March 19, 2001

It has become standard medical opinion that guns and violence are health problems, just like cancer and infection.

Now, after the Santee school shooting that killed two and wounded 13 two weeks ago, doctors say it is time to step up their prevention efforts.

Although firearm-related deaths in all age groups have dropped steadily in recent years, emergency physicians are frustrated that they haven't declined further.

Gun-control battlefield is shifting

"We have been too ineffective. Those two students died because of our failure," said Dr. A. Brent Eastman, trauma director at Scripps Memorial Hospital in San Diego.

Santana High School freshman Charles "Andy" Williams is accused of taking his father's .22-caliber revolver from their apartment and spraying the campus with perhaps 30 bullets.

The reduction in shootings over six years may have led many doctors into complacency that gun violence was going away, said Dr. David Hoyt, trauma director at UCSD Medical Center, where two Santana shooting victims were treated.

The shooting "really reaffirmed that this problem is going to take a lot more energy than any of us had thought," Hoyt said. "This has set us back."

Ultimately, doctors of all types must take on the battle in their routine encounters with patients, said Bob Seltzer, executive director of Doctors Against Handgun Injuries, a national coalition being formed by the New York Academy of Medicine and including the American Medical Association.

"Doctors should be asking their patients if they have a gun," Seltzer said.

And, he said, they should talk to patients who do own guns about the higher risk of accidental shootings and suicides in households with guns, and about keeping guns and ammunition locked in separate places.

Some doctors, including the new coalition, plan to lobby for stricter gun control and safety laws.

"We should go to Sacramento in force," Eastman said. "It is absolutely unacceptable for people to have this kind of unlimited access to a handgun."

Others, hesitant to enter the political fray over gun ownership, are aiming to change public attitudes about gun ownership, just as public health education has reduced the smoking rate.

As with the campaigns for motorcycle-helmet and seat-belt laws in past years, trauma surgeons are among the most vocal about preventing gun violence. They often see the ghastly results.

"It doesn't take but one or two nights of trauma call to understand what a compelling problem this is," said Dr. Michael Sise, trauma director at Scripps Mercy Hospital in San Diego. "There's only so much I can do in the hospital, but I can be out in the community talking about firearm injuries."

At the National Rifle Association's headquarters, spokesman Andrew Arulanandam said he would not comment on the doctors' efforts or the Santee shooting because "we don't think it has anything to do with lawful gun owners."

Nationally, almost 31,000 people died from gunshot wounds in 1998, the latest year for which statistics were available, including 3,792 aged 19 and younger.

Compared with a peak in 1993, those numbers have dropped by 22 percent for all ages and by 34 percent for teens and children. All categories of deaths are down: homicides, suicides and unintentional shootings.

For all ages, the firearm death rate is lower than it was before it started climbing in the mid-1980s. But for teen-agers it is significantly higher.

In San Diego County, the decrease in deaths has been even greater. In 1998, the county had 201 firearm deaths, 22 of them teen-agers, a rate much lower than the national average.

Federal and public health researchers attribute the improvement to a better economy, declining use of crack cocaine, community policing, youth programs and gun-control measures such as background checks, assault-weapon bans and legal liability for parents whose guns are misused.

Preliminary data for 1999 hint that the decrease in deaths may be leveling off, and the numbers may increase as a slowing economy puts more people out of work, said Jon Vernick, associate director of the Center for Gun Policy and Research at Johns Hopkins University School of Public Health in Baltimore.

An estimated 195 million firearms are owned by civilians in the United States, including 65 million handguns, Vernick said. About 40 percent of households have guns, and three-quarters of gun owners possess two or more.

One public health approach some states are considering is to require that new guns have built-in locks or fingerprint readers so they can be used only by the authorized owner.

Just as stronger frames and air bags have made cars safer, "we should try to make the product itself as safe as we possibly can," Vernick said.