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Brainstorm Health: Gun Violence and Public Health, Inversion Mergers, Breast Cancer Deaths Plunge

Earlier this year, for its health tracking poll, the Kaiser Family Foundation surveyed more than 1,200 adults on a number of issues, including about what kept them up at night. Forty-two percent of respondents said they were either somewhat worried or very worried about being the victim of gun violence. That’s a higher share than those who were worried about losing their jobs, or being able to pay their rent or mortgage, or being the victim of a terrorist attack.

As high as that percentage might seem to some, the results mirror those of other years in the Kaiser tracking poll. (In 2013, the same share of Americans—42%—expressed concerns over personally being a gunshot casualty.)

In the wake of the unforgivable and senseless killings in Las Vegas on Sunday night, the deep and widespread fear of gun violence will, no doubt, grow even deeper and more widespread. It will rise, perhaps, even to the level of our sorrow. That’s because when a “Las Vegas” (or an “Orlando,” or a “Virginia Tech,” or a “Sandy Hook”) happens, we cannot leave ourselves out of the story, says Dr. Garen Wintemute, an emergency room physician and professor at the University of California, Davis, who runs that school’s Violence Prevention Research Program. “Public mass shootings happen at concerts, they happen at movie theaters, and malls, and places of worship. They happen at the places we go to—which means all of us have to wonder if they could happen to me.”

And yet, as painful as such events are, and as much as they seem to increasingly define America’s uniquely violent profile among developed nations, they account for just 1-2% of all gun-related deaths in the U.S. “We lose upwards of 90 people a day on average to firearm violence, to suicide and homicide,” says Wintemute. “The vast majority of those events never make the news, but that’s where the problem is.”

The good doctor has spent much of the past 35 years reframing our national epidemic of gun violence as though it were any other epidemic—that is to say, as a public health problem. Or make that a national health crisis.

The effort hasn’t been easy. Since 1996, under a provision called the Dickey Amendment, Congress has prevented agencies in the U.S. Health and Human Services administration from using funds “to advocate or promote gun control.” The CDC, says Wintemute, has incorrectly “interpreted that as a mandate not to do research” on the public health dangers of guns and the epidemiology of gun violence.

But Wintemute, for his part, has steadily pressed on. When much of his traditional government funding dried up, he began financing his own program’s research in part with his savings—kicking in $300,000 a year. (“I’m an ER doc,” he says. “I live a simple life. I don’t need the money.”) By the end of 2017, Wintemute, who is 65 and who has no plans of retiring soon, will have self-funded his research program to the tune of $2.1 million. He has also gotten funding recently from the National Institute of Justice and from some private foundations.

A second challenging (and nonsensical) barrier to stemming this firearm-health crisis, he says, is the widely propagated myth that physicians can’t, or shouldn’t, talk to their patients about the safety risks of guns—a belief reinforced by a misunderstanding of a provision in the Affordable Care Act. That’s not the case at all, says Wintemute. (The law merely prevents health providers from collecting or demanding information from their patients regarding gun use.) “The language of the ACA really doesn’t apply to what doctors do,” he says.

The state of Florida passed a separate, and more strident, physician gag rule (known as the “Docs vs. Glocks” law) in 2011—but a federal appeals court overturned that this past February.

As much as those who fear any kind of measured gun control try to stop the brave Wintemutes of the world, however, there is good news too. In June 2016, the state of California passed legislation that publicly funds the University of California Firearm Violence Research Center. Wintemute’s research program will see its first funding from that this month.

Other news below.

Clifton Leaf, Editor in Chief, FORTUNE


A new kind of smoking cessation program monitors carbon monoxide levels in your blood. I chatted last week with Dr. David Utley, founder and CEO of the tech-fueled smoking cessation upstart Carrot, about his company’s intriguing new approach to helping smokers kick the habit. Utley’s firm just received FDA clearance for an over-the-counter carbon monoxide breathalyzer—a device that smokers using the company’s new Pivot cessation program would use to see the effect that smoking has on the carbon monoxide level in their blood streams. The program itself is also markedly different from the ones typically available through workplace wellness programs and the like; rather than encourage a more or less cold turkey approach, Pivot is a long-term undertaking meant to serve both people immediately ready to quit and those who want to transition more slowly into a smoke-free lifestyle.


Pharma’s favorite merger type may be coming back. Axios reports that a U.S. district court has struck down Obama administration-era rules that discourage tax-inversion mergers which allow companies to gain reduced tax rates by shifting their domiciles to another country (usually places like Ireland). These kinds of mergers were a favorite among health care and pharmaceutical companies, and the Obama administration rules came about after drug giants Pfizer and Allergan attempted to reach such a deal in 2016. The question now is, what will the Trump administration—famously critical of companies moving overseas—do about the ruling and general policy? (Axios)

FDA announces new measures to speed up complex generics approvals. The Food and Drug Administration (FDA) under Commissioner Scott Gottlieb is continuing its quest to ramp up generic drug approvals, this time for complex generics that could compete with products such as Mylan’s EpiPen. “Drug access is a matter of public health concern,” Gottlieb said in remarks. “We know that enabling more generic competition, where Congress intended, helps reduce prices, enable more access, and improve public health.” (Reuters)


Breast cancer death rate plunges nearly 40%. Some good news in the war on breast cancer: “From 1989 to 2015, breast cancer death rates decreased by 39%, which translates to 322,600 averted breast cancer deaths in the United States,” according to a new report published by the American Cancer Society. Unfortunately, the gains are uneven, the researchers note. Non-Hispanic black (NHB) women “continued to have higher breast cancer death rates than [non-Hispanic white] women, with rates 39% higher in NHB women in 2015, although the disparity has ceased to widen since 2011.”


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Produced by Sy Mukherjee

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