JAMA article on caliber lethality

[dyl]

Hey all,

I came across this recent article by the Journal of the American Medical Association and it supposedly finds that shootings involving what it considers medium (380 ACP, 38 special, 9mm) and large calibers (357 mag, 40, 44 mag, 45, and includes 7.62 x 39 -that's odd) have a higher odds ratio of being lethal. (supposedly 2.2 and 4.5 times more likely to die) It's a recent article just put out last month.

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2688536

I haven't read the entire thing in detail, and even my paraphrase may be inaccurate. Reading research articles has always been laborious for me so I just don't feel like it right now. Anyone care to have a go?

From my brief skimming, it seems like the conclusion is to propose the idea that limiting access to larger calibers would reduce fatalities from shootings.

My thoughts so far that I have (which may be answered on a detail read-through) are:
- I saw "Fackler" as a reference. From reading other sources, I had the impression that it was a good idea to take his findings with a grain of salt. Was he involved in the attempt to establish "one shot stop" statistics years ago?
- I wonder if the methodology accounted for the number of shots fired versus hits (which may be affected by caliber), the range of the encounter, and how it affects lethality. I noticed a mention of "accuracy" but I doubt every incident used in data would have been painstakingly broken down
- These were all cases that the Boston PD found to have "victims" that were shot as a result of criminal behavior. Could there be some fishiness in the selection of cases that the reader doesn't have access to? I know in some circumstances, it's hard to really say who the victim is...
- I noticed some non-lethal shootings were mixed in...."stratified". Was this a control group of some type? Were the non-lethal cases documented in terms of their caliber too? I would think that data would be very important for context. For example if all criminals in the country switched to 357 sig, you would think that 357 sig was all the sudden very lethal just because there is a large number and proportion of cases involved. But if you took into account the number of lethal and non-lethal 357 sig encounters and compared it to the mortality rate of cases of all the other calibers, then you'd have a better picture if all else were equal (which it never is really)
-

Whether the victim of a serious assault lives or dies is to a large extent a matter of chance, rather than a question of the assailant’s intent. The probability of death is connected to the intrinsic power and lethality of the weapon. T

- Anyone care to poke a hole in the article on a technical level, critiquing the methods? I don't quite think my statistics is up to the challenge and could use some backup. If reading research articles is relatively easy for any of you, please do so and share with your peer-reviewed friends So far my arguments are based on principle and suspicions, not using the data in the article. Anyone care to dive down this rabbit hole?

Please keep comments civil, and please don't bash the medical or scientific community even when they are sorely mistaken.

 

[Aguila Blanca]

I thought we had already discussed this, but perhaps it was on a different forum.

As is typical of people who don't understand firearms, they confuse/conflate "caliber" with "power." Let's face it, a .22 Short is the same caliber as a .223/5.56x45 round, but they aren't exactly the same power or of equivalent "lethality" (whatever that means).

 

[dyl]

I agree. And the principles I have which disagree with the article come from previous discussion here and other places.

I'm wondering if anyone on the board enjoys research articles enough to refute findings using the article's own data, or with specifics on the methodology.

If this article has already been discussed on TFL, apologies! I've been away a little while. But the article seems fresh, released a little over a week ago...

 

[JohnKSa]

There's no attempt to differentiate between bullet type, so all ammunition (expanding and non-expanding) is grouped together--I don't think that aspect was even considered, or maybe the data just wasn't available.

Although their data shows about 2 more shots (1.7 on average) fired in fatal shootings than non-fatal shootings, they still conclude that the major deciding factor of lethality is caliber, not the higher number of average shots fired.

No attempt (in the data) to account for the fact that the guns in their "small" category typically have much lower capacity than the main contributor (9mm) in the "medium" caliber and therefore fewer shots are likely to be fired in shootings involving those calibers than in shootings involving the "medium" calibers. They also don't provide the number of shots fired per category to allow the reader to do their own analysis. They do mention capacity in passing(more rounds fired rapidly) as being a factor but that isn't reflected in the tables. In other words, they're grouping in capacity as being equivalent to "more powerful" but without explicitly noting that fact in the data.

No rationale for including one rifle shooting into a study that was, except for that one shooting, exclusively about handgun calibers.

The data for the "small" and "large" categories (especially some of the calibers in the "large" category) is pretty sparse. Of the 6 calibers grouped into the "large" category, 4 of them account for only 24 shootings combined and 3 of those calibers actually account for only 6 shootings combined--fatal and nonfatal. However that sparse data for those additional 4 calibers definitely has an effect on the conclusion.

When the major contributor (9mm) to the "medium" caliber group is compared to the two major contributors (.40 & .45) for the "large" caliber group, the difference in the percentage of fatalities is only about 4%--57% for "medium" vs 61% for "large".

On the other hand, when the data is grouped the way they choose to do it, including the sparse caliber data in the "large" group and including .380 and .38 into the "medium" group then the difference in the percentage is about 18%--47% for "medium" and 65% for "large".

Because of the sparse data, there are some anomalies. For example, .32 caliber had a higher fatality rate in shootings than either .380 or .38.

This is not really an in-depth critique. That would take a lot more time than I'm willing to spend on the article.

 

[mete]

Always remember !! There has been for a very long time a group of doctors who are anti-gun and use their position to further their anti-gun position.
Always be suspicious of and any article by doctors. They did very well this time to get an article in JAMA !! Read them carefully and note errors , there are always many.

 

[Brit]

The minute you start looking at paperwork information, stacked in favour of lethality, of this round, or that round? My head starts to ache.

There are a million permutations in the mix! So what do we do, the average legal carrier of a pistol? In my case, I carry a calibre that works, if you do your job, placing as many rounds, into an area in the human body of an assailant, as you can, given the circumstances of your confrontation. In my case, 9mm Glock 19 4th gen. Sixteen rounds ready to go.

All here know an ideal placement of a 147g Ranger T, (my round of choice) into an eye socket at 7 yards? For instance, tends to end a confrontation?
But getting realistic, most civilian (non Police) shootings, seem to leave the shot individuals, injured but alive? Spray and pray was coined for the new hi-capacity 9 mm pistols, but the same description could fit a 6 shot 38 Special carrier? Just stick it out ignore sights, yank on the trigger.

Some home invasion confrontations where the homeowner "Retrieves his or her pistol" and fires this handgun? Are no hits registered? Or at least no incapacitating hits take place.

As most adults, when asked have you ever been in a fight, as an adult? Over 18 YOA? Will answer no! So elevate that question to "Gunfight?" it is amazing that any hits are registered at all? To add distance, movement, or poor light into the equation? Whoa!

My advice, pick the calibre you can handle, carry it every day. Decide early! To bring this firearm into play? Do not develop diarrhoea of the mouth in dealing with law enforcement after an incident where you discharged a firearm! Good luck.

 

[44 AMP]

The probability of death is connected to the intrinsic power and lethality of the weapon.

And, the sky is blue, and fire burns. This is not news, and not something we need a panel of doctors, or anyone, to conduct a study in order to tell us.

please don't bash the medical or scientific community even when they are sorely mistaken.

If we can't bash them when they are wrong, when their data is not even remotely all inclusive, and their conclusions are flawed, when CAN we bash them????

Also remember that "a connection" can be made between anything on Earth, depending on where you set your parameters.

So, another study that finds a link between things we already know have a relationship. Conclusions about how important that relationship is, which are OPINION, presented as fact.

Look at it another way, say a study looks at edged weapons, and concludes that the connection between the intrinsic power and lethality of a broadsword cutting your head off and causing death is greater than a dagger stabbing you in the chest.

or that the lethality of a car crash or an airplane crash is dependent on how fast you were going at the time of impact....

Or that how likely a gunshot wound is to be lethal might depend on other factors than the power and "lethality (I do hate that term) of the weapon? Like how much blood is lost, or perhaps the amount of time before medical attention arrives? Or maybe the quality of that medical attention?? Or any of several other factors, like actual bullet placement, for just one??


I think the time and effort of the medical profession is better spent treating people than playing Captain Obvious with studies, and making flawed conclusions in the process.

 

[Sharkbite]

Lethality is IRRELEVANT to self-defense

 

[Aguila Blanca]

If we can't bash them when they are wrong, when their data is not even remotely all inclusive, and their conclusions are flawed, when CAN we bash them????

Also remember that "a connection" can be made between anything on Earth, depending on where you set your parameters.

Too true.

When data (information) are/is misrepresented, all sorts of erroneous conclusions can be made. For example:

Everyone who breathes air dies. Are we then to conclude that breathing air is hazardous to our health? The same can be said about everyone who drinks water, or who rides in a car, bus, train, or airplane.

In fact, everyone who is born dies. Ergo, the ultimate cause of death is birth.

Once you start down that road ... where do you stop?

 

[T. O'Heir]

The American Medical Association is well known for being rabidly anti-firearm ownership. You need to take anything they say with a great big grain on salt.
Their "probability of death is connected" stuff is just the typical nonsense promulgated by 'em. They'll tell you alcohol is bad for you and that red wine is good for your heart in the same breath.

 

[CDW4ME]

Lethal doesn't automatically equal quickly incapacitating.
If I have to defend myself, I desire to use bullet(s) as quickly incapacitating as possible.
Given equal shot placement, bigger / more powerful bullets have greater potential to achieve that goal.
Less than 9mm doesn't get carried by me; I prefer more potential.

 

[Double Naught Spy]

The probability of death is connected to the intrinsic power and lethality of the weapon.

The irony of this statement from a JAMA article is just bewildering as the probability of death also has been shown to be tied to access to appropriate medical care in all sorts of injuries including GSWs. People today regularly survive GSWs that 50 years ago would have been lethal and the correlation isn't that we are using less lethal firearms.

 

[Aguila Blanca]

The irony of this statement from a JAMA article is just bewildering as the probability of death also has been shown to be tied to access to appropriate medical care in all sorts of injuries including GSWs. People today regularly survive GSWs that 50 years ago would have been lethal and the correlation isn't that we are using less lethal firearms.

Probability of death is also far more related to shot placement than "lethality" or "caliber" (as they used the term "caliber"). I'm more likely to die if shot in the heart with a .32 than if shot in the arm with a .50 BMG.

 

[dyl]

JohnKSa: Thanks for the analysis, that must have felt like work. I really appreciate it. Although you may not think it was an in-depth critique, it engaged the argument on its own turf. I'm still rather new to research articles and tend to take everything at face value because I don't know enough yet to articulate quite why something is wrong in quantitative terms. I'm unsure how much better I will become but I feel like I can rest a bit easier now about this article. I hope to be able to analyze like this some day.

Mete: Yes, I would say there are a group of all academics who are anti-gun and without getting political, when pursuing a degree or license one would hopefully be fortunate enough to have a mentor or teacher whose views might influence your own. Unfortunately, I feel academia has a bit of an echo chamber and a lack of individuals teaching personal responsibility. Or maybe a version of personal responsibility that disagrees with most of us here. So we will do what we can instead. In general though, I would say most primary care doctors have a patient's best interest at heart.

Brit: Yes, agreed. So many permutations - I know it's impossible but I wouldn't really feel satisfied with that data unless I reviewed each shooting 1 by 1 to see if it's really appropriate for caliber comparison.

44Amp: I wonder, perhaps this new-ish trend of attempting to do medical research on the subject of firearms is encouraged by (not just politics of course) relatively recent things considered successes like seat belts and smoking. Of course the research is on the side that allows a conclusion to decrease or limit firearms, but I'd love to see research (whether by a medical professional or anyone) from the other perspective. What are the odds of surviving an attempted murder or home invasion with and without a firearm present? Length of ownership? on/off body carry? level of training? - so far, there is no funding for this type of research as far as I know. It may be necessary in the future though, if preserving liberties doesn't seem like solid enough ground in and of itself. Thanks for holding back on medical community bashing. I have people close to me in the medical profession who gives way more than they get back, even monetarily. They sacrifice time with family, attention, are always on call (no coverage), do things after office hours for people, worry about patients, and it wears them out but hopefully some people live long enough to find their joy in life.

Just like we've heard before (typically from the "other side" of the argument) I think there is a need to engage things like this at least to a certain extent. I find for myself it's easier to dismiss this kind of research because it's hard for me to understand. But if this is what is floating around in places that influence policy, the data representing the counter-argument is severely under-represented. I wonder if the NRA can bank-roll some credible astute firearm-friendly researchers...

Oh yes, I do know that the "conclusion" of most research articles are when the opinions come in a bit more obvious manner. The part I thought was funny here was along the lines of "if only we could replace those firearms with clubs or other weapons, the decrease in lethality would be even greater". Because the data was based on shootings ruled *criminal* to begin with, and they'd absolutely turn in their guns for clubs! Or I guess if they had a Hi-point they could keep it (just kidding!)

 

[2damnold4this]

I think it's common sense that more powerful cartridges have more potential to do damage than lower powered cartridges. We don't arm our police or military with .22lr handguns. I'm not sure the article's attempt to show that caliber is more important than the assailant's intent really works.

The article does a poor job of categorizing cartridges into caliber. It places .357 magnum and 7.62x39 into "large caliber" instead of placing .357 along with the rest of the medium calibers and 7.62x39 into the small caliber category. The article makes no attempt to explain why this was done but it certainly doesn't seem to be measuring caliber. Some of the cartridges were used in only one, two or three shootings. These rarely used calibers were all in the "large caliber" category. Shootings with shotguns were ignored.

The article makes no attempt to control for ammunition types or the platform used.

If we look at table 2, one of the more important correlations with mortality seems to be shot placement. Another seems to be the number of times a victim is shot. These factors seem to be at least as important as the particular cartridge choice.

The article attempted to control for shot placement by placing gunshot injuries in one of three categories:
1) Head and neck,
2) Chest, back and abdomen,
3) Arms, shoulders and legs.
I'm not sure that is detailed enough to eliminate shot placement as a confounding factor. I'm not sure that categorizing shots as either one shot or multiple shots is specific enough either. In any case, I think the number of shots fired, cartridge selection and probably shot placement could be indicators of intent.

 

[Aguila Blanca]

In general though, I would say most primary care doctors have a patient's best interest at heart.

Subject to the proviso that many doctors (not all, but far too many) have a bit of a god complex. They think that THEY know what's good for you better than you do, so they have no problem decreeing how you should live your life. Most of the ones who are anti-gun don't know anything at all about guns. They read publications like the Journal of the American Medical Association, and look where that gets us. Mindless propaganda, poorly researched and even more poorly presented. But JAMA purports to be a peer-reviewed publication, so doctors who know nothing about guns will read that and accept it at face value. And come away thinking they know more than they knew before when, in fact, they actually know less because what they just "learned" is almost 100 percent misinformation.

44Amp: I wonder, perhaps this new-ish trend of attempting to do medical research on the subject of firearms is encouraged by (not just politics of course) relatively recent things considered successes like seat belts and smoking.

I'm in my mid-70s. I can recall going to assemblies (that's what they called them back then) when I was in grammar school or maybe junior high in the 1950s showing truly disgusting films of operations to remove cancer-destroyed lungs. My brother and I started installing seat belts in our family's cars in the 1950s, long before they came standard from the factory, and they were installed in airplanes long before that. There's nothing "recent" about the knowledge that smoking is bad for your health and that seatbelts increase your odds of surviving most collisions. That aside, I fail to see how using the CDC (or any other medical-related organization or agency) to conduct research on firearms is at all analagous to seatbelts. Lung cancer is a medical issue. Your own body hosts and grows the cancer. Your body doesn't ram an engine block through your lelvis, and your body doesn't put bullet holes in you if you're unfortunate enough to get shot.

The AMA wants to treat gunshot injuries as an epidemiological issue. They are not. Lung cancer is a disease. A gunshot wound is not a disease, it's an "injury." There's a difference.

 

[44 AMP]

Point #1)
The number of shots fired is not relevant. The number of HITS could be.

Back in the dark ages, when factory pistol ammo came in only two flavors, FMJ for auto pistol rounds and Lead bullets for revolvers, the 9mm Luger was considered a very lethal round. It was not thought of as good fight STOPPER, in fact the lead bullet of the .38 special was considered superior for stopping power. But the 9mm was a better "killer". And the numbers did bear this out. More people shot with 9mms died than people shot with larger calibers.

The reason for this was NOT because the 9mm was more lethal, it was because it wasn't a good stopper. If direct tissue destruction by the bullet wasn't lethal, the 9mm still killed more people than bigger rounds and more powerful rounds.

if this sounds like a paradox, it was, until someone figured out the why. And the why was, that people shot with the 9mm were shot more times, before they stopped than ones shot with bigger rounds.

Simply put, the guy who was stopped by one, two, or maybe three hits from a .357, 44, or .45, if not killed outright, had a better chance of pulling through than the guy shot 5 or 7 or more times with a 9mm.

More holes in the body (even if not in vital areas) the greater the "insult" to the body, and the more likely blood loss, shock, and infection were to kill them.

In the days before modern germ theory and antibiotics, if you were shot with ANYTHING, in a non fatal spot, you had a 50/50 chance, either you lived, or you didn't.

The old .41 RF had a reputation for being nearly 100% lethal. In about two weeks, or a bit less. The bullet was outside lubed, so it picked up all kinds of dirt, and was powerful enough to shoot about halfway through a man. Getting shot killed you, but it wasn't the bullet that did it, the bullet was just the delivery mechanism.

Today that is a much, much smaller concern (death from infection) though it still exists and still does happen.

Suspect anyone who uses "lethality" as a description of firearms or ammunition, because they literally, don't know what they are talking about.

One cannot make anything more dead than dead. Period. A rock to the temple kills you just as dead as a 155mm howitzer that blows you into little bits. Dead is dead. The condition of the corpse isn't relevant. (unless you're a trophy or market hunter )

 

[Double Naught Spy]

Probability of death is also far more related to shot placement than "lethality" or "caliber" (as they used the term "caliber"). I'm more likely to die if shot in the heart with a .32 than if shot in the arm with a .50 BMG.

No sir, it is a package deal. While some shots may be immediately and irrevocably lethal regardless of caliber, the rest will often depend on medical treatment received - speed of treatment and type of treatment. That JAMA overlooked this tidbit is very ironic.

 

[44 AMP]

the rest will often depend on medical treatment received - speed of treatment and type of treatment. That JAMA overlooked this tidbit is very ironic.

Irony? or deliberate obfuscation? "Doctors" writing about how likely caliber A is to kill, vs caliber B,C, etc., and NOT mentioning medical treatment/lack of.. as a factor??

Any table or other compilation of facts about how many of the deaths they studied were DRT, DOA, or died after receiving of medical treatment???

Do you think that might make a difference in their study base? Do you think the absence of even mentioning medical treatment might be deliberate??

Is there any differentiation made about the actual causes of death?? OR just "death due to gunshot wound" broken down into major or minor calibers??

t seems like the conclusion is to propose the idea that limiting access to larger calibers would reduce fatalities from shootings.

PERHAPS this is a "study" where the conclusion was arrived at, first, and the study constructed afterwards to support that conclusion? It does happen, you know...

- These were all cases that the Boston PD found to have "victims" that were shot as a result of criminal behavior.

well,,,duh!

once again, the obvious. other than the small number of truly accidental self inflicted gunshots, what case of a person shooting another person is NOT a result of criminal behavior???? Seriously!

People get shot either as a deliberate criminal act, or get shot as a result of a criminal act (and this covers all defensive shootings as well as police shootings).

There is no other option. Even shootings classified as accidental involve a level of negligence that is often a crime.

The study doesn't have a solid foundation. It doesn't even have one as full of holes as swiss cheese. It more like a fishnet...

But here's the bigger thing to worry about, if highly educated, respected doctors make so many mistakes on this subject, how many mistakes are they making in their medical practice??? ITs like lying under oath, it speaks to credibility, over all.

The old saying "a cobbler should stick to his last" is not entirely without merit.

 

[Brit]

A fact, an injury suffered in a battle zone, in these time of incredible advancement in medical treatment, arriving alive at a trauma facility, you have every chance of surviving. At least way more chance than say 50 years ago.

My advice to my teenaged Son, 40 years ago, nothing good is liable to happen,
to you being out after midnight? Is just as true today, as then.

Of late, being out after 10 pm is a stretch for this Grandad!