Historically-Stupid Opinion in Bruen Case Endangers Vulnerable to Gun Violence & Ajay Kaul Bowel Sounds Podcast

E Tobin-Tyler. NEJM 2023; 388: 1345-1347. Courts’ Disregard for Women’s Health and Safety — Intimate Partner Violence, Firearms, and “History and Tradition”

A few excerpts:

In June 2022, the Supreme Court issued its opinion in New York State Rifle & Pistol Association v. Bruen, which left the door open for constitutional challenges to virtually any state or federal firearm restriction.  One of these restrictions is a federal law passed in 1994 as part of the Violence Against Women Act (VAWA) that makes it unlawful for people subject to certain domestic violence–related restraining orders to possess a firearm or ammunition for the duration of the order.

Writing for the majority in Bruen, Justice Clarence Thomas struck down New York’s restrictions on who may carry a firearm in public. In doing so, he declared that a government arguing in support of a restriction on firearm possession has the burden of showing that its regulation “is consistent with the Nation’s historical tradition of firearm regulation.”..

On the heels of the Supreme Court’s decision in Bruen, a federal district judge on November 10, 2022, held in United States v. Perez-Gallan that the VAWA’s restriction on firearm possession by people subject to restraining orders is unconstitutional…

Searching for relevant laws from the 18th and 19th centuries to justify current laws protecting people who have experienced IPV (intimate partner violence) obscures the fact that married women weren’t even considered legal subjects until the late 19th century. Instead, they were understood to be the property of their husbands.1 Black women who were enslaved, married or not, had no legal rights. “Wife beating” did not become illegal in some states until the late 19th century…

In Rahimi, the court applied Bruen’s “history and tradition” analysis to a case involving a person who not only was subject to a restraining order because he had allegedly assaulted his ex-girlfriend, but also had been involved in incidents in which he had fired a gun at people and at a constable’s car…The court determined that under Bruen’s analysis, there is no reason to consider the potential consequences for people experiencing IPV of permitting their abusers to possess guns. 

My take: Deciding gun ownership laws solely on the basis of ‘history and tradition’ is incredibly stupid. Research shows that restriction of access to firearms by domestic abusers results in lower rates of gun deaths. This supreme court will allow anyone to possess a firearm, except those in their vicinity.

Related article: The Hill (5/11/23): Federal judge rules adults ages 18-20 cannot be blocked from purchasing handguns. “A federal judge in Virginia has ruled that federal laws prohibiting 18-to-20-year-olds from getting handguns at federally licensed firearms dealers are unconstitutional…The judge concluded that the Second Amendment’s “right of the people to keep and bear Arms” applies to people in that age group. “Because the statutes and regulations in question are not consistent with our Nation’s history and tradition, they, therefore, cannot stand,” Payne wrote. 

Related blog posts:

Also, I want to give a shout out to Ajay Kaul (who completed his training in Cincy one year after I did) and his recent Bowel Sounds Podcast. Ajay is a terrific person. This was a good review on Achalasia and a reminder of the improvements in motility testing. A good clinical pearl was to ask anesthesiology to intubate patients with suspected achalasia to protect their airway.

Listen now! Link to podcast: Ajay Kaul – Esophageal Achalasia in Children

Tucson Botanical Gardens

Sad Commentary on Gun Violence & Drop in Biliary Atresia Cases During Pandemic

Today.com 5/5/23: Should 3rd graders learn how to use tourniquets for school shootings? Texas bill says yes


A Arshad et al. JPGN 2023; 76: 424-427. Reduced Presentation of Biliary Atresia During the COVID-19 Lockdown: A Population Based Observational Study

Methods: This population study assessed all confirmed cases of BA, from January 2020 to December 2021 across the 3 UK pediatric liver centers originating from England and Wales. Data was then compared to the incidence of confirmed BA cases from January to December 2017, 2018, and 2019.

Key findings -BA cases:

  • 2017: 16
  • 2018: 13
  • 2019: 18
  • 2020: 8
  • 2021: 12
  • This difference was significant in a two-sided t test for 2020 (P = 0.035) but not for 2021 (P = 0.385)

The authors note that new BA diagnoses were reduce among Danish centers as well. In their discussion, the authors discuss the possibility of missed diagnosis versus an actual drop in BA cases. The later is intriguing due to concerns that perinatal infections could trigger BA.

My take: This study provides a piece of a puzzle regarding the etiology of BA, indicating a good likelihood of environmental/infectious etiologies as a trigger.

Related blog posts:

“A Smarter Way to Reduce Gun Deaths” Plus Two

N Kristof, NY Times (1/24/23): A Smarter Way to Reduce Gun Deaths

Some excerpts:

In 2021 a record 48,000 Americans were killed by firearms, including suicides, homicides and accidents. So let’s try to bypass the culture wars and try a harm-reduction model familiar from public health efforts to reduce deaths from other dangerous products such as cars and cigarettes.

Harm reduction for guns would start by acknowledging the blunt reality that we’re not going to eliminate guns any more than we have eliminated vehicles or tobacco, not in a country that already has more guns than people. 

Recommendations from article:

  • We can try to keep firearms from people who are under 21 or who have a record of violent misdemeanors, alcohol abuse, domestic violence or some red flag that they may be a threat to themselves or others
  • To keep ineligible people from buying firearms, we need universal background checks
  • A pillar of harm reduction involving motor vehicles is the requirement of a license to drive a car. So why not a license to buy a gun?… In Massachusetts, which has one of the lowest gun mortality rates in the country, an applicant who wants to buy a gun must pay $100 for a license, be fingerprinted, undergo a background check and explain why he or she wants a gun. If the permit is granted, as it typically is after a few weeks, the bearer can then go to a gun store and buy the firearm. There is then an obligation to store it safely and report if it is stolen.
  • Smoking and alcohol cause more deaths in U.S. –both are regulated, not banned. “Because we’ve worked to reduce vehicle deaths and haven’t seriously attempted to curb gun violence, firearms now kill more people than cars.”
  • Background checks to purchase ammunition… this should be possible without creating burdens for gun owners who have already gone through background checks to buy weapons
  • Waiting periods and limits on how many guns one can purchase at a time may also help. We also need to crack down on untraceable ghost guns and on firearms made by 3-D printers; ghost guns are already a growing source of weapons for criminals
  • Warning labels: One proposed ammunition label has a photo of a bloody face and states that a gun increases the risk of someone in a home being killed
  • Increase costs of ownership to cover the damage associated with weapons: raise cost of guns through taxes/fees

This article proposes a lot of practical interventions that if implemented would likely reduce gun violence.

Related article: NPR Jan 24, 2023: Gun violence deaths: How the U.S. compares with the rest of the world The chart below shows how the U.S compares to gun violence in countries with low levels of gun violence. The U.S. compares favorably with Mexico, El Salvador, Guatemala, Venezuela, The Phillipines and Iraq. However, many violent places have lower gun violence than U.S. including Syria, Somalia, Afganistan, Iran, Pakistan, Yemen, and Libya.

Related blog posts:

Atlanta Botanical Gardens

From NPR article.

Aslo, gun violence is widespread and is more common in ‘red’ states than ‘blue’ states despite the widely-held notion that gun violence occurs mainly in large urban centers.

Axios 1/27/23: Not an anomaly: 2020’s red states have higher murder rates Murder rates in red states have outpaced blue states by an average of 23% over the past two decades.

The Harms from the Supreme Court’s Bruen Decision

MR Ulcrich. NEJM 2022; 387: 1245-1247. Public Carry versus Public Health — The Harms to Come from the Supreme Court’s Decision in Bruen

Some excerpts:

“The majority opinion in Bruen, written by Justice Clarence Thomas, will have a devastating impact on efforts to mitigate gun violence and address racial disparities, but the reasoning used in the decision could cause even more havoc moving forward.”

“Allowing more guns in public does nothing to address the real drivers of criminal behavior, which include social determinants such as poverty, neighborhood violence, poor education, and substandard housing.2 Instead, an increased presence of firearms in public is likely to escalate confrontations, with data suggesting either that people who act aggressively are more likely to arm themselves or that people who are armed are more likely to act aggressively — or perhaps both.1

“No right is absolute, and the government is able — if not obligated — to prevent harm to the broader public even in the exercise of constitutional rights. Such authority holds for the speech and religious practices covered by the First Amendment, and the Second Amendment should be no different. But the Court’s new theory of the Second Amendment compels lower courts to ignore public health research, empirical evidence, the current gun-violence epidemic, and other rights and liberties of the broader public.”

E Tobin-Tyler. NEJM 2022; 387: 1247-1249. A Grim New Reality — Intimate-Partner Violence after Dobbs and Bruen

“Pregnancy is associated with both the initiation of IPV [intimate partner violence] and an increase in IPV severity, making it a particularly dangerous time.3 Homicide is the leading cause of pregnancy-associated death in the United States; pregnant and postpartum women are more than twice as likely to die from homicide as from either hemorrhage or hypertensive disorders.3 …Studies show that abortion access plays an important role in reducing IPV.4 “

“In his dissent in Bruen, Justice Stephen Breyer noted that U.S. women are five times as likely to be killed by an intimate partner if the partner has access to a gun…In expanding the right to carry firearms, the Bruen decision exacerbates safety concerns for people actively trying to escape abusive relationships.”

NEJM Interactive: Gun Violence in the United States (last updated 6/30/22)

2022: 240 Mass Shootings in U.S as of 6/3022
Gun Deaths have been increasing with more than 45,00 in 2020.
Per capita deaths in 2020 -Wyoming and Mississippi have mortality rates

Related blog posts:

How the U.S. Compares in Rate of Gun Violence Deaths

A recent political cartoon by Mike Lukovich had a caption/commentary on U.S. troops leaving Afghanistan: “Our times up here. We are being redeployed to a war zone.”

As it turns out, gun violence deaths are higher in the U.S. than in Afghanistan, according to a recent NPR article: Gun Violence Deaths: How The U.S. Compares With The Rest Of The World. In addition, there are more gun deaths in children 4 and younger than police (NY Times: How Do We Stop the Parade of Gun Deaths? April 3, 2021).

Related blog posts:

Senseless Gun Homocides

Even “The Onion” sometimes has a serious article: ‘No Way To Prevent This,’ Says Only Nation Where This Regularly Happens

Related blog posts:

Another Day in the US: School Deaths Related to Firearms

Between 2001-2013, gun related deaths exceeded the total number of deaths from AIDS, terrorism, war, and illegal drug overdoses combined (according to Vox -see Firearm Mortality in U.S).  Here are some tweets in reaction to yesterday’s tragic events.

Link to The Onion commentary: ‘No Way To Prevent This’

Related blog posts: