Violence in America: a public health emergency. Time to bite the bullet back.

Violence, according to one dictionary, is defined as "(1) exertion of any physical force so as to injure or abuse, (2) injury by or as if by distortion, infringement, or profanation, (3) intense, turbulent and often destructive action, or force." In his book Powershift Alvin Toffler identifies violence or the threat of violence as one of the three fundamental sources of all human power, the other two beingmoney and knowledge. Toffler convincingly argues that these power sources influence every person and all groups including government. Of the three, violence is the lowest form of power because it can only be used to punish. Knowledge and money are far more versatile and can be used in an infinite variety of positive as well as negative ormanipulative ways.1 The violence referred to in this issue of JAMA is the interpersonal kind rather than such types as war or that produced by forces of nature.