This is the feeling we learn to live with in North America

I guess it’s just the day for it.

(put NOFX and Fooly Cooly together – I’m happy).

The New England Journal of Medicine (I’ve really taken to the idea of Wednesday being NEJM Day) has three terrific editorials starting it off, this week – all related to (hand)guns. It’s hard, for example, not to be mightily impressed by the likes of how “Handgun Violence, Public Health, and the Law” kicks off:

Firearms were used to kill 30,143 people in the United States in 2005, the most recent year with complete data from the Centers for Disease Control and Prevention. A total of 17,002 of these were suicides, 12,352 homicides, and 789 accidental firearm deaths. Nearly half of these deaths occurred in people under the age of 35. When we consider that there were also nearly 70,000 nonfatal injuries from firearms, we are left with the staggering fact that 100,000 men, women, and children were killed or wounded by firearms in the span of just one year. This translates into one death from firearms every 17 minutes and one death or nonfatal injury every 5 minutes.

By any standard, this constitutes a serious public health issue that demands a response not only from law enforcement and the courts, but also from the medical community.

A very interesting perspective – that handguns and handgun violence represent not only a public health issue, but such a one that we are obliged to respond from within our profession. Remember the excellent book/site Understanding the USA?

The two editorials proper are “Guns, Fear, the Constitution, and the Public’s Health” and “http://content.nejm.org/cgi/content/full/NEJMp0801601?query=TOC” – the former the more relevant (which is not to suggest the latter is not interesting in its own right, focussing specifically upon the issue at hand: District of Columbia v. Heller, a case challenging handgun-control statutes adopted in 1976 in Washington, D.C., and currently being heard by the Supreme Court):

Gun violence is often an unintended consequence of gun ownership. Americans have purchased millions of guns, predominantly handguns, believing that having a gun at home makes them safer. In fact, handgun purchasers substantially increase their risk of a violent death. This increase begins the moment the gun is acquired — suicide is the leading cause of death among handgun owners in the first year after purchase — and lasts for years.

The risks associated with household exposure to guns apply not only to the people who buy them; epidemiologically, there can be said to be “passive” gun owners who are analogous to passive smokers. Living in a home where there are guns increases the risk of homicide by 40 to 170% and the risk of suicide by 90 to 460%. Young people who commit suicide with a gun usually use a weapon kept at home, and among women in shelters for victims of domestic violence, two thirds of those who come from homes with guns have had those guns used against them.

Handguns, like cars, like fatty food, like a great, great many things, simply kill way too many Americans. If only it were acceptable to use “9/11” as a unit of comparison – handgun-related-fatalities being around 10 of them every year. What’s insane is that the same lunatics (say, the GOP) who defend such a thing go around insisting that abortion is the reason the US economy is in trouble – because all of those potential American Workers were killed in the womb. Go figure.

Huckabee called abortion a holocaust because he says “we have aborted more than a million people” in the last 35 years. I’m willing to bet guns have killed more than that. Worse, they’ve probably killed plenty of women who could have given birth! (my cheap shot).

Personally – and I realise full-well that I’m a foreigner with no claim to any sort of up-bringing within the 2nd Amendment – the idea that the 2nd Amendment protects individual rights to bear arms is a little crazy. For a start there’s a “the” before “people”, clear as day. It’s written down, for Cliff’s sake – it isn’t like it’s Neal Armstrong, or anything.

Back to regarding the title of this post (and the song of the link of the youtube clip at the top):

It’s like seeing a car crash from inside the car
The driver’s got his head craned back he’s telling you a joke
You see the bus on collision course
You point your arm and turn your head and wait for the impact
This is the feeling we learn to live with in North America
The morning headlines always accompanied with sweat and nausea
Every week another puzzle piece gets permanently glued into place

We see the iceberg from 15 miles away
The captain orders the ship to “stay the course”
“Full speed ahead” shouts the accursed
The next thing we heard was, “Rich women and children first”
The ship is listing, the captain’s placing blame on the iceberg
“That berg attacked us, I am declaring war on the Arctic”
Who could ever have predicted the greatest ship could so easily sink (duh)

Lifeboats are useless without rescue
The only ships show up for salvage
When setting sail on the St. Louis
We all knew what consequences could be
With the crew we had at the controls

On the doing of body counts

The quote for the day –

Lieutenant General Tommy Franks, who led the invasions of Iraq and Afghanistan during his time as head of US Central Command, once announced, “We don’t do body counts.”

He, of course, had nothing on a certain former first lady:

But back to the story.

… five years after Bush and Tony Blair launched the invasion of Iraq against the wishes of a majority of UN members, no one knows how many Iraqis have died. We do know that more than two million have fled abroad. Another 1.5 million have sought safety elsewhere in Iraq. We know that the combined horror of car bombs, suicide attacks, sectarian killing and disproportionate US counter-insurgency tactics and air strikes have produced the worst humanitarian catastrophe in today’s world. But the exact death toll remains a mystery.

There is no shortage of estimates, but they vary enormously. The Iraqi ministry of health initially tried to keep a count based on morgue records but then stopped releasing figures under pressure from the US-supported government in the Green Zone. The director of the Baghdad morgue, already under stress because of the mounting horror of his work, was threatened with death on the grounds that by publishing statistics he was causing embarrassment. The families of the bereaved wanted him to tell the truth, but like other professionals he came to the view that he had to flee Iraq.

An independent UK-based research group, calling itself the Iraq Body Count (IBC), collates all fatality reports in the media where there are two or more sources as well as figures from hospitals and other official sources. At least four household surveys have been done asking Iraqis to list the family members they have lost. The results have then been extrapolated to Iraq’s total population to give a nationwide estimate.

The results range from just under 100,000 dead to well over a million. Inevitably, the issue has become a political football, with the Bush administration, the British government and other supporters of the US-led occupation seizing on the lowest estimates and opponents on the highest.

It is a long and fantastic article about the trouble involved in trying to get estimates of dead civilians when the corporation making them won’t co-operate. For those of you who’ve not been to the site of the Iraq Body Count, you really should:

247 dead: Last week’s death toll (as counted by Iraq Body Count)

Monday March 10 – 34 dead
Including Dr Khalid Nasir, the only neurosurgeon in Basra; sheikh Thair Ibrahim and his five-year-old niece, killed by a female suicide bomber; 10 people killed by a suicide bomber; and a mother and son killed by gunmen.

Tuesday March 11 – 90 dead
Including a couple kidnapped the week before; 16 members of a family returning from a funeral, killed by a roadside bomb; three killed in a US air strike; and 20 people whose bodies were found in a mass grave.

Wednesday March 12 – 24 dead
Including a 10-year-old girl killed by US forces; five shot and beheaded at a checkpoint; and three truck drivers killed in a roadside bomb.

Thursday March 13 – 39 dead
Including a journalist killed by gunmen; 18 people killed by a car bomb in Baghdad; a 15-year-old girl shot dead by police; and Archbishop Paulos Faraj Rahho.

Friday March 14 – 15 dead
Including ex-footballer Munther Khalaf, killed outside his home by a group of armed men; a street sweeper killed by a roadside bomb; an Iraqi interpreter, killed by a suicide bomber; and the son of the chief of al-Kharaj tribes, killed during a raid by joint forces.

Saturday March 15 – 19 dead
Including Hussein Awda, killed by gunmen; three brothers; and an Iraqi contractor, Athir Ibrahim.

Sunday March 16 – 26 dead
Including two policemen killed in an armed assault and 16 others whose bodies were found, including that of an 11-year-old boy.

icasualties.org is another site worth visiting. Amongst other things, it might just remind you of how many non-civilians have died, also (since surveys here in the US show fewer people than ever know these numbers – rather relevant ones, one would think – 3988 confirmed by the DOD, by the by):