If American society every becomes rational for any sustained
period in the future – everyone living in the current epoch will be
mocked. We will be mocked for the absurd
and obvious inconsistencies in society almost entirely driven by politics. Guns, abortion, the discrimination and
scapegoating of small segments of society, persistent racism, misogyny, a lack of concern
for the disabled and disadvantaged, and a total lack of concern for the
planet. Sometime in the very near past –
we stepped into a fantasy world where politicians could say anything – no
matter how absurd, be believed, and get elected.
The lesson today is firearms and gun laws. Over the course of writing this blog I have
written about this many times. How the gun issue has been co-opted by one party
and their judges. That party has
extremist views about gun laws and the Second Amendment. Those extremist views endanger all of
us and make the likelihood of ending school and other mass shootings
impossible.
About a week ago, a paper came out in JAMA Pediatrics
(1) that looked at the issue of permissive gun laws and pediatric
mortality. Guns in the United States are
the number one cause of pediatric deaths in the country. There are no other countries in the world
where that is the case. It speaks to
these unique aspects of gun extremism in American culture and the degree to
which people will rationalize gun access and laws that enable rapid deployment
of guns with very little rationale.
Children and young men are dying in that crossfire and they have been
for some time.
The research design of this paper was very interesting. It
looks at the change in pediatric gun mortality over time stratifying states by
their degree of gun permissiveness before and after the 2010 Supreme Court
decision McDonald
v. City of Chicago. In that case, a retiree and two additional
plaintiffs brought action against the city of Chicago because they wanted to
purchase handguns – but were not able to due to a citywide ban on issuing
permits that began in 1982. Details of
the decision are included at the above link and my assessment is that the
decision against the Chicago law was based on technical interpretations about
whether gun ownership is a fundamental right.
The overall effect of this decision was that many states
changed their gun laws to make them much more permissive. Permissive gun laws
are what I have been calling gun extremism.
Examples include mandatory issuance of gun permits and carry
permits, permitless carry laws, open
carry laws (with or without permits including all types of firearms), stand
your ground or castle laws that say if
you are armed you have no duty to retreat in certain environments, no bans on
assault weapons, high-capacity magazine, or bump stocks, no red flag laws that
remove weapons from individuals considered to be high risk, and no local laws
that override state laws. There is
action in some cases to remove the ban on returning firearms to people
convicted of domestic violence or drug charges.
You do not have to be a public health researcher to figure
out what is wrong with these laws. They
basically return us to the days of the Wild West, where it took the local
sheriff to come up with laws that guns needed to be checked at the city
limits. People roaming the streets
carrying high-capacity automatic weapons is a recipe for disaster. The current televised real crime genre
– is an endless source of stories about gun homicides that occurred because
somebody was angry, had access to a firearm, and impulsively shot
somebody. In the case of children and
adolescents there is the additional risk of accidental shootings, suicide, and
in some well publicized cases holding parents responsible for giving their
child access to a gun that is subsequently used in the commission of a crime by
that same child. When guns are everywhere – gun tragedies follow.
In this paper the researchers group states into 3 categories
based on how permissive their gun laws have become since the MacDonald
decision. The categories were strict, permissive, and
most permissive based on a classification protocol available in this
supplement. States rated as strict (total of 9) include: California, Connecticut, Hawaii, Illinois,
Maryland, Massachusetts, New Jersey, New York, and Rhode Island. States rated as permissive (total of
11) include: Colorado, Delaware,
Michigan. Minnesota, Nevada, New Mexico, Oregon, Pennsylvania, Vermont,
Virginia, and Washington. The remaining
states were rated most permissive (total of 30) and include: Alabama, Alaska, Arizona, Arkansas, Florida,
Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Mississippi,
Missouri, Montana, Nebraska, New Hampshire, North Carolina, North Dakota, Ohio,
Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Utah, West Virginia,
Wisconsin, and Wyoming.
What might a head-to-head comparison of states from each
category look like. Here are three
states from the upper Midwest – one from each category (taken from
supplementary data from reference 1).
|
Illinois
(strict) |
Minnesota
(permissive) |
Wisconsin
(most permissive) |
|
2013: Concealed Carry Act - Allowed concealed carry
of firearms. 2013: Firearm Concealed Carry Act - strict
requirements for obtaining a concealed carry license. 2014: Private Sale Background Check Law - Required
private sellers to verify buyer's FOID card with state police. 2018: 72-Hour Waiting Period Law - Enacted a 72-hour
waiting period for all firearm purchases. 2019: Firearm Dealer License Certification Act -
Required gun dealers to obtain a state license in addition to federal
license. 2019: Red Flag Law - Allowed family or law
enforcement to petition for temporary firearm removal from at-risk
individuals. 2021: Universal Background Check Expansion -
Extended background check requirements to all private firearm transfers. 2022:
Ghost Gun Ban - Prohibited the sale and manufacture of unserialized and
untraceable firearms. 2023: Protect Illinois Communities Act - Banned
sale, manufacture, and possession of assault weapons and high-capacity
magazines. 2024: FOID Fingerprint Requirement - Mandated
fingerprint submission for FOID card applicants FOID = Firearm Owner Identification Card |
2003: Minnesota Citizens' Personal Protection Act -
Established a "shall-issue" system for concealed carry permits. 2005: Stand Your Ground Law - Expanded self-defense
rights, removing the duty to retreat in certain situations. 2014: Domestic Violence Gun Ban - Prohibited
individuals convicted of domestic violence or subject to protective orders
from possessing firearms. 2015: Suppressor Legalization - Legalized the
ownership and use of firearm suppressors. 2019: Gun Violence Protective Order Law - Allowed
family members and law enforcement to petition courts for temporary removal
of firearms from individuals deemed a risk. 2021: Capitol Carry Notification Law - Required the
Department of Public Safety to notify permit holders about their right to
carry in the State Capitol complex. 2023: Universal Background Check Law - Required
background checks for private firearm transfers, with some exceptions. 2023: Red Flag Law - Implemented an Extreme Risk
Protection Order system, allowing courts to temporarily remove firearms from
individuals deemed a significant danger. 2023: Safe Storage Law - Required
firearms to be securely stored to prevent unauthorized access, especially by
minors. 2024: Ghost Gun Regulation - Restricted the sale and possession of
unserialized firearms and unfinished frames or receivers. |
2011: Concealed Carry - Legalized concealed carry of
firearms with a permit. 2011: Castle Doctrine - Expanded self-defense rights
in one's home, vehicle, and place of business. 2015: Waiting Period Repeal - Eliminated the 48-hour
waiting period for handgun purchases. 2015: Switchblade Legalization -
Legalized the possession and carry of switchblade knives. 2017: Constitutional Carry for Knives - Removed
restrictions on carrying knives, including in a vehicle. 2018: Extreme Risk Protection Orders - Implemented
"red flag" law allowing temporary removal of firearms from
individuals deemed a risk (Note: This may have faced legal challenges or
implementation delays). 2021: Second Amendment Sanctuary - Some counties
declared themselves Second Amendment sanctuaries, though not at the state
level. 2022 (L): Campus Carry Proposal - Significant
discussions about allowing concealed carry on college campuses, though it may
not have been enacted. 2023: Universal Background Checks - Implemented
background checks for private gun sales (Note: If not enacted, this was a
significant proposal during this period). |
Note that there is significant overlap in terms of gun
permissiveness. For example, all states
now have concealed carry laws. Illinois
was the last state to legalize this but all 50 states legalized concealed carry
within a period of 10 years. The creates
the obvious question of how we all survived without concealed carry for a period of 222 years after the Second Amendment was ratified? Minnesota and Wisconsin both have stand your
ground laws. Stand your ground and
castle laws are euphemisms for shoot first and ask questions later. All 3 states have red flag laws that allow for
gun removal from high risk individuals but only one state mentions domestic
violence as a condition. Illinois has a
FOID (Firearm Owner Identification Card) requirement. Minnesota used to have one in order to
purchase firearms but currently the concealed carry permit serves that purpose.
Minnesota also allows businesses to post whether firearms can be carried on
their campuses – but there is no enforcement.
Any way you look at these comparisons – the last 20 years has resulted
in an unprecedented growth in firearm access.
The study period was 1999-2023 and during that time there
were 41,012 pediatric firearm deaths accounting for about 4% of the total
mortality. Expected mortality
calculations were done comparing the pre-decision period (199-2010) to the post
decision period (2011-2023) and excess mortality was determined. Incident rates as deaths per million were
calculated based on the populations in each study period. The firearm mortality crude rate increased in
33 states (see Table. Incident Rates Pre– and Post–McDonald v Chicago
With Incident Rate Ratios). Suicide and
homicide by firearms both increased. The
most permissive states had the greatest number of deaths due to firearm suicide
and homicide..
That authors list three minor limitations to their study,
but seem to omit a major one and that is a control or no-gun category. That may seem like a truism – how can you
have gun related suicides and homicides if you have no guns? One estimate is to compare firearm mortality to
peer countries like the graphic from the Kaiser Family foundation at the top of
this post. The US child and teen firearm
mortality rate is 10 to 200 times that in peer countries. The same is true for
adult gun homicides and suicides. All of
those thousands of excess child deaths are due to easy gun availability in the
US that is getting even easier.
We have a grim reality of a country that is chock full of
guns to the point that we are trying to establish a dose-response curve. We are
doing that exercise in a landscape that is still driven by gun extremists wanting
even more permissive gun laws. Common sense has clearly been suspended in favor
of political convenience in the US when it comes to guns. Until it returns America’s children will pay
the price in the form of completely unnecessary deaths and the ruined lives and
families of the both the victims and perpetrators.
George Dawson, MD, DFAPA
References:
1: Faust JS, Chen J,
Bhat S, Otugo O, Yaver M, Renton B, Chen AJ, Lin Z, Krumholz HM. Firearm Laws
and Pediatric Mortality in the US. JAMA Pediatr. 2025 Jun 9:e251363. doi:
10.1001/jamapediatrics.2025.1363. Epub ahead of print. PMID: 40489107; PMCID:
PMC12150223.
Graphics Credit:
Excellent analysis of child firearm death rates compared to
peer countries is from the Kaiser Family Foundation at this link: https://www.kff.org/mental-health/issue-brief/child-and-teen-firearm-mortality-in-the-u-s-and-peer-countries/
Use here is per the CC BY-NC-ND 4.0 license: https://creativecommons.org/licenses/by-nc-nd/4.0/
No changes were made to this graphic downloaded on June 16,
2025.
