Priorities in Recovering From a Lost Generation of Firearms Research

Firearm violence in the United States continues. What was once labeled an epidemic is now better described as hyperendemic. Over the past 40 years, between 30 000 and 40 000 Americans have lost their lives, and roughly 100 000 more have been nonfatally injured by firearms each year. That is more Americans that have been killed by guns since 1970 than all US servicemen and -women killed in all foreign wars combined. Although firearms result in an average of 90 deaths—and up to 300 injuries—every day in combined individual incidents, it is mass shootings that draw the most media coverage. There were 384 and 346 mass shootings of four or more people in the United States in 2016 and 2017, respectively¹—exactly one mass shooting a day over this two-year period. These events include some high-profile events like the Newtown, Connecticut; Orlando, Florida; and Las Vegas, Nevada shootings.

The year 2018 opened with 17 school shootings within the first 45 days of the year, including the Marjory Stoneman Douglas High School shooting in Parkland, Florida.² The Parkland shooting resulted in unprecedented action, including some of the largest and most prominent gun dealers and retailers, such as Dick’s Sporting Goods and Walmart, voluntarily stopping the sales of assault weapons and increasing the age at which customers can buy certain firearms.

IMPERVIOUSNESS TO CHANGE

Whether the Parkland shooting will be a watershed moment in the history of gun safety reform in the United States remains to be seen. Our firearm violence problem has been a consistent feature of American life for more than half a century, and it is seemingly impervious to change. There are many reasons for the ongoing epidemic, which are amply discussed in the literature. Driven by the gun lobby’s success in protecting gun manufacturers from regulation, the political discussion has largely been at a standstill. Intermittent expressions of support for gun safety reform—such as that President Trump recently voiced after the Parkland shooting—have failed to gain traction leading to meaningful reform. Public debate also waxes and wanes, with substantial attention paid to the issue after each high-profile, devastating mass shooting and relatively little sustained conversation on the topic after these tragic events.

PAUCITY OF SCIENTIFIC WORK

Of key importance and contributing to this state of affairs has been the paucity of scientific work in the area.³ Firearm research funding has been extraordinarily hard to come by; it has been stifled in no small part by the Dickey Amendment that Congress enacted after the Centers for Disease Control and Prevention (CDC) supported firearms research. Accusing the CDC of attempting to influence policy, Congress cut the CDC’s firearm research funding. Over time this has been interpreted as a ban on funding gun-related research and has subsequently influenced a broad range of federal scientific-funding agencies. Previous work has shown that, comparing research funding to burden of mortality, the consequences of firearms are among the least well-studied contributors to population health.⁴ The polarized politics of gun violence have prevented critical research on gun injuries and deaths that could help reduce this public health crisis, similar to what has proven so effective with other inherently dangerous consumer products such as automobiles and cigarettes. The paucity of critical research has resulted in serious gaps in our understanding of the negative consequences of firearms and, in particular, of the actions that can potentially mitigate these consequences.

PUBLICATION TRENDS

Perhaps most important, however, has been the disinvestment in generations of scholars who might have decided on firearm violence research as an area of inquiry on which to build their careers. Population health research relies on funding to create training opportunities for junior researchers. Because of the lack of training program funding, and of senior researchers to sponsor junior researchers in the field, there is an enormous shortage of scholars—a lost generation—who might have committed themselves to studying this particularly challenging and large public health crisis from an early stage in their careers.

Perhaps this is best illustrated by a simple look at publications in the field. Figure 1a shows a PubMed search of the number of articles published with the word “firearms” in the title or abstract. The figure shows a gradual increase in the number of such articles, with a substantial increase in 2017. However, the figure does not account for the overall gradual increase in all publications over the past 20 years as biomedical research more broadly has expanded, largely influenced by an increase in federal funding for such research. Therefore, Figure 1b shows the same data as in panel a but using as a denominator the number of articles with the words “public health” in the title or abstract. Correcting for the temporal trend, the figure reveals something rather different.

FIGURE 1—

Publications Indexed in PubMed With “Firearms” in the Title or Abstract by (a) Total Number of Articles and (b) Ratio of “Firearms” Articles to Articles With “Public Health” in the Title or Abstract: 2000–2017

Figure 1b shows that the relative number of articles concerned with firearms actually decreased compared with the overall baseline of such articles between 2000 and 2016. It is only last year, 2017, that there was a relative increase in the articles concerned with firearms compared with the overall concern with public health. This illustration is borne out by a review of the articles AJPH published on the topic. AJPH published one firearm-related article in 2013, four in 2014, five in 2015, six in 2016, and 12 in 2017, essentially publishing as many articles on the topic in 2017 as it had in all the preceding four years combined. Other scientific journals have also followed this trend, putting forward new high-quality research despite continued opposition and ridicule from the gun lobby.

Any such overall comparison of number of publications is obviously a simplification of a much more complex picture. However, the trends do make the general point, namely that we have been undergenerating articles in this field of inquiry, commensurate with our shortfall in firearm research funding combined with fewer researchers focusing on this issue.

SPIKE IN PUBLIC ATTENTION

That there was a clear increase in firearms-related articles in 2017 is heartening. It is also consistent with the dramatic increase in the mainstream media’s attention to the issue—catalyzed in no small part by high-profile mass shooting incidents. In the past year alone, all large media outlets have featured high-profile discussions of firearms, including compelling presentations of data and summaries of the range of solutions that would potentially contribute to a solution to the problem. The increase in academic publications appears to coincide with this spike in public attention, and to the extent that this represents a shift toward more research in the area it is a welcome shift indeed. Importantly, there is now, perhaps more than ever, the momentum for this research. Efforts by states and other entities to pass firearm legislation introduce a unique opportunity for research on the efficacy and effectiveness of such laws and policies to decrease firearm-related morbidity and mortality.

The question at this point, therefore, seems to be how do we collectively sustain this increase in firearm-related science to create a new generation of scholarship that elucidates the public debate? We suggest three approaches to recovering the lost generation of scholarship in the field.

TRAINING PROGRAMS

First, there is an urgent need for training programs that are explicitly designed to fund junior scholars in firearm violence and injury research. There has been some progress on this front, for example, the Bloomberg Philanthropies–funded focus on gun violence at the Johns Hopkins Bloomberg School of Public Health. Federal and foundation funding for such training programs, across academic schools of public health, is ultimately a priority to create glide paths to new junior firearm violence researchers focused on this highly understudied topic.

INNOVATIVE FUNDING MECHANISMS

Second, even as several institutes in the National Institutes of Health ecosystem move to create funding mechanisms that can support investigator-initiated grants, the shallow base of research where we are starting suggests the need for more innovative funding mechanisms that allow rapid funding of innovative ideas. Foundations are filling some of this need; for example, the Joyce Foundation and the Robert Wood Johnson Foundation have funded some firearms-related research.

Ultimately, however, any one foundation alone will not move us ahead. Innovative funding mechanisms could overcome the limited preliminary data that many investigators have and allow rapid turnaround for grants for studying prominent events in near real time. This will involve a concerted effort via a host of foundations, perhaps evolving into a consortium of researchers and foundations that work together to move this research forward. We should also not rule out the possibility of private and industry donors who would champion the cause of science and unbiased inquiry in helping reduce the vast US firearm violence problem.

NATIONAL REGISTRY OF FIREARM VIOLENCE

Third, we need a national registry of firearm violence, and it should include fatal and nonfatal firearm injuries and then create a robust database that investigators can publicly access. The World Trade Center Health Registry stands as an exemplar of this, having generated the most consequential data on the long-term consequences of the September 11, 2001, terrorist attacks. This has served as an opportunity for a range of investigators to publish on the basis of these data. New investigators are well served by having publicly available data that allow them to overcome barriers to entry in any particular field; this is as much, if not more, the case for firearms research as it is for other fields. Efforts such as the recently announced States for Gun Safety coalition (currently involving Connecticut, New Jersey, New York, and Rhode Island) will create a Regional Gun Violence Research Consortium that can provide the formative foundation for such a registry.

NEW GENERATION OF JUNIOR SCHOLARS

In 2016, we participated in a meeting of deans and directors of schools and programs of public health that resulted in an agenda for action in response to the firearms crisis.⁵ The first item on the agenda was strengthening research and scholarship. The increase in firearms-related publications in the past year is an encouraging sign of movement in the right direction. Creating opportunities for a new generation of junior scholars would be a major investment in a future when our firearm violence crisis is a concern of the past.