Tale of 2 Agencies: CDC Avoids Gun Violence Research but NIH Funds It

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Medical News & Perspectives Tale of 2 Agencies: CDC Avoids Gun Violence Research But NIH Funds It

Rita Rubin, MA

aren Wintemute, MD, MPH, is the tions are more likely to commit violence than leaders of CDC are scared to take this on be- first to describe his lifestyle as fru- gun owners without such a criminal history cause it’s so politically controversial.” G gal. An emergency room physician (http://1.usa.gov/1Vn5GiB). David Satcher, MD, PhD, a former sur- on the faculty of the University of California, Why the 2 federal agencies have inter- geon general who now directs the Satcher Davis, Wintemute lives in a $900-a-month preted the same rider so differently is not Health Leadership Institute at the More- 1-bedroom apartment on the outskirts of clear. Critics say the CDC has overreacted house School of Medicine, was CDC direc- Sacramento.Hehasnochildren,sohedoesn’t to the amendment’s vague language. But tor when Congress first tacked on the have to sock away a chunk of his salary to- other observers note that the size of the Dickey Amendment to the 1997 budget ward college tuition. “There’s a fair amount of NIH budget gives it less reason to be con- bill. “I’m not prepared to judge the people money left over every year,” he said. cerned about retaliation by pro-gun mem- at the CDC,” Satcher said. “They don’t want So much so that the 64-year-old bers of Congress. For the current fiscal to get into this [gun violence prevention Wintemute has already donated $1.3 mil- year, the NIH budget is $32.3 billion, com- research] unless they know someone has lion of the $2 million he has pledged toward pared with the CDC’s $11.8 billion ($4.5 bil- their back.” the UC Davis Violence Prevention Research lion of which is earmarked for mandatory Mary Woolley, president of Re- Program, which he happens to direct. With- programs such as Vaccines for Children). search!America, a nonprofit organization out his contribution, “we probably would Officials at the CDC and NIH declined to that advocates for increased funding for gov- have disbanded,” Wintemute said, noting comment on agency policies regarding gun ernment agencies involved in scientific re- that at one time he was the program’s main violence prevention research. search, says she understands why the CDC source of money. “Whatpeopledon’tunderstandisthere’s might fear retribution from Congress if it re- Such financial woes can be attributed in no federal ban on research,” said Mark sumed research into the roots of gun vio- part to the fact that the US Centers for Dis- Rosenberg, MD, MPP, a 20-year CDC vet- lence. “The CDC is funded in a different way ease Control and Prevention (CDC) hasn’t eran who says he was fired as director of the than the NIH,”Woolley said. “They have line- funded research into gun violence preven- National Center for Injury Prevention and item budgeting.”The NIH, on the other hand, tion for 2 decades, ever since Congress in- Control in 1999 because of his commitment has had more latitude in deciding what it cluded these 3 lines—named the Dickey tostudyinggunviolenceprevention.“Butthe wants to study, she said. Amendment for then-representative Jay Dickey (R, Ark), who introduced it—on page 245 of the 750-page Omnibus Consoli- dated Appropriations Act of 1997: “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.”(http://1.usa .gov/22zCqKD) The amendment was in response to a CDC-funded study that concluded having a gun in the home was associated with a higher risk of homicide by a family member or intimate acquaintance (Kellerman AL et al. N Engl J Med. 1993: 329[15]:1084-1091). Since the Consolidated Appropriations Act of 2012, the same language has also ap- plied to the National Institutes of Health (NIH). However, as part of a funding opportunity for violence research announced in 2013, the NIH awarded Wintemute a total of about $850 000, from May 2015 through April 2017, to study whether gun owners with a history of alcohol and drug convic-

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Window Dressing or Curtains Parting? squirrels and targets, is a member of the lence for nearly 20 years,”Thompson, a gun The CDC doesn’t completely ignore the is- National Rifle Association (NRA). owner himself, said in a statement to JAMA. sue of gun violence. In 2002, it created the “Both of us now believe strongly that “The omnibus bill (signed by Obama in De- National Violent Death Reporting System federal funding for research into gun- cember) gave us a chance to fix that, but (NVDRS), which covers all types of violent violence prevention should be dramatically once again, Republicans refused to simply deaths, including homicides and suicides increased,” wrote Dickey and Rosenberg, get out of the way and let our experts do committed with firearms. However, the now president and chief executive officer of what they do best—conduct research that NVDRS collects data from only 32 states. the Task Force for Global Health, a non- will save some lives.” “That’s about as benign as you can get,” profit public health organization. But, they But in an opinion piece for Politico in De- Stephen Teret, JD, director of the Center for added, the language accompanying this ap- cember, Chris W. Cox, the executive direc- Law and the Public’s Health at the Johns propriation should mirror the 1996 Dickey tor of the National Rifle Association Insti- Hopkins Bloomberg School of Public Health, Amendment in that research aimed at re- tute for Legislative Action questioned the said of the NVDRS. “It’s not only about guns, stricting gun ownership be excluded from motives of those calling for Congress to re- it’s about violence, and it’s just data collec- federal funding. store CDC funds for gun violence research tion.” The NVDRS could be used as a tool in The op-ed piece echoed a letter Dickey (http://politi.co/1IEHTcu). gun violence research, Wintemute said, but had sent earlier in December to Rep Mike “Anti-gun advocates in Congress are “most of us see it as not research in itself.” Thompson (D, Calif), chair of the House Gun looking for creative methods to change pub- In December, the Senate passed by Violence Prevention Task Force. “Research lic opinion. What better way than under the unanimous consent the Mental Health could have been continued on gun violence auspices of science?” Cox wrote. “Now, they Awareness and Improvement Act, which, without infringing on the rights of gun own- just need some government-sponsored, among many other things, “encourages” the ers,” Dickey wrote (http://1.usa.gov taxpayer-funded data points to validate their secretary of Health and Human Services, /1NHBW0A). “Doing nothing is no longer an anti-gun agenda.” through the CDC director, “to improve, par- acceptable solution.” The Dickey Amendment does not op- ticularly through the inclusion of additional pose funding research into gun violence, he states,” the NVDRS. However, “participa- President’s Orders wrote. “Instead, it forbids funding for re- tion in the system by the states shall be vol- After 20 children and 6 adults were mur- search meant to drive the political gun con- untary,”according to the bill (http://1.usa.gov dered in December 2012 at Sandy Hook trol agenda.” /1QjPwSM). Elementary School in Newtown, Connecti- The NRA “is not opposed to research Unlike with other measures it pro- cut, President Obama called on Congress a that would encourage the safe and respon- poses, the legislation doesn’t mention how month later to appropriate $10 million to sible use of firearms and reduce the num- it would fund an expanded NVDRS. Accord- CDC for gun violence prevention research bers of firearm-related deaths,” Cox wrote. ing to the Congressional Budget Office, add- (http://1.usa.gov/1JFGZGN). He directed the ing the remaining states and the District of agency to immediately begin “assessing NIH Forges Ahead Columbia would cost an estimated $12 mil- existing strategies for preventing gun Although Congress has deemed since 2012 lion from 2016 through 2020 (http://1.usa violence and identifying the most pressing that no NIH funds can be used “to advocate .gov/1LrTbg6). research questions, with the greatest or promote gun control,”that agency in 2013 “It’s hard to know if this would mean potential public health impact.” announced a funding opportunity for re- that, yes, firearm research is coming back, or “Research on gun violence is not advo- search examining violence, in particular fire- if it’s just window dressing,” Sandro Galea, cacy; it is critical public health research that arm violence (http://1.usa.gov/1Q3PK6A). MD, DrPH, said of the legislation’s intention gives all Americans information they need,” An NIH news release said the agency to expand the NVDRS. Obama said. “developed this call for proposals in re- “The challenge to CDC is simple: is there In a January 2013 memorandum, sponse to the Presidential memorandum in new money for this work?” said Galea, dean Obama ordered that “the secretary of Health January 2013 directing science agencies of the Boston University School of Public and Human Services, through the director of within the US Department of Health and Health. “If there isn’t, then it’s really hard to the Centers for Disease Control and Preven- Human Services to fund research into the see them devoting much money to fire- tion and other scientific agencies within causes of firearm violence and ways to pre- arms. It’s hard for me to see a bill with sub- the Department of Health and Human Ser- vent it.” (http://1.usa.gov/1Xe5B24) stantial new resources for firearms to pass vices, shall conduct or sponsor research into The NIH has funded 9 proposals, in this current political climate.” the causes of gun violence and the ways to although only 2 specifically address fire- Dickey,who left Congress in 2000, says prevent it.” (http://1.usa.gov/1Q6aOto) arms (http://1.usa.gov/1nYywLR). Besides he regrets his amendment’s unintended And yet, the Dickey Amendment re- Wintemute’s, the other was submitted chilling effect on gun violence research. On mains in the yearly budget bill, including the by Rina Eiden, PhD, a substance abuse December 25, 2015, he and Rosenberg co- one Obama signed in December, and Con- researcher at the University of Buffalo. authored an op-ed piece in the Washington gress still hasn’t earmarked any money for Eiden received $723 000 in fiscal year Post, “How to protect gun rights while re- gun violence research at the CDC. 2015 to study the precursors of gun vio- ducing the toll of gun violence.”(http://wapo The Dickey Amendment “has prohib- lence,suchasganginvolvementandweapon .st/1MzGY8g) Like Dickey, Rosenberg, who ited experts at the CDC from researching the carrying, in a cohort of 218 children aged 11 says he owns a pellet air rifle to shoot causes of and best ways to prevent gun vio- to 14 years, whom she had recruited at birth

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for a separate study of developmental prob- “I’m not as optimistic about CDC as I am /1PWhEOU), and a California state lawmaker lems linked to prenatal cocaine exposure. perhaps about other federal agencies or pri- introduced a bill in February that would The project is her first foray into gun vio- vate foundations doing some of the fund- establish a firearm violence research center lence research; she had not previously had ing,” said Degutis, a past president of the at the University of California. “I hope my a funding opportunity to study the topic, American Public Health Association who was colleagues in Congress will find the courage Eiden said. on the faculty at Yale before working at the to follow California’s lead and permit fed- “Ultimately,funding drives science, to a CDC. “It seems so crazy to not find out what eral funding for gun violence research,” certainextent,”Eidensaid.“It’shardtoblame works [to reduce gun violence].” Sen Dianne Feinstein (D, Calif) said in a the CDC when they’re so dependent on Teret, who previously directed Johns statement (http://bit.ly/1V6FR6k). funding. They really have to pick and choose Hopkins’ Center for Gun Policy and Re- Hanifa Shabazz, a councilwoman in their battles.” search and its Center for Injury Research and Wilmington,Delaware,astatethatisnotpart Policy,believes the CDC is “being overly fear- of the NVDRS, said she was surprised to learn “Crazy to Not Find Out What Works” ful and misinterpreting what Congress told that the CDC was not funding research into Linda Degutis, DrPH, MSN, said frustration it many years ago.”From the beginning, CDC gun violence prevention. Last year, the CDC over the lack of funding for gun violence pre- worried that Congress might perceive any agreed to Shabazz’s request to investigate vention research was “one of the many rea- type of gun violence research as a violation why her small city has one of the highest sons” she left the CDC in 2014 after 3 years of the Dickey Amendment, said Teret, add- murder rates in the country. as director of the National Center for Injury ing that funding for his current research into The agency sent a team of Epidemic In- Prevention and Control. designing safer guns comes mainly from pri- telligence Service officers to Wilmington, Shenowworkspart-timefortheHenryM. vate individuals. and they submitted their final report to the Jackson Foundation for the Advancement “I don’t think CDC has ever been seen as Delaware Department of Health and Social of Military Medicine and volunteers with the being politically adventurous or coura- Services, which released it in November. Avielle Foundation, created by the parents geous,” he said. “Even in the absence of an However, the report makes no mention of of 6-year-old Avielle Richman, who was mur- additional $10 million, CDC could have said, what types of guns are used in Wilmington dered at Sandy Hook. The foundation funds ‘Let’s reallocate some of our spending.’” homicides and how perpetrators obtained “research exploring the underpinnings of Meanwhile, at least 1 city and 1 state are them (http://1.usa.gov/1o05R93). the brain that lead to violent behaviors looking to pick up the slack. Seattle began “People are dying [as a result of and to foster the engagement of communi- taxing guns and ammunition on January 1, firearms], 90 or so a day on average,” ties to apply these insights.” (http://bit.ly 2016, to fund firearm violence prevention Wintemute noted. “It must gall CDC a great /1mnQcyH) programs and research (http://bit.ly deal not to be in the game.”

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