An editorial by UMass Medical School public health experts calls for legislators and policymakers to take bold action on gun control, similar to the recent ban in Massachusetts on vaping products in response to lung illnesses in vaping device and e-cigarette users

Goldberg, Robert J.

Hirsh, Michael P.

Lapane, Kate L.

Lemon, Stephenie C.

English

eScholarship@UMMS

University of Massachusetts Medical School eScholarship@UMMS Open Access Articles Open Access Publications by UMMS Authors 2020-01-01 The Smoking Gun: Can We Do for Gun Control What We Are Doing to Control the Vaping and E-Cigarettes Epidemic? Robert J. Goldberg University of Massachusetts Medical School Et al. Let us know how access to this document benefits you. Follow this and additional works at: https://escholarship.umassmed.edu/oapubs  Part of the Health Policy Commons, Public Health Commons, Social Control, Law, Crime, and Deviance Commons, and the Substance Abuse and Addiction Commons Repository Citation Goldberg RJ, Lapane KL, Lemon SC, Hirsh MP. (2020). The Smoking Gun: Can We Do for Gun Control What We Are Doing to Control the Vaping and E-Cigarettes Epidemic?. Open Access Articles. https://doi.org/10.1097/MLR.0000000000001251. Retrieved from https://escholarship.umassmed.edu/oapubs/4077 Creative Commons License This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License. This material is brought to you by eScholarship@UMMS. It has been accepted for inclusion in Open Access Articles by an authorized administrator of eScholarship@UMMS. For more information, please contact Lisa.Palmer@umassmed.edu. The Smoking GunCan We Do for Gun Control What We Are Doing toControl the Vaping and E-Cigarettes Epidemic?Robert J. Goldberg, PhD,* Kate Lapane, PhD,*Stephenie Lemon, PhD,* and Michael P. Hirsh, MD†On September 24, 2019, the Governor of Massachusetts, Charlie Baker, took the un-precedented step of keeping e-cigarettes and vaping products out of the hands of thegeneral public by signing into law a temporary 4-month ban on the sale of these products anddevices. This declaration of a public health emergency in Massachusetts through the banningof all vaping products and e-cigarettes was quickly followed by the Governors, legislativebodies, and health councils in several additional states, including Michigan, New York, andRhode Island, which have also moved to temporarily ban or restrict the sale of flavored orunflavored vaping products. These bold and timely actions based on discussions with, and thereview of available evidence by, various medical experts including addiction specialists,pulmonologists, and pediatricians will hopefully forestall an impending and incompletelyunderstood outbreak of vaping-related respiratory illnesses that has claimed the lives of 26young persons and has resulted in >1200 hospitalized cases as of October 8, 20191; this evergrowing number, however, pales in comparison with the nearly 40,000 persons who died fromgun-related injuries in the United States in 2017,2 an epidemic that we have yet to containdespite knowing the primary etiologic agent involved and having proven means to reduce gun-related violence. The Centers for Disease Control and Prevention (CDC) have reinforced thehealth concerns associated with vaping by issuing a broad public health warning recom-mending that persons concerned about contracting serious lung-related illness abstain fromusing vaping products and that no single product or brand has been linked to the cases thathave been identified to date.3 Only time will tell about the magnitude and impact of thisevolving public health threat and the profile of individuals who may be at particularly high riskfor developing various lung-related illnesses thought to be associated with the use of e-cig-arettes and vaping products.The rapidity of this “call to action” by the Governor of Massachusetts and politiciansfrom other US states, which will allow for the collection of further data and a period ofreflection and possible further actions by researchers, public health advocates, and industryrepresentatives, is highly encouraging and reflective of an effective public health surveillancesystem, informed electorate and thoughtful governmental officials, and committed healthprofessionals who are attempting to nip this emerging epidemic of serious pulmonary diseasesin the bud. While the merits of these vaping moratoriums or outright bans are currently beingdebated by some, with legitimate concerns expressed about persons switching to the smokingof cigarettes or to the underground network that will supply vaping products to adolescentsand young adults, these announcements are reflective of a highly functional health system thatis charged with protecting the health of children and young adults from this latest scourge ofe-cigarettes. As commented on by one of the medical experts providing input and advice toGovernor Baker in formulating his bold decision to temporarily ban vaping products, it wasFrom the Departments of *Population and Quantitative Health Sciences; and †Surgery, University of Massachusetts Medical School, Worcester, MA.The authors declare no conflict of interest.Reprints: Robert J. Goldberg, PhD, Department of Population and Quantitative Health Sciences, Division of Epidemiology, University of Massachusetts MedicalSchool, 368 Plantation Street, Worcester, MA 01605. E-mail: robert.goldberg@umassmed.edu.Copyright © 2019 The Author(s). Published by Wolters Kluwer Health, Inc. This is an open-access article distributed under the terms of the Creative CommonsAttribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properlycited. The work cannot be changed in any way or used commercially without permission from the journal.ISSN: 0025-7079/20/5801-0001SPECIAL COMMENTARYMedical Care  Volume 58, Number 1, January 2020 www.lww-medicalcare.com | 1stunning to hear the Governor’s announcement when even as-sault rifles aren’t banned in the United States.The rapid response by the public health community andseveral state legislatures to the highly morbid and fatal publichealth emergency associated with vaping is in stark contrast tothat of the well-established and senseless epidemic that continuesto worsen despite increasing calls by the general public, especiallyby young people, for Congress to act on a number and variety ofbills that have been put forward over the past several years to stopgun-related deaths. We know the direct cause(s) of gun-relatedviolence, in contrast to that of vaping-related illnesses, but we stillrefuse to act on this knowledge leading to needless deaths at thehands of guns. Indeed, the sordid history of the inability of theCongress to pass meaningful and commonsense legislation ongun control in the United States reached its pinnacle in the mid-1990s, when the National Rifle Association and its supporterspressed Congress to pass the Dickey Amendment.4 Thisamendment, which was passed in 1996, stopped in its tracks anyfuture funding support to the CDC to study gun violence as apublic health issue. This highly unfortunate >2-decade longfreeze on federal spending for research into gun-related violence,and solutions into its control, has contributed to the tragic deathsof many thousands of gunshot victims. Moreover, it has led toconsiderable despair by individuals who have been affected bygun violence and cries by the general public to ban these weaponsof destruction. Many of us refuse to accept the notion that gunsare now a part of the American fabric and nothing further can bedone to control and eventually eliminate gun-related violence anddeaths by suicide from our collective DNA.Since allowing the federal assault weapons ban of 1994to expire a decade later,5 we have seen an alarming increasein the number of mass shootings in the United States withassault weapons playing a large role in these horrific events.On the basis of these and other data, and believing what oureyes and common sense tells us, we no longer need additionalresearch into whether having a gun in a home is a risk factorfor these mass casualties or whether civilian access to assaultweapons leads to more mass casualty events. The evidence isin front of our collective noses about our need for action ongun control. The research that we do need, however, is aboutproviding insights into which population-based interventionscould be designed and delivered to prevent gun-related vio-lence and alter the trajectory of gun-related deaths in theUnited States. This could entail researching the effects ofmore aggressive counseling by health care providers to re-move guns from homes and/or their safe keeping, especiallyfrom those who are known to be domestic abusers or frompeople convicted of violent crimes, red flag laws, and betterenforceable background checks, improving the green spacesof impoverished neighborhoods with concomitant job trainingefforts, and improving the quality of the information con-tained in our national databases so that when gun ownershipbackground checks are performed, they contain the vital in-formation needed to halt gun sales to dangerous individuals.There is, however, some light that may be emerging fromthis dark and foreboding tunnel. After the horrific schoolshooting of high school students in Parkland, Florida, on Feb-ruary 2, 2018,6 and a groundswell of support and activism ofcalls for more effective gun control, led primarily by school-agechildren and not by adults who should know better, Congresshas recently stated that the CDC could in fact use governmentfunds to study gun violence. To date, however, while $50million has been earmarked by the House of Representatives tostudy the problem of gun violence in America through grantsupport to the CDC and the National Institutes of Health (NIH),this bill has not even been discussed on the Senate floor for avariety of inexcusable reasons. One could further argue thatwhile it is encouraging to see that monies have been set asidefor research into gun violence and its ultimate control, as wehave successfully done for numerous infectious and chronicdiseases for more than a century, this is a mere pittance of theamount of federal support that needs to be devoted to curb thissenseless epidemic. We need strong leadership from membersof Congress, as was recently demonstrated by the Prime Min-ister of New Zealand and the country’s governing body inbanning the sale and distribution of assault rifles and all militarystyle semiautomatic type weapons following a mass shootingthere.7 Indeed, as has been recently shown by Congress inproviding an infusion of funds to victims of 9/11, members ofCongress need to “do their jobs” and provide support andleadership for ending gun-related violence. Would it not be atleast a thoughtful first step to consider a temporary ban on thefuture sale of guns and assault rifles in the United States whilewe more systematically study gun safety and begin to imple-ment control measures? Several states are pursuing such anapproach to forestalling the epidemic of lung-related illnesseslinked to e-cigarettes and vaping products and these “lessonslearned” should be extended to gun control.To paraphrase Charles Dickens, we have seen the best oftimes and the worst of times. The best of public health times isnow being shown in terms of the rapid identification of seriouslung diseases associated with the use of vaping devices inadolescents and young adults and the courage of politicians andpublic health officials to halt this emerging epidemic that hasalready been associated with considerable morbidity and mor-tality. We have also seen the worst of times in failing to musterthe political grit to curb the epidemic of gun violence that hasplagued our nation for far too long. It is time to hold our electedofficials and ourselves to a higher moral standard and demandthat Congress pass legislation and secure meaningful fundingthat will send this epidemic on a downward course. Inaction onthis front is inexcusable and the general public and the familiesthat have been affected by gun violence deserve better.We have learned much from the epidemiologic study ofdisease outbreaks in the United States and elsewhere and how toprevent as well as control these health threats. We have firmlyestablished the importance of recognizing an emerging publichealth problem through careful surveillance efforts, identifyingimportant contributory factors to the initiation and spread ofpredisposing factors, and then developing and applying effectivecontrol measures for the general public as well as high-risk in-dividuals. We have learned much in a short time about the sig-nificant respiratory health hazards associated with e-cigarettes andvaping and seem to be acting thoughtfully and accordingly withregards to control measures that will ultimately lead to sustainededucational efforts. While there is still much to be learned aboutthe factors predisposing individuals and communities to gun-re-lated violence, isn’t it time to draw a line in the sand and say thatSpecial Commentary Medical Care  Volume 58, Number 1, January 20202 | www.lww-medicalcare.com Copyright © 2019 The Author(s). Published by Wolters Kluwer Health, Inc.enough is enough with regards to this major public health crisis?Societies that appear to be knowledgeable and civilized such asthe United States should not behave in the manner that we arepresently doing with regards to gun control, and we need ourpublic health and governmental leaders to face this problem headon and do what we know in our hearts is needed. Similar to thedecisive actions that are being undertaken to minimize the healththreats posed by e-cigarettes and vaping products, isn’t it time weput our “smoking guns” in their rightful places?REFERENCES1. Editorials and Correspondence. E-cigarettes and vaping-related disease (topicpage). N Engl J Med 2019. Available at: www.nejm.org/vaping. AccessedOctober 20, 2019.2. Gramlich J. What the data says about gun deaths in the US Pew ResearchCenter, 2019. Available at: https://pewrsr.ch/2KPjZii. Accessed October 20,2019.3. Siegel DA, Jatlaoui TC, Koumans EH, et al. Update: interim guidance forhealth care providers evaluating and caring for patients with suspectede-cigarette, or vaping, product use associated lung injury – United States,2019. MMWR Morb Mortal Wkly Rep. 2019;68:919–927.4. Rostron A. The Dickey amendment on federal funding for research on gunviolence: a legal dissection. Am J Public Health. 2018;108:865–867.5. DiMaggio C, Avraham J, Berry C, et al. Changes in US mass shootingdeaths associated with the 1994-2004 federal assault weapons ban:analysis of open-source data. J Trauma Acute Care Surg. 2019;86:11–19.6. Stoneman Douglas High School Shooting. Wikipedia. The free encyclopedia.7. Schwartz MS. New Zealand passes law banning most semi-automaticweapons. 2019. Available at: www.npr.org/2019/04/10/711820023/new-zealand-passes-law-banning-most-semi-automatic-weapons. Accessed Oc-tober 20, 2019.Medical Care  Volume 58, Number 1, January 2020 Special CommentaryCopyright © 2019 The Author(s). Published by Wolters Kluwer Health, Inc. www.lww-medicalcare.com | 3

The Smoking Gun: Can We Do for Gun Control What We Are Doing to Control the Vaping and E-Cigarettes Epidemic?

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The Smoking Gun: Can We Do for Gun Control What We Are Doing to Control the Vaping and E-Cigarettes Epidemic?

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