Dear Editor

Barber et al.[1] note that some fatal gun accidents (FGAs) may be missclassified as homicides, and conclude that the nation "may be undercounting the burden of unintentional firearm deaths". They report 168 gun deaths labelled negligent (and thus accidental) manslaughters by police, and estimate that 75 % were misclassified as intentional homicides on death certificates, implying an undercount of perhaps 126 FGAs.

The authors mention misclassification of gun suicides as accidents, but as if it were merely a possible source of errors in the opposite direction. Morrow carefully reexamined a statewide sample of deaths officially labelled self-inflicted gun accidents and concluded that 11-28 % were actually suicides.[2] Since about half of the nation's 981 official FGAs in 1997 were self-inflicted, these figures imply 54-137 suicides wrongly counted as FGAs. If we accept a midrange figure of 96 "overcounts" v the authors' undercount of 126, there was a net undercount of 30, just 3.1 % of the national FGA total. Using the 137 upper limit figure would of course imply there was a net overcount of FGAs.

In sum, a more balanced appraisal of the evidence suggests that at present there is little foundation for concluding that there is any significant undercount of unintentional firearm deaths.

References

(1) Barber C, Hemenway D, Hochstadt J, and Azrael D. Underestimates of unintentional firearm fatalities: comparing Supplementary Homicide Report data with the National Vital Statistics System. Inj Prev 2002;8:252-256.

(2) Morrow PL. Response from Morrow [Response to Kleck G., Accidental firearm fatalities] Am J Public Health 1987;77(4):153-154.

Dear Editor

Thank you for your fine article on how child-resistant safety features on cigarette lighters have saved lives and reduced injuries of children. While I was Chairman of the U.S. Consumer Product Safety Commission (CPSC), I supported this effort as well as other actions to reduce fires caused by cigarettes.

Research conducted by CPSC and the National Institute of Standards and Technology (NIST) shows that cigarettes can be made more resistant to fires. A fire-safe cigarette is one that has been designed to be less likely than a conventional cigarette to ignite soft furnishings such as a couch or mattress.

Cigarette-ignited fires cause more than 900 deaths each year and more than 2400 injuries, many to innocent children. Now, as chairman of the safety group SAFE (Safer America for Everyone), I have publicly supported the legislation originally introduced by the late Congressman Joe Moakley, and reintroduced by Congressman Ed Markey (D-Mass.) and Senator Richard Durbin (D.Ill.) as the "Joseph Moakley Memorial Fire Safe Cigarette Act of 2002".

Based on the research, I believe the legislative approach of requiring CPSC to establish a mandatory standard to reduce the ignition of fires by cigarettes is both sound and practical. The bill would require CPSC to establish a standard specified in the legislation by which cigarettes could be regulated with respect to their propensity to ignite fires. The standard could be modified if new, more effective testing technologies are developed that would enhance the safety standard.

Passage of fire-safe-cigarette legislation would be a major victory for children.

Sincerely

Ann Brown
Chairman
SAFE (Safer America for Everyone)

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.

Dear Editor

The finding of an abnormally low pH in the exhaled breath condensates from patients with asthma and cystic fibrosis [1] raises the possibility that this pH might be a better metabolic marker to use especially if each driver were to establish his/her own control values. If exhaled breath were used alcohol and even other chemical levels could also be measured, recorded and stored in a black box. What is needed is a large prospective observational study to determine which measurement or combination of measurements is the best predictor of accidents and/or irresponsible and criminal behaviour.

References

1. Giovanna E. Carpagnano,Peter J. Barnes, Jackie Francis, Nicola Wilson, Andrew Bush, Sergei A. Kharitonov. Breath Condensate pH in Children With Cystic Fibrosis and Asthma: A New Noninvasive Marker of Airway Inflammation?