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The Last Word – Occam is sometimes wrong

“For every thousand hacking at the leaves of evil, there is one striking at the root.” –Henry David Thoreau

by Tom Black, MD

Publications Committee Chair Dr. Hujefa Vora will be taking a temporary break from his committee duties. In his stead, members of the committee will continue to contribute to the Last Word. Dr. Robert Bunata will serve as Interim Chair.

As a recent session of the American College of Surgeons was ending, the words of Ray Magliozzi came to my mind, “Well, it’s happened again—you’ve squandered another perfectly good hour . . .” The subject of the session had been “Firearm Injuries,” and the take-away message was, of course, the need for gun control. As I waited to file out of the auditorium, Thoreau’s words rang in my ears, and I wondered how many more fruitless discussions we must endure, hacking at the leaves of the issue, before someone begins striking at the root?

When a question arises that can’t easily be answered, it’s often because the wrong question is being asked. Maybe that’s why we have repeatedly and consistently failed to resolve the conundrum of firearm injuries. 

In the well-known parable of the six blind men and the elephant, each of the men describes the elephant differently. Although none of the men were incorrect, none had defined the entirety of the elephant itself. Similarly, there are so many aspects to the problem of firearm injuries that until we begin discussing them as disparate entities with different causes and remedies, we will continue to be enticed into advocating only the lowest common denominator—the supernatural disappearance of all firearms.

In this era of frenetic 24-hour news, consumers expect the “quick fix” and the “one size fits all” solution so they can move their attention expeditiously onward to the next crisis. In the world of reality, within which some—perhaps even most—of us live, the usually reliable Occam’s law of parsimony is simply unrealistic when applied to this multi-faceted issue. It’s simply so much easier to demand the confiscation of all firearms than it is to analyze the root causes of firearm violence and address them as the distinct and unique issues that they are. 

I would be among the last to suggest looking to Hollywood as a moral North Star, but occasionally a pearl of wisdom is unexpectedly heard from the silver screen. In the 1953 movie “Shane,” the heroic title character expresses the following: 

“A gun is a tool, Marian; no better or no worse than any other tool: an axe, a shovel or anything. A gun is as good or as bad as the man using it.”

These are words from a by-gone era that would never be heard today in the same medium, but are they not true?

Let’s analyze the problem of firearm violence as if it were a medical condition. All rashes are not treated in the same manner, nor are all cases of shock or of diarrhea or of headache. Does treating a fever address the cause of the illness? I submit that firearm violence is a symptom or expression of societal disease, not a disease itself, and treating it without addressing the root cause makes as little sense as treating pneumonia with acetaminophen alone.  

Viewing firearm violence as a symptom of disease, the list of differential diagnoses would include the following:

• Suicide:
• genetic or acquired mental disorders; drug abuse; acute                       psychological states such as trauma or loss; cultural, familial, and social situations.

• Homicide:
• hate, greed, lust, desire for control, mental disorders, emotional                        agitation, impaired judgment due to substance abuse. 

• Unintentional injuries:
• inadequate gun education, carelessness, improper storage.

Would anyone suggest, aside from the impractical proposition of decreeing the disappearance of all firearms, that the solution to each of these issues is anywhere near the same? In some cases, controlling access to firearms is indeed the best solution, but to mandate it as a panacea is as inappropriate as treating every case of arterial hypotension with epinephrine alone.

Assume for a moment that all guns vanished instantaneously into thin air. Would the despair and depression that leads one to commit suicide be simultaneously cured? Would the hatred and greed that result in homicide abruptly disappear? Would everyone prone to foolish and reckless behavior suddenly become wise? 

Factors contributing to intentional violence are numerous, pervasive, and so entrenched in our culture that it is not hard to see why we have chosen to focus our attention on the utopian and inherently impossible objective of eliminating guns. Such factors must certainly include the ubiquitous and desensitizing violence portrayed in movies, television shows, video games, music lyrics, and music videos; illegal drugs; rampant materialism; the lack of self-esteem due to a hedonistic obsession with personal appearance; the rise of secularism and the decline of religion; and the general decline of ethical behavior toward others. Regarding unintentional injuries. Ah—there’s an area in which we might actually be able to make some inroads, such as mandating trigger locks and education regarding the handling of firearms. But in the overall incidence of gun violence, unintentional injuries are but a drop in the bucket.

Firearm violence is a symptom, not a disease. It’s a common pathway by which various deeply rooted maladies of society are expressed. Only when we begin seeing firearm violence as a symptom can we begin the arduous task of diagnosing and appropriately treating underlying societal diseases. Meanwhile we must halt the irrational, perpetually unproductive, and divisive demand to cure a variety of diseases by treating their common symptom. 

We seem to have three choices: continue the Sisyphean efforts to eliminate all firearms; begin tackling the overwhelming issues that contribute to firearm violence; or resign ourselves to the future we have created.

The real question is, does society have the resolve to identify and remedy the roots of societal disease, or would we prefer to continue hacking at the leaves?

“When a question arises that can’t easily be answered, it’s often because the wrong question is being asked.”

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