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By Mark PA

Public health methods could have enormous power to mitigate the scourge of firearm mortality and morbidity. But only if faithfully applied.

One of the earliest and most profound examples were Dr. John Snow’s actions in the 1854 London cholera outbreak. This incident killed 616 people, occurred in the midst of the 1846 – 1860 worldwide cholera pandemic. His method added the term “focus of infection” to the public health lexicon.

The cholera-causing bacterium vibrio cholera was (coincidently) isolated in 1854, but its significance wasn’t immediately understood.  The leading theory was causation by “miasma” (particles in the air), as “germ theory” was not even proposed until 1861, by Louis Pasteur.  Dr. Snow pursued the idea that some specific contaminant might be the cause.  But the lead medical officer for London, John Simon labeled Snow’s theory as “peculiar”.

No matter. Snow documented the cases of cholera in the vicinity of London and noticed a concentration near Broad Street in the Soho district of the City of Westminster in London.  He ultimately illustrated this discovery with a “dot map” now known as a Voronoi diagram. A central point coincided with a public water pump. Of course, any other object in the area could be a competing focal point, for example, a pub, butcher shop or bakery.

Carefully examining the data, Snow lit upon the pump and hypothesized that something in the water caused the illnesses. Some victims at greater distance from Broad Street, he discovered, had used this water pump.

While people in the Broad Street neighborhood might have been equally likely to patronize the pub, butcher and baker, these more distant water pump users presumably patronized pubs, butchers and bakeries closer to home. The water pump tied them together in their illness. Snow got the handle removed in order to stop people using that pump, and the cases dropped off dramatically.

Now that the germ theory is well accepted, this may seem like an obvious solution. But scientific observations are rarely so clear in the moment. Cholera cases were widely distributed throughout England and across the world regardless of class, occupation, age, sex and so forth.

Anecdotally, miasma theory had just as much explanatory value as Snow’s hypothesis. But Snow looked at the numbers, the real-world locations of a number of cases. That cases were concentrated geographically suggested that the theory that “it’s in the air, it’s everywhere” wasn’t so persuasive after all.

Suppose a Dr. Johns Hopkins observed the same locus of infection as Snow did—the water pump. His hypothesis might have been that the iron handle itself of the pump was the source of infection rather than germs on it or the lack of hygiene on the part of the users. His solution might have been the same as Snow’s:  Remove the handle from the pump and see what happens.

Now that Broad Street neighborhood could fairly be described as “inner city” in modern terms, populated by, e.g., “fallen women”, criminals and similar individuals. Our Dr. Hopkins might have thought that these victims were not much worth saving. Moreover, they would be difficult to discipline to his scientific insights. These non-compliant residents might just replace the removed iron handle.

Far better for Dr. Hopkins to pursue his hypothesis in other precincts where compliance rates might be more easily achieved. Perhaps in places where upper classes resided—people worth saving. People who could reasonably be expected to comply with the public authorities’ decision to remove their well pump handles.

After all, members of the upper classes were also known to succumb tragically to cholera.  Little attention was paid to the death of a “fallen woman” who died.  No telling which of her proclivities might have led to her little mourned death.

By concentrating on anecdotal evidence driven by press reports, with a heaping measure of class consciousness, our public health expert Dr. Hopkins would have missed the boat.

A geographic focus on the most concentrated incidence was absolutely necessary. Perhaps it was the well, the water in the well or the pump handle. Perhaps it was elsewhere nearby in that neighborhood. Like the drunk who looks for his car keys under the street light, it does no good just to search where “the light is better”.

It is well established that firearm mortality and morbidity is concentrated in a small fraction of the nation’s Zip codes. Fifty percent of gunshot deaths occur in 2% of its counties.  

When the focus is put on these counties, the gunshot deaths are concentrated in a small fraction of the neighborhoods, and even at certain street corners. Andrew V. Papachristos’ research also shows that gunshot victims are highly concentrated in tiny “social networks”. Identify members of these networks and you can predict with remarkable precision the most likely future victims of gun violence.

Nevertheless, for whatever inexplicable reason, “the light is better here,” that is in all areas but the specific loci of homicides and violent crimes using guns.

Public health firearms “safety” researchers keep focusing on the wide distribution of “pump handles” (that is, guns) throughout the nation, instead of the factors that lead these tools to be used wrongfully.

Some stereotypes are statistically indisputable—but not the conclusions by those promulgating them. Homicides and suicides by gun are overwhelmingly committed by males. So, should females be disarmed?

Homicide is predominately perpetrated by younger males, say, 17 to 37 years old. So, the elderly should be disarmed? Homicide is most committed by the physically fit. So, must the physically challenged be disarmed?

Firearm homicides overwhelmingly use handguns. So, black “assault rifles” have to be banned, especially those with adjustable stocks, bayonet mounts and the dreaded “shoulder thing that goes up”?

A popular method for estimating the distribution of firearms in states is to consider it proportional to the number rate of gunshot suicides. More gunshot suicides imply more guns.

But who most tends to commit suicide by gun? Old fat white guys in rural areas. Paradoxically, young black males have a notably lower propensity for suicide and lower likelihood of suicide by gunshot, though they are more likely to become victims of homicide.

So, Mr. and Mrs. America, “Turn them all in!” And, to those of you who resist, we will “kick your doors down” and “buy-back” your “assault weapons”…at the point of a gun.

Should we really be convinced by this sort of lazy “public health” analysis? Is it so clear that it’s the pump handle, not the well water?  Is “gun violence” really “in the air”? Are we all equally vulnerable? Are we all equally likely to “snap”? A “focus of infection” analysis suggests that such is not the case.

Times have changed. It was once a matter of weeks—even months—for a contagion to spread from one continent to the next. Today, we fly halfway around the world in a day, far more swiftly than the incubation period of a deadly disease.

Once it took a skilled craftsman a month or more to cold-forge a rifle. Today, a CNC mill or 3-D printer can crank out a finished rifle receiver in a few hours in a hobbyist’s basement, to which can be added cheap mass-produced components.

We can no longer quarantine sick immigrants in the wards of Ellis Island any more than we can sequester gun-making tools nowadays.

Serious public health researchers who adhere to the scientific method know better. Yet, their voices get drowned out by others who can plausibly be accused of having political bias, much like the notion of “miasma”.

It’s something “in the air…it’s everywhere”.  It’s easiest to pursue the low hanging fruit: get rid of all the pump handles from the law-abiding (cooperative) elements of the public. Because the light’s better over here.

If “public health” researchers really believe that “gun violence” is an epidemic, they’ve abandoned the approaches that could actually solve it. Those of us who understand know that it isn’t, and know that their attitudes control their methodology and pre-determine their conclusions.


‘MarkPA’  is trained in economics, a life-long gun owner, NRA Instructor and Massad Ayoob graduate. He is inspired by our inalienable rights to “life, liberty and the pursuit of happiness” and holds that having the means to defend oneself and one’s community is vital to securing them.

This article originally appeared at and is reprinted here with permission. 

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  1. Not sure why there’s so much consternation and discussion over this topic. The cause of gun violence is clear – our current generation’s drift away from the belief that absolute morals exist, and that we’re all bags of protoplasm who are not accountable for our actions to a Creator. The “cure” to immediately reduce such violence in a society that doesn’t want to acknowledge this is to remove all carry restrictions and allow anyone, anywhere, to carry. After a possible short term spike in shootings due largely to the few idiots who will think they have a newfound power on their hip, The People will quickly take care of those idiots, and peace will prevail once it dawns on everyone that pulling a gun on someone in an aggressive and criminal manner might be your last act on Earth.

    • Haz,

      Yes! Civility, respect, accountability, and caring are fading in some areas of our society.

      When I see signs of disrespect even on this blog, I cringe. I hold out strongly that gun owners are probably the group that most cherishes the principles on which this county was founded.

      We are brothers and sisters in that regard.

      Forgive me for my sentimentality; principles (and faith) are how we hold to our civility.

    • It looks to me, and many others, like violence has been trending down since ’92 and overall really really went down after the mega killing spree of the “greatest generation’ (the axis soldiers were part of that generation too) and the generation before them. It also appears that the millennials and gen Z are less violent than Gen X and Gen Z is about as violent as the boomers were.

  2. On the other end of the spectrum, you could create a global police state. That’s the only way a population that makes up its morality on the fly and believes themselves to be just another animal can be governed. I think you know which one we’re quickly progressing toward.

  3. MarkPA,

    Nicely done. Whatever made you think of using actual science (statistical analysis) to analyze gun use and violence? I’ve been following the CDC for a couple of decades(related to very specific issues in which I have an interest); it seems to me outcomes of their research on the topics I follow (one of which is ‘guns’) are determined in advance. Isn’t that a much simpler approach?

    Wry smile.
    Again, thank you for this well-organized and rational essay.

    • If you knew something was going on over the last 8 weeks (should have been 16weeks) you will understand how useless and inept is the CDC. Incompetent swampies.

      And WTF was the NSA with detecting the chicom flu?

  4. One of the best articles I’ve read in a long time. Unfortunately, outside of a forum like this one, it will fall on deaf ears.

  5. This is called the “medicalization of deviance”. It happens when routine behavior becomes so stigmatized that it comes to be viewed as a “sickness” which must be “treated” by medical doctors. Social epidemiology is happy to turn watching porn or playing “violent” video games as an “addiction” which must, of course, be treated by doctors. Something similar is currently happening with gun-ownership—gun owners are being stigmatized by gun-control ideology with the ultimate goal of defining something as traditional—and important enough to be guaranteed by our 2nd Amendment—as deviant behavior. Once this happens, the stigmatized deviant behavior becomes the target of the medical community. The goal is to turn gun-ownership into a mental illness so severe that the mere act of owning a gun is too dangerous to be allowed in civil society.

    • Garrison,

      Yes. A few years ago the DSM-5 included as an illness the obsessive checking of food labels for ingredients. They tried to medical-ize fastidious holding to a healthy diet.

      Once owning guns is medical-ized, all gun-owners can be identified as ill and needing treatment.

      But we are not going to let that happen.

        • Gun control keeps running into the 2nd Amendment thanks to a few men in black robes.

          One day, that natural, unalienable, right that is enumerated and protected by the 2nd Amendment may again run head long into gun control like it did on April 19th, 1775.

  6. I say the medical community is morally incapable of involving itself in the “gun violence” debate. When doctors refuse to treat wounded soldiers it seems to be ok with many in the “medical community”‘

    But when Senator Rand Paul (R) from Kentucky, a practicing eye doctor, asked an Obama official, if a doctor could be forced to perform abortions? He was told yes they could be be forced by the government.

    What would really help is if doctors refuse to treat wound gangsters. After they have been in gun battles in Baltimore, Detroit, Chiraq, Seattle, Los Angeles, and the D.C. area. If you say I’m out of line then explain why it’s ok for a doctor to refuse treating wounded military personnel from a different battlefield?

    “At War Over Her Call to Heal : A doctor cited ethics in refusing reservist duty in the Persian Gulf–and paid the price of 8 months in Leavenworth. Kansas medical officials now want her license revoked as well.”

  7. There’s no such thing as a “Violent Gun,” so “Gun Violence” is BS. There is such a thing as a “Violent Person” though, so some behavior modification may be in order.

  8. You misunderstand completely. The “public health” approach to guns isn’t about reducing gun violence. It’s about dismantling gun rights, because “public health” is a magical phrase that invalidates your natural and civil rights. “Public health” is how you triage someone off from the healthcare system and leave them to die. “Public health” is how you quarantine people against their will. “Public health” is how you revoke freedom of movement and cease commerce by executive fiat.

    If they can get “public health” invoked on guns, the 2nd Amendment is gone and guns can be taken away from anyone, anywhere, without debate or legal recourse. Just like you can be handcuffed, dragged into quarantine, and shot if you resist. “Public health” is the ultimate end run around the constitution and that’s why it keeps getting brought up as a justification for gun control.

    • Alarming. Totally plausible after what we’ve seen virtually the entire globe accede to in the last week.

  9. Your idiotic hate is showing. That bit of history has nothing to do with a person’s individual hygiene. A leak existed in a septic tank, that is what infected the water from the pump, not the pump itself. Hey, but at least you could tell yourself that they were unwashed scumbags who had it coming. You should call them Breeders.

    • @Cory
      Your reading comprehension is abhorrent. Please go back to school and this time learn something! You need to start at about the 2nd grade level from what I can tell.

  10. So how is the 60% or more of intentional violence involving knives, blunt objects, motor vehicles and other physical trauma (at least where I live) not ‘violence’? They have patterns of use as well if one wants to do the stats. But somehow public health and mental health disciplines excuse the mindset and circumstances of such violence as not in their scope or range of professional capability. That’s like saying we can excuse ourselves from a universe made up of mostly unknown dark matter because we don’t, and can’t yet, know what it is.

    I made a lucrative living on the administrative, information and statistical end of the health care industrial complex for 30 years. When it comes to developing public policy input, that industry and its professions are about as competent, scientific, objective and unbiased as most all of us (and most all physicians) would be at performing brain surgery.

    The evolution of the DSM-5, as a comment above pointed out, is as haphazard and slowly deteriorating in efficacy as the ‘profession’ that wields it. That’s just one end of diminishing returns on the of quasi-governmental allowance to medical and related health professions to regulate, train and govern themselves in too self-serving a political society.

    Is the foundation of medical care delivery, epidemiology and public health cracking and crumbling? No. It’s just hard, and not wise, to build any unquestioning faith on their claims to having multi-disciplinary analytic capabilities, or policy solutions.

    • “It’s just hard, and not wise, to build any unquestioning faith on their claims to having multi-disciplinary analytic capabilities, or policy solutions.”

      That is what the the politically ‘Progressive’ would love to do with the very concept of civilian gun ownership – allow it to be attacked on ‘medical’ grounds.

      I believe his *point* was to not allow them to do it…

  11. Cand the “Public Health System” really deal with so-called “Gun Violence?”

    Hell no. The public health system can’t even deal with public health.

  12. MarkPA, well done, Sir. Clearly thought out, great examples, and excellent hypothetical questions posed to the gun grabbers. Thank you for a fine, thoughtful article.

  13. Gun violence is not a public health issue, it is a criminology issue. Public health deals with things like diseases and pollutants in the air and water, not why humans seek to harm other humans. By that argument, how to deal with nuclear-armed aggressors and terrorists also would be public health issues. When Hitler started WW2, that was a public health issue by such a standard.

  14. There is no such thing as gun violence, let’s stop using the Left’s terms. If there were such a thing, there would then have to be fork obesity.

    • Mine is more of a spoon obesity problem….. those damn spoons are just so dangerous to my health!

  15. Off topic I know, but revolvers are straight up intimidating at close range! Even single action jobs with ball ammo. Making me miss having a snubby pocket revolver right now.

  16. The problem is criminal violence. A gun is merely a handy tool for a criminal and makes his “job” easier. “Common sense” gun laws make the criminal’s task even easier by eliminating the possibility that his victim will have a gun to protect himself/herself. Want to see fewer victims of crime and more criminals thwarted, then pass laws that allow law abiding people to carry firearms for defense against criminals.

    • Hey Mac, you are promoting common sense. That is something that is the Left doesn’t understand. The Left has done more to aid the criminals in this country in the last 50 years than it has done for the unfortunates who reside in ghettos.

  17. That Was a well written and interesting article.
    The only problem with all your sound and reasoned and logical arguments is that they want the citizens disarmed.
    The only way to oppress the public is to disarm them.
    Criminals, terrorism, safety, none of that matters to the gun banners.
    Whole point of gun control is control of the population.
    So don’t even bother with your population studies and your murder maps by county. We have to resist them with a not 1 inch, no compromise policy.

  18. This was one of the best Articles I’ve read in recent years. It should be published in the JAMA. It should inspire self evaluation of their ethics and professionalism which they currently throw behind every junk science “Research” paper that states guns are bad.

    Very weel done Sir!

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