Recent eLetters

Dear Editor

Re: Profs. Chapman and Alpers reply to Dr Lawson. E-letter 9 Jan 2007.

I thank Professors Chapman and Alpers for their interest in my letter[1] in response to their paper[2].

It seems that all parties[3,4,5] agree on the facts, that there was a steady decline in gun murder and suicide before the Australian National Firearms Agreement of 1996 and that this trend continued at a slightly accelerated rate post NFA. A few years later, a declining trend in total murder and suicide also began. Whether this means we can call the NFA a “success’ is problematic. As I pointed out in 1999[6], the precise goals were never defined at the outset. Hence anyone can make up their own concept and change it whenever they like. Chapman et al have chosen to define success as fewer or no mass murders with guns. They are of course entitled to do this. Chapman considers that the activist must "frame the debate". “How best can these different framings be assessed in terms of their reception by politicians and others who make decisions about policies.” [7]. Others may equally consider success as a sustained reduction in murder and suicide rates, not otherwise achieved, in a cost effective manner.

I cannot comment on the “gun lobby" websites mentioned by Profs. Chapman and Alpers, as they do not list them in their references. However the factors mentioned are indeed included in the Australian Institute of Criminology publication “Indicators of Aggressive Behaviour”[8], as being relevant to violence in general, along with firearms availability as one factor. This paper reiterates that firearms account for only 24% of suicides and 15% of murders (p22)

It is interesting to review the references provided by Profs. Chapman and Alpers.

The FBI uniform crime reports quoted[9] indeed give frighteningly large numbers for US homicides and presumably Chapman and Alpers have calculated their ratios from these. However Chapman and Alpers neglect to point out that the same site reports decreases in rates of 2.4% and 3.3% for 2003 and 2004 respectively, an annual fall similar to that in Australia. The WISQARS Injury mortality reports[10] similarly show large figures for the numbers of US deaths. However, the rates per 100,000 are printed right alongside and are more informative. For 2004, US total murder rate=5..91, The ratio of US to Australian total murder rate of 5.91/1.6=3.69 is not nearly as exciting as saying that the US has 173 times the number of Australian gun deaths. This is an outstanding example of Chapman’s concept of using of "creative epidemiology" in advocacy work, ie. “reworking” the data into "new, interesting and arresting forms."[11]. From the same source, 67% of US murders are with guns, compared with Australia’s 16%. For the US, the same reference shows a black murder rate of 21.07, about six times the white rate of 3.63 and a black gun murder rate of 16.06, about 8 times the white rate of 3.96. One wonders about the cause of this discrepancy, as blacks and whites presumably have the same access to both legal and illegal guns. Could broader societal factors be involved? I find it incomprehensible that Chapman and Alpers declare we cannot learn anything from a society which has halved its murder rate over 10 years. The US suicide rate of 11.05 is very similar to the Australian rate.[12]

The British are indeed fortunate that their spiraling gun murder rate has started from such a low base. Chapman and Alpers have not addressed the problem that the confiscations they favor are associated with the opposite of the desired effect. The deaths are still going up, even if many of the lesser offences do involve air guns and replicas.

The article by Morrell et al,[13] quoted by Chapman and Alpers, maintains that the fall in suicide of young adult males is attributable to the government’s National Youth Suicide Prevention Strategy. This cost AUS$31 million over 4 years, less than one tenth the cost of the legal gun confiscations and less than the annual cost of the various states firearms registries. Yet Morell et al confirm that firearm suicide showed no sharp decrease as occurred for hanging or gas.

In regard to the Lott and Mustard paper, Chapman and Alpers quote the US National Academy of Sciences report [14] as finding no evidence that right to carry laws have no impact, either way, on violent crime. The report actually says “it is impossible to draw strong conclusions-on the causal impact”(p121) and “it is not possible to determine that there is a causal link between the passage of right to carry laws and crime rates”(p150).The report did not dispute the finding of a fall in violent crime rates associates with increased legal gun carrying in some US states, the opposite of the result predicted by the more extreme anti-gun dogma. This report also states “existing research studies and data ------- do not credibly demonstrate a causal relationship between ownership of firearms and ---causes or prevention of criminal violence and suicide”(p6). And “a high level of violence may be a cause of high level of firearms availability instead of the other way around”(p54). Also “It is the committee’s view that the theory underlying gun buy-back programs is badly flawed and the empirical evidence demonstrates the ineffectiveness of these programs”(p95).

In their letter, Profs Chapman and Alpers state “Other than the Childers incident, we know of no other mass killing by any method--“ Yet Chapman et al quote Reuter and Mouzos [15] “Given that mass murders cause so much fear-----it is appropriate to choose this as an evaluation outcome separate from homicide---“. Apparently Chapman and Alpers missed the immediately preceding sentence where Reuter and Mouzos state “There have been 3 mass murders in 5 years, a statistically insignificantly lower rate then pre-1996.”( Reuter and Mouzos do not mention the Childers incident-15 deaths, and presumably were writing prior to this.)

Profs Chapman and Alpers accuse myself and the "gun lobby" of “trivializing mass public shootings as rare events”, on the basis that I put the problem in perspective by pointing out that such killings constitute less than 3% of total murders. This is very strange, as Chapman’s co-author, Prof. Alpers is also co-author of a paper [16] where mass public shootings are described as “very rare” and “exceptionally rare”(p283) and of “extreme rarity”(p284). Piehl [17] states they are “rare events” and claims there is a 13.5% chance of no mass killings in a 5 year period, even if the frequency were unchanged. Mouzos [18] describes mass and serial murder as “statistically rare” It is unlikely that Chapman and Alpers would agree that they are trivializing the other 97% of Australian murders because they are not mass murders committed with guns.

I cannot accept Chapman and Alpers apparent casual dismissal of the need for an inquiry into exactly how the mentally retarded unlicensed Port Arthur murderer obtained military rifles. If we are serious about preventing a recurrence, it is not good enough to just say that “the answer would seem rather obvious”.

There was indeed great media support for the NFA, doubtless assisted by Prof. Chapman putting “several hours a week into advocacy for stronger gun control” over the 4 years before Port Arthur. The intense public debate in 1996 could not be fully informed as little hard data were available at that time. For example, it was not until 4 years later that Mouzos’ work[19] was published, confirming that 90% of gun crime is committed by unlicensed persons with unregistered guns. Indeed, the mass media may well be part of the problem. Again, Chapman’s co-author, Prof. Alpers, is also co-author in Cantor et al[20] who suggest “the media are a necessary link in the chain of causation” (p287) Criminologists have repeatedly pointed out the media practice of concentrating on rare sensational events, thus misleading the public about crime risks in the real world. [21-23]. In fact, Mouzos and Segrave specifically state that the media misrepresentations may lead to misconceptions about the realities of homicide in Australia, through the media tendency to focus on firearms.

Prof. Chapman’s style of writing blurs any distinction between military weapons and civilian firearms and also between legal and illegal firearms. According to Wilmoth [24], figures are only available for the state of Victoria, but these show that only 3.3% of the guns destroyed were high powered semi-automatics. The rest were civilian shotguns or rimfire rifles useful only for hunting and target shooting.

I have not seen the film “Bowling for Columbine”. Those who have may be interested in the critique by Hardy.[25] Also, Thompson gives an interesting psychiatric perspective on the debate [26].

Finally, Profs. Chapman and Alpers seem to believe I am some sort of spokesman for the “gun lobby”, although they give no reason for this and I would be interested to know what their reasons are. It cannot be simply that I do not agree with their conclusions.

In summary, the NFA is a success if we adopt the criteria of Chapman et al, of fewer subsequent mass gun murders. Unfortunately, it has also been extremely expensive to establish and maintain and is irrelevant to 97% of murders and at least 80% of suicides. To remove all legal guns in Australia would be even more expensive and could not reduce the murder rate by more than 2%. Could we save more lives by using the resources differently?

References

1. E-letter to Injury Prevention 4 Jan 2007.

2. Chapman et al. Injury Prevention: 12; 365-372. Dec 2006. Australia’s 1996 gun law reforms: faster falls in firearms, deaths firearms suicides and a decade without mass shootings.

3. Reuter P, Mouzos J."Australia: a Massive Buyback of Low-Risk Guns".Chapter 4. In: "Evaluating Gun Policy- Effects on crime and violence". Eds. Ludwig J, Cook P J. Brookings Institute Press, 2003.

4. Ozanne-Smith J et al. Firearms related deaths: the impact of regulatory reform. Injury prevention 2004;10:280-286.

5. Baker J, McPhedran S. Gun laws and Sudden Death: Did the Australian Firearms Legislation of 1996 Make a Difference? British Journal of Criminology 2006- Advance Access published 18 Oct 2006.

6. Lawson JB. “New national Gun Laws: are they cost-effective. Institute of Public affairs Review. 51(4) 27-8. Dec 1999 http://www.ipa.org.au/publications/publisting_detail.asp? pubid=5 Accessed 20-1-07.

7. Chapman S, Lupton D. "The Fight for Public Health-Principles and practice of media advocacy". BMJ Publishing Group 1994. p12.

8. McDonald D, Brown M. “Indicators of Aggressive Behaviour” Australian Iinstitute of Criminology 1996.

9. US Department of Justice. Federal Bureau of Investigation. Murder. Table 2.9 http://www.fbi.gov/ucr/cius_04/offenses_reported/violent_crime/murder.html Accessed 20 Jan 2007.

10. US Centers for Disease Control. National Center for Injury Prevention and Control. WISQARS Injury Mortality Reports 2004. http://webapp.cdc.gov/sasweb/ncipc/mortrate10_sy.html Accessed 20 Jan 2007.

11. Chapman S, Lupton D. "The Fight for Public Health-Principles and practice of media advocacy". BMJ Publishing Group 1994. p160.

12. Australian Bureau of Statistics Year Book Australia 2002. Health- Special Article—Suicide.

13. Morrell S, Page AN, Taylor RJ. “The decline in Young Australian male suicide” Social Science and Medicine 64 2007, 747-754.

14. 9. National Academy of Sciences. Committee on Law and Justice. Firearm violence: a critical review. Washington, 2004.

15. Reuter P, Mouzos J. op ci t. p141.

16. Cantor CH, Sheehan P, Alpers P, Mullen P, “Media and Mass homicide. ” Archives of Suicide Research .5, 283-290. 1999.

17. Piehl AM. Commentary on Reuter and Mouzos. In "Evaluating Gun Policy- Effects on crime and violence". Eds. Ludwig J, Cook P J. Brookings Institute Press, 2003. p143.

18. Mouzos J ”Homicidal Encounters A study of homicide in Australia 1989-1999. “ Australian Institute of Criminology 2000. p83.

19. 25. Mouzos J. “The Licensing and Registration Status of Firearms used in Homicide”. Australian Institute of Criminology May2000.Trends and Issues Paper 151. http://www.aic.gov.au/publications/tandi/tandi151.html Accessed 20 Jan 2007.

20. Cantor CH, Sheehan P, Alpers P, Mullen P, “Media and Mass homicide. ” Archives of Suicide Research .5, 283-290. 1999.

21. Mouzos J., Segrave M. "Homicide in Australia. 2002-2003 National Homicide Monitoring Program Annual Report". Australian Institute of Criminology 2004. p3.

22. Weatherburn D. "Law and Order in Australia-Rhetoric and reality". The Federation Press 2004. pp 2,3,48

23. Grabowsy P., Wilson P. "Journalism and Justice-How crime is reported". Pluto Press Sydney. 1989. Especially chapters 2,8,9.

24. Wilmoth R. Unpublished report. Copy available from author.

25.Hardy DT. The truth about “Bowling for Columbine”. http://www.hardylaw.net/Truth_About_Bowling.html Accessed 19-Jan 2007

26. Thompson S. “Raging against Self defence”. http://www.jpfo.org/ragingagainstselfdefense.htm Accessed 19 Jan 2007.

Dr.J.B.Lawson. MB BS., B Med Sc., FRANZCR. 3 Lucas St. Brighton Vic 3186. Australia.

Mob 0417 08 1113 lawbb@melbpc.org.au 20 Jan 2007.

Barry Pless claimed that critics of helmet laws rely on fatality data. Yet my review considered all injuries serious enough to require hospital admission in all jurisdictions where helmet wearing increased substantially (more than 40 percentage points). There were no obvious responses in percent head injury.[1]

In contrast, the large, obvious falls in both non-head and head injuries with Victoria's helmet law – see graph (right) – refute Pless' claim that times series studies are "weak". Helmets cannot prevent non-head injuries, so the only plausible explanation for the large drop in non-head injuries is a decrease in cycle-use. Coupled with pre- and post-law observational surveys (640 person-hours per year at the same sites, observation times and the same time of year) showing a 36% reduction in cyclists counted, this represents overwhelming evidence that the main effect of the law was to discourage cycling.

Confusion arises when people hear only half the story. A busy researcher, reading in the Cochrane review of Thompson et al.[2] that Victoria's helmet law reduced head injuries by an estimated 40% would have no idea that non-head injuries also fell substantially. It would be natural to jump to the conclusion that the effect was due to increased helmet wearing. Even though Pless finds the arguments "tiresome, almost boilerplate", people need to see the data on both head and non-head injuries so that constructive debate can take place.

Despite the irritation, real progress has been made, as demonstrated by Pless' comment that "no sensible helmet advocate has argued that a typical bike helmet provides adequate protection against several tons of moving metal". Only about 47% of non-helmeted cyclists die of head injury (a proportion that, after adjusting for age, sex and other confounders appears no different to the 33% of helmet wearers dying of head injury), yet two recent papers in Injury Prevention claimed or assumed that helmets prevent an astonishing 73% and 65% fatalities.

The moderation from claims that helmets prevent 65-73% of fatalities (i.e. all head injury deaths and a large proportion of other deaths) to "inadequate protection" is a welcome improvement. Debate can now focus on the evidence (summarised in my review and elsewhere) that risk compensation, losses in health and environmental benefits from reduced cycling, and reduced safety in numbers probably outweigh any benefits of helmet laws.

Health benefits vs cost of reduced cyling
The health benefits of cycling are large. In Denmark (where only about 3% of cyclists wear helmets), the modest amount of daily cycling needed to ride to work reduces mortality by 40%.[3] A UK study of mainly non-helmeted cyclists found that the health benefits of cycling, measured in years of life gained, outweigh the injury risks, measured in years of life lost, by about 20 to 1.[4]

In contrast, the benefits of helmet laws are small. Estimated head injury reductions from New Zealand's helmet law ranged from zero (if trends were fitted in the model) to about 19% (ignoring trends). A peer-reviewed paper calculated the saving in hospital costs. The most optimistic estimate for a helmet bought to satisfy the law was a saving of NZ$0.65 over its 5-year lifespan, i.e. 13 cents per helmet per year![5]

Estimates are slightly higher (about NZ$2.85/helmet/year) if no consideration is given to the cost of reduced cycling nor willingness to pay to avoid inconvenience and discomfort of helmet-wearing, but willingness to pay to avoid pain and inconvenience of injury is included. Cyclists who are free to choose can weigh up the risks and the inconvenience, perhaps wearing a helmet for a rapid mountain descent but not for a short trip to the shops on a hot day. One possible explanation for the lack of benefit from helmet laws is that cyclists are able to judge the risks and know what gear is appropriate.

Simple criteria vs "solid" research designs
Simple criteria, such as the absence or presence of a response (and the size of that response) are an effective way of judging the value of an intervention. For example, fatality data provide very convincing evidence that speed cameras and random breath testing are highly effective road safety measures. But if no response had been evident (either for fatalities or serious injuries), would we argue that the measures were effective, the lack of response being due to the "weakness" of time series data? Or simply concentrate on measures that produced large, obvious responses?

Case-control studies that Pless describes as "solid research designs" led to the conclusion that hormone replacement therapy (HRT) reduces the risk of heart disease by 50%. This was later dismissed when randomised control trials showed that HRT can actually increase the risk of heart disease.[6]

A case-control study of children injured in an activity that could entail use of protective equipment (PE) led Barry Pless to conclude that risk compensation by children was "highly doubtful".[7] Yet when completing an obstacle course in a gym, wearing a helmet and wrist guards increased risk taking (measured by tripping, falling and bumping into things) by 60% and 49% for 10-12 and 7-9 year old girls and 48% for 10-12 and 7-9 year old boys. Just as the best way to measure risk compensation is to observe the behaviour of the same children with and without PE, the most reliable way to determine the outcomes of helmet laws is to evaluate what happens when such laws are passed. Consequences such as risk compensation or reduced safety in numbers do not have to be quantified separately. They are instead (quite correctly) treated as consequences of legislation.

All costs and benefits should be considered. To assess potential returns from use of scarce resources, cost-benefits should be compared those for other road safety measures. For example, one team of researchers concluded from real-life crash data that helmets for motor vehicle occupants might prevent 28%, 40% and 26% of minor, moderate and severe brain injuries. Thus a helmet law for motorists (in addition to seatbelts) could save $1.9 billion (over 5 years, all vehicles equipped with airbags) to $2.2 billion (50% with airbags).[8] This works out at more than $100 per helmet, an order of magnitude greater than the most optimistic estimate of the benefit of NZ's helmet law.

Although benefits of helmet laws for vehicle occupants might be offset by risk compensation, there would be no problem of discouraging healthy exercise and environmentally friendly transport. The higher estimated benefits and fewer drawbacks imply that any future calls for bicycle helmet laws should be postponed until helmet laws for motorists have been implemented and shown to be beneficial.

References
1 Robinson DL. No clear evidence from countries that have enforced the wearing of helmets. BMJ 2006;332:722-725.
2 Thompson D, Rivara F, Thompson R. Helmets for preventing head and facial injuries in bicyclists (Cochrane Review). In: The Cochrane Library, Issue 3. Oxford: Update Software, 2003.
3 Andersen LB, Schnohr P, Schroll M, Hein HO. All-cause mortality associated with physical activity during leisure time, work,sports, and cycling to work. Arch Intern Med 2000;160(11):1621-8.
4 Adams J, Hillman M. The risk compensation theory and bicycle helmets. Inj Prevent 2001;7(2):89-91.
5 Taylor M, Scuffham P. New Zealand bicycle helmet law-do the costs outweigh the benefits? Inj. Prevent. 2002;8:317-320.
6 Lawlor DA, Davey Smith G, Ebrahim S. Commentary: The hormone replacement-coronary heart disease conundrum: is this thedeath of observational epidemiology? Int. J. Epidemiol. 2004;33(3):464-467.
7 Pless IB, Magdalinos H, Hagel B. Risk-compensation behavior in children - myth or reality? Arch Pediatr Adolesc Med 2006;160:610-614.
8 McLean A, Fildes B, Kloeden C, Digges K, Anderson R, Moore V, et al. Prevention of Head Injuries to Car Occupants An Investigation of Interior Padding Options: Federal Office of Road Safety: Rpt CR160. Available at http://www.monash.edu.au/muarc/reports/atsb160.pdf 1997.

Dear Editor

In his letter "Timely reporting of research is necessary", Mr Wardlaw suggests that lack of enforcement of bicycle helmet legislation in Ontario is an underreported aspect of bicycle helmet research.

Although the issue of enforcement of legislation has been raised as a potentially important aspect of bicycle helmet laws, to our knowledge, no one has studied the nature of enforcement of helmet legislation in Ontario (or elsewhere). A single police force in Ontario (Toronto Police Services) has no record of charging a child for not wearing a helmet, there are many ways that the police can enforce legislation that do not include the police issuing citations. For example, the police can warn children verbally that there is a helmet law. Further, Toronto Police Services routinely work with schools to promote safe bicycling in the form of Bike Rodeos. All children must ride helmeted at these events.

Many other ways of ‘enforcing’ laws exist, particularly for laws aimed at children. Laws give parents, teachers, and other adults the authority to promote certain behaviours in children. Many parents are grateful for the helmet law, because the requirement to wear a helmet is not based on their decision, but on a societal choice. They can therefore enforce the law within their own family. Further, school principals often require that children wear helmets bicycling to school because "it is the law". These are just two examples of ways that helmet laws have been enforced in Ontario, but their measurement is beyond the scope of the published study. The unit of analysis in our study was observed children, not their parents or teachers, and we did not measure their knowledge of the law.

Mr. Wardlaw comments on the decline in hospitalizations for head injuries in Ontario <1>. Administrative data are helpful in assessing trends in hospitalizations, but they do not measure factors such as helmet use. The report cited by Mr. Wardlaw measured hospitalizations which have been declining for many reasons, including changes in practice patterns for admission of head injuries. There is no concurrent comparison group with which to compare these trends. Although evidence from systematic reviews suggests that helmets are effective in reducing head injuries <2,3>, we do not know whether children admitted to hospital for bicycle-related injuries in Ontario were helmeted or not. The distribution of helmet use among admitted children is one key (unmeasured) factor that is necessary to understand the population impact of helmet laws.

In conclusion, we agree that timely reporting of results is necessary. We also believe that research results reported in the peer reviewed literature must be based on scientific evaluation of risk factors considered within the study design. Helmet laws have been shown to be effective in reducing head injuries in published studies from around the world <4,5,6,7,8>. Our study did not measure enforcement of the helmet law in Ontario.

References

1. "Bicycle-related injuries among Ontario children declining". Canadian Institute for Health Information. http://secure.cihi.ca/cihiweb/dispPage.jsp?cw_page=media_19mar2003_e

2. Thompson DC, Rivara FP, Thompson R. Helmets for preventing head and facial injuries in bicyclists (Cochrane Review). In The Cochrane Library, Issue 3, 2000. Oxford: Update Software

3. Attewell RG, Glase K, McFadden M. Bicycle helmet efficacy: a meta -analysis. Accident Analysis & Prevention 2001;33:345-52.

4. Scuffham P, Alsop J, Cryer C, Langley JD. Head injuries to bicyclists and the New Zealand bicycle helmet law. Accident Analysis & Prevention 2000; 32:565-73.

5. Macpherson AK, To TM, Macarthur C, Chipman ML, Wright JG, Parkin PC. Impact of mandatory helmet legislation on bicycle-related head injuries in children: a population-based study. Pediatric 2000; 110:e60.

6. Cameron MH, Vulcan AP., Finch CF, Newstead SV. Mandatory bicycle helmet use following a decade of helmet promotion in Victoria, Australia-- an evaluation. Accident Analysis & Prevention 1994; 26:325-37.

7. Leblanc JC, Beattie TL, Culligan C. Effect of legislation on the use of bicycle helmets. CMAJ Canadian Medical Association Journal 2002; 166:592-5.

8. Shafi S, Gilbert J, Loghmanee F, Allen JE, Caty MG, Glick PL, Carden S, Azizkhan RG. Impact of bicycle helmet safety legislation on children admitted to a regional pediatric trauma centre. J Pediatr Surg 1998;33:317-321.

Editor

Re: Australia’s 1996 gun law reforms: faster falls in firearms, deaths firearms suicides and a decade without mass shootings. Chapman et al. Injury Prevention: 12; 365-372. Dec 2006.

Chapman et al. use official Australian Government statistics to demonstrate a continuing fall in firearms murder and suicide following the implementation of the Australian National Firearms Agreement (NFA) of 1996. They also state that this was a continuation of a pre-existing trend in falling firearms deaths over several years. This confirms the previous reports of Reuter and Mouzos [1], Ozanne-Smith et al [2] and Baker and McPhedran [3]. In all four papers, the authors agree that there had been a steady decline in gun murder and gun suicide before the NFA [4] and that this decline continued post NFA. Reuter and Mouzos and Ozanne-Smith et al found no decrease in total suicide after 5 years. Reuter and Mouzos found a marginal fall in total murder, whereas Ozanne-Smith did not. Ten years post NFA, Baker and McPhedran and Chapman et al confirm continuing falls in both gun murder and gun suicide and also total murder and total suicide. Thus far, all authors are in agreement.

Controversy arises in that Baker and McPhedran report a slightly faster fall in total and gun suicide post NFA but no significant increase in the rate of decline in gun and total murder. They attribute the continuing decline to general social factors, not the NFA. In contrast, Chapman et al maintain that there are marginally faster rates of decline in gun and total murders and suicides which are significant and due to the NFA. While it makes sense that fewer guns would be associated with fewer gun deaths, it is intuitively difficult to see how mass gun confiscations would reduce suicides by hanging and car exhausts and reduce murders by stabbing and beating.

Harrison and Steenkamp reported a marked increase in suicide by hanging and car exhaust in the first 2 years after the NFA [5], suggesting initial method substitution. The subsequent fall in total suicide developed after Australia mounted a strong campaign to raise awareness of depression as a severe and treatable illness and to remove any shame or stigma attached to depression and other mental illness. Well known public figures, including politicians, actors and sporting personalities have described in the media their personal struggles with depressive illness [6]. This may account for the observed fall in total suicides, including the continuing decline in the subset of gun suicides.

Despite the welcome post NFA fall in murder, the current rate is still higher than in 1950-1980, when there were virtually no long gun controls at all [7]. Curiously, Weatherburn maintains, that for the most populous state of New South Wales, the fall in gun crime is due to good policing, reduced availability of heroin and the arrest of hard core violent criminals [8]. This has apparently occurred despite a 25% increase in legal gun ownership over 2002-5.

International comparisons are even more confusing. Despite increasingly strict gun laws, the United Kingdom murder rate doubled since 1966 [9] and is now higher than the Australian rate. (See Povey - Table 1.01 p15). In particular, since the total handgun confiscations of 1996, the total murder numbers have risen 62%. This includes gun murder numbers up 20%. ( Povey - Table 1.03 p17) and handgun crime numbers up 66%. (Povey - Table 2.03 p 51.) IE Mass gun confiscations in UK have produced exactly the opposite effect claimed for Australia.

The USA murder rate doubled during 1960-1975, from about 5/100,000 to 10/100,000per annum, remained at this level for 10 years, and has now fallen to almost 1960 levels.[10] This drop occurred despite a 36% increase in the number of legal US guns over 1975-1985 [11]. Paradoxically, the landmark paper of Lott and Mustard [12] reported a marked decrease in mass gun murders in public places in those US states which changed their laws to allow citizens to carry concealed handguns. Curiously, new Zealand, which participated in the Australian deliberations, but chose not to implement the NFA, experienced a significant decline in gun murder, but no change in total murder. [13] Strangely, Chapman et al do not mention any of the international figures.

Chapman et al claim correctly that there have been no mass gun murders in Australia since the implementation of the NFA in 1996 and that the NFA is therefore a “success”. Unfortunately, there was never any generally agreed definition of “success” at the time the NFA was implemented .However there have been a few mass murders, not involving firearms, particularly the arson attack at Childers, Queensland, in which 15 people died. The others were domestic tragedies in which parents killed their children and then suicided. Oddly, Chapman et al appear to define a mass murder as an incident with 5 or more deaths [14]. They state specifically that “this is to exclude most of the more common firearm related spousal and family violence killings” (footnote to Table 1 p367). In contrast, the Australian Institute of Criminology uses a definition of 4 or more deaths in a single incident [15]. Chapman’s choice of definition would result in fewer “mass murders”. (Note: The murders in Snowtown, South Australia, 12 deaths, were serial killings). It is puzzling that Chapman et al quote Reuter and Mouzos [16] that mass murders are an “appropriate evaluation outcome”, but ignore their contention in the same article that “the frequency of those events is so low that not much can be inferred”[17] and that mass murder shows a “statistically insignificant lower rate than pre-1996”[18]. Fortunately, Reuter and Mouzos put the matter in perspective, pointing out that mass murders account for only 3% of all homicides in Australia [19].

In an earlier work, Chapman points out that the Port Arthur murderer was receiving a pension for intellectual handicap and sociopathic personality disorder, and had a mental age of 11[20]. The murderer had never had a gun licence and also drove a car without a licence [21]. If we wish to prevent further mass gun murders in public places, it seems a good idea to find out how such a person managed to obtain a military assault rifle illegally. This was never even investigated. It did not emerge at the trial as the accused pleaded guilty.( Note: For the benefit of readers outside Australia, I point out that all the Port Arthur victims were unarmed, as local laws prohibited weapon carrying for self defence. I state this as a matter of fact, without comment).

Chapman et al quite correctly point out that there was great public and media support for the NFA in 1996. Most of the credit for this must go to Chapman himself. Over several years before the Port Arthur killings, Chapman himself co-ordinated “the planned ,strategic use of media”, and “a sustained period of public advocacy for gun law reform” [22]. He describes “preceding years of advocacy”[23] and recommends that “violent gun incidents should be anticipated and planned for so “advocates exploit to advantage the huge public and political interest these disasters generate when they occur” [24]. The distinction between media advocacy and propaganda is never explained.

These matters are not mere academic quibbles. The Australian federal government has spent at least half a billion dollars of public funds on mass confiscations of legally owned guns over 1996-2003. “Buy-back” was a euphemism for confiscation under threat of fines and imprisonment, although monetary compensation was paid. Further tens of millions of dollars are spent annually on registering each individual legal firearm, despite the lack of any clear benefit. The state of Victoria has actually gone so far as to require registration of all antique black powder muzzle loaders and blank-firing sports starting pistols! As 90% of Australian gun crime is committed by unlicensed persons with unregistered guns [25] and legal guns are involved in about 2% of Australian murders [26], even total destruction of all legal guns in Australia would have only minimal benefit.

Could greater cost effectiveness have been achieved by using the resources for improving mental health services or drug rehabilitation, preventing domestic violence, anti-smoking campaigns? No-one has examined this, a surprising omission for a Professor of Public Health.

References

1"Australia: a Massive Buyback of Low-Risk Guns".Chapter 4. In: "Evaluating Gun Policy- Effects on crime and violence". Eds. Ludwig J, Cook P J. Brookings Institute Press, 2003.

2. Ozanne-Smith J et al. Firearms related deaths: the impact of regulatory reform. Injury prevention 2004;10:280-286.

3. Baker J, McPhedran S. Gun laws and Sudden Death: Did the Australian Firearms Legislation of 1996 Make a Difference? British Journal of Criminology 2006- Advance Access published 18 Oct 2006.

4.Firearms Deaths-Australia 1980—1995.Australian Bureau of Statistics 1997. cat no. 4397.0.

5. Harrison JE, Steenkamp M. Australian Injury prevention bulletin Issue 23, 2000. http://www.nisu.flinders.edu.au/pubs/bulletin23/bulletin23.html Accessed 22 12 2006.

6. See for example http://www.beyondblue.org.au/

7. Mouzos J. Homicidal Encounters. A study of homicide in Australia 1989-1999. Australian Institute of Criminology. 2000. p9.

8. Weatherburn D. “ Gun laws fall short in war on crime.” Quoted in Sydney Morning Herald 29 10 2005.

9. Povey D. (ed).Crime in England and Wales 2002/2003: Supplementary Volume 1: Homicide and Gun Crime 01/04 Editor: David Povey January 2004. Home Office Research, Development and Statistics Directorate (RDS). www.homeoffice.gov.uk/rds/pdfs2/hosb0104.pdf Accessed 23-12 2006.

10. Fox JA, Zawitz MW. “Homicide Trends in the US. Long term trends and patterns.” United States Dept. of Justice. Office of Justice Programs. Bureau of Justice Statistics. http://www.ojp.usdoj.gov.bjs/homicide/hmrt.htm Accessed 23-12-2006.

11. Kleck G. “Targeting guns”. Aldine de Gruyter 1997. pp96-97.

12. Lott JR, Mustard DB. “Crime, Deterrence and Right-to-Carry Concealed Handguns.” Journal of Legal Studies 26(1). Jan 1997.

13. Reuter P, Mouzos J. op cit. p135.

14. Chapman S, Alpers P, Agho K,Jones M. “ustralia’s 1996 gun law reforms: faster falls in firearms, deaths firearms suicides and a decade without mass shootings” Injury Prevention: 12; 365-372. Dec 2006. p366.

15. Mouzos J. “Homicidal Encounters. A study of homicide in Australia 1989-1999”. Australian Institute of Criminology 2000.

16. Reuter P, Mouzos J. op cit. p131.

17. ibid. p122

18. ibid p141.

19. ibid p127.

20. Chapman S. Over Our dead Bodies. Port Arthur and the Fight for Gun control. Pluto Press 1997. pp136-7.

21. ibid p73.

22. ibid. preface, 1st page

23. ibid p5.

24. ibid pp6-7.

25. Mouzos J. “The Licensing and Registration Status of Firearms used in Homicide”. Australian Institute of Criminology May2000.Trends and Issues Paper 151. http://www.aic.gov.au/publications/tandi/tandi151.html Accessed 28- 12 2006

26. Mouzos J, Segrave M. Homicide in Australia. 2002-2003 National Homicide Monitoring Program Annual Report. Australian Institute of Criminology. 2004 p15. http://www.aic.gov.au/publications/rpp/66/ accessed 28-12 2006.

Dr.J.B.Lawson. MB BS., B Med Sc., FRANZCR. 3 Lucas St. Brighton Vic 3186. Australia. Mob 0417 08 1113 lawbb@melbpc.org.au

2 Jan 2007.

In his zeal to defend bicycle helmet laws, Editor Barry Pless ignored two important issues identified by Malcom Wardlaw and in doing so raises one of even more vital importance.

First, child cyclist head injuries declined in Ontario while data from Macpherson showed a declining rate of bicycle helmet use. This suggests a factor other than helmet use and helmet laws was responsible for the decline in head injuries. Second, the authors of the 2001 Injury Prevention study which concluded that Ontario's helmet law had not negatively impacted levels of cycling, however they were aware but failed to mention two critical factors in evaluating the effect of helmet laws - (a) within four years the law had reached a null impact on helmet use, and (b) the lack of police enforcement.

In an editorial, Pless has admitted his own biases and sensitivities in dealing with issues concerning bicycle helmets[1] and Macpherson recently appeared in the Ontario Legislature[2] in support of a motion to impose a helmet law on adults. Such activism raises questions about whether personal biases are taking priority ahead of scientific findings and criticisms.

Pless says that he struggles to understand why Wardlaw and others work so consistently to oppose helmet legislation. This is an astonishing statement given Wardlaw along with Robinson, myself and others restrict ourselves to questioning the science upon which helmet laws are based. If Pless doesn't understand the fundamental objection to having the state unjustifiably impose a requirement on its citizens, then what he's really saying is that he struggles to understand human nature.

Please, let's restrict ourselves to facts. Political activism doesn't belong in a scientific journal.

References

1. Pless B, Are Editors free from bias? The special case of Letters to the Editor, Inj Prev 2006 12: 353-354. doi:10.1136/ip.2006.014472

2. Hansard, Legislative Assembly of Ontario, 14 December 2006