17 Dec, 12 | by BMJ Group
A few days ago a disturbed young man in Newtown, Connecticut, shot his mother before going to the primary school where she worked to murder 20 children, aged between six and seven years old, and six staff. The immediate response was disbelief and shock at yet another mass shooting in America. But this was followed, almost at once, by the question of why the shooting happened and how it is that the United States seems incapable of preventing such events from happening with depressing regularity.
Yet not everyone agreed that these questions should be asked at all. Three days after the shooting there was still no mention of the shooting on the website of the National Rifle Association (NRA).  Its Twitter feed was equally silent. However, its sympathisers were willing to speak. As if reading from a script, their message was that this was a time to mourn the dead. It was not a time to discuss the reasons for the shooting or what might be done to prevent such atrocities happening again. This should wait until all the facts were known, presumably at some time far in the indeterminate future when news of the shooting had been displaced by other events. Amazingly, this view was also voiced by the President’s spokesman, until sense prevailed.
Among those willing to discuss the issue, views were polarised. Some argued that the problem was not access to guns. Instead it was mental health, or even the presence of “evil” in the world.  Indeed, for them, guns may even be the solution. They suggested that many of the children could have been saved if their teachers had themselves been armed. In their view, weapons will always be available and the only solution is for each individual to arm him or herself as a means of protection. The Gun Owners of America, a prominent lobby group, suggested that legislators who blocked the arming of teachers had “blood on their hands.” 
Others took a very different view. What possible reason, they asked, is there for allowing people easy access to assault rifles and other weapons that would, in most other countries, be restricted to the armed forces? They noted how mass shootings, such as that in Newtown, or earlier ones at Virginia Tech University or Columbine, are just the tip of the iceberg, with firearms claiming the lives of about 12,000 Americans every year from homicide and another 18,000 from suicide.  They pointed out how Americans are dying from firearms related homicide at twenty times the rate of other industrialised countries.  They noted research showing a close correlation between the availability of firearms in different states and gun deaths among children in those states that cannot be explained by education, poverty, and the like.  They countered the argument that banning guns would be ineffective by pointing to the example of Australia, where there have been no mass shootings since a ban introduced in the wake of a massacre in Tasmania.  But they also despaired at the seeming inability of their political leaders to do anything to control access to guns. Worse, in 2004, former President George W Bush allowed a ban on sales of assault weapons, such as that used in Newtown, to lapse. Those favouring gun control, a view that would have overwhelming support in most of the rest of the world, could see that they were losing ground, with polling evidence that they were now fewer than half of the population. 
The challenge, for gun control advocates, is that the opposition has long abandoned rational argument. Supporters of access to guns argue that it in some way makes them safer. Yet the probability of dying in a firearms-related incident, especially from suicide or accidental shooting, is far higher among those who have weapons in their own homes.  The perpetrator of the Connecticut shootings first killed his mother with her own weapons before using them on those at the school. Advocates of laws to make it easier to carry concealed weapons, now attracting growing support among state legislators, argue that this would ensure that someone would be able to stop the perpetrator of a shooting spree. Yet the presence of such a law in Colorado did nothing to stop the shooting at the screening of a Batman movie in the town of Aurora earlier in 2012 and students, seen as at particular risk of mass shootings, are overwhelmingly opposed to concealed weapons being carried on campus. 
Deaths on this scale are a public health issue and there are lessons from other situations where people were dying unnecessarily because of strongly held views devoid of evidence. One is the struggle against smoking. The first step is to mount a sustained campaign not against gun owners, but against the vested interests that promote ownership. The counter-advertising campaign by the American Legacy Foundation shows how.  It has helped to ensure that the tobacco industry today has no credibility yet, remarkably, the NRA still has, so far at least. However, this may be changing. Support is mounting rapidly for a campaign against the NRA organised by the advocacy group CREDO, with commentators on CREDO’s Facebook page saying that they hold the NRA accountable for the continuing toll of needless deaths.  Perhaps more importantly, a small, but increasing, number of politicians are willing to speak out against the NRA, with Michael Bloomberg, the Mayor of New York, suggesting that the results of this year’s presidential election reveals that the NRA’s power is “vastly overrated.”  The second is to understand why people think that their gun makes them safer when it clearly does not. This will require insights from cognitive psychology to develop messages that make sense to them. Giving people information that contradicts their prior beliefs often, paradoxically, reinforces that belief.  However, as the advertising industry is well aware, it is possible to change perceptions if messages are carefully crafted. The third is for ordinary Americans to realise that Newtown has held a mirror up to their society and for them to decide whether this is what they really want. President Obama, in his speech at the memorial to the dead, has asked as much, but has also answered clearly. That answer is “no.”
The NRA, the Gun Owners of America, and their political allies may not want us to discuss the reasons why Charlotte, Daniel, Olivia, Josephine, Ana, Dylan, Madeline, Catherine, Chase, Jesse, James, Grace, Emilie, Jack, Noah, Caroline, Jessica, Benjamin, Avielle, and Allison died. That is their problem. We do.
Martin McKee is professor of european public health at the London School of Hygiene and Tropical Medicine.
Acknowledgement. I am grateful to Charlotte McKee for drawing attention to news coverage of some of the more bizarre statements by pro-gun advocates.
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