Arthur Kellermann

Dr. Arthur L. Kellermann, M.D., M.P.H., F.A.C.E.P. (born 1955) was recently named the Director of RAND Health. He was the founding chairman of the department of Emergency Medicine at Emory University in Atlanta, Georgia, USA, and founding director of the Center for Injury Control at Rollins School of Public Health, a collaborating center for injury and violence prevention of the World Health Organization. His writings include more than 200 scientific and lay publications on various aspects of emergency cardiac care, health services research, injury prevention and the role of emergency departments in the provision of health care to the poor.^[1][2][3]

Kellermann co-chaired the Committee on the Consequences of Uninsurance of the Institute of Medicine of the United States National Academies, of which he is an elected member. Kellermann holds career achievement awards for excellence in science from the Society for Academic Emergency Medicine, and the Injury Control and Emergency Health Services Section of the American Public Health Association.^[1] As a 2006-2007 Robert Wood Johnson Foundation Health Policy Fellow, he joined the Professional Staff of the United States House Committee on Oversight and Government Reform in Washington, D.C. In 2007 he was presented with the John G. Wiegenstein Leadership Award by the American College of Emergency Physicians, their highest award.^[2][4]

Kellermann is well known for his research on the epidemiology of firearm related injuries and deaths. In a 1995 interview, Kellermann saw firearm and other injuries not as random, unavoidable acts but as preventable public health priorities: "I grew up around guns. My dad taught me how to shoot when I was eleven or twelve years old. Firearms are fascinating pieces of equipment. I enjoy the sport of shooting, although I rarely shoot anymore. However, as a clinician, as someone who is committed to emergency medicine, it is equally evident to me that firearm violence is wreaking havoc on public health."^[5]

In this polarized debate, Kellermann’s studies quantifying the risk of mortality associated with gun ownership attracted criticism from pro-gun organizations and individuals.^[6] The National Rifle Association of America contends that Dr Kellermann “severely understates defensive uses of guns,” and that his “conclusions provide anti-gunners propaganda.”^[7] Kellermann’s findings have been linked to the June, 1996 Republican-led decision of the U.S. House Appropriations Committee to strip US$2.6 million from the budget of the National Center for Injury Prevention and Control at the U.S. Centers for Disease Control – the exact amount previously set aside for NCIPC/CDC research into the causes and effects of firearm-related death and injury.^[8][9]

Kellermann's published studies on gun ownership

Kellermann states that as an emergency room doctor, he noted that the number of gunowners injured by their own gun or that of a family member seemed to greatly outnumber the number of intruders shot by the gun of a homeowner, and therefore he determined to study whether or not this was in fact true.

1986

In his first publication on the subject, in 1986, Kellermann studied all gunshot related deaths in Seattle over six years, and found that

• 54% of firearm-related deaths occurred in the home where the gun was kept
• 70.5% of these (firearm-related deaths in the home where the gun was kept) involved handguns
• 0.5% of these (firearm-related deaths in the home where the gun was kept) involved an intruder shot while attempting entry
• 1.8% of these (firearm-related deaths in the home where the gun was kept) were judged by police as self-defense
• there were 1.3 times as many accidental firearm-related deaths in the home where the gun was kept as self-protection shootings
• there were 4.6 times as many criminal firearm-related homicides in the home where the gun was kept as self-protection shootings
• there were 37 times as many suicides in the home where the gun was kept as self-protection shootings.

He concluded that "the advisability of keeping firearms in the home for protection must be questioned". Critics of this study noted that it was restricted to firearm-related deaths, effectively excluding incidents in which gun owners used their firearm to injure and frighten away an intruder. But the study also excluded incidents in which individuals were non-fatally injured in a firearm accident, criminal assault or suicide attempt, as well as instances in which a homeowner used a gun to threaten or terrorize another member of the household, as sometimes occurs in the context of domestic violence. A subsequent Kellermann-led study identified both fatal and nonfatal injuries occurring in homes in 3 cities – Seattle WA, Memphis TN, and Galveston TX. It noted that for every time a gun in the home was used in a self defense or legally justifiable shooting, there were four accidental shootings, seven criminal assaults or homicides, and 11 attempted or completed suicides. (J of Trauma, August, 1998. pp: 263-267). He then developed the now much disputed 43:1 ratio that states every time a gun is used in self-defense, it is 43 times more likely to be used in a homicide, suicide, or accidental shooting.

1988

In 1988, Kellermann published a study comparing robberies, burglaries, assaults, and homicides in Seattle, Washington and Vancouver, British Columbia, a city "similar to Seattle in many ways" that had "adopted a more restrictive approach to the regulation of handguns." The study found that

• both cities had similar rates of burglary and robbery
• in Seattle, the total rate of assaults with any weapon was modestly higher than that in Vancouver
• rates of homicide by means other than guns were not substantially different in the two study communities
• the rate of assaults involving firearms was seven times higher in Seattle than in Vancouver
• the rate of being murdered by a handgun was 4.8 times higher in Seattle than in Vancouver.

The study concluded that restricting access to handguns may reduce the rate of homicide in a community by reducing the lethality of assaults.

1993

In 1993, Kellermann responded to the criticism of his 1986 paper with a case-control study^[10] of the rates of all homicides in the victim's home in Cleveland, Ohio, Memphis, Tennessee, and Seattle over five years, in homes where a gun was kept versus homes where a gun was not. This study found that

Kellermann's 1993 Table 4

Variables Included in the Final Conditional Logistic-Regression Model

Variable	Adjusted Odds Ratio	95% CI
Any household member used illicit drugs	5.7	2.6-12.6
Home rented	4.4	2.3-8.2
Any household member hit or hurt in a fight in the home	4.4	2.2-8.8
Case subject or control lived alone	3.7	2.1-6.6
Gun or guns kept in the home	2.7	1.6-4.4
Any household member arrested	2.5	1.6-4.1

• 23.9% of homicides occurred in the victim's home
• 35.8% of the controls (homes where there was not a homicide) kept a firearm in their home
• 45.4% of all victims of homicides in their home kept a firearm in their home
• 62% of victims of firearm homicides in their home kept a firearm in their home (correction to original paper)
• other protective measures, (reinforced doors, deadbolts, burglar alarms, and bars on the windows) were associated with small (about 0.8 times) reductions in risk of homicide in the home
• after adjusting for other factors (such as a police-report history of violence in the home, a convicted felon in the home, drug or alcohol abuse in the home, race, etc.) there remained an independent 2.7 times increase in risk of homicide, specifically associated with a firearm in the home; this risk was not attributable to any particular "high risk" subgroup(s) identifiable by the above factors but was evident to some degree in all subgroups
• this risk was essentially entirely attributable to being shot by a family member or intimate acquaintance with a handgun which was kept loaded and unlocked in the house
• this risk was significantly less than the increased risk due to sociological factors (rental of a home instead of ownership, living alone) but close to that associated with the presence of a convicted felon in the home (see table at right).

These results confirmed the 1986 finding that, in the net, a firearm in the home represents a greater risk overall than the protection it may offer against intruders, either indirectly or by discouraging potential assaults. Kellermann noted that the study demonstrates the pervasiveness of domestic assault, as compared to better publicized crimes such as home invasion, but continued to stress the role of handguns in increasing the lethality of such assaults.

Critics of Kellermann's 1993 paper responded with a number of objections, some accurate (e.g. the study population was urban and therefore higher risk in general, compared to suburban or rural areas; that residents of homes where there is a risk of fatal domestic violence typically are more aware of the fact than external researchers), and some inaccurate (e.g. that members of rival gangs were tabulated as "family member or intimate acquaintance"; that the data was cherry-picked). Particular attention was paid to the fact that Kellermann did not release his data immediately upon publication. SUNY-Buffalo's Lawrence Southwick, among others, publicly speculated "that Kellermann's full data set would actually vindicate defensive gun ownership." [1]

However, Centers for Disease Control and Prevention grants do not require the individual investigator to make data public until there are no more publications to be developed from them. After publishing additional analyses, Kellermann released the dataset to the Inter-university Consortium for Political and Social Research, the world’s largest archive for social science research [2]. ICPSR released the data for public access on May 30, 1997 [3]

In 1996, lobbyists for the National Rifle Association began pressuring Congress to eliminate the CDC’s National Center for Injury Prevention and Control (NCIPC) which had funded much of Kellermann’s research. Although the effort was ultimately unsuccessful, the House voted to cut the NCIPC’s funding by $2.6 million, precisely the amount it had spent on the firearms research the previous year. [4]. The money was ultimately restored by the Senate, but earmarked for traumatic brain injury prevention. The final appropriation language included the following statement: “[N]one of the funds made available for injury control at the Centers for Disease Control and Prevention may be used to advocate or promote gun control”. These words appear in every CDC grant announcement to this day. [5]

Other work

Firearm injury prevention research accounts for a minority of Kellermann’s research output. Only 30 percent of his papers address the issue. He has published extensively in other areas of emergency medicine and public health, including studies of emergency cardiac care, use of diagnostic technologies in the emergency department, and a promising treatment for traumatic brain injury. He has also published research on the role of emergency departments in providing health care to the poor, the role of insurance [6] and the situation of the uninsured [7]. In recent years, he has written about domestic preparedness to respond to different forms of terrorism [8]. Kellermann was very instrumental in the planning and implementation of the American Heart Association's "Racing the Clock to Restart Atlanta's Hearts" initiative, one of the largest cardiopulmonary resuscitation and automated external defibrillator programs in the nation. He also played an important role in the Institute of Medicine’s three-volume report on the Future of Emergency Care in the United States, [9].

References

1. ^ ^{a b} "Arthur Kellermann, M.D., M.P.H., F.A.C.E.P.", Robert Wood Johnson Foundation National Advisory Committee
2. ^ ^{a b} "Emory Center for Emergency Control Faculty"
3. ^ "Curriculum Vitae, Arthur L Kellermann, M.D., M.P.H., F.A.C.E.P.", University of Texas System News 2007
4. ^ "John G. Wiegenstein Leadership Award", American College of Emergency Physicians
5. ^ "Accidents Don't Happen", John D. Thomas, Emory University Magazine, Summer 1995
6. ^ "Trigger Points", Bob Thompson, The Washington Post Magazine, March 29, 1998
7. ^ "22 Times Less Safe? Anti-Gun Lobby's Favorite Spin Re-Attacks Guns In The Home", National Rifle Association of America, Institute for Legislative Action, December 11, 2001
8. ^ "The Perversion of Science and Medicine (Part IV):The Battle Continues", Miguel A. Faria, Jr., M.D., Medical Sentinel, 1997;2(3): 83-86
9. ^ "Public Health Pot Shots How the CDC succumbed to the Gun "Epidemic"", Don Kates, Henry E. Schaffer & William B. Waters IV, Reason, April 1997
10. ^ Kellermann, Arthur L. and Rivara, Frederick P. and Rushforth, Norman B. and Banton, Joyce G. and Reay, Donald T. and Francisco, Jerry T. and Locci, Ana B. and Prodzinski, Janice and Hackman, Bela B. and Somes, Grant (1993), "Gun Ownership as a Risk Factor for Homicide in the Home", New England Journal of Medicine 329 (15): 1084–1091, doi:10.1056/NEJM199310073291506 

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Name	Kellermann, Arthur
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Date of birth	1955
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