With his crisp blue suit and wire-framed spectacles, Garen Wintemute hardly looked frightening as he stepped to the podium on a spring day in 2013 to address a conference on pediatric emergency medicine in San Francisco. But his presence there made the organizers nervous.
Wintemute, an emergency department doctor and longtime director of the Violence Prevention Research Program at the University of California, Davis, today also heads the newly inaugurated University of California Firearm Violence Research Center, launched in July 2017 with a $5-million, five-year commitment of state funding. He is a natural for the role: he has published dozens of papers on the effects of guns in the U.S., where widespread gun ownership and loose laws make it easy for criminals and potentially violent people to obtain firearms. Wintemute has pushed the bounds of research, going undercover into gun shows with a hidden camera to document how people often sidestep the law when purchasing weapons. He has also worked with California lawmakers on crafting gun policy and helped to drive a group of gun-making companies out of business.
All this made Wintemute a potentially risky speaker for the organization hosting the 2013 conference, a branch of the U.S. Department of Health and Human Services, which is barred by law from providing funds to any activities that advocate or promote gun control. The meeting organizers had told Wintemute to stick to facts and avoid any mention of policies. But with the nation still reeling from the murder of 20 children and six educators at the Sandy Hook Elementary School in Newtown, Conn., in December 2012, the conference organizers were not sure what Wintemute would say.
He stuck to the facts but also managed to make clear how he feels about the funding prohibition, which had effectively killed off most research on gun violence. “We don't have a labor force,” Wintemute told the assembled doctors.
That has led to a striking imbalance in U.S. medical research. Firearms accounted for more than 31,000 deaths in America in 2011. But as Wintemute stepped to the podium in 2013, fewer than 20 academics in the country were studying gun violence, most of them economists, criminologists or sociologists. Wintemute is one of just a few public health experts devoted to this research, which he has funded through a mixture of grants and nearly $2 million of his own money.
His undercover gun-show tactics have led him into situations where he feared for his safety, and they have also raised protests from some gun-rights advocates, who charge that Wintemute is more a biased campaigner than a researcher.
But even a few of his ideological opponents praise Wintemute's work. “Garen is one of the very best in terms of his research skills,” says David Kopel, research director at the Independence Institute in Denver, a think tank that supports gun-owners' rights.
And Wintemute, who is 65, makes no apologies for his passion or his methods. “I believe just as strongly as I can articulate in the value of free inquiry,” he says, “especially when the stakes are so high—when so many people are dying through no fault of their own; when so much of the country simply turns its back on this problem.”
Aiming true
Wintemute grew up in a home in Long Beach, Calif., where his father, a decorated veteran of the Second World War, kept a Japanese officer's saber and infantry rifle, a Winchester carbine and a Marlin .22 caliber rifle in a bedroom cupboard. Wintemute learned to shoot and begged to go hunting. That chance came when he was around 12, and his father asked him to help clear out sparrows from the rafters of his company's warehouse.
Wintemute's aim was good, he recalls. “But I held those birds and looked at the finality of it all and felt them turn cold in my hands and decided this was not for me.”
As an undergraduate at Yale University, Wintemute flirted with oceanography and neuroscience but eventually decided that he wanted to be a physician. After completing medical school and a residency in family practice, both at U.C. Davis, Wintemute went to work in 1981 as medical coordinator at the Nong Samet Refugee Camp, just inside Cambodia's border with Thailand. The camp was in an area that had only recently been liberated from Khmer Rouge dictator Pol Pot, and Wintemute took care of gunshot wounds on a daily basis. Even more common were shrapnel injuries from land mines. There was no electricity, and amputations were done under local anesthetic.
“I never once met an intact family,” Wintemute recalls. “Everybody had lost somebody. There came a point where I said: ‘I need to pick up a rifle. I can't be on the sidelines.'”
But instead of grabbing a gun, Wintemute decided to pursue “big picture” international health. He left Cambodia and enrolled in a one-year master's program in public health at Johns Hopkins University. One of his first courses was taught by a former trial lawyer named Stephen Teret, who is now co-director of the Center for Law and the Public's Health at Johns Hopkins.
Teret remembers the day in September 1982 when the students of that class introduced themselves, and Wintemute stunned him with his charisma and eloquence. “I said to myself: ‘I'm going to get to know this guy,’” Teret recalls, and the two of them soon became friends and collaborators.
On a cold winter day several months later, some close friends of Teret's dropped their 21-month-old son off at the house of his caregiver. Around noon, the caregiver laid him down for a nap and left the room, whereupon her four-year-old son took his father's loaded handgun from a nearby drawer, pointed it at the sleeping infant and shot him through the head.
Within weeks Teret switched his main research focus from motor vehicle injuries to gun injuries, an area in which public health research was all but nonexistent. Wintemute began assisting him, and their first project was a law review article laying out a legal strategy for suing gunmakers who fail to use available safety technologies to prevent accidental gun deaths.
Wintemute returned to U.C. Davis, with the goal of focusing on gun injuries.
In Cambodia and then in the Sacramento emergency department, Wintemute learned the hard lesson that, as a doctor, he had little chance of saving many people with gunshot wounds; most of those who died did so before they even reached the hospital. He realized that if he wanted to reduce deaths from firearms, he needed to prevent shootings in the first place.
One day he set himself a question as he left for a run in the foothills east of Sacramento. Looking to make an impact, he wondered, “What subset of firearm injuries can people simply not turn away from?” By the time he got back, he had decided to focus on the kind of shooting that had shattered the lives of Teret's friends.
In June 1987 Wintemute published a paper called “When Children Shoot Children: 88 Unintended Deaths in California.” He reported that in 36 percent of these cases, the shooters didn't think that the gun was loaded or was real, or they were too young to tell the difference. Forty percent of the children's fatal injuries were self-inflicted, including separate incidents in which a five-year-old boy and a two-year-old boy, using. 38-caliber revolvers—one found under a pillow, the other in his parents' bedroom—each shot himself in the head.
To illustrate one facet of the problem, Wintemute borrowed several of the guns used in the shootings from the Sacramento medical examiner. He then bought toy lookalikes, mounted the paired guns on a piece of plywood and, when the paper was published, called a press conference. Few of the reporters who attended could tell the toy guns from the real ones. His work and other events that year focused scrutiny on toy guns, and in December toy retailers began to pull realistic-looking toy guns from their shelves. The next year California banned their sale and manufacture.
Wintemute was increasingly convinced that gun manufacturing was a pressure point that could be turned to advantage, by tying the industry to the public health consequences of its products. He was contemplating how to do that when the Wall Street Journal published an article about a group of companies in and around Los Angeles, owned by one extended family that made small-caliber, inexpensive handguns known as “Saturday night specials.” Poorly made and lacking some safety features, the guns were disproportionately used in crime, particularly by juveniles.
The article contained a trove of details about the family that ran the companies, and Wintemute decided to follow that trail. The result was Ring of Fire, a book published in 1994 that described the enterprise and impact of the six companies, which in 1992 produced 34 percent of the handguns made in the country.
Ring of Fire painted such a stark portrait of the problematic guns that “it became the focus of the rallying cry for local legislative action,” says Sayre Weaver, a lawyer who represented West Hollywood, the first of several Los Angeles communities to ban the sale of the Saturday night specials. In 1999 the California legislature followed by making it illegal to manufacture and sell the handguns. Within several years, five of the six companies were out of business.
Battle to survive
Although his book had a big impact, Wintemute's research soon hit a snag. With grant support from the U.S. Centers for Disease Control and Prevention, Wintemute had been conducting a retrospective cohort study looking at whether handgun buyers with prior misdemeanor convictions are more likely than those without a criminal history to be charged with new crimes, particularly those involving firearms and violence. (Many states allow purchases by criminals who have been convicted of misdemeanors, such as assault.)
But as he was digging into the study, his source of funding came under attack from the National Rifle Association (NRA), a powerful lobbying group based in Fairfax, Va., that supports gun ownership. NRA leaders were upset with the CDC for funding work by another researcher who had found that people with a gun in their home were 2.7 times more likely than those without one to be murdered and 4.8 times more likely to commit suicide.
In 1996 the NRA persuaded the late Representative Jay Dickey of Arkansas to insert language into a budget bill to prohibit the CDC from advocating or promoting gun control. (That ban has been renewed every year since then.) Dickey's amendment also stripped $2.6 million from the agency's 1997 funding—the exact amount that the CDC had spent on firearm research the previous year.
Also in 1996 Wintemute had received $292,000 from the CDC for the misdemeanor study, but after the change, the agency provided just $50,000 to close down the program.
The research restrictions were extended in 2012 to encompass all of the CDC's parent agency, the Department of Health and Human Services. And they have had a measurable effect. According to an analysis of Elsevier's Scopus database by the group Mayors Against Illegal Guns, the proportion of all publications dealing with U.S. firearms and their impacts declined by 60 percent between 1996 and 2010. On the heels of the Sandy Hook murders, President Barack Obama in 2013 ordered the CDC and other health research agencies to resume firearms violence research, on the grounds that the Dickey amendment prohibits advocacy for gun control but not research on gun violence. In each of the years 2014 through 2017, Obama asked for $10 million for CDC firearms research. Congress did not enact the requests, and the CDC launched no gun-specific research.
In 2013, however, the National Institutes of Health opened a multimillion-dollar grant program supporting researchers to probe the health consequences of violence and how to prevent it. The agency wasn't coy: the program's title included the words “Particularly Firearm Violence.” The program lapsed in January 2017, and agency officials have not renewed it, although renewal is “still under consideration,” said Renate Myles, an agency spokesperson. She added that “the agency continues to accept research applications about violence, including firearms violence,” through general funding mechanisms.
U.S. researchers still produce more papers per capita on the topic than investigators from other countries do. But the subject may not be as high on other countries' research agendas, because gun ownership is so much lower in most developed nations. The U.K., for example, banned private possession of handguns in 1998 after a gunman shot and killed 16 children and their teacher in a school in Dunblane, Scotland.
Wintemute was rare in staying devoted to gun research after the restrictions were imposed. He turned to the California Wellness Foundation, a large private charity based in Los Angeles that focuses on health care and health education, and the foundation provided the funds to complete his study. Wintemute followed up on nearly 6,000 authorized handgun purchasers, most of them for 15 years. He found that men who had had two or more convictions for misdemeanor violence were 15 times as likely as those with no criminal history to be charged with the most violent crimes.
In the years since Wintemute's 2013 conference appearance, his prominence has grown, and his research has expanded, thanks to $848,000 in NIH funding from the now discontinued program and to $2.2 million in support from the National Institute of Justice, the research arm of the U.S. Department of Justice. The California Department of Justice and several private foundations have also funded his work, and U.C. Davis has guaranteed portions of four staff members' salaries for several years. The staff of his Violence Prevention Research Program, then at four, including him, has grown to 15; eight of the new hires have Ph.D.s. And with the California money in hand, Wintemute is gearing up to hire more analysts and support staff. The financial backing marks a big change: back in 2013, Wintemute had donated $945,000 over eight years from his own savings and stock sales to support his program. Now, he says, he continues to donate personal funds “because I can,” not because he must.
Most significant in Wintemute's published research since 2013 are data published in January in Injury Prevention about the relation between alcohol abuse and future violence among firearms owners. The retrospective study of 4,066 Californians who purchased handguns in 1977 found that buyers with prior alcohol-related convictions, mainly while driving under the influence, were four to five times more likely to be arrested for a violent or firearm-related crime in the next 14 years.
The NIH grant, which was funded in 2015 and 2016, allowed Wintemute to launch a much larger follow-up study, which he expects to complete in 2018, looking at the same question in some 116,000 people who legally purchased handguns in California in 2001, with follow-up through the end of 2013.
Inside out
As Wintemute delved into gun research in the 1980s, he decided to immerse himself in gun culture. He joined the NRA and the rifle and pistol club in Davis, where he practiced shooting at an indoor range. In 1999 he started to visit gun shows, good opportunities to observe firearm purchases. “Gun shows are sort of like zoos,” he says. “You can easily see a wide range of behaviors.”
At his first show in Milwaukee, the signs used to advertise guns caught his attention. One licensed retailer displayed a Mossberg Model 500 shotgun with a pistol grip next to a poster that read “Great for Urban Hunting.” Another sign, beside a Savage rifle, read: “Great for Getto [sic] Cruisers.”
Wintemute says that he was astonished by the blatant promotion of guns as murder weapons. “It was clearly a story that had to be told—bearing witness is part of the job—but I wanted to figure out a way to tell the story quantitatively, scientifically.”
It took several years of trial and error at shows before he was confident enough of his methods to begin collecting data. He cut off his waist-length ponytail so he would not stand out in the crowds, bought a small camera and placed it in a bag of Panda licorice with a lens-size hole cut in the side. A pen and notepad would attract too much notice, so he set up his office voicemail so that he could call it from his mobile phone and record long messages. He later added a video camera disguised to look like a button on his shirt.
Several times Wintemute was accused of taking unauthorized photographs, and his phone was temporarily confiscated by security personnel, who examined it and found no pictures. After one such episode, he says, a colleague overheard a group of men planning to attack Wintemute outside the show, but he successfully avoided them.
Altogether he attended 78 gun shows in 19 states, strolling the aisles while apparently deep in a phone conversation. A paper on the findings showed, among other things, that the restrictive policies regulating gun shows in California resulted in fewer illegal “straw” purchases—in which someone buys a gun on behalf of a person legally barred from doing so—than in other states.
That publication, and Wintemute's statements in the media, prompted a backlash from proponents of gun ownership. In June 2007 David Codrea, author of a blog called WarOnGuns, had posted Wintemute's picture online with the note: “WARNING! IF YOU SEE THIS MAN, NOTIFY SECURITY IMMEDIATELY.” The post identified Wintemute by name and called him an “anti-gun ‘researcher’” who stalked gun shows with hidden cameras and recorders.
But by that point, Wintemute says, he had learned all he could and stopped going to shows.
Critical approach
On that spring day in 2013, after Wintemute spoke to the emergency room researchers in San Francisco, the NRA posted a critique slamming a study that reported that states with more firearm laws had lower rates of firearm fatalities.
The NRA quoted from an unlikely source to attack the paper: Wintemute, who had published a sharp rebuttal to the paper in the same journal. He had argued that the association between more laws and fewer deaths disappeared when the authors accounted for firearm ownership in a state—meaning that it is impossible to say whether the restrictive gun laws save lives by inhibiting gun ownership or whether laws are simply easier to enact in states in which ownership rates are already low. The latter is a more plausible explanation, he wrote.
One of the paper's authors, Eric Fleegler, an emergency physician at Boston Children's Hospital, responds that, “when you look at firearm-related homicides, even controlling for firearm ownership, firearm-related homicides do decrease in states with more gun laws.”
This is not the first time that Wintemute has attacked papers he perceives to be weak, even if they point toward policies he would like to see adopted. And he goes no easier on policies that he views as ineffective, even ones that seek to limit firearm ownership. He has, for instance, repeatedly criticized the assault-weapons ban enacted by Congress in 1994, in part because the ban was easily circumvented. Instead he advocates three steps informed by research: requiring background checks for all U.S. gun sales, forbidding alcohol abusers and those convicted of violent misdemeanors from buying guns, and rewriting current federal restrictions on gun ownership to better capture people who are mentally ill and at risk of violence to themselves or others.
Wintemute's rigor has earned the respect of some ideological opponents, but others say that his work betrays antigun biases by, for instance, selectively citing the literature in a way that minimizes the value of firearms for self-defense.
“We have followed his research for many years. Progun scholars have criticized it for just as long,” says John Frazer, who in 2013 was director of the Research and Information Division at the NRA's lobbying arm, the Institute for Legislative Action in Fairfax and today is the organization's secretary and general counsel.
Wintemute's work at gun shows has also triggered complaints. Kopel, the Independence Institute's researcher, says that Wintemute's hidden-camera tactics were “sleazy.” “I have a higher opinion of him as a guy who looks at the data and analyzes them in a serious way,” Kopel says.
Today, with his gun-show days behind him, Wintemute is focused on such analyses, finishing a randomized trial supported by the National Institute of Justice and California's Department of Justice. It is studying roughly 20,000 people who purchased guns legally in California but have since lost the right to own firearms because they committed a violent crime, were served with a restraining order stemming from domestic violence, or were judged mentally ill and potentially violent. Unlike in other states, authorities in California take guns away from those people. Wintemute is aiming to test the effectiveness of the policy by comparing reoffending rates among those whose guns are seized quickly versus those who keep them for longer.
The money from California is separately enabling new work, beginning with a survey of some 2,000 Californians looking at the prevalence of firearm ownership and of firearm violence and its consequences. “The very cool thing is that the legislature appropriated five years of operating funds up front, so it's possible to make long-term plans and engage in research that will take time to complete,” Wintemute says.
It's an unfamiliar feeling. But for however long the new support lasts, Wintemute will continue the work he began 30 years ago. For him, it is part of his mission as a physician to relieve suffering. “Everything that was true of firearm violence in the early 1980s is still true today,” he declares. “There is a fundamental injustice in violence. People don't ask for it; it comes to them.”
This article is reproduced with permission from Nature magazine. It was first published on April 24, 2013, and has been updated.
