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)