SHARE OCTOBER 2019 V42, NO.10 PERSPECTIVE “I HAVE REGRETS”: 23 YEARS OF DICKEY AMENDMENT Maria G. Frank, MD; Rhea Powell, MD, MPH Dr. Frank ([email protected]) is an associate professor of medicine at the University of Colorado School of Medicine and a hospitalist at Denver Health and Hospital Authority. Dr. Powell ([email protected]) is an associate professor of medicine in the Division of Internal Medicine at Thomas Jefferson University, and a member of the SGIM Health Policy Research Subcommittee. have regrets”1 admitted former congressman Jay The spending bill that included the Dickey Dickey (R-AR) in a 2015 interview with The Amendment language ultimately passed, and in 1996, “I Huffington Post, only five days after a shooting the NRA-backed amendment repurposed $2.6 million at a community college in Oregon left 10 dead and eight previously dedicated to the Center for Disease Control more injured, and almost two decades after the passage of (CDC) Injury Prevention Program, towards research the federal amendment that bears his name. The Dickey on traumatic brain injury;4 even though only 5% of the Amendment, as it is known, added language to a 1996 fed- budget was dedicated to gun violence related research. eral spending bill specifying that no funds could be used to The Dickey Amendment language was then extended to “advocate or promote gun control,” effectively halting fed- other federal agencies including the National Institutes erally-funded research related to gun-violence. Mr. Dickey, of Health in 2011. When interviewed about the decision who passed away in 2017, reflected “I wish we had started to prohibit federal funding of research related to gun the proper research and kept it going all this time.” In a violence, then-House Speaker John Boehner said “a gun separate interview on National Public Radio, he explained is not a disease.”1 that the intention of the legislation was to prevent govern- In the years since it was first passed in 1996, The ment’s dollars to be used for gun control advocacy, but not Dickey Amendment language has continued to be in- to stop all research related to guns.2 cluded in annual federal spending bills, despite mounting In 1993, three years prior to the passage of the pressure to address gun violence. In 2013, and following Dickey Amendment, a Centers for Disease Control 2012’s Sandy Hook Elementary and Aurora Theatre (CDC) funded study conveyed that presence of firearms shootings, President Barack Obama directed the CDC to in households was associated with increased risk of conduct research into gun violence; however, efforts were homicide in the home. “Gun Ownership as Risk Factor restrained to certain categories such as youth violence, for Homicide in the Home,” an article by Kellermann, domestic and sexual violence, and suicide. Active and et.al., published in the New England Journal of Medicine unsuccessful negotiations continued through March (NEJM). A year earlier Kellerman had published a paper 2018 when Congress agreed on a budget that, while finding that readily available firearms increased risk of still including the Dickey Amendment language, offered death by suicide. Kellerman’s findings drew national at- clarification on the intent of the amendment. A report tention, steering the National Rifle Association (NRA) to accompanying the bill stated that “[while] appropriations successfully augment their lobbying in Congress. language prohibits the CDC and other agencies from The NRA, founded in 1871 as a non-profit organiza- using appropriated funding to advocate or promote gun tion focused on advocacy for gun rights, started inform- control, the Secretary of Health and Human Services has ing its members about firearm-related legislation in 1934, stated the CDC has the authority to conduct research on and became an active lobbyist in 1975. In the wake of in- the causes of gun violence.”5 creased scientific literature emerging related to the health Physicians and the research community are import- risks from gun injuries in the 1980s–1990s, the NRA ant voices in the discussion about need for federally fund- lobbied congress to prevent federal funds from being used ed research related to gun violence. Many professional to support gun-related research. During a Congressional physician associations have published position papers session on the matter in 1996, opponents of the Dickey on the imperative need for gun-violence prevention and amendment referenced NRA’s influence multiple times, research, including the American College of Physicians while Rep. Jay Dickey claimed that the “NRA has noth- (ACP), American College of Emergency Medicine (ACEP) ing to do with this bill whatsoever. It has not testified.”3 continued on page 2 1 1 SGIM FORUM OCTOBER 2019 V42, NO.10 SHARE PERSPECTIVE (continued from page 1) and American College of Surgeons increase with age. Mass shootings Agencies Appropriation Act, (ACS). The ACEP proposed more shake communities far too often. 1997. Congressional Record. than 60 specific research questions Lives are lost both intentionally and https://www.congress.gov/con- needed to be addressed. The ACP’s accidentally to firearms, and physi- gressional-record/1996/07/11/ report not only supported gun cians are first-hand witnesses to this house-section/article/H7280- violence research but also expressed public health crisis. Gun violence 2. 142;(102)—House of the College’s position in relation to demands the national attention, and Representatives, July 11, 1996. firearm ownership policy. The ACS like any health crisis the nation’s Accessed September 15, 2019. paper reflects on the polarity be- response must include robust and 4. Rostron A. The Dickey tween perceived “freedom control vs. adequately-funded research. Repeal Amendment on federal funding violence control” and calls for col- of the Dickey Amendment is a nec- for research on gun violence: laborative approach to engage both essary, but not sufficient, step to the A legal dissection. Am J Public poles to re-write the “narrative.” path to reducing gun violence. Health. 2018;108(7). https://doi. Meanwhile, gun violence kills org/10.2105/AJPH.2018.304450. more people in the United States References Accessed September 15, 2019. than in any other developed coun- 1. Kirkland A. Congressman whose 5. https://docs.house.gov/bills- try. 6 An average of 645 people die amendment ended federal gun thisweek/20180319/DIV%20 per week in the United States to research: ‘I have regrets’. Talking H%20LABORHHS%20 gun-violence,7 and it’s estimated that Points Memo. https://talking- SOM%20FY18%20OMNI. nearly 2.5 times as many people pointsmemo.com/livewire/ OCR.pdf Accessed July 7, 2019. present to emergency departments jay-dickey-regrets-amendment. 6. The Global Burden of Disease with non-fatal firearm injuries. Gun- Published October 6, 2015. 2016 Injury Collaborators. related fatalities affect people from Accessed September 15, 2019. Global mortality from fire- all races, ages and neighborhoods, 2. NPR. Ex-Rep. Dickey regrets arms, 1990-2016. JAMA. 2018; yet the nature and factors contrib- restrictive law on gun violence 320(8):792-814. doi:10.1001/ uting to these fatalities differ, and research. https://www.npr. jama.2018.10060. Published significant health disparities exist. org/2015/10/09/447098666/ August 28, 2018. Accessed The vast majority of gun deaths are ex-rep-dickey-regrets-restrictive- September 15, 2019. among men, and fatal gun injuries law-on-gun-violence-research. 7. Fowler KA, Dahlberga LL, disproportionally affecting young, Published October 9, 2015. Haileyesusb T, et al. Firearm non-Hispanic black males.7 Young Accessed September 15, 2019. injuries in the United States. people are most likely to die from 3. Departments of Labor, Prev Med. 2015 October; fatal gun-related injuries; howev- Health and Human Services, 79: 5–14. doi:10.1016/j. er, rates of gun deaths by suicide and Education, and Related ypmed.2015.06.002. SGIM 2.