Faust Files: Preventing the Next Uvalde

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Following the Robb Elementary School shooting in Uvalde, Texas, Jeremy Faust, MD, MedPage Today's editor-in-chief, sits down with S.E. Cupp, a CNN political commentator, and Megan Ranney, MD, MPH, director of Brown University's School of Public Health, to discuss how to move forward in a conversation focused on intersectional cooperation, compassion, and our own humanity.

The following is a transcript of their remarks:

Faust: Hello, everybody, this is Jeremy Faust, writer of the "Inside Medicine" newsletter on Bulletin.com and editor-in-chief of MedPage Today. I am joined today by two really smart people: S.E. Cupp and Megan Ranney.

S.E. Cupp is a political commentator for CNN, and Dr. Megan Ranney is the vice dean at the Brown University School of Public Health and an emergency doctor and gun safety researcher.

So great to have you here. I'm sorry that we have to have this discussion, but we have to. Let me start with S.E., because you are someone who has a very large ability to reach a lot of people because of who you represent and your story and where you come from. I would like to know, really your journey. What would you have said 10 or 15 years ago after an event like Uvalde? What do you say now, and what has changed? What made that change for you?

Cupp: Well, it's not a hypothetical. I did have to do this 10 years ago. You know, over the course of my career in media, I have had to break these awful stories on the air. I broke Sandy Hook. I was on the air for a show at MSNBC when that happened. I had to break it. I was very emotional while I did it. I have had to do it many times since.

I think the way I've covered the trauma of it hasn't changed. It was traumatic for me and the country then and it still is. But the way I presented the inevitable debate over what to do next has changed dramatically.

I can tell you what I did then, which is what I see a lot of people doing now on the side of gun rights and gun owners is to say, "Well, this new law would not have prevented this" or "Criminals don't follow gun laws" or "Only 2% of gun deaths are caused by assault weapons," or – name your reason why we can't change. That's what I would say.

And listen, I was right. Those things that I just said could be true. But they are conversation enders. They're a way of not exploring what we can do all along on the contours, from mental health to, yes, gun laws, to public safety and public health, the way politics involves itself in this.

I stopped wanting to do that because I got sick of perpetuating this cycle of inaction. And so when I decided I want to do something different, [I thought] let me do this differently, and do this as a mom and not a gun owner, an NRA member (which I'm not anymore), a Republican (which I'm not anymore). So really, it was just so that I could feel better about my role in participating in this conversation over and over and over again.

Faust: Well, I think that's really brave and it's important. And you also are still obviously in a part of your career and your advocacy where you can make a huge difference.

I want to throw it over to Megan to tell us what works and what doesn't work. And then I want to throw back to S.E. to say, knowing that, how do you go to your old side of the aisle and get people on those things? Can they do it?

So, Megan, we'll start with you: what does work?

Ranney: There are things that we know work for violence prevention. There are things that we know work for suicide prevention. And there are some things that we know work for firearm violence and suicide prevention. There's a large range that go from policy to very much non-policy solutions.

If I start on the policy side, the things that work are things like permit to purchase laws that allow not just a background check but a more thorough check of someone's history. The idea that you actually have to provide an active permit rather than just a passive background check. Those have been shown to decrease gun homicides and suicides. Stronger laws around access to firearms for people who've been convicted of domestic violence or even have had charges of domestic violence.

Those laws, of course, have to be accompanied by enforcement. Those are the types of policies that do make a difference.

And then a newer policy, so-called "red flag" or extreme-risk protection orders, have been shown to potentially decrease firearm suicides a bit and certainly have been used in stopping a number of school shootings over the last couple of years across the country.

Where there's actually a ton more evidence behind how to prevent firearm injury is the stuff that S.E. was just talking about. It is around safe storage. We know that most kids who hurt themselves or someone else do so with a friend or family member's gun. And there are some really good interventions out there that are discussions between pediatricians and families, or between firearm owners and other firearm owners to increase safe storage.

Community interventions, violence prevention programs, boys and girls clubs make a big difference in firearm homicide rates. Community interventions also can help to identify and deflect the risk of these public mass shootings as well.

The last thing is that there are structural changes that make a difference. Things that lessen isolation, that improve community cohesion. One of our colleagues, a fellow emergency physician in Philadelphia, a woman named Gina South, has a whole program of work around greening vacant lots in Philadelphia. That has been shown to significantly decrease not just the rate of gunshot injuries, but also surrounding depression, anxiety, and other stress-related conditions in the neighborhoods.

That's just a quick smattering of the types of things that work. And the big thing that I want people to take away is, yes, policies make a difference, but if we stick only on policy, we are missing the bigger picture.

Faust: To S.E., I want to talk about these conversations that I wonder if you've been having over the years, and I assume you have been. We were talking a little bit before; I just finished reading Madeleine Albright's first memoir, Madam Secretary, and she tells a really interesting story about the Middle East negotiations.

At one point, she met with each side and they said, "Yeah, we're going to get an agreement. We're going to do it. This is going to happen." And she felt really good. Then she found out that the reason why was that each side thought the other side would eventually bend, not that each side was willing to say, "Well, I'm willing to make this concession, but they don't know that yet." So that's problematic.

When you go to have these conversations, S.E., are you hearing that people on the right are actually more reasonable than they sometimes appear, but they're worried that it's a slippery slope? Tell me about those conversations.

Cupp: Well, you just said it. The slippery slope argument has been bedrock for Republicans and the NRA and the gun position for decades. And it's proven really successful to not give an inch, because "slippery slope," and then hide behind the Constitution.

This is just what is done. It's done every time. So for things that sound like common sense, like CDC funding for the study of gun violence, even that was a bridge too far for the NRA. And so the policies that the NRA set in place trickled down to Republican lawmakers. You really couldn't get anything. I mean, there was so much intransigence from the NRA position, which became the same as the Republican position for a long time, that there was a total wall.

Now, I will say, and it's important to remind people because I don't think people know this, but there was a time when the gun rights advocates, including the NRA, were proponents of some big changes. We have 5-day waiting periods because of the NRA, because the NRA fought to keep that and make that part of the Brady Bill.

The NRA is behind a Fix NICS [National Instant Criminal Background Check System] campaign. The NICS system is the background check database. Essentially, if you fail a background check, it's supposed to go into the NICS system and then that's supposed to be accessible to law enforcement. We need to fix it so that it's actually being used, so that data is actually populating the NICS system and is available and used by law enforcement and courts that adjudicate mental health and red flag laws. All of that stuff.

So there have been some, but it's really limited. I've heard more flexibility from Republicans recently, folks like Adam Kinzinger. He's a Congressman, he's a friend of mine, fellow gun owner, and he's offered a raft of policy changes. Things that you wouldn't have heard a Republican say 5 years ago. I think we have to look for those voices, and Democrats have to want to hear from those voices.

I've said, to your Madeleine Albright point, that leaving problems broken has become so politically profitable in Washington. If you solve it, you can't run on it. If you solve it, you can't fundraise off of it. There's not a reason we can't solve gun violence. We can't prevent it completely, but there's not a reason we can't solve it or solve a broken immigration system. We've chosen not to because on both sides, it's too politically profitable.

You know, I talk to Democrats about some of the common sense gun legislation that some Republicans are offering and say, "Take it all. Take it all now and don't try to gum it up with huge things that are never going to happen. Pass these discrete new policies and new pieces of legislation while they're being offered." But, you know, politics gets in the way a lot.

Faust: And Megan, let me ask you about this, because you've been in this space for a long time. Through the years, now with gun safety funding, I think you are a big part of that change, getting that [funding] back online. In order to achieve that, you have to really convince people that you weren't coming after the Second Amendment and that you were actually coming for public health.

How did those conversations go, and tell me about the successful ones?

Ranney: Yeah, that is exactly it. That's what I will actually add on to what S.E. said, which is I think that the biggest thing from the public health or health perspective – there are two. One is to do this in partnership between firearm owners and non-firearm owners. And the second is to be utterly clear that this is not about taking away people's guns.

Let's talk about the reality in the United States, which is that there are more than 400 million firearms in private hands. There are more than 5 million people who became first-time firearm owners during COVID-19. Many of those first-time firearm owners are people that you don't think of as being in the traditional gun demographic. It is Blacks, Hispanics, women, right?

So instead of demonizing 40% of our country, how about we have discussions where we say, "Listen, the Second Amendment exists. Yes, it is part of our Constitution. Let's make sure that you own a firearm safely. Let's make sure that you are trained appropriately. Let's make sure that you know how to recognize signs of trauma, signs of danger. And let's also make sure that you stand up for those norms within your community."

That's been the conversation that I have had. I have actually left the policy conversation aside largely because, honestly right now, it feels pointless. Right? It creates these 10% of folks on either side who are utterly extreme. People that either say, "Oh, the answer is let's arm every teacher," which is baloney, or people who say, "I'm going to go and we're going to take away every gun," which is also baloney. And it leaves the 80% in the middle feeling like there is nothing that they can do.

So my work has been all about creating those partnerships. It has been entirely about joining together with people who may not think of themselves as being on the same side as me and creating a path forward where we can say, "Listen, you do have a tremendously low injury rate in your community and you also have high rates of firearm ownership. How have you done this? What are the community standards that are in place? What are the community supports that are in place?"

The last thing I'll say is that it is inherent to our public health or health approach. Now, again, in COVID, a lot of stuff got politicized unnecessarily, but normally our health-based or public health approach is about harm reduction. It's about not being judgmental. It's about creating space for people to move, in as much as they are capable of, into a space where you reduce the risk of injury or illness or death rather than insisting on absolutes.

It's trying to bring that kind of an ethos back into the work and the language and the hope that we can actually make progress. And I've seen signs of it in communities across the country.

Faust: Well, one thing that you bring up is fighting misinformation and COVID. We've been on the front line of that, Megan and I, and S.E. you've been on the front line of that and everything else. But I wanted to see if I can bring up one data snapshot here that you can see.

This is from the New York Times. And it just shows the number of people killed in active shooter attacks at schools since the '70s, year by year. And then it shows – you can see these really huge spikes. There's Columbine and then there are Sandy Hook and Santa Fe and Parkland and then Uvalde just a couple of days ago.

What strikes me is that there's often the talking point that says, "Oh, school shootings haven't gotten that much worse. We're just covering them more. We're just more attuned to it." If you look at these data, sort of just do the whiff test, then maybe the number of shootings hasn't changed, but certainly the number of those killed per these horrible events seems to correlate to the emergence of these weapons of war in our society.

I just wonder, do we sense that there is a denial of the problem from some people, or is it really just a denial of what to do about it?

Cupp: On the one hand, you could say, "Well, look at the period where we actually had an assault weapons ban. We still had mass shootings, we still had Columbine." But then you can clearly see when the assault weapon ban went away, when it was dissolved and wasn't renewed, you had an uptick in the number of people who were killed because you had more access to assault weapons.

I mean, that just seems to be another fact. I think you can parse data anywhere you want. You have to be interested in data.

For a long time I said that my friends on the left were really not interested in the data, weren't interested in looking at the facts. It was a lot about feelings, which I understood, but there were inevitable facts that we had to agree to before we then had a trusting space to talk about guns.

Now that seems flipped. Now it seems like it's the folks on the right who really don't want to talk about facts. It's just feelings. And that feeling is grievance and anger and division and blaming other folks for their perceived problems. That seems to be driving a lot of the disinformation campaigns and the politics, and cutting through that has become impossible. It has become really, really hard. The way I felt cutting through the feelings on the left for so long was really, really hard.

So, I don't know how you get around that other than trying to have good conversations with good actors who want to talk and want to talk facts, even if they're inconvenient for their so-called positions.

Also, just reminding us all, we don't all hate each other. There are actually more people – like Megan was saying, 80% of people are somewhere in the middle on all these issues. They're not the far right. They're not the far left. So having these conversations is helpful, hopeful. It reminds you of our shared humanity.

Ranney: It is about showing up day after day and knowing that every single day it's human nature to call into question that I'm not saying the same thing and I'm giving them space to think differently, but they're also giving me space to think differently. Coming in with that curiosity, with that open mind and also showing up day after day and not saying, "I'm here to pass XYZ law."

Also being willing to call into question that data. If I go back to that graph that you showed, it is a powerful graph, but/and to go back to some of the data points that S.E. quoted at the beginning, if you actually look at the number of shootings at schools in a year or the number of shootings of kids, yes, the numbers have been going up inexorably, but it is not due to AR-15s; it is due to handguns.

So I think that this is an easy talking point that many folks like to land on, but I think that it misses the bigger picture. And then folks who are firearm owners, folks who are on the right, look at that graph and go "See, I told you, they're just trying to take away my guns."

The reality is that most people who own an AR-15 do so because it is lighter, it is easier to use – especially for women – for hunting it is a more enjoyable firearm to own. I'm not saying that it should be available to 18-year-olds, right? There's a large debate around the age at which you can purchase it. But there's a language and there's a data aspect.

So it's me showing up and saying, "You know what? I am actually going to be honest. There is a greater complexity to the data than just that graph. And now let's talk through what we can do."

Let's talk through the fact that there are more mass school shootings than there were. That there are greater numbers of kids being killed. Let's start with that as a fact and not automatically go to, "Oh, it's the assault rifle ban." And let's talk about copycats. Let's talk about the fact that this is a form of terrorism. Let's talk about all the other kids that are being killed by guns. And let's actually have a real conversation about how we can switch that instead of going again into our automatic extremes on the two sides.

There is no single solution for any health problem. There is no single solution for firearm injury in this country. That doesn't absolve us from taking all the actions that make a difference. So us as physicians having conversations – if we're a pediatrician, having a conversation with parents about safe storage, if we're a psychiatrist, making sure that we have a conversation with our patient or their family about making sure that they don't have access to a firearm in a moment of depression or impulsivity, if we're an ER doc, talking about reducing recurrent violence or intervening to reduce PTSD.

Each of those makes a difference. Added together, it makes a bigger difference. Then add on to it school interventions, boys and girls clubs. Add on to it safety training in firearm ranges. Add on to it interventions with veterans or the military.

No single one of those is going to be enough. We need to do them all and we have to make that commitment to, again, not go to extremes.

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