Dr. Davidoff's editorial [1] proposed "reframing" gun-related violence as a public health issue. Those who read it should consider the following points.

Handling gun violence as a public health problem is doomed to failure. Unlike alcoholism or domestic violence, which are common across all socioeconomic classes, gun violence is overwhelmingly related to poverty and its associated ills. Most gun violence stems from the illicit drug trade and youth gangs. The lure of easy money or peer support from gangs is irresistible to the children of poverty and dysfunctional families.

The illegal drug trade nets billions of dollars each year, all outside government regulation. Competition is vicious and deadly. Therefore, participants buy the best weapons available anywhere in the world. Smuggling is their specialty. It is now more profitable to smuggle drugs, but an ill-conceived ban on weapons would cause gun smuggling to compete with drugs as a profit-center. Never forget the law of unintended consequences.

Many children of the poverty-stricken underclasses have no functioning family unit. A child raised on the streets develops the mores of the gang, which are usually violent and antisocial. Many graduate to the drug trade if they live long enough, whereas others produce more crime and broken homes.

Outside the underclasses, death rates from gun-related accidents have steadily declined over the past 30 years, whereas rates of gun ownership have increased. The suicide rate in the United States is low compared with that in many western nations, and you are just as dead whether hanged or poisoned as shot. If the homicide rate and the suicide rate for each western nation are combined as an aggregate "unlawful death" rate, the United States ranks somewhere between Belgium and Sweden.

If the problems of the drug trade and youth gangs can be solved, gun violence will take care of itself; it is only a symptom of social disintegration. Voiding the Second Amendment, disarming the peaceful majority, and creating a new class of criminals are too high a price to pay for a dubious solution to a spurious problem.

The real reason most physicians do not talk to their patients about gun safety issues is that they have so little knowledge of firearms. A young urban physician raised in a household without guns fears being laughed at by patients who know more about the subject than he or she does.