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Monday, February 19, 2018

The costs of firearms violence

I've been stewing, aghast, over the Parkland FL mass school shooting, finding it difficult to just move on to other topics just yet. For one thing, I tweeted,

My Reno physician friend Andy responded on Facebook with this link:

Emergency Department Visits For Firearm-Related Injuries In The United States, 2006–14

Firearm-related deaths are the third leading cause of injury-related deaths in the United States. Yet limited data exist on contemporary epidemiological trends and risk factors for firearm-related injuries. Using data from the Nationwide Emergency Department Sample, we report epidemiological trends and quantify the clinical and financial burden associated with emergency department (ED) visits for firearm-related injuries. We identified 150,930 patients—representing a weighted total of 704,916 patients nationally—who presented alive to the ED in the period 2006–14 with firearm-related injuries. Such injuries were approximately nine times more common among male than female patients and highest among males ages 20–24. Of the patients who presented alive to the ED, 37.2 percent were admitted to inpatient care, while 8.3 percent died during their ED visit or inpatient admission. The mean per person ED and inpatient charges were $5,254 and $95,887, respectively, resulting in an annual financial burden of approximately $2.8 billion in ED and inpatient charges. Although future research is warranted to better understand firearm-related injuries, policy makers might consider implementing universal background checks for firearm purchases and limiting access to firearms for people with a history of violence or previous convictions to reduce the clinical and financial burden associated with these injuries.
My response on Facebook:
Very good. But, we have to add to those data all of the postacute care stuff. Relatedly, how about all of the expenses associated with law-enforcement and other first responders? Not to mention the myriad n-dimensional legal expenses.
Beyond all the unquantifiable tragic, searing human miseries, what about the broader adverse economic impacts? apropos,
As reported by CNN, NOAA estimates the aggregate cost of 2017 U.S. natural disasters at $306 billion. I can't help but wonder how much of that is reflected in the "recent GDP growth" that Donald Trump never fails to brag about?
I can't help but feel that the Health Affairs article seriously understates the overall financial impacts of these shootings. We can be sure that the NRA will not let the government do any precise analytical studies on the topic -- "that I can tell you."

The President stopped by in Parkland on his way to Mar-a-Lago.

I'd tweeted this:

That was before I saw the photos.

Barron Trump will most certainly never face the muzzle of an assault rifle while at school



The (tobacco industry) analogy is a bit of a stretch, I know (and I know that some of my "gun enthusiast" friends will scoff). But, not that much of one. A "perfect analogy" is essentially a redundancy, anyway. Relevant similarities are what matter.

In civil tort terminology, the “Inherently Dangerous Instrumentality” is one for which there is no "safe" use. “Used as directed,” it harms or kills its customers (e.g., tobacco products; not even mentioning the tangential effects of “second-hand smoke”). Cigarettes were finally found legally to be ‘inherently dangerous instrumentalities” (notwithstanding that many users were/are not made diagnosably "ill" or killed by smoking). While that designation did not outlaw tobacco products, it laid the foundation for by-now settled legislative and regulatory actions.

While, yes, a firearm can be used “safely,” the projectiles it fires are designed and manufactured for one purpose — the damage or destruction of the objects of their targeted aim, be they beer bottles, tin cans, paper targets, or living beings. IMO, a firearm comes quite close enough to the logic of the “inherently dangerous instrumentality” to warrant rational regulation (slippery slope hand-wringing by 2nd Amendment paranoid “gun enthusiasts” aside). That this does not happen owing principally to the political power of the NRA is an outrage.


Things may well get materially worse. From The Incidental Economist:

AI Rifles and Future Mass Shootings
The scale and frequency of mass killings have been increasing, and this is likely to continue. One reason — but just one — is that weapons are always getting more lethal. One of the next technical innovations in small arms will be the use of artificial intelligence (AI) to improve the aiming of weapons. There is no reason for civilians to have this technology and we should ban it now…
Good grief.

Hey, chill, the "Tracking Point XS1" is merely an improved accuracy deer rifle, just a 21st century musket. Pay no attention to the heat vent barrel outer cover.

The Intractable Debate over Guns

When Russian forces stormed the school held hostage by Chechen terrorists, over 300 people died. The Beslan school siege wasn’t the worst terrorist attack arithmetically – the fatalities were only a tenth of September 11th. What made the school siege particularly gruesome was that many who died, and died in the most gruesome manner, were children.

There’s something particularly distressing about kids being massacred, which can’t be quantified mathematically. You either get that point or you don’t. And the famed Chechen rebel, Shamil Basayev, got it. Issuing a statement after the attack Basayev claimed responsibility for the siege but called the deaths a “tragedy.” He did not think that the Russians would storm the school. Basayev expressed regret saying that he was “not delighted by what happened there.” Basayev was not known for contrition but death of children doesn’t look good even for someone whose modus operandi was in killing as many as possible.

There’s a code even amongst terrorists – you don’t slaughter children – it’s ok flying planes into big towers but not ok deliberately killing children. Of course, neither is ok but the point is that even the most immoral of our species have a moral code. Strict utilitarians won’t understand this moral code. Strict utilitarians, or rational amoralists, accord significance by multiplying the number of life years lost by the number died, and whether a death from medical error or of a child burnt in a school siege, the conversion factor is the same. Thus, for rational amoralists sentimentality specifically over children dying, such as in Parkland, Florida, in so far as this sentimentality affects policy, must be justified scientifically.

The debate over gun control is paralyzed by unsentimental utilitarianism but with an ironic twist – it is the conservatives, known to eschew utilitarianism, who seek refuge in it. After every mass killing, I receive three lines of reasoning from conservatives opposed to gun control: a) If you restrict guns there’ll be a net increase in crimes and deaths, b) there’s no evidence restricting access to guns will reduce mass shootings, and c) people will still get guns if they really wish to. This type of reasoning comes from the same people who oppose population health, and who deeply oppose the sacrifice of individuals for the greater good, i.e. oppose utilitarianism…
Real all of it. 



 Aren't we all comforted? #NeverAgain


More to come...#NeverAgain

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