Why Should Doctors Talk To Patients About Guns? Let The NRA Do It.

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When the 11th Circuit re-instated the Florida gag law on physicians talking to patients about guns I knew that sooner or later we would hear from Timothy Wheeler and his gun-promoting group which believes that 19,000 gun suicides, 11,000 gun homicides and 50,000 (or more) intentional gun injuries each year shouldn’t concern physicians at all.  Wheeler is the doctor who began promoting the idea that doctors who inquire about gun ownership are their patients’ worst enemies, and his organization is rolled out by the pro-gun lobby whenever they need additional ammunition to keep America from adopting a common-sense approach to the issue of gun violence.

Wheeler’s organization, for which his claim of having thousands of members has never been verified in any way whatsoever, has just launched a small campaign to support the Florida gag law, at the same time that a coalition of medical associations and advocacy groups are going back to the 11th Circuit to ask the entire court, en banc, to overturn the recent ruling.  Which is exactly why Wheeler and his buddies in the gun-blogging community are trying to tilt public opinion the other way.

docs versus glocks                In the interests of full disclosure, I should state that I am married to an attending pediatrician, and am also a member and certified gun trainer for the NRA.  I have no issue with private ownership of guns but I take personally these indecorous attacks on physicians who are required to speak with patients about any matter which they feel might pose a medical risk, particularly involving something as potentially lethal as a gun.  The shabby attempt by physicians like Wheeler to pretend that guns do not constitute a health risk reminds me of the pathetic charades conducted back in the 1950’s by a few physicians and scientists who publicly disavowed any link between smoking and cancer.

Of course Wheeler and his cronies, in this case a psychiatrist named Robert Young, don’t want their audience to believe that they are against safe use and storage of guns.  After all, everyone’s in favor of safe gun use these days,  just ask the NRA and they’ll tout their gun safety program, aka Eddie Eagle which has “reached more than 26 million children in all 50 states.”  The same website that contains this information about Eddie Eagle also states that the NRA is “not affiliated with any firearm or ammunition manufacturers,” which is, simply put, a lie.  But Dr. Young seems oblivious to the requirement in his own medical profession to base clinical decisions and strategies on evidence-based information, since he advises his medical colleagues to use the Eddie Eagle handouts in contacts with patients who might or might not own guns.

I saved the best part for last.  Although Dr. Young believes in educating children in safe behavior around guns, he also wants to make sure that the safety of children is balanced out by the requirements for self defense.  And I quote:  “Even the sound practice of storing guns and ammunition in separate, locked places isn’t always right if they are intended to be used for emergency protection.”

This guy’s a physician?  This guy took the Hippocratic Oath which requires him to counsel patients about risks to their health?  There is not one single piece of credible research which shows that keeping a loaded, unlocked gun around the house creates protection from crime that outweighs the risks of injury or death from the existence of that gun.

People like Robert Young and Timothy Wheeler find media outlets for their destructive ideas because we really are committed to the idea of hearing “both sides” in the public policy debate.  But I don’t think that there are two sides when it comes to discussing a health issue which claims 80,000 or more victims each year.  Unless, of course, you’d rather believe that mortality and morbidity at those levels has nothing to do with health at all.

A Different Perspective On Docs Versus Glocks

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I’m going to paraphrase President Obama’s quip about Cliven Bundy at the White House Correspondents’ Dinner: If someone starts off by saying that doctors shouldn’t invade the privacy of patients by asking about guns, you don’t really need to know the rest of it. But an op-ed in the Pensacola News Journal caught my attention because the writer came up with a rather ingenious reason why gun ownership should not be considered a risk when compared to other, much more serious health risks that physicians don’t treat at all.  And what is the risk that physicians overlook in their obsession to take away all our guns?  Flat feet.

The author of this remarkable missive, a Pensacola resident named David Dodson, was reacting to the newspaper’s editorial which called on physicians, particularly pediatricians, to willfully ignore the law and continue to ask their patients about guns.  What drove Dodson to respond to the newspaper’s opinion was not just the invasion of privacy that occurred every time a physician asked a patient about guns, but his discovery that other, much more important medical issues were being ignored during examinations, in fact, were no longer part of the medical school curriculum.

The result of this negligence, according to Dodson, is s veritable “epidemic” (his word) that physicians have needlessly “thrust” on children by not treating their bad feet which then leads to “bad knees, bad hips, bad backs and lame adults.”  And how did it come about that such an important part of the human anatomy is completely ignored in consultations between physicians and children?  Because “the care of children’s feet is not taught in medical schools anymore.”

docs versus glocks                Dodson’s information on medical school curriculum was told to him by a “member of a national board of pediatrics” which, unfortunately, he neglects to identify or name.  This is too bad because if there is such an organization, it’s probably an offshoot of the medical board that allowed Rand Paul to certify himself as an ophthalmologist.  Maybe Dodson’s a podiatrist, maybe he’s just a nincompoop, and maybe he’s just one of these retired guys who strolls over to the local park every morning to engage the other, self-professed retired experts in whatever important news issues were discussed that morning on Fox.  Whatever he is, physicians and other medical professionals should be heartened by the fact that his op-ed piece was printed by the Pensacola News Journal as a response to its editorial about doctors and guns.

The way it works in the news media is that if an editorial board publishes an editorial on any given subject, they usually feel obliged, in keeping with the notions of balance and fairness, to publish something which gives the opposite argument to what the editorial actually said.  But since the readers don’t see every response to an editorial, we have to assume that the editors can pick and choose based on what they hope their readers will learn from being exposed to both points of view. And I have to imagine that in their decision to publish Dodson’s response, the editors of the Pensacola News Journal wanted their readers to understand exactly why the law criminalizing physician’s seeking information about guns was proof, as they said, that the Florida legislature was “sick in the head.”

Defending the Florida law as an “assault” on the 2nd Amendment, like Obama said about Bundy, just doesn’t go very far.  And anyone who talks about the issue on that basis will wind up talking only to people who don’t have a clue.  But here’s a guy who doesn’t want physicians to ask about guns because he knows that medical school anatomy cuts the human body off somewhere below the knees.  And if we don’t believe him, we can always trust his unidentified source. Now if this is the best that the gun community can produce to keep physicians from asking about guns, on this issue the physicians clearly have the upper hand. The Florid legislature may be sick in the head, but I doubt if the illness will spread all that far.

 

 

What’s The Difference Between Roe V. Wade and Heller vs. District of Columbia? Maybe Nothing.

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The right to bear arms, as stated in the 2nd Amendment and defined by the SCOTUS in the Heller and McDonald cases, got a boost this week from the most unlikely source; i.e., an abortion-rights case in Alabama where Federal District Court Judge Myron Thompson struck down a 2013 law that would have made it extremely difficult for women to receive abortion services unless they were able to travel long distances from home, thereby creating an undue burden and nullifying the right to an abortion guaranteed by Roe Vs. Wade.

The new law, similar to a measure that was voided in Mississippi, required physicians who performed abortions to be granted credentials in neighboring hospitals, but such credentials are only granted to physicians who live and practice within a limited distance of the particular hospital.  Three of the five abortion clinics in Alabama are currently staffed by physicians who reside in other states and travel to Alabama for the purpose of administering scheduled abortions.  Hence, they could not receive hospital credentials and therefore could not operate their abortion clinics.

  Judge Myron Thompson

Judge Myron Thompson

Judge Thompson heard testimony from numerous witnesses representing both the State of Alabama and the abortion providers, and nearly all of the 172-page decision is a very careful summary of what was said by parties on both sides.  Ultimately the weight of the testimony convinced the jurist that by reducing the number of abortion clinics from five to just two, the State was effectively blocking access to an abortion and therefore could not be reconciled with the rights of women to terminate their pregnancies as stipulated in Roe vs. Wade.

You have to wade through almost the entire decision, however, before you come to the point where women in Alabama seeking an abortion find themselves making common cause with Alabama residents who want to own a gun.  To quote Judge Thompson: “At its core, each protected right is held by the individual: the right to decide to have an abortion and the right to have and use firearms for self-defense.  With this parallelism in mind, the court poses the hypothetical that suppose the government the government were to implement a new restriction on who may sell firearms and ammunition, and further, only two vendors in the State of Alabama were capable of complying with the restriction.  The defenders of this law would be called upon to do a heck of a lot of explaining — and rightly so in the face of an effect so severe.”

Last year Alabama also passed a new gun law that made it easier for residents to receive a concealed-carry license and also allowed for concealed-carry of handguns into certain public events. Alabama has always been a gun-rich state, with per capita gun ownership well above the national norm.  Now I can’t imagine there would ever be as many women in Alabama seeking an abortion as there might be folks looking to buy guns.  But even though Judge Thompson was educated at Yale, he’s Crimson Tide through and through. Abortion might not be a popular issue in an Evangelical state, but when explained as a parallel to the 2nd Amendment, all those God-fearing, Bible-thumpin’ gun owners may just agree that what’s right is a right.

But Thompson’s decision is also a case in point for the folks who want more controls over guns.  Because ultimately in order to make their case for more gun control, people who don’t own guns are going to have to figure out how to talk to people who do.  The last few pages of Judge Taylor’s decision should be required reading for Brady, Everytown and all the rest.  Supporters of the 2nd Amendment and supporters of abortion rights may have more in common than we think.

What’s Wrong With Using A Gun To Have Some Fun?

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Last week I received an email advertising a “Level II Defensive Carbine Class” that will be held at a gun range in a neighboring state.  The class will be led by a gun trainer whose website offers the usual list of shooting courses, some of which I also teach.  According to the email, you show up with 150 bucks and either an AR or AK-style gun, and before the class is over you will, among other things, learn how to shoot while moving, shoot behind cover, shoot from the side, close-contact with the target and so forth.  In other words, by the time you’re finished shooting upwards of 700 rounds, whether it’s Al-Qaeda, the Muslim Brotherhood, a marauding band of local criminals or anyone else, you’ll be ready to take them all on..

assault                These tactical shoots and classes have become much more popular over the last few years, just as assault-style rifles have supplanted bolt-action rifles and shotguns as the one long gun that everyone needs to have. And while you’re at it, after you buy the gun and the thousand rounds of ammunition, let’s not forget the indispensable gear like a night-vision scope, some extra hi-cap mags, a pair of tactical boots and a camo battle jacket that will hold everything and anything you might need out in the field.  For good measure go online and buy a couple of instructional videos from Daniel Defense or watch and play the latest Youtube tactical video from Combat Arms.

Now whenever the gun control gets together, the first thing they always want to do is eliminate all this fun.  Hi-cap magazines?  Ban ‘em.  Tactical rifles?  Ban ‘em.  And while you’re at it, why not ban night-vision scopes as well?  After all, imagine how much more damage James Holmes might have committed if his assault rifle had been mounted with a night-vision scope.  Never mind that rifles, regardless of design or caliber account for less than 10% of all gun homicides and assaults each year.  Ask the average man or woman who’s active in any kind of gun control organization and they’ll tell you that getting rid of those assault rifles needs to be done.

But let’s get back to the group that’s going to be shooting their AR’s and AK’s in the defensive carbine class.  The truth is that none of these guys (and gals) will ever have to defend the homeland from a terrorist attack.  And if anyone has used an assault rifle recently to shoot someone breaking down their door, it hasn’t made the evening news.  I looked at the stories posted by the NRA on their Armed Citizen website which contains 40 accounts of how good guys shot or shot at bad guys since April, 2014, and there wasn’t a single incident listed in which the gun used was a rifle of any kind, never mind an AK-47 or an AR-15.  Training with an assault rifle to repel an attacker is like getting instructions for putting on the oxygen mask before the airplane takes off.  You have to know how to do it but the odds that you’ll actually need it are somewhere between non-existent and zilch.

The real reason that people are going to show up for this carbine class is because they’ll have a lot of fun.  They’ll get to shoot their gun again and again, compare one gun to another, maybe play a little game to see who can shoot accurately, and spend a day with other folks who share their enjoyment in shooting those guns.  Do you really think there’s any difference between a bunch of guys running around a sand pit shooting at Osama Bin Laden Zombie targets and the way we used to run around the back yard with our Red Ryders pretending there was an Indian behind every tree? Anyone who thinks that 30,000 gun fatalities and 50,000 gun injuries each year isn’t a problem has at least one screw loose if not two, but that problem won’t be solved by taking the toys away from grown-ups who still enjoy acting like kids.

Here Comes Bloomberg And Some Senators May Not Be Able To Duck

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Several months ago I wrote a blog in which I pointed out that Mike Bloomberg’s access to media at all levels would make him a formidable opponent of the NRA when it came to talking to non-gun owners about guns.  The NRA has a lock on communicating with the gun-owning community, but a majority of Americans don’t own guns.  So how do you engage this usually-silent majority to counteract the power and influence of the NRA?  Well here comes a good test case.

Tomorrow the Senate Judiciary Committee holds a hearing on a bill introduced by Senator Amy Klobuchar (D-Minn) that would more clearly define domestic violence and strengthen what is already a Federal prohibition against the purchase of guns by individuals convicted of misdemeanor domestic abuse.  The NRA is against the measure but in atypical fashion is opposing it in a rather quiet way, restricting themselves to sending a non-public letter to some Senators, but so far avoiding any public comment on the debate. Their stealth approach to this issue lies in the fact that they have been making a major marketing push towards women as owners and users of guns, but they know that opposing domestic abuse laws would, from the perspective of most women, put them on the wrong side.

bloom                It can’t be said, however, that Mike Bloomberg shares the NRA’s reluctance to make a lot of public noise. On the eve of the Senate hearing, he’s running a 30-second television spot in media markets covering territories belonging to Senators Kelly Ayotte, Jeff Flake and Dean Heller, three Republicans who last year voted against the Manchin-Toomey compromise after Sandy Hook and whom, it is felt, may this time with Klobuchar’s bill, be swayed to go the other way. The ad is pretty dramatic and the Everytown website also contains a quick-click method to send a message to Ayotte, Heller and Flake.

Last month the Everytown group won a big one when their pressure pushed the mega-retailer Target to issue a public statement requesting that shoppers refrain from bringing guns into their stores.  Target’s decision was a slap in the face of the NRA which has been pushing a roll-back of gun-free zones as part of their strategy to widen the acceptance of concealed-carry laws.  But the strategy used by Bloomberg’s group against Target was, if you’ll pardon the pun, a very targeted affair.  Inviting local media to a picket-line around a store entrance is one thing; inundating elected officials with emails and calls is quite another.  The latter tactic has always been seen as a major weapon in the NRA’s arsenal for swaying votes.  For the first time, the other side in the gun debate is doing the same thing.

It’s not really the number of phone calls or emails that makes politicians respond.  It’s a less tangible thing that we call the intensity of the folks sending their messages, a devotion to the cause that the NRA has diligently developed amongst its membership over many years. When something terrible and high-profile occurs like Sandy Hook, it’s not very difficult to get a grass-roots response from either side.  But a Senate hearing isn’t usually the stuff that makes for media buzz, so it will be interesting to see the degree to which Bloomberg’s group can generate a grass-roots response to their ad.  And if they do, the playing-field that has been tilted for so long in the NRA’s direction may just start moving back the other way.

Docs Versus Glocks – Round Three And Not Yet Finished

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Remember the Thrilla in Manila?  We’ve got Docs Versus Glocks and Round 3 has just come to an end.  The epic battle began in 2011 when the Florida legislature passed a law prohibiting physicians from inquiring about ownership of firearms unless the question was “relevant to the patient’s medical care or safety or the safety of others.” [All quotes from the decision posted on the 11th Circuit website.]  That was Round 1.  The law was then challenged in Federal District Court and overthrown by Judge Marcia Cooke who issued a permanent injunction because it violated physicians’ 1st Amendment free speech by curbing the ability of the doctor to freely inquire into situations that might impact a patient’s health. That was Round 2. The State of Florida then appealed to the 11th Circuit which declared the law constitutional last week. Interestingly, the Circuit Court did not order Judge Cooke’s injunction to be lifted, which means that as of the end of Round 3, it’s something of a tie.

I’m no constitutional lawyer, or any other kind of lawyer for that matter, but I have been following this case very closely because it’s part and parcel of the NRA’s attempt to push physicians out of the discussion about guns, a campaign they have been effectively waging since 1996.  That year Congress removed funding for gun research from the CDC budget, a prohibition that was later spread to other federal research agencies and remains in effect to this day.  And even though a meeting of the Institute of Medicine following Sandy Hook identified areas of gun research that should be pursued, there’s scant (which means ‘no’) chance that such funding will appear.

glock 23                The ‘official’ reason that the NRA is against research into gun violence is that the research is being carried out by public health and medical scholars who use such research to advance an anti-gun agenda.  And if by ‘anti-gun’ the NRA means any form of gun control, they happen to be right.  The basic public health research on guns shows again and again that the presence of a gun heightens the possibility of homicides, assaults and suicides, findings that the NRA says are contradicted by the research of people like Gary Kleck and John Lott whose research allegedly proves that more guns equals less crime.  But no matter how you shake or bake the data, it’s simply impossible to deny the intuitive judgement of the novelist Walter Mosley that “if you carry a gun, it’s bound to go off sooner or later.” And if the bullet from that gun hits another person, there’s only one group of professionals whose response we really trust.

. The 11th Circuit majority found the Florida law constitutional because they believe that the professional-client communication doesn’t necessarily warrant 1st Amendment guarantees.   The law, according to the majority, only prohibits physicians from “inquiring about a private matter irrelevant to medical care.”  But what the majority avoided in its decision was spelling out who has the authority and obligation to decide the issue of relevancy, which, according to the dissenting judge in this case, is the responsibility of doctors themselves.  The dissent noted that gun violence is considered a public health issue by virtually every medical society, and physicians are performing their “chosen role” by informing their patients about risks that come with the ownership of guns.

I was in the audience at Madison Square Garden  when Ali won the Thrilla in Manila because he just outlasted Smokin’ Joe.  I think that Docs Versus Glocks will end the same way because no matter how hard the NRA keeps hammering, we value the competence and  expertise of physicians and we ultimately expect them to decide what’s best for our health.  The majority in the 11th Circuit recognized that “the patient must place his or her trust in the physician’s guidance,” which means listening to what the doctor says even if even it’s something we don’t want to hear.  And by the way, there’s no patient in America who ever has to do what the doctor says.

Score One For The NRA. And For Everyone Who Wants To Carry A Gun

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The NRA won a big one Friday when District Court Judge Frederick Scullin, Jr., issued a long-awaited decision in Palmer, et. al., vs. District of Columbia,  a case that was initially brought in 2005 against DC’s total ban on carrying concealed guns outside the home.  The judge not only ordered the District to stop enforcing its concealed-carry ban, but also ordered the District to stop enforcing the same ban against non-residents who want to travel through DC while carrying a gun.  This is because one of the plaintiffs, Edward Raymond, was a resident of Maryland and held a concealed-carry permit from his state of residence but did not have any legal authorization to carry a gun in DC.  Nevertheless the District Court noted that, “the District of Columbia may not completely bar him, or any other qualified individual, from carrying a handgun in public for self-defense simply because they are not residents of the District.”

scalia                Wow!  Talk about a gift.  If this ruling is not challenged and overthrown, Palmer vs. DC paves the way for the gun lobby to get what it has always wanted, namely, national concealed-carry without having to pass a federal law at all.  Every year pro-gun Senators and Congressmen routinely file bills that call for a reciprocal concealed-carry, much in the same way that a driver’s license issued by any one state is valid in every state jurisdiction in the land.  Such laws have never gotten to the floor of either chamber for a vote, but Judge Scullin’s decision may nullify the need to travel down this legal avenue any more.

Much of Judge Scullin’s reasoning followed from the recent Peruta decision, in which the Ninth Circuit Court of Appeals overturned a concealed-carry law that had effectively made it impossible to carry a gun outside the home in San Diego County.  This decision struck down the County’s law which required applicants to show “good cause” for wanting to carry a gun outside the home, because the definition of good cause went far beyond a general desire for self-protection and basically required the applicant to prove that without a gun he or she would be unable to protect themselves against a specific threat and therefore would be placing themselves in “harm’s way.” The Peruta decision claimed that the 2nd Amendment, as decided in Heller, required some form of concealed-carry outside the home. This is an interesting reading of Scalia’s decision in Heller, which explicitly limited civilian ownership of guns to keeping them within the home.

There are now five federal circuit courts that have ruled on whether the 2nd Amendment protects concealed-carry outside the home.  Right now the score is 3-2 in favor of the more limited view of the 2nd Amendment that defines the “right to bear arms” as allowing people to keep a gun for self-defense inside their homes. But even the more expansive 2nd Amendment interpretations of the Seventh and Ninth Circuits give issuing authorities the right to “regulate” the issuance of concealed-carry as long as the regulations do not effectively prevent the average citizen from walking around with a gun. What cooked the goose of San Diego County was the willingness of the County to grant CCW to certain individuals (retired law enforcement, federal officers, etc.) which meant that the right was being extended to certain people but not others, a clear abridgement of any Constitutional right.

To date the SCOTUS has refused to resolve the disagreements between the different federal circuit courts over how far to extend 2nd Amendment guarantees.  But even if that bench remains silent, the decision by Judge Scullin to extend concealed-carry reciprocity to people who visit but do not live in DC could effectively make concealed-carry the de facto law of the land. Given the fact that only 9 states had any degree of unfettered concealed-carry laws less than thirty years ago, perhaps it’s time for the NRA to stop preaching that gun owners constitute a persecuted minority whose rights to own and carry guns are constantly under attack.

 

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