Gun-related injury in the United States claimed 38000 lives in the 12 months preceding October 1994, a number 5 to 10 times higher than that in other developed countries. Since 1980, more than 50000 U.S. children have died of gunshot wounds; for African-American male youths, gun-related homicide is the leading cause of death. Certainly Drs. DeHart and Nacol would agree that these potentially preventable deaths are a national tragedy that must be addressed.

Violence prevention, building on the older field of injury control, is a dynamic new field of public health recognized by the American College of Physicians, the American Medical Association, the American Public Health Association, and the Centers for Disease Control and Prevention [1]. The quality and quantity of the science is growing as more researchers enter this field.

We agree with Drs. Waters and Roosevelt that efforts to reduce firearm injuries should be informed by scientifically sound evidence. We acknowledge, as Kleck agrees, that epidemiologic and experimental research in gun injury is complex, and we urge that the field expand [2]. The conflicting claims that firearm ownership enhances personal safety or increases the chance of death fourfold are at least equally subject to methodologic critique. Dr. Roosevelt argues that legal firearm possession deters crime and that gun use in self-defense reduces injury, but a recent study of the easing of laws for carrying concealed firearms suggests that in five cities in three states, the overall incidence of homicide increased after the laws went into effect [3]. The recent JAMA report stating that persons who had more training in gun safety used less safe practices with guns in the home, particularly where children were living, leads to the question of whether gun safety training is enough [4].

Finally, it is important to recognize that in the United States, more than half of all gun-related deaths are suicides, not associated with issues of self-defense or criminal deterrence. The field of suicide prevention must deal more directly with handguns, the most common instrument of suicide. We believe it is important to explore gun control as one possible way in which the disputes between domestic partners and acquaintances that lead to violence might be made less lethal.

The College urges a comprehensive approach to gun violence prevention, including defining and modifying risk factors and educating the public and policymakers about this important risk to American lives.