Citation

Ertle AR, Jena AB, Olenski AR. New Engl. J. Med. 2018; 378(19): 1853.

Comment On:

N Engl J Med. ;378(19):1853

Copyright

(Copyright © 2018, Massachusetts Medical Society)

DOI

10.1056/NEJMc1804096

PMID

29742378

Abstract

With regard to the letter to the editor by Jena and Olenski (March 1 issue)1: I do not find convincing their argument that there is an association between attendance at National Rifle Association (NRA) annual conventions and reductions in firearm injuries. Estimates put the number of gun owners in the United States between 73 million and 81 million. There are an estimated 5 million NRA members (approximately 6.5% of gun owners). The NRA estimates that 80,000 people, or approximately 0.1% of all gun owners, attend their national convention. It does not make sense that so few of all gun owners in the United States would account for the dramatic decrease in the rate of firearm injuries from 1.49 per 100,000 persons to 1.19 per 100,000 persons, as described by Jena and Olenski.

In addition, I am not aware that it has been shown that NRA members account for a substantial number of firearm injuries. In my experience, people who are familiar with weapons, such as those who would join the NRA, generally treat them with “safety first” in mind. The claims in the letter to the editor by Jena and Olenski are not plausible.

The authors reply: We appreciate the points raised by Ertle and agree that a 20% reduction in firearm injuries due to a small segment of the gun-owning population attending NRA conventions seems implausibly large. However, several points must be noted. Our estimate has a large confidence interval, which means that a more “plausible,” smaller effect cannot be statistically distinguished from our estimate. Second, we know of no data on the empirical distribution of firearm injuries among gun owners. It is likely that firearm use and injuries are highly skewed such that a small segment of the gun-owning population accounts for a disproportionate share of firearm injuries. Therefore, a reduction in firearm use among a nonrandom group of gun owners could generate disproportionately large reductions in firearm injuries. Third, our study posits other “spillover” effects that include temporary closure of venues where guns are used, which could reduce firearm use among persons who do not attend NRA conventions. Although anecdotes support that possibility, the validity of that mechanism requires additional investigation.

Language: en