fallen (yet gun sales have skyrocketed). Medicine's gun ban polemicists have been silent about this news, but we expect that when violent crime parallels the anticipated increase in the crime-prone age cohort, we will once again hear Chicken Little in white coat and stethoscope shriek that "the sky is falling"; and, of course, that will certainly be "due to guns."
Yours,
Edgar A. Suter MD
Chair, Doctors for Integrity in Policy Research Inc.
[1] Max W and Rice DP. Shooting in the dark: estimating the cost of firearm injuries. Health Affairs. 1993; 12(4): 171-85.
[2] Leape LL. Error in medicine. JAMA. 1994; 272(23): 1851-57.
[3] Suter EA Waters WC 4th Murray GB Hopkins CB Asiaf J Moore JB Fackler M Cowan DN Eckenhoff RG Singer TR et al. Violence in America. Effective solutions J Med Assoc Georgia (1995 Jun) 84(6):253-63.
[4] Nieto M, Dunstan R, and Koehler GA. Firearm-related violence in California: incidence and economic costs. Sacramento CA: California Research Bureau, California State Library. October 1994.
[5] Rummel RJ. Death by Government. London: Transaction Publishers. 1994. p. 9.
If we rightfully acknowlege that some justified encounters do not end with just pulling a gun, then it must be acknowledged that there will be BGs shot and medically expenses incurred by purps.
Taken to the extreme, what would the economic benefit to society be of the following scenario:
1) Educate concealed carry holders on how to most effectively end a threatening encounter.
2) Send the BGs directly to the coroner instead of to the emergency room.
