Think of a 12-year-old, white, little girl
living in safe suburbia with her parents and an older brother.
She's playing in her parents' bedroom,
and she finds a gun in her father's nightstand.
She's so excited.
She runs down to her brother and shows him the gun.
They're both very, very thrilled.
One day, her mom decides to go for shopping with her aunt,
and every time she went shopping,
they got a little treat, McDonald's Happy Meal.
So, she and her brother
are sitting together and eating their food,
and her brother wanted her fries.
She decided, "No, I am not giving you the fries."
He got so angry and he ran up the stairs.
At that instance, she knew he was going for the gun.
She runs behind him,
and at the top of the stairs, she sees him with a gun pointed at her.
Then she heard a bang and she fell back.
Her brother shot her in her face.
Life changed for her after that.
And this is a real story.
These are the stories of trauma that you hear day in and day out.
But now,
let's think that this is not a little, white girl
but a 12-year-old boy.
He's coming back from school into a neighborhood
which is rife with crime,
and he gets shot in his back.
The story was not even mentioned in the newspapers.
This happens more often than the earlier story.
America makes up about 5% of the world's population
but also has 42% of civilian guns.
Now we're at a time where there are more guns than people.
The constellation of NRA lobbying power,
gun culture, easy availability of guns, and the Second Amendment together
has resulted in high numbers of deaths and injuries due to guns,
and this directly violates basic human rights.
James Madison proposed the Second Amendment
as a compromise between Federalists and Anti-Federalists,
but now we are at a point
where there are more guns than people in the country.
Given that, we have to also take a step back
and look at the history of guns.
Guns and America were born together, and then they grew up together.
Guns, then, were used to enslave people
and also to take land from the natives,
though we have to keep in mind those basic human rights violation
right from the get-go.
In modern America,
most of the gun owners say that they own guns for protection;
however, national crime rates have been declining since 1993 -
we are at an all-time low.
America's safe.
I'm from India.
Now, for the protection of the guns, right?
So guns protect.
On the other hand, is it risky?
Most often people say that "Oh, we still don't know,"
but that's untrue.
We've known it from 1986,
when Dr. Kellermann first reported in New England Journal of Medicine,
for every self-protection gun event,
there will be 1.3 accidental deaths,
4.6 criminal homicides, and 37 suicides.
In Boston, there are at least one shooting in a day.
Nationally, more than 100 Americans are shot dead,
and another 220 to 280 will be shot,
but they are treated in emergency rooms across the country and they survive.
So seven out of ten who are shot will survive.
As a result, we have at least 1 million gun violence survivors amongst us.
And the annual cost of treating such injuries
amount to around 18 billion dollars.
We've heard a lot about mass shootings and school shootings,
but in reality, that's only the tip of the iceberg.
It's 2% of the annual deaths.
In fact, there is about 40,000 people or more die every year.
That's about 30% - they're shot, they die right away.
And another 30% are taken into the ER, they have very low injury severity,
and therefore, they're patched up and sent home.
Another 40% have very severe injuries from the ER;
they're hospitalized.
As for the non-fatal gun injuries, we have about 85,000 to 100,000 per year.
There are five different types, or intents, of injury:
The red band is the assault.
And the blue band is unintentional.
Green is suicide.
Yellow is undetermined.
And finally, legal intervention,
where a civilian is shot by an officer of the law.
Those people who survive gun injuries
are largely because of assault injuries as well as unintentional injuries.
88% of those who use a gun for suicides will die.
We also found that the severity of gun injuries are also rising with time,
and that indicates that guns have become better,
bullets are becoming better,
therefore more lethal.
But our healthcare is also improving.
With regards to gun violence survivorship,
it's a nonentity
because people think about gun violence as something very dramatic,
something like a mass shooting, something like a school shooting,
but in fact, most of the victims are those who survive this gun violence,
and they are poor folks who live in impoverished neighborhoods.
They usually have Medicare or no insurance at all.
And gun violence survivors
doesn't mean that "OK, we are treated in the hospital.
We're all good.
We're going back to our lives."
They never return back to their lives.
Their lives are blighted by addiction, hospitalizations, pain,
neurological complications, disability, and even early death.
Overall, surviving gun violence is very, very expensive.
We studied the impact of gun suicides in rural counties,
and we found that those rural counties with high gun suicides
also had opioid death rates which are high,
high opioid prescription rates,
high veteran population, and also high crime rates.
These counties were also adjacent to urban counties,
which explains easy availability of guns and drugs.
So we concluded that the opioid epidemic and gun suicides
co-occur in rural populations as diseases of despair.
We also studied survivors of gun suicide
and looked at their clinical descriptions,
and we found three distinct phenotypes.
The largest group had depression, hypertension, blood loss anemia,
they smoked and they drank alcohol.
The second group was mainly children, pregnant women, and new mothers.
Third group were all depressed and had fewer injuries.
We also studied the impact of having mental illness
when a person is shot.
We compared people with mental illness versus people without mental illness,
and we found that the risk of drug use during the first year
is about twice as much in people with mental illness
as compared to people without mental illness,
and that risk shot up to 3.5 in the third year.
There is also racial discrimination.
Gun violence does discriminate.
It discriminates
because most of the gun violence occur in poor communities.
And we are easy.
We feel almost a need
to be able to associate a white person who survives gun violence as a hero
whereas, quickly, a black person from a poor community
is seen as a criminal.
That happens not just, you know, when they are treated,
but it also happens in terms of how they are presented in the media.
Primarily, suicide victims are white men,
and assault victims are black men who are below 25 years.
So they don't have the luxury to get cancer.
They do not have the luxury to get chronic diseases.
And even before that, they'd have been injured and traumatized.
It is very easy for us to think
that gun violence happening in a community is their fault,
but that's not it.
It is poverty.
The root cause of gun violence is poverty.
Poverty leads to crime.
Crime leads to violence exposures, leading to mental illness,
and then keeps that cycle going,
making the poor poorer.
That's what gun violence does.
There is another discriminatory term, "trauma recidivism," used in medical care.
So in 1990, Dr. Reiner decided, "Hey, let me talk about trauma recidivism."
These are hospitalized trauma patients with a known history of trauma.
He intended it not to be discriminatory,
but in the end, he was extremely discriminatory,
and it stuck.
There are about 78 different papers on trauma recidivism
implying that every victim is a perpetrator, is a criminal.
The first time I heard about this term was from a survivor.
He was refusing to go back to his doctor - and he was shot the second time.
He was a janitor in a school.
And he told me,
"I'm not going back to that doctor.
He called me a criminal."
And I told him, "Doctors don't call people criminals."
He said, "He called me a recidivist.
I looked it up. I know what that means."
So we have to be careful in using such terms.
Then there is this fantastical culture of gun violence,
the heroic depiction of having a gun,
where we can shoot ourselves out of a situation.
And it's rampant,
but it's rampant in certain population.
There are pockets of gun culture,
the strong gun culture
rooted in this country for the reasons I mentioned before.
But the real effects are in cultures
or in communities which are poor, where people of color live.
It causes mental illness, and it causes poverty.
It makes sure that the poor remains poor or even poorer.
They never have the chance to move to resiliency.
They live in high stress all the time, traumatic exposures all the time.
Imagine if you have to listen to gunshots every day in your life.
You're not in a war zone, but that is how Roxbury is.
We know guns are the dark underbelly of America.
It helped to enslave people, it helped to steal lands -
that violent history.
Then we also know that violent-crime rates are on the decline.
We know the risk of guns outweigh the benefits.
And we know that gun violence
affects and marginalizes poor communities of color.
At this point, we've got to really ask ourselves,
"Is it really the fear of victimization that's causing you to own guns,
or is it just that you want to be a Viking?"
The question is also,
"Given that we know all these, are there solutions?"
Yes, there is a solution.
Until now, NRA and the gun manufacturers
have made a lot of money
killing people and decimating different populations,
but they have never taken ownership of gun debts and gun violence.
It's time to change that.
We need policies.
I'm not talking about the 99 different restrictive gun policies
but policies which will change the communities that guns have decimated:
provide them with lifetime health care, financial assistance
regardless of this victim status
or regardless of whether they are perpetrating a crime
because a bullet through a human body is the same,
regardless of whether you are a victim or a criminal.
Mental health services, one of the main results of gun violence -
and we've realized
that the opioid epidemic is really fueled
because of a mental health crisis that we have.
And of course, self-servingly,
we need research funding dollars
to study gun violence survivorship as a disease,
not as a political problem.
We have to come together as a medical community
and actually allocate dollars
so that we can study this
and make sure our communities, which are suffering, will heal.
Thank you.
(Applause)