Neurology: Violence at home

One of us (SLH) recently spent an evening with Jeremy Richman and Jennifer Hensel, parents of Avielle Richman, a sparkling eyed 6 year old who was one of 20 children, with 6 teachers, killed at the Sandy Hook school shooting last October. It is simply not possible to put into words the poignancy of this meeting with her grieving parents. Of the 20 children murdered, Avielle was the only one who was also an only child. Her father is a neuropharmacologist with a background in synaptic biology and developing drugs for neurologic diseases; her mother is an immunologist, and shares our interest in B-cells and their signaling pathways. We’ve also been stunned by the recent shotgun and stabbing deaths of Creighton University child neurologist Roger Brumback, murdered with his wife Mary in their home. Roger was an internationally renowned figure in child neurology and neuropathology, and among many accomplishments was founding Editor-in-Chief of the Journal of Child Neurology, a position that he continued to hold for more than a quarter-century. Mary was an attorney and Roger’s partner in many professional activities – including the Journal. They were inseparable and intensely devoted to each other. Roger and Mary leave a rich legacy, not only in the example of their lives but also in their children. There is yet another recent premature death in the neurosciences community. Autumn Klein, a neurologist at the University of Pittsburgh, an expert on women’s health issues including pregnancy related disorders, and the mother of a 6 year old daughter, was found dead in her home after her husband, the well-known neuroscientist Dr. Robert Ferrante, called 911 to report that she had suffered a stroke. The true cause of death was cyanide poisoning. At the time of this writing, Dr. Ferrante remains jailed without bond in Pittsburgh, pending a rescheduled preliminary hearing for 23 September 2013. In medicine, as in civilian life, we are accustomed to death and human tragedy. In these pages we’ve not infrequently eulogized the passing of our colleagues, remembering their impact on our profession. Our words are usually tempered with an understanding, implicit or explicit, that life is transient, and that its end is predestined. What is truly shocking, and enormously unsettling, is to witness a cluster in our own professional community of premature, painful, and totally unnecessary deaths caused by meaningless violence. Violence is nothing new, of course and, as the Klein case clearly reminds us, guns are by no means the only source of violent deaths in the Western world or elsewhere. However, it is worth reviewing the numbers. As detailed in a recent Institute of Medicine (IOM) report on gun violence, in 2010 there were more than 105,000 injuries from firearms; about a third of these were fatal. Not all represent violent crimes, as about 60% of the total number resulted from attempted or successful suicide. Firearms are responsible for the vast majority of murders in the US, and each year an estimated 600,000 people are robbed at gunpoint. There are about as many firearms in the US as there are people; given this statistic, it is not surprising that firearm-related homicides are 20 fold higher in the US than in other industrialized nations. There has been vigorous debate over whether the widespread availability of guns in the US makes sense in the 21 century. Should the right to bear arms, cited in the second amendment of the US Constitution but originally intended to protect 18 C. militia, be interpreted as a carte blanche to extend firearm ownership to all citizens in 2013? Should this free-range policy include highly lethal semiautomatic weapons, the weapons of choice in many mass murders, unknown at the time of the Founding Fathers? Unfortunately, arguments on all sides are unlikely to be shaped by much data, given current governmental restrictions on research into firearmrelated violence. The Gun Control Act of 1968 prohibits the federal government from creating a database of gun owners, other Congressional action in 1996 bans the CDC from conducting firearm injury research and, amazingly, in 2011 a similar ban was enacted across the entire US Department of Health and Human Services (housing the NIH)! Clarifying the biology of maladaptive behaviors, and developing evidence to improve prevention, risk stratification, and treatment of violent behaviors, is a wonderful research priority for the neuroscience community. Associations with poor mental health, drug and alcohol use, impulsivity and aggressive behavior, recent active military service, stress and PTSD, among other associations, need