Dr. Garen Wintemute, Director of the Violence Prevention Research Program

Dr. Garen Wintemute, Director of the Violence Prevention Research Program

(Music)

Mark Masselli: This is Conversations on Health Care. I am Mark Masselli.

Margaret Flinter: And I am Margaret Flinter.

Mark Masselli: Well Margaret, more interesting news on the economic impact of
the Affordable Care Act the Department of He alth and Human Services has
reported that health care caused for millions of Americans who bought health
insurance on the state and federal exchanges remain steady in 2015.

Margaret Flinter: The report shows that states with the highest enrollment growth
they solved significant reductions in the average medical cost per enrollee.

Mark Masselli: This news comes in as an important pivot point, Margaret.
Several of the nations’ biggest insurers have made moves to exit the insurance
exchanges but the study revealed insurers who sold policies on the exchange set
prices low in the first year.

Margaret Flinter: So the second year of open enrollment however saw more
healthy people participating and that of course leads to more stabilized overall
health cost. And of course, this dovetails nicely off of a recent Harvard study
which show that in states where Medicaid was expanded and where low income
residents gained access to health insurance coverage, good preventive primary
health care and better health outco me.

Mark Masselli: HHS Secretary Sylvia Burwell said the study shows the online
insurance marketplace is improving as each year passes. They anticipate the
rate of increase to level o f f overtime as healthier young people enter the risk
pool .

Margaret F linter: And HHS plans to do more outreach into the young invincible
demographic during the next open enrollment, those are the healthy young adults
who are more likely to feel they don’t really need the coverage.

Mark Masselli: Now let’s shift to anothe r that has gripped our nation and that’s
the prevalence of gun violence, Margaret. Well we often take note of the terrible
mass shootings which dominate the headlines we don’t think of the 90 Americans
per day who die by gun. Our guest today is one of th e world’s leading experts on
gun violence.

Margaret Flinter: Dr. Garen Wintemute is an emergency room physician at the
University of California at Davis and he has dedicated much of his life’s work to
conducting vital research on gun violence, we are rea lly looking forward to that
conversation, Mark, it's so important.

Dr. Garen Wintemute, Director of the Violence Prevention Research Program

Mark Masselli: And also Lori Robertson, stops by the Managing Editor of
FactCheck.org, who looks at misstatements spoken about health policy in the
public domain. But no matter what the topic, you can hear all of our shows by
going to www.chcradio.com .

Margaret Flinter: And as always, if you have comments, please e - mail us at
[email protected] , or find us on Facebook or Twitter because we love to hear
from you. We will get to our interview with Dr. Garen Wintemute in just a
moment.

Mark Masselli: But first, here is our producer Marianne O’Hare with this week’s
Headline News.

(Music)

Marianne O’Hare: I am Marianne O’Hare with these Health Care Headlines.
Aetna is the latest large insurer to take a step back from the Obamacare Health
Insurance Exchanges. Aetna has joined large insurers Humana and United
Healthcare and pulling out of the marketplaces o pting to stay in just a handful of
markets. So what does this mean for consumers? Health law experts suggested
that consumers won’t likely feel much of the pinch. Eight out of the 10 insurance
marketplace consumers received tax subsidies to cover much o f the cost of their
insurance purchase, and as plan prices rise so do the tax subsidies. Consumers
in parts of the south however will feel much of the blood. Florida, Georgia and
North and South Carolina are also states that failed to expand Medicaid for their
residents living close to the poverty line leaving many residents still uninsured. A
report by the nonpartisan commonwealth fund charts the reduction of the
uninsured population from 2013 to today about 26 million Americans have gained
coverage at that time, but the report also concludes a persistent sector or the
population remains uninsured.

Latinos making $16,000 per year or less, Millennials and those who live in the 20
states that are failed to expand Medicaid. As the Zika virus continues to pose a
threat to folks largely living along with southern coastal regions of the U.S.
Researchers may have zeroed in and the culprit is responsible for interrupting
neural development and growing fetuses. Researchers at the University of
Southern Califor nia have identified two proteins in particular NS4A and NS4B
which affect the brain by targeting signaling process that controls cell growth.
And report in Kaiser Health news scientist report their findings that if Zika
spreads in the developing fetus the virus actually uses the disposal process to
continue proliferating. Cells began dying as early as two weeks after infection
occurred. The discovery this process may accelerate the pace of developing
drugs that can counter this devastating result from be ing exposed to Zika in
utero.

I am Marianne O’Hare with these Health Care Headlines.

Dr. Garen Wintemute, Director of the Violence Prevention Research Program

(Music)

Mark Masselli: We are speaking today with Dr. Garen Wintemute, Director of the
Violence Prevention Research Institute at the University of California Davis, an
ER physician and professor of emerging medicine. Dr. Winte mute is also a
leading global researcher on analyzing gun violence from a public health
perspective. He served as Medical Coordinator at the Non g Samet Refugee
Camp in Cambodia. He earned his un dergraduate degree at Yale, his master’s
in public health at Johns Hopkins and earned his medical degree and did his
residency at UC Davis. Dr. Wintemute, thank you for joining us on
Conversations on Health Care today.

Dr. Garen Wintemute: Thanks for ha ving me.

Mark Masselli: You launched after your ER experience the violence protection
research program at UC Davis back in the 1980s and so kudos to you for being a
pioneer, and I am wondering if you could take our listeners back to sort of the
driving m ission of the work that you do at the violence protection research
program and maybe in a seminal moment or experience that brought you to
spend lifetime engaged in this work.

Dr. Garen Wintemute: We, for some years, have used emergency departments
and t rauma services here in the U.S. to train the arm services, combat surgical
teams because they can see battlefield trauma right here in the United States.
Back in the 80s and early 90s, it was actually something of the hard sell that
violence was the healt h problem and not a crime problem, and the best
encapsulation of the argument I have ever heard came from David Satcher a
physician who just take over the CDC and was asked about this, and he said,
“Look, if violence isn’t a health problem then why are all these people dying from
it.” In my own case, the experience was at that time in Cambodia that you
mentioned. It was a very intensive experience in a power of violence to disrupt
people’s life not long after I got home realized I can do that work right h ere. And
the other realization the vast majority of people who died from gunshot we say in
the United States die where they are shot. It doesn't matter how fast the
ambulance is, it doesn't matter how good the ER doctors and surgeons are,
those people ar e just dead. And for me and others there came the recognition
that if we as clinicians want to make the maximum inroad into the number of
people who died from firearm violence we need to prevent them from being shot
in the first place.

Margaret Flinter: Dr. Wintemute , I am not sure our listeners would be very
familiar with the Dickey Amendment which Congress passed 20 years ago which
essentially barred the Centers for Disease Control from utilizing any government
funds for research that might somehow sup port gun control legislation to help our
listeners understand what was this Dickey Amendment and the impact it had

Dr. Garen Wintemute, Director of the Violence Prevention Research Program

your research or the research of your colleagues. I understand that you basically
began to contribute your own personal funds to keep this v ital work going, tell us
about that.

Dr. Garen Wintemute: So in the early 1990s, we were facing a real epidemic of
firearm violence and the country did what we do best, and it should be very proud
of. We committed funding to understanding the problem bet ter, Congress was
interested in doing something with the results of the research. It's sort of like the
mobilization that we've had for cancer and heart disease and motor vehicle
injuries, we are doing it now for opioid abuse and the Zika virus. The diff erence
is that that mobilization was choked off. There were and are interests in the
United States who oppose changes in firearm policy, and I think they took to the
position that let's simply choke off the supply of the evidence that might make
those cha nges possible. Jay Dickey was a congressman from Arkansas
describing himself as the point person for the National Rifle Association carried
an amendment that was adopted by Congress and that said that federal funds
could not be used “to advocate or promot e gun control.” Congress took from the
CDC's budget, this is the mid 1990s, took from CDC’s budget the amount of
money that they have been spending on firearm research and gave it back to
them you know Mark for another purpose. CDC has overnight within a few
months of shutdown their extramural funding program. We had a research
program going in large part with their support and CDC still does not fund
research, other federal agencies do.

The National Institute of Justice I think NIH but for criminal jus tice matters, and a
few years ago, the National Institutes of Health launched for the first time in their
history a program of funding for research on firearm violence. Compared to
what's needed it falls way, way short. The question that I have as both a
researcher and the clinician is how many thousands of people are dead today
would be alive if that work had been allowed to continue, if we have been able to
enact policies based on the answers to tough questions when today we don't
have those questions a nswered.

Mark Masselli: Well, there were 34,000 gun related tests per year in this country
it's about hundred a day decided to do control evaluation of the California Armed
and Prohibited Person System which seeks to prevent violence by recovering
firear ms from person who may have purchase them legally, but have since
become prohibited persons. Can you tell our listeners a little bit more about your
findings?

Dr. Garen Wintemute: We worked very hard in the United States to prevent
prohibited people, fe lons, people who have been convicted of domestic violence
and so on from purchasing firearms. But we do essentially nothing when the
reverse set of circumstances applies. When someone purchases a firearm
legally and then at some time later, newly becomes a prohibited person. Here in
California, an effort is being undertaken to address that gap. If a person has just

Dr. Garen Wintemute, Director of the Violence Prevention Research Program

had a prohibiting event occur and if they show up in their archive of firearm
transactions, there's obviously a real possibility that they s till possess a firearm
and are prohibited from doing that. What follows is a knock on the door and they
have taken on a temporary basis because those prohibitions might expire. What
we know so far is that such a program is feasible, it can operate, it's been
operating for a while now, thousands of firearms have been recovered, no one
has been hurt, nothing has happened. What we need to let some time passed in
order to determine is whether the program works in the sense of reducing the risk
of future viol ence on the part of people who are affected and we are in the middle
of that work right now.

Margaret Flinter: Well, that sort of leads us to the research that you have done in
primary care we routinely screen patients for the prevalence of substance abu se
and we know that there is a corollary particularly between alcohol and domestic
violence. How did you analyze the connection between alcohol or substance
abuse and gun violence and what did you find?

Dr. Garen Wintemute: There is a huge body of evide nce establishing that
alcohol abuse is a risk factor for future violence by itself even when other risk
factors are controlled for, specifically involving firearms. What there hasn't been
is a study of whether alcohol abuse is a risk factor for future vio lence specifically
among people who own firearms. And we have just actually finished one study in
this area and what we learned is that firearm owners are just like everybody else,
that even when you control for other risk factors for violence in the futu re such as
age and sex and our past history of violence, alcohol abuse is a substantial and
independent risk factor for future violence involving firearms, major violent crimes
like homicide rape and robbery and aggravated assault. The bottom line is that
we are learning that firearm owners aren’t different they are just like the rest of us
when it comes to the relationship between alcohol and future violence.

Dr. Mark Masselli: We are speaking today with Dr. Garen Wintemute director of
the Violence Prev ention Research Institute at the University of California Davis
Dr. Wintemute in the quest to understand the recent spate of the mass shootings
that have occurred around the country the discussion often turns to the link
between mental illness and gun viol ence and what is your research revealed
about the role of mental illness that are more likely to lead to gun violence?

Dr. Garen Wintemute: Well no more than 4 - 5% of interpersonal violence can be
directly attributed to serious mental illness by itself. There are certain points in
the history of a mental illness, when risk is increased, one is when that mental
illness is first diagnosed another is at times of acute exacerbation, when there's
been a mental health emergency and I want to draw a parallel her e between
mental illness and other chronic illnesses public mass shootings are a very, very
small part of the overall problem of firearm violence in the United States. Well
under 1% of fatalities from firearm violence in the United States come from mass
s hootings.

Dr. Garen Wintemute, Director of the Violence Prevention Research Program

Margaret Flinter: One of the problems is just the unbelievable proliferation of
weapon ownership in this country I understand that you have looked at the whole
area of gun shows and gone to gun shows were private gun sales were common
occurrenc e can you talk about this less regulated marketplace.

Dr. Garen Wintemute: We have fewer than 5% of the people on the planet we
have more than 40% of firearms in civilian hands. We have a set of policies that
make the widest possible array of firearms a vailable to the widest possible array
of people for use one such federal policy establish what amounted two separate
systems of commerce in firearms. If I buy a gun from a licensed retailer I have to
show my ID and fill out a very lengthy form and undergo a background check and
the retailer has to keep a permanent record of the sale which means I can be
linked to the gun, but I can buy a gun from a private party and there's no
paperwork there's no background check there's no waiting period if gun cash and
a handshake and I the buyer get to choose which system I'm going to use. If I'm
acquiring that gun with criminal intent and don’t want anybody to know about it
that private party purchase is the only option for me nearly 40% of all firearm
acquisitions in the United States occur through that unregulated don’t ask don’t
tell system, and that proportion doubles from 40% to more than 80% if the
firearm is being acquired with criminal intent.

Mark Masselli: You know that you said a person can have the misdem eanor rap
sheet as long as an arm and till be able to purchase a gun legally, your
researchers shown that the most telling factor in predicting potential gun violence
is a person's prevalence of petty crimes and misdemeanor convictions, so tell our
listene rs what your data has shown you about the connections between lax gun
laws and the incident of gun violence.

Dr. Garen Wintemute: So it is a myth that violent criminals cannot buy guns
legally, a person under federal law can be convicted of any number of violent
misdemeanor assault and battery is a good example. Here in California of
violence misdemeanors are not allowed to purchase firearms and we evaluated
that change in policy and found it was quite effective. It reduces the risk of future
violence i n that population by 25 to 30%. We've got 50 laboratories in the United
States conducting experiments in firearm policy and all the experiments are
being conducted and there are very few people available to see what the results
are?

Margaret Flinter: Dr . Wintemute with so many guns and circulations could telling
the influence of the NRA is likely to happen anytime soon certainly a very vocal
contingent in Congress willing to hold the 24 - hour sitting demanding a more
rational approach to gun policies but I would like to ask you what is your
recommendation for the best way forward on getting the proper emphasis on the
public health threat of gun violence?

Dr. Garen Wintemute, Director of the Violence Prevention Research Program

Dr. Garen Wintemute: One is to get better evidence at a time when policy reform
might be in the offin g we need the best available evidence to guide those
reforms. Here in California the legislature authorized in the University of
California is probably about to establish of a firearm violence research Center
that's a big problem in California as it is na tionally Congress hasn’t stepped up
fair enough California will do its part, that measure was it that was legislation that
was considered by the state legislature and Jay Dickey wrote a very strong letter
in support of that bill to establish a Research Cen ter, Jay Dickey has had a
change of heart and has recognized that his language which spoke only to
advocacy had been used to suppress research, and he's come to see that is
wrong and it was very heartening to get his support. I think that whatever the
out come of the election in November, there's going to be more support for
research on this obvious large and pressing problem. I am optimistic having
lived through the last three decades of this I know the following to be true, that
the conversation has simp ly not stopped since December of 2012 people have
been talking without end and an increasingly about a bigger a problem this is and
how we need to do more about it.

New people are signing up to help with the research effort to help with the
advocacy effor t if that’s where their skill set lies. I think we are not far away from
seeing substantial change for the better.

Margaret Flinter: We have been speaking today with Dr. Garen Wintemute
Director of the Violence Prevention Research Institute at the Unive rsity of
California at Davis. You can learn more about his work by going to
ucdavis.edu/vprp, Dr. Wintemute thank you so much for the very important work
that you are doing and for joining us on Conversations on Healthcare today.

Dr. Garen Wintemute: Su re thanks very much for having me.

[Music]

Mark Masselli: At Conversations on Health Care, we want our audience to be
truly in the know when it comes to the facts about health care reform and policy.
Lori Robertson is an award - winning journalist and ma naging editor of
FactCheck.org, a nonpartisan, nonprofit consumer advocate for voters that aim to
reduce the level of deception in U.S. politics. Lori, what have you got for us this
week?

Lori Robertson: Hillary Clinton falsely claimed that Donald Trump campaign
officials have called Zika “an insignificant issue” that was said by an unpaid local
supporter of Trump not campaign officials, Trump himself has called Zika a “big
problem” for instance the democratic presidential nominee made the claim about
he r republican opponent, during a visit at a Medical Center in Miami. As of early
August there have been six locally acquired cases of Zika in Florida throughout
the US, there has been more than 1800 travel associated cases. Clinton

Dr. Garen Wintemute, Director of the Violence Prevention Research Program

expressed disappointmen t with Congress's failure before going on a summer
recess to pass Legislation for emergency funding to combat the Zika epidemic.
Clinton’s campaign told us she was speaking of one field who was quoted in
June by the Boston Globe as saying we have bigger m osquitoes to squashed in
Zika, like ISIS the National debt Iraq and Afghanistan. He called Clinton
sophomoric for taking on such an insignificant issue who is feel he was identified
by the globe as Trump vice chairman of Miami - Dade County but Trump Florid a
chief strategist and senior political adviser told us that’s not the case and that
field is in unpaid supporter. The Trump volunteer told us “I speak for myself and
not Trump, we checked and feel isn’t on the payroll and Trump July 2016
campaign finance report. Trump himself has made limited comments on Zika but
called it a big problem in early August, and that’s my fact check for this week. I
am Lori Robertson, managing editor of FactCheck.org.

Margaret Flinter: FactCheck.org is committed to factual accuracy from the
country's major political players and is a project of the Annenberg Public Policy
Center at the University of Pennsylvania. If you have a fact, that you would like
checked, email us at www.chcradi o.com . We will have FactCheck.org's Lori
Robertson check it out for you here on Conversations on Health Care.

(Music0

Margaret Flinter: Each week, Conversations highlights a bright idea about how
to make wellness a part of our communities and everyday lives. Tel Aviv
Computer Scientist and developer Oded Ben Dov has been coding since he was
six years old and he's always been interested in hacking systems to make them
better. So when this young entrepreneur unveiled a hands - free gaming system
on Israe li TV local quadriplegic in the viewing audience took notice and urged
him to think about adapting this hands - free gaming system to help quadriplegics
interact with their smart phones by using simple head movement s , Ben Dov
couldn't resist the challenge fr om Giora Livne who had been paralyzed for eight
years following an accident.

Oded Ben Dov : And again the call said hello my name is Giora I can’t move my
hands or legs, could you make me a Smartphone I could use and that really cut
my ear, cut my heart.

Margaret Flinter: The two hit partner together on the project deciding to call the
device, Sesame Phone as in Open Sesame.

Oded Ben Dov: So someone could opt for big head movement or very small
head movement. You could use it like expanded voice comman ds or you could
use a built in Google dictation capabilities.

Margaret Flinter: Ben Dov says he has seen both children and adults formerly
locked in by paralysis literally come alive.

Dr. Garen Wintemute, Director of the Violence Prevention Research Program

Oded Ben Dov: It feels emotional, and every user uses it differently . Someone
immediately called his wife, children you know rushed to the most popular game
and played that.

Margaret Flinter: The gathering funding to make the Smartphone software
available around the world and Ben Dov says, they have got bigger plans for
developing this and other systems that are geared to assist the handicapped
community.

Oded Ben Dov: We are positioned as well within the special need space and we
use new technologies and offer a completely different product as we are exposed
to more an d more needs.

Margaret Flinter: Sesame Phone, a simply devised hands - free interface that
allows the paralyzed and physically handicap to interact with their world through
their Smartphones allowing them a new level of independence, now that’s a
bright id ea.

(Music)
Margaret Flinter: This is Conversations on Health C are, I am Margaret Flinter.

Mark Masselli: And I am Mark Masselli, peace and health.

Conversations on Health Care , broadcast from the campus of WESU at
Wesleyan University, streaming live at www.wesufm.org and brought to you by
the Community Health Center.