Tale of 2 Agencies: CDC Avoids Gun Violence Research But NIH Funds It.
Venue: JAMA

Garen Wintemute, MD, MPH, is the first to describe his lifestyle as frugal. An emergency room physician on the faculty of the University of California, Davis, Wintemute lives in a $900 a month 1 bedroom apartment on the outskirts of Sacramento. He has no children, so he doesn't have to sock away a chunk of his salary toward college tuition. "There's a fair amount of money left over every year," he said. So much so that the 64 year old Wintemute has already donated $1.3 millionof the$2millionhehaspledged toward theUCDavis Violence PreventionResearch Program,whichhehappens todirect.Without his contribution, "we probably would have disbanded," Wintemute said, noting that at one time hewas the program'smain source of money. Such financialwoescanbeattributed in part to the fact that the US Centers for Disease Control and Prevention (CDC) hasn't funded research into gun violence prevention for 2 decades, ever since Congress included these 3 lines named the Dickey Amendment for then representative Jay Dickey (R,Ark),who introduced it onpage 245 of the 750 page Omnibus ConsolidatedAppropriations Act of 1997: "None of the fundsmade available for injury prevention and control at the Centers for Disease Control and Preventionmay be used to advocateorpromoteguncontrol." (http:/1.usa .gov/22zCqKD) The amendment was in response to a CDC funded study that concluded having a gun in the home was associatedwith a higher risk of homicideby a family member or intimate acquaintance (Kellerman AL et al. .  Since the Consolidated Appropriations Act of 2012, the same language has also applied to the National Institutes of Health (NIH) However, as part of a funding opportunity for violence research announced in 2013, theNIHawardedWintemutea total of about $850000, from May 2015 through April 2017, to study whether gun owners with a history of alcohol and drug convictionsaremore likely tocommitviolencethan gun owners without such a criminal history (http:/1.usa.gov/1Vn5GiB) Why the 2 federal agencies have interpreted the same rider so differently is not clear. Critics say the CDC has overreacted to the amendment's vague language. But other observers note that the size of the NIH budget gives it less reason to be concerned about retaliation by pro gun members of Congress. For the current fiscal year, the NIH budget is $32.3 billion, compared with the CDC's $11.8 billion $4.5 billion of which is earmarked for mandatory programs such as Vaccines for Children) Officials at the CDC and NIH declined to comment on agency policies regarding gun violence prevention research. "What people don't understand is there's no federal ban on research," said Mark Rosenberg, MD, MPP, a 20 year CDC veteran who says he was fired as director of the National Center for Injury Prevention and Control in 1999 because of his commitment to studying gun violence prevention. "But the leaders of CDC are scared to take this on because it's so politically controversial." David Satcher, MD, PhD, a former surgeon general who now directs the Satcher Health Leadership Institute at the Morehouse School of Medicine, was CDC director when Congress first tacked on the Dickey Amendment to the 1997 budget bill. "I'm not prepared to judge the people at the CDC," Satcher said. "They don't want to get into this [gun violence prevention research] unless they know someone has their back." Mary Wool ley, pres ident of Research!America, a nonprofit organization that advocates for increased funding for government agencies involved in scientific research, says she understands why the CDC might fear retribution from Congress if it resumed research into the roots of gun violence. "The CDC is funded in a different way than the NIH," Woolley said. "They have line item budgeting." The NIH, on the Medical News&Perspectives .p1689