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--:-- Sean Rameswaram: Welcome to Today Explained. I'm Sean Rameswaram.
--:-- Noel King: And I'm Noel King.
--:-- Sean Rameswaram: Today, we're talking about America's gun violence epidemic. It's a public health crisis that's been going on for decades. After 24 years of blocked funding, Congress is finally starting to treat it like one.
--:-- Noel King: We've been doing a lot of shows on guns this week, and I have to say, it's been a lot of guns. So many guns. So many guns in this country, something like 400 million.
--:-- Sean Rameswaram: That's right. And we started the week by talking about the protest movement for better control on these guns. Then, per your request, we talked about the District of Columbia v. Heller, the most important Supreme Court case about the Second Amendment. And yesterday, we talked about the laws. The laws, some of them that work.
--:-- Noel King: But today, we're going to talk about Dickey. Dickey. Do you know about Dickey?
--:-- Sean Rameswaram: No, I don't.
--:-- Noel King: Dickey is an amendment that prevented this country for over two decades from doing any research into gun violence as a public health problem.
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--:-- Sean Rameswaram: Support for this show comes from ServiceNow. AI is only as powerful as the platform it's built into, don't you know? That's why it's no surprise that more than 85% of the Fortune 500 use the ServiceNow AI platform.
--:-- Noel King: Didn't know that.
--:-- Sean Rameswaram: While other platforms duct tape tools together, ServiceNow seamlessly unifies people, data, workflows, and AI, connecting every corner of your business. And with AI agents working together autonomously, anyone in any department can focus on the work that matters most.
--:-- Noel King: I've never met an AI agent.
--:-- Sean Rameswaram: Learn how ServiceNow puts AI to work for people at servicenow.com.
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--:-- Sean Rameswaram: Support for this show comes from Macy's. Layering is an art form. All it takes is a bit of intention, style, and of course, the perfect cold weather staples.
--:-- Noel King: So find the perfect look for you with the help of Macy's Fall Fashion Guide, your one-stop shop for fall's latest trends and must-haves, curated by their experts.
--:-- Sean Rameswaram: From leather to denim to cozy knits, find everything you need to piece together your new fall look. Explore the Macy's Fall Guide for yourself and shop in-store or online at Macy's.com.
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--:-- Sean Rameswaram: It's Today Explained. I'm Sean Rameswaram and this is Dr. Megan Ranney.
--:-- Dr. Megan Ranney: I'm an emergency physician and academic dean of the School of Public Health at Brown University. My second favorite university.
--:-- Sean Rameswaram: And have been a violence prevention researcher for over 15 years.
--:-- Dr. Megan Ranney: Those of you who listen closely may recognize my voice. We had me on the show a few weeks ago to answer listener questions around gun violence in the United States after Uvaldi.
--:-- Sean Rameswaram: But we wanted to have you back to explain your own firsthand experience with this issue.
--:-- Dr. Megan Ranney: As an emergency physician, I see firsthand the effects of a bullet on the human body, but also the ripple effects of gunshot wounds on not just their victims, but also on the community and the society around them.
--:-- Sean Rameswaram: I also, as an emergency physician and as a researcher, know that there is nothing that comes through my doors in the ER that can't be prevented.
--:-- Dr. Megan Ranney: And by approaching firearm injury as a public health problem, it means not being pro-gun or anti-gun any more than I am pro-car or anti-car or pro-pool or anti-pool.
--:-- Sean Rameswaram: I'm about trying to make sure that the gun does not cause harm to humans. And I'm using the same science that we use for every other injury and illness to try to stop people from getting shot and stop having to have them come to the ER.
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--:-- Dr. Megan Ranney: This is my whole thing. The gun problem in the country is a public health problem, and it should be treated that way.
--:-- Sean Rameswaram: But the thing is, it hasn't been treated that way. And the reason? The reason is that for 24 years, we had virtually no federal funding to talk or study firearms as a public health problem.
--:-- Dr. Megan Ranney: That dates back to 1996, when the infamous Dickey Amendment was passed.
--:-- Sean Rameswaram: The gentleman from Arkansas. It was led by a junior representative from Arkansas, a guy named Jay Dickey.
--:-- Dr. Megan Ranney: I'd like to generally discuss this issue. Who created this amendment in the wake of a study showing that folks with a firearm in the home have a higher chance of dying of a firearm injury than folks who don't have a firearm in the home.
--:-- Sean Rameswaram: We have the ownership of guns by itself is what this particular amount of money is going to. It is not a public health threat.
--:-- Dr. Megan Ranney: This is not a statement on firearms per se, but rather an identification that there is risk.
--:-- Sean Rameswaram: Unfortunately, it was interpreted as a shot across the bow around the value of firearm ownership.
--:-- Dr. Megan Ranney: This is an issue of federally funded political advocacy. And advocacy organizations, particularly at that point the NRA, mobilized members of Congress to say that research on this topic shouldn't be done.
--:-- Sean Rameswaram: Rather than calling violence a disease and guns as a germ, these people should be looking at the other root causes of crime. Poverty, drug trade, gangs, and children growing up without parental support, and the cruel trap of welfare dependency.
--:-- Dr. Megan Ranney: And when the Dickey Amendment was passed, the CDC had all of the money that it had been spending on firearm injury removed from its budget.
--:-- Sean Rameswaram: And again, to be precise, the Dickey Amendment did not ban federal funding of firearm injury prevention research, but it was interpreted that way.
--:-- Dr. Megan Ranney: Do you know that Congress will not allow the Center for Disease Control to study gun violence? Because the notion is, is that by studying it the same way we do with traffic accidents, somehow that's going to lead to everybody's guns being confiscated.
--:-- Sean Rameswaram: What the Dickey Amendment actually said was that the CDC was forbidden from promoting or advocating for gun control.
--:-- Dr. Megan Ranney: To be clear the CDC can promote or advocate for policies anyhow It was almost a throwaway amendment in many ways but it was interpreted and the result was the same which is that federal funding was frozen
--:-- Sean Rameswaram: Help us understand what isn't being researched in this 24-ish year period where people think the Dickey Amendment says they can't fund research on guns.
--:-- Dr. Megan Ranney: Gun violence was the least researched of the 30 leading causes of death in the United States.
--:-- Sean Rameswaram: Overall funding for this was less than 0.7% of diseases with similar mortality burdens, like sepsis.
--:-- Dr. Megan Ranney: And the number of people doing research in this area could be counted on basically two hands.
--:-- Sean Rameswaram: Compare that to the hundreds or even thousands who are doing research on other issues that have similar mortality burdens.
--:-- Dr. Megan Ranney: It basically destroyed the entire field and meant as a result that governments, community groups, and individuals had no evidence on which to implement firearm injury prevention programs.
--:-- Sean Rameswaram: Again, imagine if the American Heart Association was having to work with no data on how to prevent heart disease.
--:-- Dr. Megan Ranney: So this guy, Dickey, gets this amendment passed that says the CDC can't advocate for a certain policy on guns, which is already the case.
--:-- Sean Rameswaram: And you're saying that that leads to the CDC basically defunding gun research?
--:-- Dr. Megan Ranney: Well, it led to Congress basically defunding gun research. Even though the Dickey amendment didn't say it had to do that.
--:-- Sean Rameswaram: That's correct.
--:-- Dr. Megan Ranney: And can I tell you the irony is, towards the end of Dickey's life, he actually said that that was a mistake.
--:-- Sean Rameswaram: I was on to other things and worrying about my constituents, and I didn't follow through and say we still need to do research.
--:-- Dr. Megan Ranney: I didn't do that.
--:-- Sean Rameswaram: The same way that we do research on automobile safety and reducing motor vehicle crashes and trying to reduce the incidence of motor vehicle deaths.
--:-- Dr. Megan Ranney: I've gone back through it in my mind to say, what could we have done?
--:-- Sean Rameswaram: And I know what we could have done. We could have kept the fund alive and just restricted the expenditure of dollars.
--:-- Dr. Megan Ranney: Was this amendment eternal? Does it have an expiry date?
--:-- Sean Rameswaram: You know, again, because the amendment doesn't explicitly ban federal funding of firearm research, there have been over the years various attempts to go around it, in particular after Sandy Hook.
--:-- Dr. Megan Ranney: Lift our national hold on the CDC and allow them actually to study the issue of gun deaths the way we are allowed to study any other cause of death in this country.
--:-- Sean Rameswaram: The American people support this as well.
--:-- Dr. Megan Ranney: It took a couple of more years to get those appropriations back.
--:-- Sean Rameswaram: How is this sort of interpretation of the Dickey Amendment finally undone?
--:-- Dr. Megan Ranney: So starting even a couple of years before Sandy Hook, many of us in medicine had started to work to try to remind folks in medicine as well as outside of it that firearm injury is a health and public health problem.
--:-- Sean Rameswaram: We started within our own house, within the American Medical Association, American College of Surgeons, American College of Emergency Physicians, and the American Public Health Association.
--:-- Dr. Megan Ranney: That work picked up steam after Sandy Hook.
--:-- Sean Rameswaram: We gradually increased awareness and coalitions around the importance of both talking about firearms as a health problem and doing the research on how to prevent it, the same way that we do for any other injury or illness.
--:-- Dr. Megan Ranney: So in late 2018, the American College of Physicians published a paper talking about firearm injury as a health and public health problem.
--:-- Sean Rameswaram: And in response to this paper, the NRA sent off a tweet.
--:-- Dr. Megan Ranney: This tweet from the National Rifle Association said, quote, someone should tell self-important anti-gun doctors to stay in their lane.
--:-- Sean Rameswaram: That NRA tweet set off a firestorm of response from the health and public health community.
--:-- Dr. Megan Ranney: Thousands of physicians, nurses, social workers shared stories about how firearm injury is very much in our lane.
--:-- Sean Rameswaram: I mean, Sean— I'm sorry, did you get in a fight with the NRA?
--:-- Dr. Megan Ranney: So I don't actually call it a fight with the NRA. I have no interest in fighting with them.
--:-- Sean Rameswaram: Let me be clear. The NRA can do what the NRA wants to do.
--:-- Dr. Megan Ranney: I have interest in advancing the health of my patients and the communities in which I work.
--:-- Sean Rameswaram: But the NRA was directing some ire at you directly?
--:-- Dr. Megan Ranney: Yeah, maybe. But we didn't direct our ire back.
--:-- Sean Rameswaram: Our ire was directed at the fact that we were not getting funding to do the research that we know that we need to do.
--:-- Dr. Megan Ranney: I mean, John, imagine if I told you that we'd done no research on the causes, prevention, or treatment of heart disease or cancer or HIV in 24 years.
--:-- Sean Rameswaram: You would never accept that.
--:-- Dr. Megan Ranney: And we shouldn't accept it for firearms either.
--:-- Sean Rameswaram: So you guys kind of win this stay-in-your-lane fight?
--:-- Dr. Megan Ranney: So I would say, rather than the win-lose language, I would say that we reframed Congress's view to the same view that Jay Dickey had at the end of his life, which is that firearm injury prevention research is not a pro- or anti-gun thing.
--:-- Sean Rameswaram: It's about reducing the burden of injury and death in our communities.
--:-- Dr. Megan Ranney: But I know this, all this time that we have had, we would have found a solution, in my opinion.
--:-- Sean Rameswaram: And I think it's a shame that we haven't.
--:-- Dr. Megan Ranney: No one in the United States, or virtually no one, wants their loved one to die from a firearm injury.
--:-- Sean Rameswaram: And that's what this work is about.
--:-- Dr. Megan Ranney: Okay, I'm not going to use the win or lose language here, but how do you, how does one know when they've reframed how Congress thinks about something?
--:-- Sean Rameswaram: How do you know that Dickey's no longer the status quo?
--:-- Dr. Megan Ranney: Because we succeeded in having $25 million put into appropriations for CDC and NIH in 2019.
--:-- Sean Rameswaram: That was released in 2020
--:-- Dr. Megan Ranney: And the first tranche of firearm injury prevention grants were funded September of 2020
--:-- Sean Rameswaram: A drop in the bucket of what is needed, but a step in the right direction nonetheless.
--:-- Dr. Megan Ranney: More with Dr. Megan Ranney momentarily on Today Explained.
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--:-- Sean Rameswaram: Support for Today Explained comes from Built Rewards. These days, it seems like everybody has a rewards program.
--:-- Dr. Megan Ranney: You swipe your card and you get one cent on the hundred dollars.
--:-- Sean Rameswaram: But with your rent, frequently, you just pay month after month.
--:-- Dr. Megan Ranney: You never get anything from it other than that roof over your head.
--:-- Sean Rameswaram: Not anymore, says Built Rewards.
--:-- Dr. Megan Ranney: Built Rewards says it lets you earn points on your rent.
--:-- Sean Rameswaram: By paying rent through Built, they say you can earn flexible points that can be redeemed toward hundreds of hotels and airlines.
--:-- Dr. Megan Ranney: Perhaps a future rent payment, your next Lyft ride, and so much more.
--:-- Sean Rameswaram: Your home isn't just where you sleep, it's your community.
--:-- Dr. Megan Ranney: And Built wants you to go out and do things in the community.
--:-- Sean Rameswaram: You can eat at your favorite local restaurants, then earn more points.
--:-- Dr. Megan Ranney: You can get VIP treatment at certain fitness studios.
--:-- Sean Rameswaram: You can enjoy exclusive experiences just for Built members every month.
--:-- Dr. Megan Ranney: When you're ready to travel, they say Built points can be converted to miles or hotel points all around the world.
--:-- Sean Rameswaram: You can earn points on rent and around your neighborhood wherever you call home by joining Built.com slash Explained.
--:-- Dr. Megan Ranney: That's J-O-I-N-B-I-L-T dot com slash Explained.
--:-- Sean Rameswaram: Thank you.
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--:-- Sean Rameswaram: Your way at Schwab. Visit schwab.com to learn more.
--:-- Dr. Megan Ranney: Do they explain?
--:-- Sean Rameswaram: Yeah. Okay, so Dr. Rennie, where we left off, the federal government is finally funding research on gun violence after this 24-year period of subscribing to something they believe the Dickey Amendment says.
--:-- Dr. Megan Ranney: You play a pivotal role in this sea change.
--:-- Sean Rameswaram: What are people like you advocating they research with this $25 million in initial funding?
--:-- Dr. Megan Ranney: That first $25 million led to around 15, 16 grants, which are looking at everything from trying to define the actual numbers of injuries that happen in a community.
--:-- Sean Rameswaram: P.S., we don't even know exactly how many people are injured by a gun every year in the United States.
--:-- Dr. Megan Ranney: So really simple data questions like that, which are almost unbelievable that we don't know it, through projects like the one that I'm leading, which is a collaboration with 4-H and 4-H Shooting Sports, which have amazing track records of safety among the kids that participate in their programs, but which don't talk about risk factors for firearm injury.
--:-- Sean Rameswaram: So we're collaborating with them to work with kids to try to talk about risk factors and empower kids to identify and do something about those risk factors in their communities.
--:-- Dr. Megan Ranney: Two projects working with hospitals and emergency departments to help them identify folks at risk and provide appropriate culturally competent counseling to firearm owners.
--:-- Sean Rameswaram: So there's a huge spectrum of projects that are being undertaken with this funding, none of which, to be very clear, have anything to do with promoting or advocating for gun control.
--:-- Dr. Megan Ranney: Rather, we are trying to create a science and knowledge around what works and what doesn't.
--:-- Sean Rameswaram: The first big place that we need knowledge is around just that basic data.
--:-- Dr. Megan Ranney: Just like with COVID, we need to know who's getting hurt, what are the circumstances surrounding their injury, and where do those injuries happen.
--:-- Sean Rameswaram: The second big bucket is around identifying risk factors and protective factors.
--:-- Dr. Megan Ranney: There are around 400 million guns in private hands in the United States.
--:-- Sean Rameswaram: There are around 45,000 fatal injuries per year, at least in 2020.
--:-- Dr. Megan Ranney: But that means that most firearms are not used to hurt or kill someone.
--:-- Sean Rameswaram: So what's the difference? What can we do to increase protection for people who have a firearm in the home to reduce the risk that they or a family member die from a gun?
--:-- Dr. Megan Ranney: What can we do to reduce risk among those who live in communities where firearms are prevalent or where firearm injury is prevalent?
--:-- Sean Rameswaram: That's the second bucket of research.
--:-- Dr. Megan Ranney: The third bucket of research is around what do we actually do? It's around designing programs.
--:-- Sean Rameswaram: It may be around changing the engineering of firearms.
--:-- Dr. Megan Ranney: It may be around changing policies.
--:-- Sean Rameswaram: It may be around community interventions or one-on-one change, hospital-based change.
--:-- Dr. Megan Ranney: There's a whole list of things we could be doing in interventions.
--:-- Sean Rameswaram: And then the last bucket of research is how do we put it in place? Once we know what works, how do we standardize it and implement it?
--:-- Dr. Megan Ranney: In some ways, that's the toughest part.
--:-- Sean Rameswaram: Why is it so important that funding on research on the host of issues that you just listed come from the federal government?
--:-- Dr. Megan Ranney: So for the past 24 years, others have been trying to fill in the blinks.
--:-- Sean Rameswaram: The little bit of research that has been done has been done with philanthropy or with foundation funds.
--:-- Dr. Megan Ranney: And many of us have actually done it for free on the side.
--:-- Sean Rameswaram: But that is not adequate to gather the quality of data or develop the large programs that are needed to address this problem which again is the leading cause of death for children in America and is among the top causes of death for folks up to about age 44
--:-- Dr. Megan Ranney: Imagine if we had tried to address COVID without federal funding
--:-- Sean Rameswaram: We saw what happened in the early months right
--:-- Dr. Megan Ranney: We didn't have adequate personal protective equipment.
--:-- Sean Rameswaram: We didn't have adequate tests.
--:-- Dr. Megan Ranney: We would never have gotten those vaccines up and off the ground as quickly as we did if we had not invested billions into Operation Warp Speed and vaccine research.
--:-- Sean Rameswaram: And we're investing federal funds now in investigating things like like long COVID, which are also of tremendous public health importance.
--:-- Dr. Megan Ranney: Those federal funds make a difference because they allow groups of researchers, community members, patients to come together and do really high-quality, trustworthy work.
--:-- Sean Rameswaram: Without those large-scale federal funds, you're not going to be able to create that forward momentum, and you're not going to have the same quality of evidence.
--:-- Dr. Megan Ranney: And it sounds like just dating back to the mid-90s when there still was funding on this issue, for public health research, that the fear from the NRA and gun rights types was that this kind of research would invariably lead to policy.
--:-- Sean Rameswaram: And hearing you sort of list out all the different areas that we could better understand now, it does seem like, well, when you understand them, when you have the data, you might want to change some policies.
--:-- Dr. Megan Ranney: Is that invariably where this leads?
--:-- Sean Rameswaram: Policy is always part of the solution to a public health problem, but it is never in and of itself sufficient.
--:-- Dr. Megan Ranney: Moreover, policy, good policy, should be rooted in the mores of a community and should be created in a way that it can actually be implemented and enforced.
--:-- Sean Rameswaram: So to me, yeah, policy will be part of it, but only part.
--:-- Dr. Megan Ranney: And the policies that should be put in place should be ones that have data behind them and that we actually are committed to implementing and enforcing.
--:-- Sean Rameswaram: And the policies surely won't be get rid of all the guns.
--:-- Dr. Megan Ranney: God, no.
--:-- Sean Rameswaram: First of all, that's not possible in our country.
--:-- Dr. Megan Ranney: We do have this thing called the Second Amendment.
--:-- Sean Rameswaram: Secondly, again, there are 400 million guns in private hands.
--:-- Dr. Megan Ranney: And third, can you imagine if we had a policy that said get rid of all the cars or get rid of sex or we tried get rid of alcohol, which wasn't even in the Constitution?
--:-- Sean Rameswaram: Didn't work so well when we tried to ban alcohol.
--:-- Dr. Megan Ranney: Instead, we've created policies that mitigate alcohol's harms as best we can.
--:-- Sean Rameswaram: We have a lot more work to do in that front.
--:-- Dr. Megan Ranney: But there's a lot of federal funding to do it.
--:-- Sean Rameswaram: When do we start to see the results of this research that's now being done?
--:-- Dr. Megan Ranney: When do we start to get, you know, groundbreaking revelations?
--:-- Sean Rameswaram: It is likely sometime in the next year that we're going to start seeing results out of some of these studies.
--:-- Dr. Megan Ranney: It takes a little bit to get stuff up and running, and COVID sure as heck delayed a lot of us.
--:-- Sean Rameswaram: Because you couldn't do as much in-person stuff.
--:-- Dr. Megan Ranney: But I would expect that we'll start to see results in the next 6 to 12 months.
--:-- Sean Rameswaram: You mentioned COVID, and it feels like a reminder that when we're talking about the gun problem in the United States, we're talking about an epidemic.
--:-- Dr. Megan Ranney: Firearm injury meets all the definitions of an epidemic.
--:-- Sean Rameswaram: It's a growing problem concentrated among certain groups or geographies, although it is distributed across the United States, to be clear.
--:-- Dr. Megan Ranney: And it's growing at a rate faster than expected.
--:-- Sean Rameswaram: Do you think that idea itself is divisive?
--:-- Dr. Megan Ranney: We are on a journey to both sides, seeing this as an epidemic.
--:-- Sean Rameswaram: But I will tell you it's a journey I've been on for about a decade, and increasingly it's one that both sides are on together.
--:-- Dr. Megan Ranney: Just yesterday I had a phone call with one of my community partners, and we talked about how for firearm owners there has never been a more important time to talk about firearm injury as a public health epidemic and that we all need to be on deck to reducing the risk to our kids and our communities and that this is the way to preserve this constitutional right is to be committed to changing the patterns of injury and death.
--:-- Sean Rameswaram: There will always be some folks who espouse the extremes
--:-- Dr. Megan Ranney: And we're more likely to see that, of course, among the politicians who want to get re-elected
--:-- Sean Rameswaram: And are appealing to a very specific base
--:-- Dr. Megan Ranney: But if you talk to the average person, most folks are on board
--:-- Sean Rameswaram: Dr. Megan Ranney. She kind of got in a fight with the NRA once and won, though she clearly wouldn't call it a fight or pick a winner or loser.
--:-- Dr. Megan Ranney: She's an emergency physician as well as the academic dean of the School of Public Health at Brown University as well as a violence prevention researcher.
--:-- Sean Rameswaram: Our show today was produced by Victoria Chamberlain, edited by Matthew Collette, fact-checked by Laura Bullard, engineered by Afim Shapiro.
--:-- Dr. Megan Ranney: The rest of the Today Explained team includes Halima Shah, Abishai Artsy, Hadi Mawadi, Miles Bryan, Paul Mounsey, and my co-host, Noelle King.
--:-- Sean Rameswaram: Our audio fellow is Tori Dominguez.
--:-- Dr. Megan Ranney: Our supervising producer is Amna Al-Sadi.
--:-- Sean Rameswaram: Vox's VP of audio is Liz Kelly Nelson.
--:-- Dr. Megan Ranney: We use music by Breakmaster Cylinder and Noam Hassenfeld.
--:-- Sean Rameswaram: We've been talking about this gun problem in America all week, and we've had a whole lot of help from Jillian Weinberger.
--:-- Dr. Megan Ranney: I'm Sean Rameswaram from Today Explained as part of the Vox Media Podcast Network, and we're distributed on the radio by WNYC Studios.
--:-- Sean Rameswaram: Thank you.
