Gun Violence as a Public Health issue

The protest poster above is too tame, so this 1-min video adds shame. Combined with different framing of gun violence as a public health issue, I hope it helps move the conversation forward. As we’ve seen, thoughts and prayers just aren’t working and actually impede progress.

To reduce gun violence, maybe we need to replace thoughts & prayers with real and graphic truths that shock the public and force real change. Since the gun lobby is dug in to protect profits for gun manufacturers, and calls for gun control only cause more resistance, a better approach is to reframe gun violence as a public health issue with high human and economic costs. 

reframe gun violence as a public health issue with high human and economic costs
UPDATE: Harvard research published in JAMA in 2022 estimated the cost if gun injuries at $557 billion annually, or 2.6% of the US GDP. That’s more than twice the Mother Jones estimate from 2015.

This article was originally published in March 2018 (view original as PDF)
Updated occasionally to add new info., so you may notice conflicts with some of the data.

TOPICS:

The Public Health Impact of Gun Violence

Public Health officials have a legitimate interest in preventing gun violence. It now costs more than $1,700 per American a year, or $557 billion in total. That’s according to a Mother Jones report that the NRA doesn’t want you to see, The True Cost of Gun Violence in America, and updated with more current data from Harvard research. Mother Jones got its data from the US Congress Joint Economic Committee, which includes a collection of state-by-state infographics.

I’m not sure the medical industrial complex (hospitals, insurers, drug companies, testing companies, and equipment providers) wants you to see the report or fix the problem either, because they profit from treating gun injuries and long-term disabilities. As with the NRA, preventing gun violence would go against their profit motive.

We can’t feel safe going to work or to school, church, a concert, a mosque, a synagogue, or the movies. But we CAN get involved politically at the Federal and State levels through organizations like Texas Gun Sense, which says:
*  3,350 people die from gun violence in Texas annually.
*  62% of all suicides are by firearm in Texas.
*  $16.6 Billion/year is the cost of gun violence in Texas.

But what does gun violence, suicide and accidental injury cost us? The Mother Jones report digs into the long-term costs of serious injury and disability, where we spend more on the results of gun violence than on obesity, and almost as much as we spend on Medicaid. I’ll use those costs in this article to justify sensible solutions that have worked elsewhere.

In the video below, Jennifer Longdon tells us how she faced financial ruin after being shot in the spine years ago. Her all-too-common story tells of the hidden costs that “must” be included in debates over gun safety reform.

Jennifer was among the 750,000 Americans injured by gunshots over the last decade. She’s lucky not to be one of the 320,000 killed. The Mother Jones report says that each year more than 11,000 people are murdered with firearms, and another 22,000 others commit suicide with a gun. That’s about 60/day, but they don’t all get media attention; in fact, most don’t.

Beyond the mass shootings, each week brings news of another accidental shooting with an unsecured gun as hundreds of children die from firearms. Sadly, even as violent crime has declined in recent years, gun deaths and injuries are up since 2011, at 11% and 4% respectively. The news media largely stems from mass shootings, yet much of the cost inflicted on victims, their families and employers, and the nation go unreported.

Nobody doubts that gun violence is a serious problem, except maybe the NRA and gun lobbyists. But it doesn’t seem to matter whether we believe that “guns kill people” or “people kill people,” the result is the same: a public health crisis.

Solving this Public Health Crisis begins with Data

The US government has spent hundreds of billions researching other public health problems. The Department of Transportation (DOT), for example, studied deadly car crashes and then took measures to reduce the causes and the number of deaths and injuries per million miles driven went down significantly. The Environmental Protection Agency (EPA) studied the health impact of pollution, and the Department of Health and Human Services (HHS) studied the costs of domestic violence. But thanks to intense NRA lobbying, Congress amended a bill designed to fund the CDC and National Institutes of Health (NIH) but then preventing them from studying the medical and lost-work cost of gun violence. It was called the Dickie Amendment[UPDATE: From 1996 to 2013, CDC funding for gun research dropped by 96 percent, but this week the CDC has committed to study the issue again and seek solutions. A March 2024 article by KFF Health News gives history of that Amendment and those working outside of government since then to study the issue.]

To address this gun-related public health crisis, Congress must overcome NRA objections and get the facts straight. They need to better understand the scope, scale, and cost of the gun violence problem. But not only do politicians fear reprisal from the NRA for actions taken against the powerful gun lobby; so do the researchers. Academic researchers fear personal attacks that could result in funding cuts for other important research, such as heart disease and obesity.

Every drop of blood that stains the floors of our schools and places of worship is another dollar sign in the reelection fund of President Trump and his Republican Congress. Trump won’t even discuss gun law reform out of fear of angering his NRA donors and gun-worshipping base.

11/15/2019 UPDATE: While CDC and NIH studies of gun violence have been limited, I did find two new studies in the American Journal of Public Health. One is on the affect of Right-to-Carry laws, and the other studied bans on Large Capacity Magazines. Both had significant affects on public health.

  • “The 25 states that passed an RTC law from 1992 to 2017, on average, experienced 24% greater rates in firearm WPH incidence after law implementation.”
  • “Between 1990 and 2017, there were 69 high-fatality mass shootings. Attacks involving LCMs resulted in a 62% higher mean average death toll. The incidence of high-fatality mass shootings in non–LCM ban states was more than double the rate in LCM ban states; the annual number of deaths was more than 3 times higher.”

What Statistics do we Have So Far, and why we Need More?

Admitting that you have a problem, and measuring its size and impact is the first step toward fixing it. We’ve fixed other public health problems and should be able to fix gun violence too – if we can agree on the data.
Disease Research Comparisons. Congress clearly does not see gun violence as a public health issue like Rabies, Polio, Cholera, and Diphtheria

1967 – Jane Mansfield was killed when her car ran under the rear end of a tractor-trailer. Since then, all trailers have a DOT bar at the rear to keep cars from going under.

1982 – Seven people died when Tylenol packaging was tampered with. Since then, it takes a Ph.D., channel locks, and a sharp object to get into a bottle of pills.

1995 – When bomb using ammonium nitrate fertilizer killed 168 people, the government imposed severe restrictions on the purchase of that fertilizer.

2001 – Ever since one person tried to blow up a plane with a shoe bomb, we must take off our shoes for scanning to get through security.

Since 1968 – Well over 1.5 million people have died from guns on U.S. soil, which is well over 100 a day. But our only government reaction so far has been to send “Thoughts and Prayers.”

Our unforgivable gun problem is largely because of the lack of agreed upon facts and the willful ignorance of gun enthusiasts. The table above is another example, comparing willingness to do disease research but not study gun violence.

Gun murders per capita compared to other rich nations. Clearly, America does not see gun violence as a public health issue.
“Violent Death Rates: The US Compared with Other High-income OECD Countries, 2010,” American Journal of Medicine, 2015

Statistics from Varied Sources:

Federally funded research on gun violence is extremely limited, but here are some stats from other sources. Any discrepancy between data shown here and other sources is likely the result of working with different base data, and that highlights the need for federally funded research so we can all work from the same facts.

  • With more than 350,000,000 guns in the U.S., there are now more guns than people, but most don’t own guns.
  • 78% of Americans do not own a gun, and just 3% own more than half of all U.S. guns. That 3%, and the NRA representing them and gun manufacturers, is holding the rest of us hostage.
  • Americans own nearly half of all the guns in the world, but that’s nothing to brag about when you consider the consequences.
  • 300 Americans are shot every DAY, and 100 of them die as a result.
  • 38,000 US gun deaths were reported by the CDC in 2016, which is slightly more than the number of people who died form car wrecks.
  • In US, 11,000 murdered each year plus 22,000 suicides.
  • In Europe, which has twice the population, just 18 die per day from gun violence.
  • Japan has only about 10 gun deaths per YEAR.
  • 320,000 Americans were killed by guns in that last 10 years, and over 1.5 million were killed since 1968. About half of those deaths were from suicide.
  • Access to firearms increases the risk of suicide by three times.
  • The rate of firearm suicide deaths for children and teens is up 61% over the past decade, primarily because of wider availability and easier access to guns.
  • Mass shootings may only account for about 2% of all gun deaths nationally, but still there were 385 U.S. mass shootings in 2016, resulting in 257 deaths and 1546 injuries, according to MassShootingTracker.org.
  • 427 mass shootings in 2017 resulted in 594 deaths and 1981 injuries ,which is a 28% increase in deaths and well over one mass shooting per day.
  • The profile of a mass shooter is young men who display anti-social behavior or domestic violence before committing their act. Most of them obtained their weapons legally.
  • 64% of the victims of mass shootings are women and children, and 67% are black.
  • Only 3% to 5% of all violence, including firearm violence, is attributable to serious mental illness. People with serious mental illness are rarely violent, and they’re far more likely to be victims of violence than the perpetrators (12 times higher).
  • More than 30 studies in the U.S. and abroad have shown that more guns increase gun violence and homicides.
  • More US children and adolescents today die from firearms than any other cause. Many more (>80%) sustain firearm injuries and survive, but with lifetime medical costs, pain, and psychiatric disorders.

Mass Shootings In The United States

This Health Affairs article presents the population health impacts and policy levers of mass shootings. Here are my highlights:

“During the past four decades, mass shootings have caused at least 1,000 deaths and another 1,500 injuries in the United States. Although mass shootings account for less than 1 percent of all firearm deaths annually in the country, they evoke significant public interest and have detrimental effects that extend far beyond the harm to the direct victims and their families.” [While others estimate 2%, it’s still a small percent.]

That’s because “exposure to a mass shooting does not just mean being physically present when the shots were fired but, rather, living in the community or attending the school where the shooting occurred.”

ASSAULT RIFLES: “A study of public mass shootings resulting in four or more deaths found that assault rifles caused more than 85 percent of such fatalities. … There is some evidence that assault weapons bans reduce mass shooting casualties, but little research has been performed on the effects of other gun control policies.”

OTHER NATIONS: “Until researchers can better understand what prevention policies will work in the United States, the lessons learned from the experiences of other counties can provide some guidance. For instance, after a horrific shooting in 1996, Australia implemented the National Firearms Agreement, which banned automatic and semiautomatic weapons and included a weapon buyback scheme. There was not a single mass shooting in twenty years after the agreement went into effect. Similarly, after a school shooting in 1996, the United Kingdom banned private ownership of handguns and assault weapons, and there has been only one mass shooting since.”

SCHOOLS: “Studies show that active shooter drills have little impact on preventing school shootings or offering the school community protection should a shooting take place.”

Mass Shooting Tracker

MassShootingTracker.org is an excellent reference, because it accounts for ALL mass shooting incidents, including those that don’t get reported in the mainstream media or match the FBI’s “mass gun violence” definition as three or more people murdered in one event. That definition unfortunately ignores those who survive a shooting but may be left with life long disabilities and trauma. Those costs are too often ignored and would be substantially higher if all gun victims and their families could actually afford and seek counseling and treatment.

Public costs like these are what keep big city mayors awake at night, but they are hardly studied at all. We tend to not account for the legal fees, and the fear that stunts neighborhood growth or prompts schools to harden their campus and deploy armed guards. These are just some of the hidden costs of gun violence that the Mother Jones report touches upon.

Funding for research on gun violence compared to other leading causes of death shows that Congress does not see gun violence as a public health issue.

Regulatory Thoughts

Gun enthusiasts, who fear Liberals will ban guns and confiscate them, often cite their 2nd Amendment right. But shouldn’t that right come with responsibility? Maybe we could simply relate guns like we regulate motor vehicles to improve gun safety, and reduce deaths and injury from gun violence.

What if we Regulated Guns like Cars and Trucks?

We’ve also heard them say cars kill about as many people as guns, but we don’t ban cars. That’s no longer true, as fatal car accidents had declined while gun deaths increased. As the following chart shows, deaths per 100 million vehicle miles driven dropped 95% through regulation, operator licensing, registration, and required liability insurance. Drivers and car manufactures initially opposed these legislative changes but eventually complied, and the result was dramatic.  

Chart showing Deaths per 100M miles driven declining with each new safety law.

16 THOUGHTS FOR REGULATING GUNS LIKE CARS:

1. License gun owners like we license drivers, with age limits and periodic renewal. A driver’s license gives you “permission” to drive and own a car; it does not grant you a “right” to do so. And just as with driving, a judge can revoke your license if the privilege is abused, or laws are broken.

2. Test knowledge of laws and gun safety and require a proficiency exam before granting a license.

3. Consider different proficiency levels and uses like we do with a driver’s license, starting with a Learner’s Permit and progressing to something the equivalent of a Commercial Driver’s License to show the increased responsibility and skill to use more powerful weapons. Concealed carry and open carry permits, for example, could require stricter licensure than guns purchased and stored for sport and hunting. It could also apply to different classes of weapons.

4. Require criminal background checks (22% of guns are obtained without one) and at least a 3-day waiting period as a condition of obtaining a license and purchasing a gun. Prohibit gun sales to anyone with a felony criminal conviction, history of mental illness or domestic abuse, or listed on the FAA’s No Fly list.

5. Close the gun show loophole. Watch this 13-year-old boy try to buy beer, cigarettes, adult magazines and lottery tickets with no luck, and then see how he just walked into a gun show and walk out with a gun. (https://www.youtube.com/watch?v=fB7MwvqCtlk)

6. Allow protection orders (red flag laws) with due process that would authorize authorities to intervene when a person becomes a threat to others, and temporarily confiscate guns they can use to cause harm. When a driver is charged with reckless driving, most states allow local police to impound the car until a judge determines that it’s safe to return it.

7. Require Liability Insurance covering gun owners, as we do for drivers. Insurance companies, through free-market competition would set rates through the actuarial process, and gun owners could then decide when and if they want to move up to more firepower, including higher caliber and semi-automatic weapons, or higher quantities of ammunition, knowing that more stringent testing, storage, inspection, and insurance would be required.

8. Register each gun to make it easier to return them if lost or stolen, require periodic inspection to make sure safety features are in working order, and ensure safe storage requirements are followed. Charge an annual registration tax as we do for motor vehicles, to help pay the cost administrative costs of gun regulations, like we do with car registration. And require proof of insurance to register each year, as we do with cars.

9. Consider bans on the most dangerous firearms, such as those designed for military purposes to kill the most people in the shortest time possible, or at least restrict how they are used and who gets to use them. Certain types of cars, such as those designed for racing, are not “street legal,” but we don’t prohibit them. On the other hand, we don’t allow private ownership of tanks and fighter jets. The same concept could apply to guns too if approached with commonsense and real data rather than emotion. Add-on accessories, such as bump stocks, that turn consumer weapons into the equivalent of weapons of war could be included in such bans.

10. Require updates to registration and insurance when a gun is disposed of in a private sale, like we do with cars. That would end the gun show loophole that now is used to avoid background checks.

11. Require safe storage, locks and security measures designed to prevent unintentional access to guns and ammo by unlicensed people, including children. This is like cars having ignition locks, so they aren’t stollen.

12. Limit quantities of guns and ammo except under tightly restricted and regulated circumstances, such as with collectors and shooting ranges that rent weapons for use there. There’s no justification for people to amass private arsenals. We don’t limit the number of cars one can own, and Jay Leno is an example of that, but the higher cost of cars discourages such collection naturally.

13. Research and encourage the development of “smart gun” technologies that prevent accidental discharge except by the owner, through a PIN number or biometric sensor like a fingerprint. If someone steals my iPhone, it’s useless for example, and if the same were true for guns, it would reduce the number of guns stolen each year, now about 200,000, which are then available to criminals. It would also prevent a child from firing dad’s gun or a criminal from using a policeman’s gun against him.

14. Repeal the Protection of Lawful Commerce in Arms Act (PLCAA), which prevents the gun manufacturing industry from being held liable in civil court for crimes “resulting from the criminal or unlawful misuse of firearms or ammunition.” We don’t give the auto industry such immunity.

15. Allow lawsuits against manufacturers for selling products that are knowingly defective or promoted irresponsibly, such as targeting teens.

16. Explore buy-back options to help cut the total number of guns on the street, since studies worldwide show that fewer guns result in fewer deaths.

Note that auto manufacturers complained each time government imposed new rules like seat belts and air bags, but the result has greatly improved safety. Did any of these “restrictions” slow car sales or impose undue restrictions on car ownership? Of course not, and the government hasn’t used registration to confiscate cars either. So, make politicians opposing these new rules justify their position on each of them and ask if they’d support removing the matching car safety rules.

Even Fox News admits the vast majority of of voters in both parties
favor reasonable gun control measures, as shown in this recent poll:

Even Fox News acknowledges that the vast majority of Americans support gun control measures

What if we Regulated Guns like Abortions?

Gloria Steinem suggested this alternative: “How about we treat every young man who wants to buy a gun like every woman who wants to get an abortion

  • Mandatory 48-hour waiting period;
  • Parental permission;
  • A note from his doctor proving he understands what he’s about to do; and
  • A video he has to watch about the effects of gun violence.
  • Let’s close down all but one gun shop in every state and make him travel hundreds of miles, take time off work, and stay overnight in a strange town to get a gun.
  • Make him walk through a gauntlet of people holding photos of loved ones who were shot to death, people who call him a murderer and beg him not to buy a gun.”

75% of Americans want Congress to do more to reduce gun violence

American voters support stricter gun laws by a 2:1 margin (66% v. 31%), including most gun owners, according to a new Quinnipiac University poll. These results are up considerably from a negative 47:50 percent measure of support in 2015. 97% support universal background checks, 83% support a mandatory waiting period, and 70% favor registering all guns with the police.

According to this Michael Moore interview, 78% of Americans do not own a gun. That’s why Beto O’Rourke’s comment during the 2020 Presidential debates got such a roaring response from the audience, even as Democrat politicians cringed. But the scary thought is that just 3% of Americans own half of the nation’s guns. I went to a gun show to understand the culture of that 3% and wrote about it here: Gun Smoke Culture.I do not believe in the general promiscuous toting of guns. I think it should be sharply restricted and only under licenses. NRA President Karl T. Frederick, 1934

Won’t Gun Registration Lead to Confiscation?

The NRA once believed in gun control, but bring up the topic of gun licensing or registration today, and die-hard gun enthusiasts, including some of the 5 million NRA members, will likely tell you about Adolf Hitler, Nazi gun laws, gun confiscation, and the Holocaust. Thanks to influence from the gun lobby, the NRA has used this argument for decades: “One of the first things Hitler did when he seized power was to impose gun registration laws to make it easier for his troops to disarm his opponents.” But PolitiFact.com rates that claim as FALSE and a misrepresentation of history on two levels.

“First, German citizens as a whole were not disarmed by the Nazis. Jews and other supposed enemies of the state were subject to having their weapons seized. But for most German citizens, the Nazi period was one in which gun regulations were loosened, not tightened. Second, a lack of guns was not the issue. If the majority of Germans had wanted to use these guns to fight the Nazis, they could have. But they didn’t.”

Conservative Supreme Court Chief Justice Warren describes the NRA's interpretation of the 2nd Amendment as a great fraud.

Fear and distrust of government are central to NRA’s current strategy, and this tactic ignores the fact that the Nazis enjoyed significant popular support, or at least, broad acquiescence; and that, not gun control, is what really led to the Holocaust. The NRA argument against gun control or registration attempts not to clarify history but to protect their hardline interpretation of the 2nd Amendment, and the profits of gun manufacturers.

“A well regulated Militia, being necessary to the security of a free State, the right of the people to keep and bear Arms, shall not be infringed.”

Alexander Hamilton, in The Federalist Papers, described what the Founding Fathers meant by a “well-regulated militia,” and it was essentially the National Guard. It has nothing at all to do with granting citizens unfettered access to guns, according to analysis by Brett Trends in this essay in Market Watch.

Conservative Supreme Court justices Warren Burger and Antonin Scalia both said that any claim otherwise is based on a lie. So who is promoting that false narrative? It’s gun manufacturers who profit from each mass shooting or “gun control” threat, because when people think someone wants to confiscate their guns, market demand increases. The industry also profits from gun show loopholes and a black-market that drives up demand and prices.

Second Amendment: Times have changed, and guns have changed

The 2nd Amendment language is clear, but willful ignorance keeps some people from even reading it. Others just refuse to accept its purpose. According to Supreme Court Justice Ruth Ginsburg…

“The 2nd Amendment was written when the new government had no money to pay for an army, so they relied on the state militias. And the states required men to have certain weapons. They specified in the law what weapons these people had to keep in their home so that when they were called to do service as militiamen, they would have them.”

The 2nd Amendment was never meant to apply to private militias or individual ownership of military style assault rifles, high-capacity magazines, silencers, or bullet-proof vests. When it was written, the common weapon of the time was the mussel-loaded musket. It could only fire 1-2 rounds per minute.

A visit to Colonial Williamsburg is very educational and enlightening. You’ll be able to visit the gun shop to learn how they made muskets and later added rifling to the barrel for greater range and accuracy. You’ll also see how this colony kept their weapons in a locked and guarded armory with ammo stored separately.

Typical Revolutionary-era Musket versus Typical AR-15
Click image for larger view.

It seems that history could be used to strike down the 2nd Amendment as no longer necessary and counter productive. BUT, that’s not the purpose of the current debate over how to reduce gun violence. With the goal of saving lives, Democrats call for sensible gun reform, including a ban on assault rifles and high capacity magazines, universal background checks and red flag laws, and possibly licensing gun owners and registering guns like we do cars. In 2017, a federal appeals court concluded that assault weapons are NOT protected by the 2nd Amendment. It was a 10-4 decision.

When Congress banned assault weapons in 1994, mass shootings plummeted – but after the ban expired in 2004, the NRA bought off politicians to protect their profits and stop Congress from passing the ban again. (Brady Campaign to Prevent Gun Violence)

If our nation didn’t already spend $trillions/year to fund a powerful military and local police, we might want to extend the 2nd Amendment to include modern weapons of war, including RPGs, grenades, tanks, and even military aircraft or nuclear weapons. But since we don’t need or want that, unregulated private militias seem unnecessary and even dangerous. If anything, the 1/6/2020 Capitol insurrection taught us to worry more about a future coup made possible by the rise of extremists on the far right. At least I hope we learned that.

So, with such a historically strong legal argument against the 2nd Amendment, if Dems wanted to dig in and fight hard against the NRA, they might win. But again that’s not their objective.

High Velocity

What follows are two video clips from a CBS 60 MINUTES Special, November 2018.

What makes the AR-15 style rifle the weapon of choice for mass shooters? (13:38 min video) — Some of the worst massacres in recent memory have had something in common: the AR-15 style rifle. Scott Pelley reports on why the high-velocity rounds used in the gun makes it so deadly.

Learning how to “Stop the Bleed” (5:39 min video) — Ballistics tests show how lethal a wound from an AR-15 style rifle can be. Now there’s a campaign to teach civilians how to be first responders in mass shootings. A doctor who has treated too many wounds of this kind now sends his own child to school with a “Stop the Bleed” kit. The kit includes a tourniquet and gauze bandages to pack the wound with, and the child has been trained in how to use it. It’s a sad day when everyone in America must now have quick access to such a kit at all times.

The idea that our Constitution grants us a right to have firearms appeals disproportionately to white, working class, and mostly rural men who are sometimes called “the Bubba vote,” “NASCAR dads,” or just “guys with Confederate flags in their pickup trucks.”

In contrast, the anti-guns group is largely “urban, eastern, Catholic or Jewish, female, and African-American,” according to the well-researched paper, On Gun Registration, the NRA, Adolf Hitler, and Nazi Gun Laws: Exploding the Gun Culture Wars. The paper argues that to avoid a pitched culture war between sharply divided viewpoints, we need more research, scholarship, and critical thought.

I’d add that Public Health could center that conversation
and help us to review our priorities.

Which do we value most: the lives of our children, or the fun we have shooting lots of rounds with a high-powered weapon of war at a gun range? Can we still justify public ownership of weapons not well suited for hunting or personal protection? Maybe a well-regulated firing range can just rent the guns for that purpose.

What about Mental Health?

CANADA: We have mental illness, but we do not have a mass shooting problem.Mental illness refers to a lot of conditions or disorders that negatively affect your mood, thinking and behavior. Examples include depression, schizophrenia, addictive behaviors, and anxiety and eating disorders.

We seem to all agree that someone diagnosed with a serious mental illness, or a criminal history, should not be able to get their hands on a gun, especially not one designed to kill the most people in the least time possible. But People can display mental health concerns intermittently from time to time and never be diagnosed or reported.

To use mental illness as a way to avoid debating common sense gun control measures is dangerous and does little for families of victims, or to prevent future deaths.

We know that those suffering from diagnosed mental illness are far more likely to be victims of violent crime than perpetrators, and only 4% of violence in the US can be traced to mental illness.

Obviously, mental illness itself is not the cause of our nation’s gun violence problem. Other nations have just as many mental health problems, but they don’t have nearly the number of gun deaths as we do. So is this why the CDC and NIH can’t study the problem? Does Congress not want you to know the truth?

No matter how you define it, if you think that mental illness is the cause of our gun violence problem, then why did President Trump repeal the Obama-era order designed to prevent the mentally ill from buying a gun? And why did Republicans spend a year working to gut Medicaid, the biggest payer of mental health care in this nation? This makes no sense from a public health and safety perspective.

If mentally ill people aren’t committing mass murder, who is?

Here are the Top 10 Reasons why one person kills another with a gun, according to one source:

10. Mercy killing
9.   Road rage
8.   Greed
7.   Anger
6.   Self-defense
5.   Religion arguments
4.   Alcohol & drugs
3.   Revenge
2.   Money
1.   Domestic violence

According to psychiatrist Michael H. Stone, “Mass murder is an almost exclusively male phenomenon (male:female ratio is 24:1).” This reflects our genetic evolution, where men are naturally more aggressive than women. They tend to define themselves and their masculinity by their job, sport and firepower. (He who dies with the most toys wins.) Women, on the other hand, define themselves by family and relationships. So one might ask if guns substitute for feeling less relevant as women gain influence and power.

[Former-President] Trump appears to appeal more to men who are secretly insecure about their manhood. (Washington Post on Fragile Masculinity)

Stone says most mass murders are planned well in advance, usually as acts of revenge or retribution for perceived slights and wrongs. Overwhelming hopelessness is often present, and this helps explain how nearly half of the perpetrators either commit suicide or are killed by police in the immediate aftermath of the event.

2003 study in the journal World Psychiatry said, “the major determinants of violence continue to be socio-demographic and socio-economic factors such as being young, male, and of lower socio-economic status.” About 85% of those committing mass murder are working class and under age 44.

I expect gun violence and mass murder incidents will get worse with the widening wealth gap, divisive politics, and Trump administration. That’s because more and more people are feeling depressed and hopeless, and because of our broken healthcare system that makes getting mental health treatment in our nation difficult and expensive. The economic incentives work against the field of psychiatry, which is far less lucrative than other medical specialties.

What about Arming Teachers?

A Washington Post editorial responded by saying, “In gunfights, trained officers have just 18 percent hit rate. Yet, we want to arm teachers?”

In 46 weeks this year (2019), there have been 45 school shootings.Teacher responds, "You want to arm me? Good. Arm me with..." That’s basically one a week.

On his MSNBC program, Laurence O’Donnell told us why arming teachers is a stupid idea. President Trump hinted that a well-trained military veteran like General Kelly would have had no trouble stepping up to oppose a school shooter. But even Kelly would not order troops armed with handguns to attack an enemy with the superior firepower of military style weapons, much less go into that situation himself.

Hardening the physical structure of schools and employing school marshals may help in some cases, but we’ve already seen how easy it was for the Parkland shooter to time his attack to coincide with the end of school and set off the fire alarm to make sure everyone started leaving at once. We also learned that an armed and well-trained deputy sheriff stayed safely outside of the school rather than engage the shooter inside.

If we are to rely on teachers, who will train them, provide their weapons, and pay to harden the schools when so many teachers are already paying for pencils and school supplies themselves? How will first responders know if the teacher with a gun is a good guy and not the perpetrator? Who will pay to settle the wrongful death lawsuits that will certainly occur when students are shot by mistake in the crossfire? And what do the teachers say about this? Have you asked?

 

An English teacher responds to the idea of arming teachers.And what about our churches (Sutherland Springs, TX – 2017), movie theaters (Aurora, CO – 2012), shopping malls (Cascade Mall, Burlington, WA – 2016), restaurants (Luby’s, Killeen, TX – 1991), offices (San Bernardino, CA – 2015), and universities (Virginia Tech, Blacksburg, VA – 2007)? It’s incredibly difficult to stop an angry and revengeful person with suicidal thoughts, as we saw in 2009 when an Army major killed 13 people in Ft. Hood, TX with a concealed semi-automatic pistol.

What about the Students?

Here’s one teacher’s sarcastic post showing how crazy it sounds to put the responsibility on students:

“I have a student in my class that keeps hitting other kids with a hammer over and over. I can’t get anything done, and the other kids are hurt and hate it!”
“Have you tried taking the hammer away from the student,” another asked.
“No, no, it’s not the hammer’s fault. Everyone knows that kids have the right to have hammers! I want to buy a bunch of hammers and give them to all the other students, and then no one will ever have problems with hammers again!”
Oh yeah, more hammers will definitely fix everything, for sure.

I find it disgusting and sad that children must now participate in active shooter drills, even as young as those in kindergarten. It has a significant affect on their mental health, as shown in the following short video.

What about the Morality Movement?

If school kids can cope with active shooter drills, gun buyers can cope with background checks, red flag laws, and licensing. Just as the first women who came forward in the #MeToo movement showed immense courage, so too have the survivors of the Parkland school shooting. They are showing the adults that they’ve had enough, with their own #NeverAgain and #WhatIf campaigns. They’ve challenged the NRA directly. And they’ve demanded that politicians no longer take NRA campaign contributions.

It looks like this “morality movement” is gaining momentum and is having an effect in Hollywood, business, and (increasingly) in politics. A long list of powerful men in the entertainment and sports industries have been shamed, lost their jobs, and were jailed, including Harvey Weinstein, Kevin Spacey, Matt Lauer, and Dr. Larry Nassar, former USA Gymnastics team doctor.

Likewise, corporations are turning against the NRA, including United and Delta Airlines; Hertz, Avis, National, Alamo, and Enterprise Rent-A-Car; and MetLife. Wal-Mart and Dick’s Sporting Goods said they will no longer sell a gun to anyone under the age of 21, and they stopped selling assault-style guns altogether. Companies sticking with the NRA are being shamed in social media with posts like, “Hey @LifeLock why do you support the NRA? #NeverForget.

It’s too soon to see how the morality movement will affect politics and the mid-term elections, but Roy Moore, Al Franken, and Trump Campaign Manager Corey Lewandowski already lost their jobs over sexual abuse or harassment. This could be a big opportunity for Democrats, given President Trump’s own behavior and history – 19 women accused him of sexual misconduct – and how the Republican Congress has turned a blind eye.

What about our Cultural Problem?

We have a Gun problem, not a culture problem. Other countries have secular religious freedom but don’t have a gun violence problem, so it’s not a lack of God in our lives. Other countries watch violent movies and play violent video games but don’t have a gun violence problem. People in other countries get angry and want to hurt people too, and they have alcoholism and substance abuse, but what they don’t have is easy access to guns. So to anyone who claims that we have a unique cultural problem, I call “B.S.” So do the surviving students of the Florida school massacre.

It gives me hope for the future of our nation when student survivors like Delaney Tarr, David Hogg, Emma Gonzalez, Cameron Hasky, and Sarah Chadwick show more courage and leadership than the leaders who act like children and cower to NRA bullies. But it makes me angry when gun enthusiasts label them as “paid crisis actors” and send them death threats.

WFAA’s Dale Hansen, a Dallas-area sports reporter, recorded the following video editorial about the most recent school shooting in Florida, where the adults only sent “thoughts and prayers”. The have more in mind, and that’s a good thing.

During a PBS News Hour in 2016, a gentleman asked President Barak Obama why he wants to restrict gun access for all owners, and not just the bad guys. His answer is worth watching, as it hits all of the various actions our nation took to reduce auto fatalities.

The above webinar (added 3/10/2024) includes slides with important new detail on the cost of gun violence on health care and a discussion with Rep. Robin Kelly (IL-2).

If, after reading this article and watching these videos, you still think assault weapons are a human right, but healthcare is not, then YOU are what’s wrong with America today. Maybe you can tell me why people with pre-existing mental health conditions have access to Firearms but not Healthcare.

Related Articles & Videos

The NRA supported Gun Control when Black Panthers had guns, but now it's different with White Nationalists.
Click the image to view the article at History.com.

Related Quotes

The need for research – “There’s evidence [that] arming more people is typically good for the gun industry and bad for society. And there’s some evidence that certain types of gun laws, like universal background checks, may be useful. [But] There’s no evidence at all about raising the age to 21, and certainly no evidence about arming teachers.” (David Hemenway, a Harvard professor who has written extensively about gun safety)

Defunded research – “The CDC researches all threats to the health of Americans, and being shot dead is a significant risk to health. The CDC also researches deaths from car crashes, and how to mitigate those deaths, for example.” (Steven Novella, Science Based Medicine)

Incomplete data – “We have to extrapolate from what limited data we have, from different states or countries with different laws. Generalizing from this data is difficult, but we can still craft thoughtful policy based upon the data we have and plausibility. Then track the results of those policies and adjust them as necessary.” (Dr. Steven Novella, a Yale Medical School professor and executive editor at Science-Based Medicine)

Thanks to NRA opposition – “CDC research funding for gun violence fell by 96 percent between 1996 and 2012. Major public research funding for gun violence prevention is estimated at $2 million annually. By contrast, in 2011, the National Institutes of Health devoted $21 million to the study of headaches.” (Everytown for Gun Safety, a group that backs gun control)

School Shootings – “Are we prepared to say that such [gun] violence visited on our children year after year after year is somehow the price of our freedom? (President Obama in 2012 after 20 first-graders were massacred at Sandy Hook Elementary.

Horrific damage – “ Even for those who manage to survive gun violence involving these weapons [assault rifles], the severity and lasting impact of their wounds, disabilities and treatment leads to devastating consequences.” (David Barbe, AMA President, in essay after Parkland, Florida)

Challenging the powerbrokers – “We get out there and make sure everybody knows how much money their politician took from the NRA.” (David Hogg, one of the surviving students of Marjory Stoneman Douglass High School in Parkland, FL.

Morality movement – “Make no mistake. This is all about power — a powerful political lobby that has bullied America for too long, powerful men who haven’t been held accountable for their behavior, police who for too long have been unconstrained. A moral movement is growing against the violence perpetrated by all of them, making it necessary for both government and business to take action. It is being led [not by politicians, but] by people whose moral authority cannot be denied: students whose friends have been murdered, women who have been abused, the parents and partners of black men who have been slain. It is already having a profound impact on America.” (Robert Reich)

My rights versus yours – “Why was my son’s rights to life, liberty, and the pursuit of happiness not as important as your right to bear arms?” (A mother whose son died during the Parkland shooting posed this question to an NRA representative.)

AR15 as a right – “If someone tells you that we have to live with these weapons because of the 2nd Amendment, either they don’t know what they’re talking about, or they think you don’t.” (Ari Melber, MSNBC)

Mental health – “If you’re talking [about] people with mental health issues or mental illness, you’re talking 1 in 5 Americans, and to equate mental illness with violence is to say that 1 in 5 [20%] of people are violent, and that’s not the truth.” (Patricia Woods, outgoing president of the Mental Health Association)

Male phenomenon – “Mass murder is an almost exclusively male phenomenon (male:female ratio is 24:1) — a reflection of evolutionarily driven tendency for males to be more aggressive than females. Most mass murders are planned well in advance of the outburst, usually as acts of revenge or retribution for perceived slights and wrongs. Overwhelming hopelessness is often present: this may help explain how nearly half the persons committing mass murder either commit suicide or are killed by the police in the immediate aftermath of the event.” (psychiatrist Michael H. Stone, MD)

About the Author

Wayne Caswell is a retired IBM technologist, market strategist, futurist, consumer advocate, and founding editor of Modern Health Talk (www.mhealthtalk.com). He brings a unique Big Picture perspective and Holistic approach to his articles on healthcare policy, future directions, and solutions for independent living. That perspective caused him to become a strong advocate of progressive policies and candidates.

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8 Comments

  1. The new Science of Gun Policy report, conducted by the RAND Corporation, studied the impact of 18 different gun policies using the findings of 152 studies.

    Some key takeaways:
    1. Stand-your-ground laws, which allow people to use deadly force in “reasonable” cases of self-defense, are linked to “significant” increases in gun homicides.

    2. Laws expanding concealed-carry rights are also correlated with more gun homicides—and higher numbers of total homicides.

    3. But “safe storage” laws—geared toward preventing child access to firearms—reduced firearm injuries among young people, and curbed suicide and homicide rates in that demographic.

    https://www.rand.org/pubs/research_reports/RRA243-4.html

  2. America is a Gun (poem by Brian Bilston)

    England is a cup of tea.
    France, a wheel of ripened brie.
    Greece, a short, squat olive tree.
    America is a gun.

    Brazil is football on the sand.
    Argentina, Maradona’s hand.
    Germany, an oompah band.
    America is a gun.

    Holland is a wooden shoe.
    Hungary, a goulash stew.
    Australia, a kangaroo.
    America is a gun.

    Japan is a thermal spring.
    Scotland is a highland fling.
    Oh, better to be anything
    than America as a gun.

  3. Carl Behnke says:

    I’m not surprised you have no alternative comments attached to this page. Here’s my take as son of a USN Officer (WWII & Korean Conflict) and grandson of German migrants (pre-WWI).
    1. You argue the AR-15 is so bad; but you admit it is used in only a fraction of murders. 2. You also point out the US has 3.6/100k gun murders. Where is your argument that the majority of these murders, as your “top-10 reasons” alludes:

    9.   Road rage
    8.   Greed
    7.   Anger
    4.   Alcohol & drugs
    3.   Revenge
    2.   Money
    One could reasonably assume that more than 50% of the above reasons were non-preventable. The murders would have occurred with a ball-point pen, if no other weapon was available. (I would lay money it’s more like 99%.)

    You also don’t give any explanation as to what a potential victim’s choice(s) would have been regarding:
    6.   Self-defense

    This next one is rather ambiguous and could be interpreted a thousand different ways (and may actually have been involved with another reason):
    5.   Religion arguments

    Which leaves #1:
    1.   Domestic violence
    How much of this has anything to do with an AR-15, a semi-auto handgun, a shotgun, a pistol, a 22-caliber firearm? Where does the victim fall into the discussion? In my unlearned opinion, there are a multitude of reasons that this type of violence could occur. (My daughter has been involved in this type of relationship, and years later we still don’t know if the problem will be resolved, thanks to the liberal/progressive, “feel-good” court system. What happened to the “old days” when they would put the a-holes in jail?)

    I’m one of the 6% who own more than one firearm. I don’t follow the NRA; but I do believe they have as much right to lobby Congress as the Chinese do, to defend my rights.
    I consider myself part of the ready-militia in the state of Texas, based on the interpretation of the 2A. (As you stated, the NRA was founded because the militia didn’t know how to fire a weapon.) If the state calls for volunteers to defend the homeland, I’ll be ready, to defend even your homeland.
    I refuse to believe that I will be a criminal, just because some politicians decide they can stop gun violence by restricting my right to bear arms.
    The criminals will have guns until the laws and the citizens take back the cities. (Ex., NYC, Chicago, LA, Portland, St Louis, etc.)
    If you disarm the citizens (ie., make them criminals) and defund the police, who is going to protect me and you? Tell me….

    1. I don’t want to fight you on this issue but instead thank you for sharing your perspective. It adds to the insight I got from visiting the Lewisville Gun Show as I tried to better understand the gun culture, especially here in Texas. I wrote about that experience in my article on America’s Gun Smoke Culture. I’m sure your comments will also help other readers better understand the alternative viewpoints.

      I began that second article with… “Little boys grew up in this culture playing Cowboys & Indians, or Cops & Robbers. First it was with their wooden or store-bought toy guns, then they got their first air rifle and wanted to shoot something with it. Dad would take them hunting or to a gun show. It was the manly thing to do.”

      You mention being the son of a Navy veteran but said nothing of your own service. As for me, I was in the Army during Vietnam. But that’s not the point of my response, or my articles. They are education, offering facts and perspectives that are otherwise hard to find, largely because our government prohibits the CDC and NIH from even studying gun violence.

      You also mentioned considering yourself part of “the ready-militia in the state of Texas.” So you’re a member of the Texas National Guard? That’s the only militia fitting the 2nd Amendment definition of “well regulated.” Have you ever visited Colonial Williamsburg, Virginia and seen how they regulated their militia? The muskets were stored in a guarded armory, and the gun powered and ammo was stored separately. It was a fascinating visit, and I especially enjoyed learning how they made the muskets, including the rifling for improved accuracy. ‘Highly recommended.

    2. Wayne Caswell says:

      My Republican friends, also making similar arguments in support of their precious 2nd Amendment rights as they interpret them, continue to blame cities for the large number of gun deaths. But, this congressional hearing shows red states, even without large cities, have the greatest number. See https://www.facebook.com/TheIronSnowflake/videos/254349987043390

  4. Gun manufacturers got rich promoting fear of gun control.
    Gun manufacturers got rich promoting fear of Democrats and the myth that they’d take away your guns. To frame the issue properly, focus on gun safety and the public health impact of gun violence. Avoid the term gun Control, because that reinforces their false framing.

  5. Here are over 100 “March for Our Lives” posters for protesting against Gun Violence (print-ready PDF)

    RELATED ARTICLES:
    I’ll add more references articles below as I find them, so let me know if some should be included.

    GUN VIOLENCE: KEY FACTS Amnesty International compiled these additional facts about global gun violence.

    Biden names Harris to lead first federal gun violence prevention office (The Guardian, 9/21/2023) Biden said, “The administration’s top focus was the pandemic. Now it’s time to focus on the next epidemic, which is the epidemic of gun violence.” But effective regulation must be comprehensive. Without licensing and registration, there’s no good way to police the new rules, and private sales and gun show loopholes are too easily used to sidestep background checks.

    Treating Gun Violence as a Public Health Crisis (Salon, 8/21/2023) The author interviewed David Hemenway, a Harvard professor of health policy who advocates for the public health approach in his 2004 book, “Private Guns, Public Health.”

    13-year-old Georgia boy and alleged gun runner charged with murdering sister (Washington Post, 12/3/2021) An enterprising and tech-savvy 13-year-old boy, who was making “ghost guns” and selling them on the streets, used one to accidentally shoot and kill his sister. Problems with ghost guns include:
    * No serial numbers so not traceable
    * Easy to buy and assemble as a kit so no background check or age limits
    * May not be identified in X-ray machines. Only the barrel is metal; the body can be 3D printed plastic

    A Founding-era Analog for Modern Serial Number Requirements (2/10/2023) This article in the Duke Center for Firearms Law takes a deep dive into the history and origins of marking firearms, going all the way back to George Washington and the Continental Army. The objective then was to prevent theft and preserve the ability to recover stolen weapons, just like requiring serial numbers today.

    The rise of domestic extremism in America (Washington Post, 4/12/21) Data shows a surge in homegrown incidents not seen in a quarter-century, and the vast majority of them are from far-right extremists. Far fewer violent attacks have come from left-wing extremists.

    New York attorney general seeks to dissolve NRA in suit accusing gun rights group of wide-ranging fraud and self-dealing (Washington Post, 8/6/2020) “The chief executive of the National Rifle Association and several top lieutenants engaged in a decades-long pattern of fraud to raid the coffers of the powerful gun rights group for personal gain, according to a lawsuit filed Thursday by the New York attorney general, draining $64 million from the nonprofit in just three years.”

    More US school-age children die from guns than on-duty US police or global military fatalities (3/22/19) Stats in my article on Reframing Gun Violence show twice as many gun deaths from suicide than murder, but that ratio flips for kids. According to this CNN article, twice as many kids are murdered as die from accidents and suicide. That’s disturbing enough, but it makes me think it’s reason the NRA calls for lowering the gun ownership age. That way kids can control their own destiny, as in, “more accidents and suicides.”

    In 46 weeks this year, there have been 44 school shootings (CNN 11/15/2019) That’s nearly one school shooting a week, yet bipartisan gun legislation still sits on Mitch McConnell’s desk in the Senate waiting for him to bring it up for a vote.

    Democrats embracing #GunControl did well, because (1) #Healthcare was the top issue and (2) #GunViolence was framed as a #PublicHealth issue.

    A Veteran’s Views on Gun Sense — As this guy says, We must reject the NRA and embrace responsible, common sense gun legislation that will effectively reduce the number of firearm deaths without making criminals of otherwise law-abiding citizens.

    SEVEN STEPS – 27,000 LIVES (Boston Globe, printable PDF version) “If every state had the same gun death rate as Massachusetts, some 27,000 lives could have been saved.” This article shows how they did it.

    What America’s gun fanatics won’t tell you (excellent opinion analysis of 2nd amendment language from Market Watch)

    Firearm-related injuries drop during NRA conventions (Reuters) New findings from Harvard Medical School researchers, published in the New England Journal of Medicine, show a dramatic 20% national drop in firearm injuries and deaths during the convention when the 80,000 attendees weren’t at home with gun access. The results were compared to the 3 weeks before and afterwards. For nearby populations in the same state, the decline was even greater (a whopping 63%), apparently because it was easier to attend the event.

    After NRA Mocks Doctors, Physicians Reply: ‘This Is Our Lane’ (NPR) “Do you have any idea how many bullets I pull out of corpses weekly? This isn’t just my lane. It’s my f****** highway.” #ThisIsOurLane

    Texans Gave NRA It’s Firepower (Dallas Morning News) ‘Excellent deep-dive reporting by David Tarrant. “Together, [Harlon] Carter and [Neal] Know would shift the National Rifle Association from a moderate funding and shooting sports group that offered some support of gun control measures into an absolutist organization.”

    NRA under fire for ‘Target Practice’ magazine photo of Pelosi and Giffords — Intentionally or otherwise, the gun group’s headline evokes memories of the 2011 Tucson shooting.

    Gun Control Activists’ Unlikely Allies (Dallas Morning News) It seems that responsible gun owners are some of the first to call for reasonable gun controls, because they see the danger of blindly siding with the NRA.

    British planted the seeds of U.S. gun culture (Dallas Morning News) Priya Satia, a Stanford history professor and author of a new book, “Empire of Guns: The Violent Making of the Industrial Revolution,” notes that 18-th century guns were completely different from the arms we’re trying to regulate today.

    Why the NRA picked Oliver North as its New President — He’s a gun-trafficker who knows how to conceal ill-gotten gains — just what the gun lobby needs.

    Santa Fe school shooting: America’s gun problem, explained in 5 facts (VOX) Here’s another well-researched article with good stats & charts.

    Houston Police Chief says he has ‘Hit Rock Bottom’ on Gun Rights Arguments (NY Times) Police Chief Art Acevedo of Houston, center, walking with demonstrators during a “March for Our Lives” protest in March.

    2018 has been deadlier for schoolchildren than service members (Washington Post)

    We asked every member of the House of Representatives about the Parkland gun policy agenda. Here’s what they said. (Washington Post, 5/22/18)

    Firearm Injuries and Violence Prevention — The Potential Power of a Surgeon General’s Report (New England Journal of Medicine) Perhaps the time has arrived to commission the first Surgeon General’s report on firearm injuries and violence prevention to stress the importance of collecting and disseminating data on the true nature of the public health problem we are facing. The United States could then begin using a public health approach to incorporate the principles of responsible and safe firearm ownership into the legal interpretation of the Second Amendment to ensure a safer future.

    Fear and Loading: Women and Guns in America — In this 18-min video report, a Canadian journalist comes to Austin, TX to understand the American gun culture and the arguments for and against it. “American women are buying more guns than ever before, mostly to protect themselves. Manisha Krishnan heads to Texas for the annual A Girl and a Gun conference where women are being trained to fend off sexual assaults and home invasions with firearms. She’s trying to find out whether gun culture…”

    America Records More than a Third of the World’s Gun Suicides

    Guns killed more people than car crashes in 2017 (Vox) — Suicides drove an increase in gun deaths from 2016 to 2017.

    2018 was by far the worst year on record for gun violence in schools (Great Charts) — “There have been 94 school gun violence incidents so far in 2018. The previous record was 59 in 2006.”

    A year after Parkland, Mass shootings are still a regular occurrence in America — nearly one a day – VOX stats & charts

    The NRA Spends a Lot of Money on the Texas Congressional Delegation

    The majority of members also received high grades for their voting record on gun issues. (Texas Monthly) Notice the political party affiliation of those receiving NRA money and that all of those receiving $0, with an “F” rating, were Democrats. ‘Telling.

    Gun storage laws save lives, so why don’t we have more of them? (Los Angeles Times)

    How the ‘good guy with a gun’ became a deadly American fantasy (Quartz, 6/7/2019)

    Closing the Public Safety Gap on Gun Violence (5/29/2019) Technology, community policing and local activists bring hope to besieged neighborhoods. For example, ShotSpotter is an automated gunshot detection system. In neighborhoods prone to gun violence, sensors can be placed on rooftops and light poles to “listen” for the sound of gunfire, pinpoint its location, and communicate that with timestamp to a dispatcher. Then, in less than one minute, local law enforcement and the 911 dispatch center are alerted, along with any additional info such as if automatic weapons or multiple shooters are involved.

    Inside the NRA’s finances: Deepening debt, increased spending on legal fees — and cuts to gun training (Washington Post 6/14/2019) NRA’s debt deepens as “the New York attorney general is investigating the NRA’s tax-exempt status amid recent revelations of lavish spending by chief executive Wayne LaPierre and top vendors. Among the expenditures were nearly $275,000 in personal charges at a Beverly Hills men’s store and more than $253,000 in luxury travel to locations such as Italy, Budapest and the Bahamas.”

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