Two studies document a rise in gun wounds, homicides

Probably the most important message of the New Jersey study is that we need a reliable national database of firearm injuries. Most of the existing studies used trauma registries as their source of data. However, trauma registries, as was pointed out, do not include the victims who are treated and released from the emergency department. Further, victims can die at the scene and never reach hospital care; and not all victims are treated at trauma centers.

This major limitation of the registries causes a lot of confusion. For example, a recent front-page article in the Wall Street Journal reported a study that concluded that, over the last 6 years, the number of gunshot wounds has been increasing but the mortality rates have fallen, presumably because of better care. Another recent study reportedly found that over the same time period, the incidence of gunshot injuries has been going down while mortality has remained unchanged. It is obvious that we need a reliable national database to resolve these contradictions.

Dr. Demetrios Demetriades is a professor of surgery and director of acute care surgery at the University of Southern California, Los Angeles. He gave these remarks as the discussant of Dr. Livingston’s study at the meeting and reported having no financial disclosures.

Methodology, conclusions not firm

The issue of concealed-carry laws and their impact on violent crime has been a controversial political and public health issue in the United States. Currently, there are four types of concealed weapon laws. Five states now are unrestricted, like Arizona, where anyone can carry a concealed weapon without a state license. In 38 states, a permit is issued as long as the applicant meets certain requirements. Eight states "may" issue a permit and authorities may deny an applicant if a reasonable need to carry a concealed weapon in not met. The District of Columbia does not issue concealed weapons permits.

Proponents on both sides of this issue have used concealed-carry laws as a platform to espouse their viewpoints. However, today the general consensus of the public health community is that concealed weapons laws have minimal if any impact on violent crime in our nation relative to other legal political and societal factors.

Dr. Ginwalla and her colleagues sought to assess the impact of the state of Arizona’s repeal of its concealed-carry laws on gun-related injuries and deaths in the southern Arizona region. They concluded that after the repeal, gun-related homicides associated with violent crime increased significantly, presumably because of the increased presence of concealed weapons.

Although it seems intuitively reasonable that the increased access to concealed weapons would be related to the increase in gun-related fatalities in violent crimes, I have concerns regarding the study’s methodology and conclusions.

The entire "at-risk" population of violent crime decreased post repeal. Couldn’t we conclude that since there was less criminal activity after the repeal, concealed weapons were actually a deterrent?

Dr. Glen H. Tinkoff of Christiana Care Health System, Newark, Del., gave these comments as the discussant of Dr. Ginwall’s study at the meeting. He reported having no financial disclosures.