See related articles, p. 1 and p. 10.
About 2 decades ago, in a conversation with Dr. William Haddon, who is widely considered the grandfather of injury prevention, Haddon described how difficult it was for him as the first administrator of what is now the National Highway Traffic Safety Administration to make the decision that compelled the installation of seatbelts in new cars. Data on the effects of seatbelts were scarce, because seatbelts themselves were scarce. Some critics of seatbelts presented doomsday scenarios of horrendous seatbelt-induced injuries. Dr. Haddon ultimately decided that decisions sometimes can and must be made even in the absence of clear and compelling data, if you believe, based on the best available evidence, including information from analogous situations, that lives will be saved by the widespread use of an innovative modification to a product. Haddon's policy decision to mandate the installation of seatbelts proved, of course, to be a public health gem.
Included in this issue of Annals are 2 articles by Ismach et al1 and Milne et al2 that examine the design of handguns and comment on whether the inclusion of safety devices might reduce the incidence of gun-related injuries. The authors, scientists that they are, speak cautiously about the potential benefits of gun design modification. Milne et al warn that “The effect of safer handgun design and safety devices needs further evaluation.” Ismach et al provide a somewhat stronger endorsement, saying “(Safety) devices might have prevented some of the shootings attributed to mishandling.”
Editorial writers are not bound by the same conservative constraints that bind the authors of data-driven scientific reports. Editorials can accommodate opinion. Editorials can recommend policy changes even in the absence of clear and compelling data, much like the policy decision that Dr. Haddon had to make.
Of course, data are lacking that prove the effectiveness of certain safety devices on handguns. Two reasons for this come immediately to mind: The presence of the safety devices is scarce, and the data that would allow for evaluative analyses are not routinely collected. Milne et al2 and Vernick et al3 before them showed that, for example, loaded chamber indicators and magazine disconnect devices—2 firearm safety devices for which technology has existed for more than a century—presently appear on only about 11% to 22% of pistol models. Regarding the ability to evaluate these devices by the use of epidemiologic data, much has been written about the lack of a uniform data collection system in the United States that would provide the type of product-specific information on weapon-related mortality that we have for motor vehicle–related deaths.4, 5
Therefore, it is clearly true that proof beyond a reasonable doubt is lacking that the widespread inclusion of safety devices on handguns would reduce the incidence of gun injuries. Equally, it is true that proof is lacking for claims of horrendous, paradoxical damage caused by the incorporation of safety devices.6 However, the clear preponderance of evidence now shows the value of safety devices. The conclusive proof of the effect of handgun safety devices will only come when the devices are widely incorporated by gun makers into their products. In this regard, gun makers and policy makers who could govern the conduct of gun makers have been quite recalcitrant.7
However, this need not be the case. Progress continues to be made on the development of new technologies that could make guns safer and in the pursuit of new strategies to get gun makers to use safety technology. A quick review of this progress might be helpful to readers of Annals.
There are some handguns that are presently on the market that use locking devices designed to prevent the unauthorized use of the gun. For example, Taurus handguns have a lock-and-key mechanism that the company describes as follows: “The Taurus Security SystemTM renders the firearm inoperable by use of a special key. For those with concerns about unauthorized use of their Taurus firearm, the integral Taurus Security SystemTM provides an additional measure of assurance.” In describing this system for a particular line of pistols, the company says “The Taurus MillenniumTM family of semi-auto pistols features the Taurus Security SystemTM, which provides instant-ready defense with built-in ability to secure your pistol and make it inoperable at the turn of a key. When the Security System is engaged, the Millennium cannot be fired, cocked, or disassembled, and the gun's manual safety cannot be disengaged.”8 The presence of such a system (which is not ideal as a firearm personalization device but is certainly a step in the right direction) on a popular handgun belies the claim of others that the technology to make safer guns is infeasible or unavailable.
More technologically advanced systems for discriminating between authorized and unauthorized gun users have been developed, but are not yet on the market. Fingerprint-reading microchips, for example, are used in other products, including the Pro4 ID gun holster (patent pending as of March 2001) unveiled in 2001 (Michaels of Oregon, Inc., Oregon City, OR). According to the manufacturer, the Pro4 ID holster is “a biometric identification retention holster” that uses fingerprint-recognition technology to prevent the unauthorized removal of a handgun from its holster.9
In August 2002, a patent was issued for a handgun that could be discharged only in prescribed areas. By using a device that determines the location of the weapon (such as is used in global positioning systems and cellular telephone technology that determines the location of 911 calls) and memory storage technology that contains information on where the discharge of the weapon is allowed, a handgun can be made that has location-limited use. As the patent holder states in the patent material, “… this invention will reduce the criminal usefulness of a hand weapon by making it useless for crimes outside of its allowed discharging areas … .”10 An estimated 500,000 handguns are stolen from homes each year11; if this patented technology was in use, many of those handguns would be inoperable once they are removed from the home.
Attempts to put policies in place that would mandate safer handguns have been underway for some time.7 Some of these attempts are nearing fruition. As this editorial is being written, the New Jersey legislature has passed a childproof gun bill that would ultimately require new handguns sold in New Jersey to be designed such that they could not be operated by children. Maryland's legislative provision requiring new handguns to have integrated mechanical safety devices goes into effect on January 1, 2003. Litigation seeking to impose liability on gun makers for their failure to make safer guns is nearing trial in several locations.
Notwithstanding this activity, most gun makers continue to ignore or deride the possibility of safer guns. Claims of infeasibility and dangers associated with the incorporation of safety technology have been made.12 This is not new to industry in general. Product manufacturers bitterly fought, sometimes for decades, the installation of air bags in cars, age labeling on children's toys, safe temperature settings on hot water heaters, the discontinuation of 3-wheel all terrain vehicles, and many other life-saving product modifications. Each of these injury prevention changes ultimately prevailed, however, to the benefit of the public's health.
Safer gun design will also likely occur, over time. Change will be accomplished by a combination of scientific research such as that reported in this issue of Annals , advocacy in the form of legislative proposals and litigation, and the strength of public demand.
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