AMA Calls for End of Ban on CDC Research on Gun Violence

Congress should lift a ban that effectively prohibits research at the Centers for Disease Control (CDC) on gun violence as a public health hazard, declared the AMA House of Delegates at its meeting last month in Chicago.

The delegates, in an emergency resolution approved two days after the mass shooting at an Orlando, Fla., nightclub early on the morning of Sunday, June 12, adopted policy that calls gun violence “a public health crisis” requiring a comprehensive public health response and solution.

Importantly, the resolution, which was cosponsored by the AMA Section Council on Psychiatry, calls on the AMA to lobby Congress to overturn legislation that for 20 years has prohibited the CDC from researching gun violence. The language in that legislation—an amendment to the Labor-Health and Human Services-Education Appropriations bill passed in 1996—has remained in subsequent annual funding bills.

The resolution gathered support among AMA delegates almost immediately after the firearms massacre in Orlando, the worst mass shooting in U.S. history. The shooting, which left 49 people dead and many others injured, took place early in the morning of the day that AMA delegates were gathering for reference committee hearings, where reports and resolutions are debated before going before the full House of Delegates.

By the time of the vote on Tuesday, June 14, more than 70 state and medical specialty societies had signed on as cosponsors to the resolution, including all of the member groups of the Section Council on Psychiatry.

APA CEO and Medical Director Saul Levin, M.D., M.P.A., said it was long past time to overturn the congressional ban on gun violence research at the CDC.

“The massacre in Orlando is just the latest and most egregious instance in an epidemic of gun violence that calls for a comprehensive public health solution,” Levin said. “Last year, APA was one of seven physician organizations that called for policies to reduce firearm-related injuries and deaths. As physicians, we know that research is necessary to point us in the direction of common-sense solutions to this epidemic.”

Levin’s comments were echoed by AMA President Steven Sack, M.D. “With approximately 30,000 men, women, and children dying each year at the barrel of a gun in elementary schools, movie theaters, workplaces, houses of worship, and on live television, the United States faces a public health crisis of gun violence,” Stack said in a statement. “Even as America faces a crisis unrivaled in any other developed country, the Congress prohibits the CDC from conducting the very research that would help us understand the problems associated with gun violence and determine how to reduce the high rate of firearm-related deaths and injuries. An epidemiological analysis of gun violence is vital so physicians and other health providers, law enforcement, and society at large may be able to prevent injury, death, and other harms to society resulting from firearms.”

Psychiatrist Louis Kraus, M.D., chair of the AMA Council on Science and Public Health, told Psychiatric News that the resolution amounts to a demand for research that would provide important epidemiologic information about how to effectively intervene to reduce gun violence.

“We need good research, and for the past 20 years there has been a moratorium on research at the CDC,” Kraus said. “We can’t devise good interventions without good information.”

Testimony on the floor of the House was passionate and urgent, and though not unanimously supportive, was very close to it. Addiction psychiatrist Michael Miller, M.D., said, “We are the shame of the world. Other countries look at us and wonder what is wrong in America.”

Miller said the 20-year prohibition on research at the CDC has produced an environment of real avoidance among researchers, who fear that funding for their projects can be cut off if it runs afoul of the congressional language. “We need the AMA to take a stand on this,” he told the House.

Specifically, the 1996 amendment states that “none of the funds made available for injury prevention and control at the Centers for Disease Control and Prevention may be used to advocate or promote gun control.” However, the practical effect of this language has been—as Miller stated on the House floor—to freeze virtually all research on firearms. Arthur Kellerman, M.D., M.P.H., stated in a December 2012 article in the Journal of the American Medical Association, “Precisely what was or was not permitted under the clause was unclear. But no federal employee was willing to risk his or her career or the agency’s funding to find out. Extramural support for firearm injury prevention research quickly dried up.”

(Kellerman was the author of a 1993 study in the New England Journal of Medicine titled “Gun Ownership as a Risk Factor for Homicide in the Home,” which appears to have been the catalyst for the 1996 amendment. That study found that “keeping a gun in the home was strongly and independently associated with an increased risk of homicide. … Virtually all of this risk involved homicide by a family member or intimate acquaintance.”)

Even after the 2013 Newtown massacre when President Obama issued an executive order to lift the ban, research on firearms remained stifled. A January 15, 2015 article in the Washington Post reported that “today the CDC still avoids gun research demonstrating what many see as the depth of its fear about returning to one of the country’s most divisive debates.”

The shooting in Orlando took place in a gay nightclub killing mostly Latino and black patrons. The incident sparked outrage among gay communities around the nation and among gay physicians at the AMA.

AMA Trustee Jesse Ehrenfeld, M.D., and neurologist Joshua Cohen, M.D., challenged delegates to honor the victims of the Orlando shooting by contributing to an AMA Foundation LGBT Honor Fund that provides up to $10,000 annually to initiatives of interest to the LGBT medical community.

Ehrenfeld and Cohen vowed to match contributions up to $15,000. Later in the meeting, they announced that delegates had committed more than $71,000. ■

The emergency resolution on gun violence and other items enacted by the AMA House of Delegates can be accessed here.