If the federal government won’t fund gun injury prevention research, a new coalition of physicians and scientists will.
At Brown we have a strong history of practice and advocacy on behalf of vulnerable patients. Our researchers use cutting-edge theory and methodologies to reduce morbidity and mortality from a variety of preventable conditions, from opioid addiction to HIV to child abuse. We train medical students and residents in harm reduction: how to screen and counsel patients on these and other sensitive issues, to reduce risk and death. We advocate for the incorporation of evidence into policy and practice.
But there is one issue on which our profession and our school have had little impact: guns.
Approximately 38,000 Americans die each year—and another 80,000 are injured—from guns. Firearm injuries touch every segment of society, and the toll of gun deaths is similar to that of opioids or car crashes. Many of us, at and outside of Brown, have been advocating for decades for attention to this unaddressed epidemic. We have gone to Capitol Hill, written editorials, and worked within our professional societies. The reason we’ve had no impact is not a lack of rigorous research questions, nor a lack of rigorous scientific underpinnings for the field. The reason is, rather, a lack of federal funding.
Since the Dickey Amendment was passed in 1996, Congress has appropriated exactly $0 to the Centers for Disease Control and Prevention for firearm injury prevention research. The National Institutes of Health have allocated some funds to this topic, most notably in a request for applications issued after the Sandy Hook tragedy, when President Obama called for the NIH and CDC to reinvigorate their research agendas. We have had some small successes: the newly passed 2018 Omnibus Bill clarifies that the Dickey Amendment does not prohibit research, per se. The NIH currently has 14 grants focused on firearm injury prevention (I am a co-investigator on two of them).
But 14 grants is insufficient for a crisis of this magnitude. Indeed, the overall federal funding for firearm injury research remains at less than 2 percent of what would be predicted based on the mortality rate (and less than 0.2 percent of that for sepsis, a disease process with a similar mortality burden). As clinicians and researchers, we know that adequate funding is a prerequisite for high-quality research. We also know that without science, policies are unlikely to be impactful or to be based on anything other than emotion.
TIME TO ACT
Because we are tired of waiting for change, while our communities and our colleagues suffer—and because we recognize that sometimes, we need money to fix a problem—I, in conjunction with two dozen other firearm injury prevention researchers, founded the American Foundation for Firearm Injury Reduction in Medicine (AFFIRM) earlier this year.
AFFIRM’s vision is to reduce gun injuries through knowledge and action. We want to unite clinicians and researchers across specialties, disciplines, and the 50 states to create the highest-quality, most-actionable research. Thanks to our medical society partners (including the American College of Surgeons, the American College of Emergency Physicians, and the Massachusetts Medical Society), we have the potential to not only conduct research, but also to disseminate it across the country.