News & Analysis 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 preven- tion and control at the Centers for Disease Control and Prevention may be used to ad- vocate 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 oppor- tunity 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- jama.com (Reprinted) JAMA Published online April 6, 2016 E1 Copyright 2016 American Medical Association. All rights reserved. Downloaded From: http://jama.jamanetwork.com/ by a University of California - Davis User on 04/21/2016 News & Analysis 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.