You may recall that back in April, 2015, eight national medical organizations plus the American Bar Association called deaths and injuries from guns a “major public health problem in the United States,” and asked for a stronger medical response to gun violence. Now if these medical groups, representing every medical specialty, had issued a joint statement about any other medical issue that causes more than 100,000 deaths and injuries each year, the public reaction would have ranged from ‘what took you so long?’ to ‘let’s get to work and solve the problem.’ But in this instance, of course, much of the public reaction came in the form of the now-traditional response by Gun Nation, telling the tribe that this was simply another attempt by gun-grabbing, anti-gunners to take away all the guns.
When medical groups advocated in favor of seat belts, did anyone say that car safety wasn’t a medical issue because physicians didn’t, as a rule, undergo training on car repair? The proper medical response to any problem that causes injury is both prevention and cure; prevent the injury before it happens which reduces the number of people who then show up looking for a cure. But the gun lobby is wedded to the idea that there is no such medical condition known as ‘gun violence,’ and to degree that on a rare basis someone accidentally gets hurt using a gun, it’s a small price to pay considering that armed citizens prevent millions of crimes each year.
Having observed the ease with which Donald Trump convinces his supporters that his lies are really self-proclaimed truths, I’m not surprised that millions of Americans and certainly a majority of gun owners agree with the nonsense that the NRA and like-minded sycophants continue to spread about the benefits of owning a gun. But physicians do not have the luxury of developing treatment guidelines for medical conditions based on what their patients might want to believe. When research indicates repeatedly that a certain type of behavior creates medical risk, then medical professionals must respond on that basis and that basis alone, regardless of what people who sell guns for a living would like their customers to believe.
Which is why the new article by Garen Wintemute is so important because what he and his research associates are trying to do is develop a practical method to communicate concerns about gun risk to patients who might be predisposed to reject or be skeptical about what their physician tells them about guns. Their initial article, published last August, discussed the need for physicians to acquire a higher level of ‘cultural competence’ in order to communicate effectively with gun-owning patients; in particular calling on gun-owning physicians to provide leadership in developing messaging that gun-owning patients would more likely understand.
But adopting a respectful and supportive toward a patient with a different cultural outlook is one thing; knowing what has to be communicated from a clinical perspective is something else. And Wintemute’s group has now taken that step by publishing a new article that seeks to define what physicians should say and/or do if they believe that a patient’s access to guns creates a medical risk. Aligning proper responses to different levels of medical risk is standard procedure for nearly all public health issues, particularly those issues, like gun violence, that have been listed as public health concerns for more than twenty years. But thanks to the ban on CDC gun violence research and the continuous anti-medical drumbeat of the NRA, creating proper medical messaging for gun violence has been tantamount to finding yourself in deep water without a paddle or even a canoe.
The medical profession needs to ignore the NRA and self-aggrandizing politicians who cynically use their opposition to the concept of gun violence as a medical risk to inflame their base. After all, Galileo spent the last nine years of his life under arrest, but when we drop a solid object, it still falls straight down.