Hello and welcome. I am Dr George Lundberg and this is At Large at Medscape.

Changing an ingrained culture is one of the most difficult tasks a human can take on. But it can be done. Witness tobacco cigarette smoking by US physicians: once commonplace, now very rare. Witness driving after drinking in the US: once usual, now neither cool nor tolerated.

Today, the culture of almost unfettered gun ownership and use is a thoroughly entrenched behavior in some American locales. Once again, however, such a culture is under intense scrutiny as not a public good.

Growing up in the rural South, I too was once part of the gun culture. I owned my first BB gun at about age 10 and my first rifle, a .22-caliber single-shot Winchester, at age 12. It was a kind of rite of passage.

Leadership in the current challenge to gun rights comes from two new and surprising sources:

  • First: children of high school age, social media devotees, who like living and don't want to be shot and killed like their classmates in Florida were. Nor do they wish to go to school in a police state of armed teachers.

  • Second: a large company (Dick's Sporting Goods) that has decided that it no longer will derive revenue by providing assault-style weapons to potential mass killers, whose identities, intentions, and motivations cannot be accurately discerned in advance.

These are small steps but attention-grabbers of the sort that can aid in challenging a culture that has a footprint of preventable fatalities, similar to the tobacco and alcohol industries.

All cultures consist of people, all of whom have minds that can change. Growing up in the rural South, I too was once part of the gun culture. I owned my first BB gun at about age 10 and my first rifle, a .22-caliber single-shot Winchester, at age 12. It was a kind of rite of passage. My father owned a .32-caliber revolver. The only time I ever saw him shoot it was into the air in celebration on VJ Day.

I served as a Regular Army officer for 11 years during the Vietnam War, visiting the rifle range annually for target practice, without ear protection. I have a service-connected disability of high-frequency hearing loss.

Teenagers...noted in interviews that you never know what is really going on in some people's heads. This is a more profound insight than that of the entire American Psychiatric Association.

I suppose my attitude toward guns began to shift in 1975, when I did a short sabbatical at the Office of the Chief Medical Examiner in New York City for the express purpose, as a pathologist, of learning more about the forensic aspects of gunshot wounds. I personally studied 101 gunshot wound fatalities in 1 month. I learned a lot. Later, during similar, 3-month forensic stints in Lund, Sweden, and London, England, I saw four total gunshot wound deaths in 6 months. I learned a lot.

JAMA published an entire issue on violence as a public health issue in 1991. We repeated this every year until I left in 1999. Again, I learned a lot—enough to know that the US approach to handling firearms is itself an atrocity.

Quick-takes from science, knowledge, and experience:

  • The answer is not more guns; it is vastly fewer guns of all types. The idea of arming all American schoolteachers has to go into the Guinness World Records as Dumbest. Idea. Ever.

  • While I support background checks prior to approval of gun purchases as a rational notion that could avert some gunshot wounding and killing by homicide, suicide, and accidental means, a panacea it is not.

  • The sensitivity and specificity of psychological or psychiatric prediction of who will or will not become violent is far from perfect.

Teenagers in Georgia, commenting on the popular, successful high school teacher who suddenly brought a gun to school,[1] locked himself inside the classroom, and fired one shot, noted in interviews that you never know what is really going on in some people's heads. This is a more profound insight than that of the entire American Psychiatric Association. The neuroscience on violence prediction is just not there yet.

There is absolutely no reason for an American civilian to own functional military-style weaponry and ammunition in 2018. I tried to make that clear with reviews of history, language, law, and satire in my column of November 2017.[2]

Perhaps more direct language could be more effective. Hear me, now.

That's my opinion. I am Dr George Lundberg, at large at Medscape.

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