To pediatricians, gun control is a public health issue, not a political one. But they're treading a fine line, and they know it.

The American Academy of Pediatrics has begun a renewed push to try to get Congress to pass gun control measures, sending more than 100 pediatricians to Capitol Hill earlier this month. But others who have taken on the issue over the past decade have a warning for them: they can run afoul of the National Rifle Association and other pro-gun groups that are quick to paint anyone who advocates for gun control as a political extremist.

What the doctors want is an assault weapon ban, mandatory background checks and waiting periods before all firearm purchases, a ban on high-capacity magazines, handgun regulations and requirements for safe firearm storage under federal law.

“I think we can be honest brokers,” says Dr. Lolita McDavid, medical director for child advocacy and protection at University Hospitals, part of Case Western Reserve University’s school of medicine in Cleveland.

Johnny Hanson / AP file

With a little help, a child shoots an Airsoft gun at a target during NRA Youth Day events at the National Rifle Association's 142 Annual Meetings and Exhibits in Houston on Sunday, May 5, 2013..

“We have to have a collectively louder voice,” Dr. Danielle Laraque, who chairs the pediatrics department at Maimonides Infants and Children’s Hospital in Brooklyn, told a meeting of the Pediatric Academic Societies in Washington, D.C., earlier this month. “What we need is a call to action, to really look at how we can change public policy that is not often affected by data.”

They don't always get a friendly reception. Just two weeks before the doctors arrived, Congress had scuttled what gun-control advocates had considered a modest bill to expand background checks for gun sales.

Congress had already dropped a wider measure pushed by President Barack Obama and Vice President Joe Biden after the December shootings of 20 schoolchildren and six adults in Newtown, Conn.

Obama has been trying to roll back some of the restrictions placed on gun research by Congress. He’s issued an executive order specifically directing the Centers for Disease Control and Prevention to conduct research into gun injuries. While the CDC was never banned from doing so, Congress had specifically cut precisely the amount CDC spent on firearms violence research, sending a clear message.

“If you think that Congress has sort of been asleep…you are wrong,” said Dr. Daniel Webster of Johns Hopkins University, one of the few academic experts who has continued research on gun violence despite efforts to divert funding. “They have been doing a very good job of weakening the laws to make it easier for gun dealers to have the least amount of responsibility. They have made it harder to sue dealers and made it harder to access data on … which dealers are pumping out guns to criminals. They’ve made it almost impossible to prosecute a gun dealer.”

Pediatricians are puzzled that the statistics aren’t speaking for themselves.

“Where there are more guns in the United States, there are more people dying,” Dr. Matthew Miller of the Harvard Injury Control Research Center told the meeting in Washington, D.C. “There are more women dying, there are more men dying, and there are more children dying. We are talking about a lot of people who are dying when they live in places with a lot of guns and homes with guns.”

Miller’s done research on gun deaths using what CDC data he could get -- dating from before Congress cut its funding.

He divided the U.S. population in half, classifying half as living in high-gun-ownership states and half in low-gun-ownership states. In the “high gun states,” 21,148 people were murdered between 1988 and 1997, compared with 7,266 in the “low gun states”.  He found 369 kids up to 14 of age who were murdered using guns in states with high rates of gun ownership; 97 were killed deliberately with guns in low-ownership states.

And there were more murders overall, even using weapons other than guns in the high-gun-ownership states, Miller found. Other research finds kids and adults alike are more likely to commit suicide if they have access to a gun.

Miller hopes that pediatricians can change the tone of the argument, making it about safety.

“Here we are talking about children. We can’t gun-proof a child. We have to childproof our homes,” he said. “It is a leading argument that hopefully will change the way people think about guns generally.”

“Can we reframe the conversation so that it is about data, not about political beliefs?” Dr. Barbara Stoll of Emory University asked the meeting.

That might not be easy.  

“I am widely known as the ‘widely discredited Dr. Arthur Kellermann’,” Dr. Arthur Kellermann of the RAND Corporation, a think-tank, told the pediatrics meeting in D.C. Kellermann, who established the Emory Center for Injury Control, has spoken out about gun-injury and death rates that are almost 20 times higher in the U.S. than those in other high-income nations with populations of more than 1 million.

He’s also done research showing that people are 2.7 times more likely to be murdered if they have firearms in their homes – research challenged by guns-rights advocates. Kellermann says he’s not an advocate for gun control and cautioned the pediatricians to pursue changes that gun owners are comfortable with. 

Gun advocacy groups have moved to discredit the AAP, which represents 60,000 doctors who have voted overwhelmingly to support some gun measures. One was set up specifically to do this – the Doctors for Responsible Gun Ownership (DRGO).  “DRGO is a nationwide network of 1,400 medical doctors, other health care professionals, scientists, and others who support the safe and lawful use of firearms for any legitimate purpose,” the group says on its website.

Founded by the pro-gun-ownership Second Amendment Foundation, DRGO says the the AAP and the American Medical Association are “motivated by deep-seated prejudice against gun owners.” “DRGO’s mission is to expose the poor medical scholarship -- and the anti-gun bias behind it -- held out as truth by organized medicine and medical journalism,” the group says.

The NRA has sponsored legislation to stop pediatricians from asking parents about guns in the home -- something that really puzzles doctors who routinely ask about other safety issues, such as using car seats and wearing helmets while riding bikes.

A federal judge struck down Florida’s 2011 law that forbade doctors to ask about guns in the home, but the NRA has sponsored similar legislation in Alabama, North Carolina, West Virginia, Minnesota, and Oklahoma.

“The chilling effect persists,” Miller said.

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As many as one in five children who are at risk of suicide live in homes where they can get hold of guns -- the single most effective means to killing themselves -- researchers reported on Monday.

They said their findings show it’s extremely important to screen children for suicide risk, and to educate parents about how to keep guns out of their hands if they are. And early treatment is also vital.

The researchers, who presented their findings at the Pediatric Academic Societies meeting in Washington, D.C., say they don’t want their results to get mixed up in the current debate over firearms regulation. They just want to keep kids safe.

“A lot of kids, surprisingly, don’t have a history of mental illness but they attempt suicide,” says Dr. Stephen Teach, an emergency room doctor at Children’s National Medical Center in Washington, D.C.

Suicide is the No. 3 cause of death for children and youths aged 10 to 24, according to the Centers for Disease Control and Prevention. About 4,600 kids and young adults kill themselves each year, and 45 percent of them use guns. Another 40 percent suffocate or strangle themselves and 8 percent poison themselves.

Anthony Bolante / Reuters file

Crime scene investigators remove evidence the scene of a May shooting in Seattle that left six people dead, including the gunman. The Seattle City Council is poised to fund original research into the causes and effects of gun violence.

SEATTLE -- This city known for its left-coast liberalism is poised to become the first in the nation to provide direct funding for research into the causes and effects of gun violence.

In a move aimed in part at rebuking a 17-year congressional ban on federally funded studies of gun use, the Seattle City Council could allocate $153,000 to local injury prevention researchers as soon as next month.

“It will have significance in the fact that it’s a city doing it, not a state or a federal agency,” said Tim Burgess, the Seattle City Council member who has led the subcommittee promoting the cause. “It’s our statement against what Congress has prohibited for 17 or 18 years now. Shame on them for that.”

Burgess expects the proposal will be approved in April. If it is, the project will pay for access to and analysis of three large, public data sets in order to examine the relationship of substance abuse, mental illness, gun ownership, hospital injury admissions and deaths.

“One of the big needs right now is that there’s still a lack of data on the problems of gun violence,” said Dr. Frederick Rivara, a professor of pediatrics and a researcher at Harborview Injury Prevention and Research Center at the University of Washington School of Medicine.

“One of the things that’s come up in this whole discussion of guns is mental illness and substance abuse. We’re planning to link existing data sets to identify that if you have these problems, what are the risks of having gun problems in the future?”

The hope would be to use the information to target high-risk patients and their families, and then offer interventions that might prevent future gun harm, Rivara said.

It’s a project that may have been funded by a federal agency such as the Centers for Disease Control and Prevention a generation ago -- but not in recent years. Starting in the mid-1990s, members of Congress, at the behest of the National Rifle Association, cut the $2.6 million the agency previously had spent on original, peer-reviewed gun research and stipulated that no public dollars could be used “to advocate or promote gun control.” The money was later reinstated, but targeted toward traumatic brain injury, not the public health impact of gun violence.

In January, President Barack Obama issued a presidential memorandum reversing the ban, and calling on Congress to allocate $10 million for new research, part of a larger gun control plan. 

But the federal money has not been forthcoming, and is not likely to be, said Dr. Garen Wintemute, director of the University of California, Davis, Violence Research Program and an expert on firearm violence.

“There is no money for research,” Wintemute said flatly.

The need for research became even more glaring after a December gun massacre at Sandy Hook Elementary School in Newtown, Conn., left 20 children and six adults dead and galvanized a national conversation about gun violence.

“Everyone in the country was shocked by the affairs in Newtown,” Rivara said.

The tragedy resonated deeply in Seattle, where residents already were on edge after a string of high-profile shootings, including a May 2012 spree in which a mentally ill gunman killed four people at a popular café, killed another woman in a parking lot and then fatally shot himself.

Overall, in the U.S., nearly 32,000 people die each year from gun violence, according to the CDC. The city of Seattle logged a rate of 3.6 gun murders per 100,000 population in 2006-2007, according to latest CDC figures. That compares with a national rate of 4.2 firearm homicides per 100,000 population. The city's rate of adult gun suicides was 4.7 per 100,000, lower than the 5.0 per 100,000 rate nationally. 

Burgess said council members reached out to Rivara and his team at the city’s trauma hospital. “He identified the need to do this research and that this kind of research if vital to preventing gun violence.”

Using funds from the city's $4 billion 2013 budget, with a general fund of nearly $950 million, made sense, both in terms of meeting local needs and sending a national message, Burgess said.

“I believe that cities often lead the way on new policy and initiatives that spread to states, then spread to federal government,” he said.

Not everyone is pleased with the notion of the city using public funds for gun research, including Dave Workman, a senior editor at Gun Week magazine and a spokesman for the Citizens Committee for the Right to Keep and Bear Arms in Bellevue, Wash., just outside of Seattle. 

"What you're talking about is a clever way to make a study with a pre-conceived conclusion that will say guns are bad," Workman said, adding later: "I'm sure there are better uses for that money."

Rivara and Burgess said that they believe Seattle will be the first to spend city funds on gun violence analysis. Representatives for the National League of Cities and the group Mayors Against Illegal Guns said they hadn’t heard of other cities paying for basic research.

The amount of money may seem modest, but it’s enough to produce significant results, Wintemute said.

“It’s not merely symbolic,” he said. They can do a really meaningful project with it. High quality work in one place can have a national effect.”

It will take about a year to gather and analyze the data, Rivara estimated. He hopes the results will be as successful as a previous effort to identify trauma patients with alcohol abuse issues. That research resulted in an intervention that has become a national model -- and reduced subsequent alcohol use and repeat trauma admissions by 50 percent, Rivara said.

He’s encouraged by the support of the city. Like Burgess, Rivara is optimistic that the funding request will be approved.

“I think we have a very informed citizenry as a whole and an informed city council,” he said. “They’d like to know what they can do on their part to help.”

Related stories: 

• Obama plan eases freeze on CDC gun violence research
• Fewer gun deaths in states with most gun laws study finds

States with a heavier dose of firearm laws tend to have the lowest rates of gun deaths, according to a study released Wednesday by Boston-based researchers who argue their findings show "there is a role" in America for more rigid gun-control legislation.

"It seems pretty clear: If you want to know which of the states have the lowest gun-mortality rates just look for those with the greatest number of gun laws," said Dr. Eric W. Fleegler of Boston Children's Hospital who, with colleagues, analyzed firearm-related deaths reported to the Centers for Disease Control and Prevention from 2007 through 2010.

By scoring individual states simply by the sheer volume of gun laws they have on the books, the researchers noted that in states with the highest number of firearms measures, their rate of gun deaths is collectively 42 percent lower when compared to states that have passed the fewest number of gun rules. The study was published online in the journal JAMA Internal Medicine.

As proof, Fleegler pointed to the firearm-fatality rates in law-laden states such as Massachusetts (where there were 3.4 gun deaths per 100,000 individuals), New Jersey (4.9 per 100,000) and Connecticut (5.1 per 100,000). In states with sparser firearms laws, researchers reported that gun-mortality rates were higher: Louisiana (18.0 per 100,000), Alaska (17.5 per 100,000) and Arizona (13.6 per 100,000). 

In Arizona -- just as the new study was released -- former Rep. Gabrielle Giffords returned Wednesday to the grocery store where she was shot and urged Congress to expand background checks for gun purchases. She told the gathered crowd and U.S. lawmakers to: "Be bold. Be courageous. Please support background checks." 

On Thursday, the Senate Judiciary Committee is expected to vote on a bill that would stiffen penalties for people who purchase guns illegally for others, and to make gun trafficking a felony. 

Fleegler and his team openly acknowledged they could not prove a definitive "cause-and-effect" link between tighter laws and a lower risk of gun-caused homicides or gun-related suicides. But ahead of the expected Senate vote, the researchers said they did determine this:

In those states that have the most firearm laws, those states also have the lowest rates of household-firearm ownership.

"And states that have the lowest gun-ownership rates also have the lowest gun-mortality rates," Fleegler said. "So states that try to have gun laws that are meant to be meaningful, they seem to be able to actually have an impact. That’s an important thing to learn from."

The findings were quickly challenged by two critics,  a top gun-rights advocate and a leading expert on the nexus of public health and gun policy, who each questioned the merits of the Boston findings and the rigor of the science behind the study.

It sounds to me like some sort of sleight of hand from a political sense," said Dave Workman, senior editor at Gun Week magazine and director of communications for the Citizens Committee for the Right to Keep and Bear Arms, in Bellevue, Wash.

"If they are dancing around this cause and effect, I'm not sure that the public should warm up to that kind of a conclusion because it really doesn't conclude it, it only suggests or intimates something," said Workman, who served three terms on the National Rifle Association board of directors.

"It's presumably the result they wanted to get in order to have the public believe something. Is that fair? Is that good science? Is that good research? I don't know." 

Workman further argued that in states or jurisdictions where gun laws "make it difficult for law-abiding citizens" to buy firearms through legal channels, "that does not necessarily translate to lower fatalities."

"And, as proof," he added, "I give you the city of Chicago." 

In an accompanying commentary, Dr. Garen J. Wintemute of the University of California, Davis, Sacramento, wrote that the paper's conclusion "would be an important finding — if it were robust and if its meaning were clear."

Ultimately, Wintemute wrote, the new study provides no insights on the key questions facing Congress: "Do the (gun) laws work, or not? If so, which ones?"

"Correlation does not imply causation," Wintemute said in a phone interview. "The plain English way of saying this is: Just because two things exist at the same time, that does not mean one thing caused the other. That's what's being implied here. All they counted in that analysis was the number of laws in each state, not which laws. There's no information in this study on the specifics of the (state) laws and whether they were enforced or not."

"So in a sense, the only conclusion you could draw would be: Pass more more laws but it doesn't matter which ones or what they're intended to do," Wintemute said. "That's just silly." 

Fleegler's study was not related to a recent executive order by President Barack Obama lifting a ban on gun violence research funded by federal agencies such as the CDC. Fleegler said he used public data at no cost to conduct his analysis. 

Wintemute said the study actually underscores the need for well-funded research into the effects of gun violence on public health. 

"Until we revitalize firearm violence research, studies using available data will be the best we have. They are not good enough."

Related stories:

• Guns in America: The weapon of choice for criminals, but also a deterrent?
• Obama plan eases freeze on gun research

Your spouse is despondent, says life isn’t worth living – and has a gun. What do you do?

It’s a common scenario – suicide rates among young adults increased more than 200 percent over the past 50 years and suicide is the 10^th leading cause of death in the United States, according to federal statistics.

This weekend’s apparent suicide of singer Mindy McCready highlights one other statistic about suicide – people who use guns are far more likely to actually kill themselves than people who attempt suicide using pills, car exhaust or some other method.

“More than 50 percent of suicides in this country are committed using firearms,” says Dr. Liza Gold, a professor of psychiatry at Georgetown University Medical Center. “If you limit the means, you can save people’s lives.”

But getting a gun away from anyone can be difficult, as the recent debate over changes to gun laws can demonstrate. Gold and her colleague Dr. Alan Newman have some pointers for friends, relatives and caregivers of people who might be at risk of suicide and who have access to guns.

“If you have a family member with chronic mental illness, guns should not be accessible to that person,” Gold said in a telephone interview. “People are often ambivalent about committing suicide. They go back and forth, and they are scared, especially if it’s in a moment of crisis. If you can get them through that crisis period, often they can get better.”

With a gun, "there is no second chance," says Gold.

Rule number one – don’t fight over the gun. “Never try to disarm anyone,” she says. “You definitely don’t want to get into a shoving match over a weapon with someone who in distress…and potentially might not be thinking clearly or rationally,” she added.

“If you know the person has access to a weapon, is suicidal, and is not willing to give up the weapon or becomes agitated if you ask for it, back off and call the police immediately. The people most likely to be shot and killed by family members -- with or without mental illness -- are other family members.”

It’s also important not to make the person defensive. Gold recommends using “I” language. “You say, ‘Look, I am worried about you. I love you and I am concerned,’” Gold advises. “You say, ’I would feel better if you would let me take the gun out of the house. I would feel better, would it be okay if I made the gun safe?’”

It is much less threatening, Gold says, than accusations. “If you say, ‘You’re crazy -- give me that gun right now’, people don’t respond well to that kind of approach. Let them know you are worried. Let them know it’s temporary and you are not taking it away from them forever.”

It’s also all right and downright desirable to contact a loved one’s doctor, says Newman. It’s not a violation of doctor-patient confidentiality if the doctor doesn’t reveal anything about the patient.

“A lot of clinicians make a mistake – they have somebody they are giving psychotherapy to or giving medications to and the relationship is all doctor-patient. They don’t communicate with the family,” Newman says.

“In that case, the doctor is pretty much limited to what the patient tells them.” A psychiatrist needs to know if someone who is depressed and potentially suicidal has a way to get hold of a gun.

“If the family wants to give you information, in that case you are not violating confidentiality. You are listening,” Newman says.

Doctors need to be careful in reaching out to family members. “I have seen everything you can imagine, from family members who don’t want the person to get better to family members who are afraid that if they tell you about firearms, the gun may be confiscated,” Newman says.

He advises giving patient and family members alike a plan for keeping the patient safe. “The worst thing is to say to the family right before they leave is to make sure you get rid of the guns. It shouldn’t be an offhand comment,” he said.

And then a doctor needs to check back and make sure the gun has been removed or locked up.

In the worst case, the police are trained to deal with people who are armed and possibly suicidal, and it may be necessary to call them, Newman and Gold both said. “At the end of the process, if you really feel like someone is imminently dangerous – that is the criteria for involuntary detainment in pretty much every state,” Gold says.

“Certainly they will at the very least send a mental health crisis team or a police officer to see what is going on.”

Newman recommends the American Association of Suicidology’s website for more advice. 

 Related stories:

• Country singer McCready dead in apparent suicide
• McCready may have killed dog, too
• Ex-boyfriend says not shocked by McCready suicide
• Half of all gun deaths are suicides