How many people are shot each year in America?

Has non-fatal gun violence increased or decreased over the past 10 years in the US? No one really knows

How many Americans have been shot over the past 10 years? No one really knows. We don't even know if the number of people shot annually has gone up or down over that time.

The government's own numbers seem to conflict. One source of data on shooting victims suggests that gun-related violence has been declining for years, while another government estimate actually shows an increase in the number of people who have been shot. Each estimate is based on limited, incomplete data. Not even the FBI tracks the total number of nonfatal gunshot wounds.

"We know how many people die, but not how many are injured and survive," said Dr. Demetrios Demetriades, a Los Angeles trauma surgeon who has been studying nationwide gunshot injury trends.

While the number of gun murders has decreased in recent years, there's debate over whether this reflects a drop in the total number of shootings, or an improvement in how many lives emergency room doctors can save.

Doctors and researchers have been advocating for better gun injury data since the late 1980s. But fierce political battles over gun violence research — including pressure from congressional Republicans that put an end to some government-funded studies on firearms — has meant that we still don't know many basic facts about gun violence in America.

"In the absence of real data, politicians and policymakers do what the hell they want," Dr. David Livingston, the director of the New Jersey Trauma Center at University Hospital in Newark. said "They do what the hell they want anyway," he added, "but in the absence of data, they have nobody to call them on it."

An initial push to create a national database of firearm injuries in the late 1980s and early 1990s was slowed by the political fight over Centers for Disease Control and Prevention funding for gun research, according to a history of the project written by researchers who worked on it. To make the effort more politically viable, as well as more scientifically rigorous, researchers decided to collect data on all violent deaths, not just firearm deaths.

And to cut costs, they decided to focus only on fatal injuries. Even that more limited effort has languished without full congressional funding — the database currently covers fewer than half of all states.

Most discussions of crime trends in America look back 20 years, to 1993, when violent crime of all kinds hit its peak. Compare 1993 to today, and the picture looks bright: The number of murders is down nearly 50 percent, and other kinds of violent crime have dropped even further.

The Department of Justice has estimates of nonfatal shootings that suggest a similar trend: Its National Crime Victimization Survey shows a decline, from an average of about 22,000 nonfatal shootings in 2002, to roughly 12,000 a year from 2007 to 2011, according to a Department of Justice statistician.

But over the same time period, CDC estimates show that the number of Americans coming to hospitals with nonfatal, violent gun injuries has actually gone up: from an estimated 37,321 nonfatal gunshot injuries in 2002 to 55,544 in 2011.

The contrast between the two estimates is hard to clear up, since each data source has serious limitations.

Experts say that household data-gathering efforts, like the National Crime Victimization Survey, likely miss the Americans who are most likely to be victims of gun violence.

Shooting victims are "disproportionately young men of color who are living unstable lives and often involved in underground markets or criminal activity, and this is a group that is incredibly difficult to survey," said Philip Cook, a gun violence expert at Duke University. "A lot of them are in jail at any point in time, or if they're not in jail, they have no stable address."

Meanwhile, the CDC numbers are based on a representative sample of 63 hospitals nationwide, and the margin of error for each estimate is very large. The CDC's best guess for the number of nonfatal intentional shootings in 2012 is somewhere between 27,000 and 91,000.

"Uncertainty in the estimates precludes definitive conclusions," one group of medical researchers explained in a back-and-forth in a journal on internal medicine last year.
The FBI also gathers data on gun crime from local police departments, but most departments do not track the number of people who are shot and survive. Instead, shootings are counted as part of the broader category of "aggravated assault,"
which includes a range of gun-related crimes, from waving a gun at threateningly to actually shooting someone.

There were about 140,000 firearm aggravated assaults nationwide in 2012, according to the FBI's report. How many of those assaults represent someone actually getting shot? There's no way to tell.

The lack of a clear number of nonfatal shootings has caused confusion.

A frequently cited 2012 Wall Street Journal article attributed the falling murder rate to advances in trauma care: "In Medical Triumph, Homicides Fall Despite Soaring Gun Violence." The article based its conclusion — that "America has become no less violent" over the past two decades — on the CDC's shooting estimates.

The article did not cite the other estimates of gun violence that show shootings trending down, or the level of uncertainty in the CDC's own data.

Livingston, the Newark trauma surgeon, said that it's "very nice" when journalists give trauma surgeons credit for saving more lives. "I think that improvements in trauma care clearly have made a great difference," he said. "On the other hand, if you don't know the extent of all of the patients, and all of the data, you can make some erroneous conclusions."

At University Hospital, which treats the vast majority of shooting victims from Newark and surrounding towns, Livingston and other doctors decided to do their own research.
"It's easy to count dead people. But counting people who are merely injured? The data was all over the place, and, frankly, terrible," Livingston said.

In a paper published early this year, they looked back at their own hospital's records and logged every gunshot wound patient from 2000 to 2011.

What they found was that the number of patients injured by guns had actually held roughly steady over the past decade. But the injuries were getting worse. The percentage of patients who came in with multiple bullet wounds had increased from only 10 percent in 2001 to 23 percent in 2011. The incidence of brain and spinal cord injuries almost doubled.

And though trauma care has advanced over the past decade, the mortality rate for gunshot wound patients in Newark had actually increased, from 9 percent to 14 percent.
With more severe gunshot injuries came increased costs. The researchers estimated the total cost over 10 years for their hospital was at least $115 million — and three quarters of that was unreimbursed, which meant that taxpayers ultimately paid the bills.

In total, the hospital had treated an average of 527 patients with intentional violent gunshot injuries each year: "unrelenting violence," as the researchers termed it.

Are the trends that the Newark researchers observed an anomaly? Or are gunshot wound injuries across the county becoming more severe, as they have at this one hospital? The Newark researchers looked for national data and could not find it.

After the American Bar Association and medical and public health groups collaborated on an extensive campaign — with the message, "what we don't know is killing us" — Congress did approve funds to begin building a National Violent Death Reporting System in 2002. The push was inspired by a successful effort to track highway vehicle accidents, which experts say has helped reduce the number of deaths from car crashes.

But until last year, the system had only received enough congressional funding to collect detailed data on deaths in 18 states. Then after the Sandy Hook shootings, Congress approved an additional nearly $8 million for database, though that still isn't enough to detail violent deaths in all 50 states.

President Obama has asked for enough funding next year — $23.5 million — to allow the CDC to finally begin to collect violent death data nationwide.

As for tracking the number of Americans who are violently injured and survive, CDC spokeswoman Courtney Lenard, said simply, that "is something that may be considered in the future."

Funding a CDC effort to track nonfatal violence is not the only path to getting a better answer. Livingston and Demetriades, the Los Angeles trauma surgeon, suggested that independent medical associations could also help collect national nonfatal gun injury data, supported by government funding, and perhaps by legislation. In order to get a clear picture of gun violence, injury data from hospitals should be combined with local law enforcement data about crimes, they said.

Another solution might be better FBI data. "In my opinion, the FBI's UniformCrime Reports system should be changed so that it tracks nonfatal gunshot woundings in criminal assaults," said Daniel Webster, a gun violence researcher at Johns Hopkins University.

"If the FBI could get local agencies to include nonfatal criminal shootings into its UCR system, you have the capacity to track information that hospitals couldn't — distinguishing domestic shootings, from gang shootings, from robbery shootings."

An FBI spokesman said that changes in data collection practices could be made through congressional mandate or through the Criminal Justice Information Services Division Advisory Process, which would require buy-in from an advisory board of local, state and national law enforcement representatives.

In the past, changes to UCR data collection methods have been rare, the spokesman said. But several changes have been made in recent years, including changing the definition of rape, and changing how data about hate crimes is collected.

Cook, the Duke University researcher, said that the first step should be to find out why CDC data shows a different trend than other measures, and clarifying whether the ways hospitals collect data — or changes in the willingness of patients with minor gunshot wounds to come to the hospital for treatment — might explain the disparity.

"We have a variety of other evidence that gun violence is going down," Cook said. "By Occam's razor, I'd have to believe that the simplest explanation is that the nonfatal woundings are going down, too."


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    Why China failed in creating own brands

    Western markets are not dominated by Chinese brands. It is the Chinese market that is being dominated by foreign brands. Even in surveys, local Chinese brands get criticized for poor quality and engineering and lacks the trust

    When China started to make cars, a chill went through automakers in the US and Europe. They shared a vision of millions of cars made with exceptionally cheap labour landing on western shores. It looked like a repeat of the success experienced by the two exporting powerhouses, Japan and Korea. Besides, China was well on its way to become the workshop of the world dominating sector after sector. Why not cars?


    Why not indeed. Something happened that had not been predicted by the economists and analysts. It wasn’t the western markets that were dominated by Chinese brands. It was the Chinese market that became dominated by foreign brands.


    Ten years ago, Chinese brands controlled 70% of the local market. Now they have been reduced to 45%. If you exclude the barebones pickup trucks and minivans that make up the light commercial vehicle market, domestic brands have only 29.5% of the market.


    Even in a globalized world, it is distressing to watch foreigners come to dominate a local markets. This is especially, true for an important industrial segment like automobile manufacturing. Even in the US, where the Japanese cars have been present for 40 years, there are places where it is considered unpatriotic to own one.


    Why have the Chinese failed to build successful brands even in their home market? Obviously, they have not been able to match the quality of developed countries’ manufacturers. Until recently, they were very competitive on price. Why can’t they seem to develop successful brands?


    The reason for the failure is the way the Chinese government use their legal and regulatory system. Foreign companies coming to China to produce products for export were lightly regulated in every way. China wanted to encourage exports and follow the Japanese model. In contrast, foreign companies that wanted to sell into China faced discrimination.


    In theory, this sort of protectionism should have worked, but instead it backfired. The first problem for local brands was a lack of trust. For example, large Chinese dairies were only subject to minimal safety regulations. They took advantage of this by lacing infant formula with melamine a byproduct of coal. Melamine was put into the formula to allow substandard milk to pass protein tests. The result was a national scandal in 2008. Six children died and over 300,000 were sickened.


    To this day, Chinese consumers go to great lengths to buy foreign brands. They even ask their friends traveling to other countries to send back infant formula a few cases at a time.


    Rather than force local dairies, many of them government owned, to adhere to stricter standards, the Chinese government used laws, policy and even the state media to strike back at foreign brands.


    The state television has accused Danone, the French food company, of bribing hospitals in Tianjin to use its infant formula. It restricts importation of foreign infant formula created for other markets imported by third parties into China. To help local dairies it has created subsidies.


    The auto industry has similar problems. Domestic Chinese auto companies didn’t do well in crash tests. In surveys, local brands get criticized for poor quality and engineering.


    Foreign companies are required to form 50-50 partnerships with local firms. The Chinese were thinking of dropping this requirement. Trading partners might retaliate if China were ever to start exporting cars in large numbers. But since they don’t, the largest politically connected; state owned Chinese companies were able to keep the restriction in force. With this type of protectionism in place, it is even more unlikely that China will be able to develop export markets.


    The Chinese required foreign companies to produce “indigenous” brands. For example BMW Brilliance makes the local Zinoro. Dongfeng Nissan builds the Venucia. The most successful is the SAIC-GM-Wuling Automobile Company’s Baojun. They sold 100,000 Baojins in 2013 up 20%. This would be great except that Baojun’s achievement came at the expense of local Chinese brands.


    China has also inhibited foreign competition by failing to enforce intellectual property laws. Stealing intellectual property in China is done on a massive scale including wide spread computer hacking to steal information.


    Stealing from foreigners may seem like a good idea in the short term. But if Chinese companies can steal from western companies they can also steal from each other. A brand is one of the most important and valuable assets of any company. If it cannot be protected, then companies do not have an incentive to build it up.


    Consumers in India, Indonesia and the Philippines do not have the overwhelming preference for foreign brands. Indonesia and the Philippines actually have a clear preference for local brands. India gives the foreign brands a slight edge.


    What is interesting is that although their preferences are slightly different, the views of local and foreign brands in these three countries are quite similar. Foreign brands are considered to be more fashionable and of better quality. Local brands are believed to offer a better price. There is a universal preference to support local companies. As to reliability, consumers in all countries rated both local and foreign brands about equally.


    It’s not that Chinese companies cannot compete with foreigners. Jin Duo Bao is a cold herbal tea that outsells Coca-Cola in China even though it is more expensive. It sells well because it is appeals to local beliefs and preferences.


    Rather than attempt to regulate the market, the Chinese should take a lesson from the Indian processed foods market. The local companies view their competitors as positive. With large advertising budgets foreign firms have been able to increase the size of the market and create new market segments that nimble local companies with better distribution and local knowledge can exploit.


    Every policy, every law, every regulation created by governments to solve a problem will have unintended consequences. These are sometimes worse than the issue that was meant to be solved. Sometimes the best use of power is not to use it at all.


    ( William Gamble is president of Emerging Market Strategies. An international lawyer and economist, he developed his theories beginning with his first-hand experience and business dealings in the Russia starting in 1993. Mr Gamble holds two graduate law degrees. He was educated at Institute D'Etudes Politique, Trinity College, University of Miami School of Law, and University of Virginia Darden Graduate School of Business Administration. He was a member of the bar in three states, over four different federal courts and speaks four languages.)

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    7 years ago

    Well your argument may be true in consumer goods, but I see the opposite in industrial goods. In every industry, be it telecom, energy, Chinese companies have built brand value and are gaining market share. So how do we explain that?

    Weak sanction for sprinter Gay signals change in anti-doping tactics

    Anti-doping investigators say they would rather trade leniency for information on coaches and other athletes involved in doping

    This story was co-published with Sports Illustrated

    Last week, when the U.S. Anti-Doping Agency announced that sprinter Tyson Gay would be banned for just one year for failing a series of drug tests, the Olympic sports world responded with a resounding: That's it? You're kidding!

    Thanks to his cooperation with investigators, America's top sprinter was given half the standard two-year punishment. Since Gay stopped competing last summer after failing the tests, he will be eligible to compete again next month.

    As ProPublica reported in February, Gay tested positive after using creams given to him by an Atlanta chiropractor that listed several banned substances, including testosterone, right on the label.

    Stuart McMillan, sprint coach at the World Athletics Center in Arizona, neatly summarized the majority opinion when he told the Guardian Monday: "No sane person can find justification in [Jamaican sprinter Asafa] Powell receiving an 18-month ban for inadvertent stimulant use while Gay receives a 12-month ban for purposeful steroid use."

    According to people with knowledge of the USADA investigation, Gay was assured by the chiropractor that the products were legal, and that NFL players and other track athletes had used them without failing tests. Nonetheless, using a product that lists banned steroids as ingredients is, at best, "staggering negligence," according to World Anti-Doping Agency head David Howman.

    But anti-doping experts say Gay's short suspension is actually a good sign for the pursuit of doping as a whole. Anti-doping officials have learned that drug testing cannot catch the most sophisticated cheaters. Marion Jones passed over 160 drug tests; Lance Armstrong passed even more. Incentivizing athletes to become informants, as Gay did, has become a critical component of enforcement. According to people familiar with the Gay investigation, the sprinter told investigators that his former coach Jon Drummond, a gold medalist and chair of USA Track and Field's Athletes Advisory Committee, encouraged his use of the banned products and transported them for him. They said that Gay also gave information about the chiropractor, as well as NFL players and other track athletes he believes were using the same or similar products.

    Gay's seemingly light punishment, anti-doping officials say, will ultimately serve the greater good, because intelligence gathering accomplishes what drug-testing never will.

    Consider just a few of the gaping holes in testing:

    A 2006 study by Swedish scientists found that a variation of one single gene involved in urinary excretion of testosterone allows some lucky dopers to pass the most common test for steroids no matter what they inject. In that study, 9.3 percent of Swedes had the get-out-drug-testing-free gene, and 66.7 percent of Koreans had it. "It's very frustrating," said Christianne Ayotte, whose lab in Montreal conducts testing for pro sports, including Major League Baseball.

    The most common test for human growth hormone — thought to be one of the most popular substances for doping — has a detection window of 10 to 20 hours. So a baseball player who is tested following a game — when such tests typically occur — can inject HGH and be clean by post-game the next day, when he could be tested again. Plus, the threshold for deeming a test positive is so conservative that in a study in which volunteers purposely took HGH — which helps build muscle and cut fat — not a single one of them met the bar.

    Simply using frequent applications of small amounts of fast-acting steroid creams or gels will often keep a cheating athlete below test detection limits, while providing most of the benefits of traditional doping, in which athletes apply higher dosages less frequently.
    Some popular doping substances, such as insulin-like growth factor 1, or IGF-1, occur naturally in the body and current anti-doping tests cannot distinguish natural IGF-1 from synthetic IGF-1. IGF-1, which gained notoriety in sports for its presence in deer antler spray, is a potent muscle-building hormone. The reason athletes take HGH, in fact, is that it boosts levels of IGF-1 in the body.

    As Paul Scott, head of Scott Analytics, which provides testing services to pro cycling teams, put it: "Anti-doping testing has a reputation that far exceeds its capabilities...The rate of false negatives is enormous."

    Even as anti-doping technology has improved, WADA statistics show that the proportion of worldwide tests that are positive has remained between 1 percent and 2 percent per year for more than a decade. The dopers and anti-dopers, it appears, are in technological lockstep.

    Nearly all of the most high-profile, and successful, anti-doping cases — from BALCO to Biogenesis — have come from intelligence gathering, rather than failed tests. As a result, anti-doping officials are continually strengthening policies that motivate athletes to trade information for leniency. The current WADA code allows for up to a 75 percent reduction in a sanction for "substantial assistance," which requires that an athlete give significant information on people other than himself who are involved in doping. (A two-year ban, then, could become as short as six months.)

    WADA chief Howman said that such cooperation is really the only way to go after coaches and support staff who enable systematic doping. "Being able to go after the athlete entourage is huge," Howman said, "and they aren't subject to testing. If you look at the Armstrong case, Armstrong could've been picked up in a number of ways, but [former U.S. Postal team director] Johan Bruyneel couldn't have." Bruyneel was banned from any involvement with sanctioned competitions for a decade, but only because U.S. Postal riders informed on him in return for reduced suspensions, some as short as six months, despite acknowledging chronic and systematic doping.

    The Court of Arbitration for Sport — an international body in Switzerland that adjudicates doping-suspension appeals — has told anti-doping officials that continuing to penalize athletes while leaving coaches and doping doctors alone is unfair. According to one anti-doping official, simply slapping Gay with the maximum, two-year ban rather than cutting a deal to persuade him to inform on others would be "an isolated, whack-a-mole approach that doesn't solve the problem." Turning him into an informant, the official says, "reflects the newest and best anti-doping policy, which is that you can't just kill the athletes. If you want to solve the problem, you have to get those in the system who are pressuring athletes to cheat."

    Even with the potential for reduced bans — which has existed since 2009 — Howman said only "two or three athletes came forward," aside from those involved in the Armstrong case. "So omertà is still flourishing," he said. That prompted WADA to create even bigger potential incentives for athletes facing bans. Beginning in January, a new WADA code will go into effect that allows athletes who provide significant cooperation potentially to avoid a suspension entirely.

    Undoubtedly, the public blowback will be intense the first time a doping athlete gets off scot-free. But just as FBI and DEA agents have learned through investigations of organized crime, sometimes the only way to dismantle illicit networks is to motivate informants. Anti-doping is just following suit.


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