Guns and Violence: A Surgeon Speaks Out

gun violence

One of the guns used in Newtown – A Bushmaster. Also used in the 2003 Washington DC murders. The resulting lawsuit caused that factory to close. Parts still available on-line.

Children Die Every Day from Guns

I no longer do trauma surgery,  as much as I loved it there was one thing that just broke my heart- seeing children die because of guns.  The tragedy in Newtown is on all of our minds, the senseless deaths of 20 children. Sadly, what took place in Newtown is the tip of the iceberg.

5740 gun deaths for children in the US 2008 and 2009

The Center for Disease Control reports that the number of firearm deaths of kids younger than 15 is almost 12 times higher in the United States than in the next 25 industrialized countries combined. We average more than 4,000 dead children annually. This would be the same as over 2 Newtown events per week. Sixty nine percent died from homicide, and 25% from suicide, the rest were accidental or not determined.

In 2008 there were 88 preschoolers who died and in 2009 there were 85 who died from guns. In addition to the deaths, in those two years over 34,000 children were injured by guns.

I grew up in Ketchikan, Alaska. Lots of hunters there, lots of guns around. When my brother was a teenager he was accidentally shot in the leg by a neighbor- suffering severe neurologic damage to his leg requiring two complex operations. Two kids from our town of 5000 died in hunting accidents. One of my childhood friends committed suicide with his father’s shotgun. I used to think it was an aberration  growing up in a small community that had a lot of guns- it turns out that it isn’t that at all.  When I started seeing children come into the hospital ER’s – most of them dead on arrival, even with every paramedic and doctor  trying hard to save them. Try to imagine a 5 year old boy, with a large gunshot wound to his chest, dead, as the paramedics are doing CPR hoping to save him. I recall another child who we opened up his chest to find his heart in a hundred pieces- a victim of a shotgun.

This happens every day, in every major emergency room. When I did trauma surgery what we saw coming in our ER was the silent epidemic of children being killed and injured by guns.  Newtown brought home again what is going on in epidemic proportions in the United States — more so than any other country.

You can argue all you want about firearms- but we need to protect the children.

A few disturbing facts: 

Many have heard about the tragic death when a child who “finds ” a parent’s gun and plays with it. Turns out that when children of gun-owners were interviewed 39% of them knew where the gun was hidden, in spite of their parents thinking they had hidden it from them. 22% of the children reported playing with the guns, although the parents thought otherwise. Children under the age of 10 were just as likely as older children to know where the guns were “hidden.”  Gun safety classes were no guarantee against this- I remember taking this class as a kid in Ketchikan – those children, it was reported, play with the guns as often as those who don’t take the classes.

Correlation is not Causation – the arguments that gun lobby mixes up

I have a great deal of respect for my friends who are hunters, who own guns, who lock them up. I appreciate hunting a great deal- and love the fresh meat. I can understand their love of the guns – they are precision instruments, they are well built  – and you can learn to shoot well with them.  I don’t want them to lose their sport, or their collection. But let’s separate them from those who would use a semi-automatic rifle.

Somewhere, between responsible ownership, there comes this fear that restricting a gun would lead to problems. So, I’ve listened to the arguments of the most rabid pro-gun people, and here is what some of them miss:

There are two types of violence – and for the sake of debate, they need to be separated:

Criminal v Non-criminal behavior

There is violence from criminals and there is violence from non-criminals.

Criminals: they will perform crimes whether they have guns or not. The more guns we can take away from them, the better our society will be. They won’t turn them in, but with expanded laws to put them in jail longer, they think twice. It is easy for criminals to get guns in this society,  and yet, there is no evidence that non-criminals having guns stop criminals from their actions.  In fact, as a trauma surgeon when I saw gunshot wounds from violent criminals it came in two types: gang violence where sometimes innocent people were shot, but most of them were not innocent, but the worst was when a home invasion took place and the gun owner was shot with their own weapon by the criminal.

Chicago is a prime example of criminal behavior. The gang violence escalated over the year, after the hand-gun ban went into effect. People who like to misapply statistics show that there are more gun deaths since the handgun regulations went into effect than before. Correlation does not equal causation- and this is a prime example. Gun violence has decreased in the last few months, not because more people own guns- but because of more police enforcement.

Crime has gone down as the rate of people in prisons has gone up. There are many statistics showing decrease in crime with the ability of people to have more handguns – but this is correlation not causation. The most common states examined are Michigan, Texas, and Florida- all of which enacted “right-to-carry” law, but all showed lowering trends of murder in the mid 1990’s.  If you imprison bad people, crime will go down. If everyone carries a weapon does crime go down? Check out Iraq and Afghanistan. Both have rights to carry, and both have high crime as well as murder rates. Still, the drop in national crime is also seen in Los Angeles, where there is a very restrictive gun law. When you ask criminologists why there is a decrease in violent crime, they note that the spikes happened primarily because of the crack wars, and that the demographic changes, longer criminal sentencing, and better policing techniques are more the answer.

Criminal behavior does not decrease because of handguns, criminal behavior decreases with increased law enforcement. Having an “armed” citizenry does not decrease crime, more law enforcement does. Vigilantes are not welcome in our society. Ironically, the Chicago gangs disprove one of the “tenants” that more guns decreases violence, because criminals won’t bother people with guns: there is no doubt that a gang member who has a gun will use it, there is no doubt that guns bring violent and immediate action.  Yet the violence in the south side of Chicago has escalated with more guns, not decreased.

The idea that gun owners prevent crime is common. From the perspective of a trauma surgeon, we saw more damage from civilians trying to use guns to stop crime.

Non Criminal Behavior:

Colombine, Aurora, Newtown, Norway – all acts of violence.  All from individuals who are not criminals, but mentally ill. Norway has strict laws and regulations, and points out that while we cannot eliminate all guns, or bad behavior, we can decrease it.  All of Europe had less handgun murders than the United States. Just to be clear, of the 25 worst mass shootings in the last 50 years, 16 of them have taken place in the United States. In second place is Finland – which had two mass shootings.

The guns in Newtown were legally obtained. Had the Brady bill been continued past its expiration in 2004 those guns would not have been available. The guns obtained to shoot US Representative Giffords, kill the US judge, and several civilians, was legally obtained.

Sadly the Brady bill, which expired, had too many loopholes.  In 1996 Australia imposed a strict version of the assault weapons band after a mass shooting. It was followed by the country purchasing back from citizens semi-automatic rifles, pistols, and shotguns. Since that time they have not had the gun violence, either criminal or non-criminal that the US has had.

Some gun advocates point to Israel and Switzerland as meccas where there is a lot of guns and minimal regulation. They are wrong about both countries, both countries have much stricter laws, and have moved away from everyone having access and ownership. Of note suicide rates in Israel went down on weekends when soldiers were directed to leave firearms at the base instead of taking them home.

Suicide is often a spontaneous action, and easy access to guns makes suicide easier. My childhood friend, a typical suicide victim, young, a moment of feeling helpless and easy access to his dad’s shotgun. Teenagers, with all the angst, having access to parents guns has proven a deadly combination with over 800 successful suicides a year.

Armed citizens:

It worries me when people say that they are concerned that if they don’t have guns the government would take over. For this I bring two countries which lost oppressive regimes and are in the process of taking their country back: Egypt and Myanmar. Non-violence.  When you look at revolutions that took place with guns- you have Syria, Libya – all with many deaths.

Among the popular press is the story of a young man who stopped a  shooting in Pearl River, MS – sadly, this is hyperbole, and not reality. The shooting was not stopped by a 16 year old with a gun – it was stopped when the shooter left.


Fox News put up a graph -and you can see it below. Here is the bottom line: we have less deaths because surgeons are getting better at taking care of them. You get shot- then you have a chance if you can get to a trauma center.

Dear Fox News – because we surgeons get better at taking care of gunshot wounds does not mean that more guns means less deaths.

More Guns:

Just to be clear: there was an armed guard at Columbine High School.  He was Neil Gardner, a sheriff’s deputy in Jefferson County, Colorado – 15 years of law enforcement experience. He was the armed guard assigned to watch Columbine High School, who usually ate lunch with the students, so he could be in the school. Virginia Tech had armed guards. More guns do not work


I don’t like seeing children die – I have a two year old of my own now, and this hits me harder than it did years ago. No one wants that. We need to get together- all of us, to stop our kids from having more deaths per year than we lose from police officers on the street (and that is just pre-schoolers).

So here is the deal: you can be pro-gun but you can be pro-gun and pro-kid. Be that – please.

How do we prevent gun violence from non-criminals? Do we need assault weapons- or semi-automatic weapons?  I know of few hunters that want a semi-automatic (if you cannot bring down the game with one shot, better to target practice til you can- the meat is spoiled with more than one shot). The problem with the assault ban was there were so many loopholes.  I remember going into a gun shop, after the Brady bill, and the shop owner showing how I could transform a rifle to an automatic by ordering a couple of different parts – all legal, all available, all in a loophole. Even the new bill that Senator Feinstein will introduce has multiple loopholes.  We need a bill like Australia, no loopholes, no reason for a semi-automatic weapon for citizens. Do we need longer waiting periods? Both sides need to come together for some common sense regulation here: both in terms of what guns are reasonable, and what guns are not. How we can better protect our society without having to resort to “more guns,” or a “lockdown” of schools. We want a safer society- and safer in the world experience is a society with less guns.

The year after I was born automatic knives (switch-blades) were outlawed. There was no outcry, it was reasonable. The right to bare arms was not infringed, rather it was regulated.  Since 1934 automatic guns have been highly regulated – you cannot get one without lots of paperwork, and accountability. Somehow that didn’t infringe on the second amendment  It is time to bring reason back to the gun discussion – because too many kids are dying every day, in every community.


The paper below shows that there is a greater risk of firearm homicide where there are more guns

Hepburn, Lisa; Hemenway, David. Firearm availability and homicide: A review of the literature. Aggression and Violent Behavior: A Review Journal. 2004; 9:417-40.

When looking internationally the relationship between homicide and gun availability from 26 countries shows a positive correlation

Hemenway, David; Miller, Matthew. Firearm availability and homicide rates across 26 high income countries. Journal of Trauma. 2000; 49:985-88.

In states that have a lot of guns there is a higher rate of homicide, especially that which includes firearms

Miller, Matthew; Azrael, Deborah; Hemenway, David. Household firearm ownership levels and homicide rates across U.S. regions and states, 1988-1997. American Journal of Public Health. 2002: 92:1988-1993.

When examining gun availability and homicide- and removing a number of counfounding factors – the more guns the more issues:

Miller, Matthew; Azrael, Deborah; Hemenway, David. State-level homicide victimization rates in the U.S. in relation to survey measures of household firearm ownership, 2001-2003. Social Science and Medicine. 2007; 64:656-64.

A look at fire-arm deaths in many countries with many backgrounds and clearly the US was in the lead with homicide and suicides

EG Krug, KE Powell and LL Dahlberg Firearm-related deaths in the United States and 35 other high- and upper-middle income countries. INternational Epidem. Assoc 1998.
Frances Baxley and Matthew Miller. 2006. “Parental Misconceptions about Children and Firearms.” Archives of Pediatrics and Adolescent Medicine, 160(5): 542-547.

Dr. Terry Simpson About Dr. Terry Simpson
Dr. Terry Simpson received his undergraduate and graduate degrees from the University of Chicago where he spent several years in the Kovler Viral Oncology laboratories doing genetic engineering. He found he liked people more than petri dishes, and went to medical school. Dr. Simpson, a weight loss surgeon is an advocate of culinary medicine. The first surgeon to become certified in Culinary Medicine, he believes teaching people to improve their health through their food and in their kitchen. On the other side of the world, he has been a leading advocate of changing health care to make it more "relationship based," and his efforts awarded his team the Malcolm Baldrige award for healthcare in 2011 for the NUKA system of care in Alaska and in 2013 Dr Simpson won the National Indian Health Board Area Impact Award. A frequent contributor to media outlets discussing health related topics and advances in medicine, he is also a proud dad, husband, author, cook, and surgeon “in that order.” For media inquiries, please visit

Share this article on social media!

Latest Comments

  1. Lynn says:
    Here is a recent article about Israel’s strict gun licensing laws. Notice that it is on a Crown Heights website. Crown Heights unfortunately has too much gang violence. One of my sons was mugged there once and I was out shopping there when gang violence erupted and someone was shot about a block from where I was. Two years ago, when returning from a family Chanukah party, my daughter, son in law and their kids happened upon a newly shot body about a block from their apartment.

  2. thedoc says:

    It is sad that the people who are buying guns are probably the people who should not. I was happy to see that many retail outlets are not displaying these guns

  3. Brenda says:

    Very thoughtful post, Terry. What I have been trying to fathom is where in the world teachers who want to have guns in their classrooms will hide them? Doesn’t this sound like a recipe for heartache? Thank you for writing and sharing the info. Have missed you on Twitter (where I’ve been a disappearing act).

  4. Johan says:

    Can you provide a link for the news story where you got the graphs on violent injuries vs. death rates? Thanks!

Leave a Reply