During his first week as a pediatric trauma surgeon in Chicago, Dr. Chethan Sathya treated a 6-month-old baby with a bullet wound. In the five years since, he has seen dozens of children shot and wounded — and sometimes killed — by firearms.
As he grew up and went to medical school in Toronto, Dr. Sathya occasionally saw gun violence in that city. The number of patients he saw with gunshot wounds multiplied when he became a surgeon in two of America’s biggest cities: first Chicago, and now New York, where he works at Northwell Health’s Cohen Children’s Medical Center. Each time he treats a gunshot wound, the heartbreak lingers. That’s led him to pursue research in recent years.
“We’re tired of having to tell parents over and over again that they lost a loved one to a preventable disease,” said Sathya, who also leads Northwell’s Gun Violence Prevention Center. “We’re tired of not doing much about this.”
After a two-decade freeze on federal funding for gun violence research, Sathya was excited to begin a large study on violence prevention in health care settings in 2020.
In a push to revive funding for gun violence research, Congress allocated $25 million annually to the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) starting in 2019. The agencies distributed their first sets of grants to researchers like Sathya in 2020. The researchers are asking questions about school violence, safe storage, and other public health interventions. But it takes time to conduct solid research, so these projects are just now beginning to bear fruit.
Sathya said he expects results in three or four months. And his team’s research will likely be among the first published because of renewed funding. More than two dozen other studies are expected to wrap up in the next few years.
In 1996, Congress passed the Dickey Amendment, which barred the use of federal funds to “advocate or promote gun control.”
Though the amendment didn’t explicitly ban research, that’s how the CDC and researchers came to understand it, combined with Congress’s decision to effectively shift $2.6 million in funding for violence research to research on brain injuries, instead. The CDC wasn’t willing to test the prohibition and avoided funding any studies that could be perceived as anti-gun.
Every year since then, Congress has included the Dickey Amendment in annual appropriations bills. In 2011, Congress even extended the amendment so it applied to the NIH. By 2017, a study found that gun violence was the least researched and the second-least funded of 30 leading causes of death.
“It really limited knowledge development in the field, and it really restricted people’s interest in working in the field,” said Andrew Morral, the director of the National Collaborative on Gun Violence Research, which has provided millions in grants for gun violence research in the absence of federal funding.
The freeze also sent a message that gun violence research wasn’t a viable career path. When Charles Branas, a researcher at Columbia University’s Mailman School of Public Health, was in graduate school, he said, higher-ups asked students to remove the “f-word” — firearms — from research proposals, grant applications, and manuscripts. “It would risk that proposal and the manuscript,” he said, “but it might also risk the research funding for an entire unit at a university.” Many researchers turned to private foundations, state funding, and even their own salaries to pay for their work. But academic salaries and small grants couldn’t support major data collection, experiments, or clinical trials.
In 2019, Congress approved $25 million in annual appropriations — $12.5 million each for the NIH and the CDC — specifically for gun violence research. Each year since, Congress has maintained the $25 million in funding. Though the Dickey Amendment remains, Congress clarified that it doesn’t prohibit federal funding for gun violence research.
President Joe Biden asked Congress to double the amount last year, but funding remained level. In his fiscal year 2023 budget request, Biden asked for $60 million.
But even with renewed funding, the effects of the freeze persist, those still working in the field said. “The funding will slowly start to develop a deeper bench of junior researchers and people … who are active and probably more innovative in this field,” said Rosanna Smart, an economist at the RAND Corporation. But because resources were so scarce for so long, firearms research is similar to studying a new disease. Many questions remain unanswered.
At the same time, the slim research archive presents more avenues of study. “There are so many opportunities to study different elements of what causes firearm mortality, what are risk factors, what are preventative factors,” said Sathya, the New York doctor and researcher.
The four researchers who spoke to The Trace said an appropriate level of funding, given the number of deaths and injuries caused by gun violence, would range from $100 million to $250 million. That level of funding wouldn’t match the billions allocated to cancer and heart disease research, but it would bring it closer to other leading causes of death.
“The numbers [of shootings] have just been going up and up,” Sathya said. “So the [funding] number should be equivalent.”
Sathya’s NIH-funded research involves implementing and evaluating a first-of-its-kind screening and intervention effort. When patients enter three Northwell Health emergency departments in Downstate New York, health care providers ask each one of them about their access to firearms and other questions to assess their risk of violence. Those who have access to firearms receive counseling on safe storage, gun locks, and firearm safety training. Those who may be at risk of violence more generally are provided with community violence prevention resources.
So far, providers at the three participating hospitals have screened thousands of patients.
The CDC is currently funding at least 18 research projects and the NIH is funding at least 15. Researchers are using the federal grants to study the effect of firearms regulations on intimate partner violence, the connections between safe storage and suicide in rural areas, and the effectiveness of youth-focused hospital-based violence prevention programs. Other studies are examining whether lawful gun ownership increases homicide risk, community-based violence prevention programs, and suicide prevention efforts led by firearms retailers and ranges. Despite the rise of local violence intervention efforts, they remain understudied. The NIH’s call for research proposals this year focuses on evaluating state, local, and community-based interventions.
The funding is already having a noticeable impact on the ecosystem of gun violence research. Researchers no longer have to couch their gun violence studies or connect it to other issues. But reinvigorating an entire field of study can’t be done overnight. For gun violence research to become a field as vibrant as those that study other major causes of death in the U.S., it will likely take years, more money, and the recruitment of new researchers.
Private funders, sponsors, and universities, along with leading researchers, are working to develop infrastructure to improve information sharing and feedback among those working in the field. In November, researchers will be able to attend the first National Conference on Firearms Violence Research in Washington, D.C. But many challenges remain. There are few reliable sources of data, including little national data on homicides and suicides, defensive gun use, and gun ownership. “Big data questions are really hard to fill without a large and sustained investment in not just research but building a data infrastructure to be able to capture those,” Smart said.
“We know how many poultry were slaughtered across the U.S. last week. We keep track of that,” said Morral, the National Collaborative on Gun Violence Research director. “But we don’t have good information on how many people were murdered even at the state level.”