Don’t More Gun Injuries Mean More Business For Emergency Rooms?

Last week our friends at The Trace published an article on a brief but noisy exchange which broke out between a group of ER doctors and the NRA. The physicians have put up a website which claims to be collecting and distributing funds that will be awarded to gun researchers to make up for gun-research dollars no longer provided by the CDC.  The NRA is the NRA.

            This same bunch of physicians, whose gun-violence research credentials are impeccable, also put up a chain letter that could be sent to the NRA.  The letter was in response to an op-ed on the NRA website which basically told the medical community to stick its concerns about guns you know where.  The NRA editorial was the organization’s response to yet another medical article which found that, believe it or not, a connection between guns and gun injuries. Gee, what a surprise. And of course it’s even a bigger surprise that the NRA would deny that such a connection even exists.

Physicians and public health researchers have been publishing credible research on gun violence for more than twenty-five years. Know what these well-meaning and dedicated researchers have gotten for all their efforts? The elimination of CDC funding for gun research. That’s it. Period. Zilch. In fact, over the last several years, gun-violence rates appear to be going back up.  Oh well, oh well. Maybe another research article on gun violence will push the rates back down, right?  Wrong.

The good news, of course, is that the physicians who want you to sign their chain letter to the NRA also happen to be members of the American College of Emergency Physicians, the folks who usually have to figure out how to keep someone alive who has a bullet in their head. And they are remarkably skilled in this respect; of the 75,000 or so who suffer injuries from gun assaults each year, only 12,000 or so end up dead. The rest come back to the hospital on a much too-frequent basis and after a few more visits, also end up dead.

And how does the American College of Emergency Physicians (ACEP) respond to this problem? They give substantial financial support to the politicians who make a career goal out of preventing even the most minimal gun reforms from moving ahead.

How does this happen? It happens because the ACEP has a PAC which over the last two election cycles donated almost $150,000 to the election campaigns of 15 House members who are rated A+ by the NRA. The NRA gives an A rating to just about every member of the House GOP caucus, but these 15 are in a group all their own. They are the spear-carriers, the most pro-gun guys in Congress, and they do whatever is necessary to make sure that no gun legislation rears its ugly head.

So here we have a remarkable situation in which some physicians use social media to advance their gun-control agendas (and their public personalities) while their professional organization uses their dues monies to advance the cause of the NRA. Now you would think that when a doctor named Michael Siegel began writing about this issue, his concerns would be shared and amplified by the members of APEC who would like you to believe they are tirelessly working to end gun violence, right? Wrong again.

The Trace article quotes one of the self-appointed, gun-violence leaders of the medical community, Garen Wintemute, who says that physicians should ‘privately’ approach politicians about gun violence because to raise these issues publicly would be ‘divisive’ and would hurt “relationships with elected officials with whom they work on a range of policies”.

Let me break the news to you gently Garen – you don’t know what you’re talking about, but God forbid you would admit to nec sciunt quicquam and keep your mouth shut. More than any other profession, doctors should be the loudest and most vociferous contributors to the public debate on gun violence, which means first and foremost telling public officials to stop being handmaidens for the NRA.

 

 

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American College Of Emergency Physicians Promotes Guns? Yep.

It seems like eons ago when the medical profession found itself under direct assault by Gun-nut Nation exemplified by a 2011 Florida law that criminalized physicians who chose to counsel patients on the health risks of guns. This attempt to intimidate doctors, known as ‘Docs versus Glocks,’ was eventually thrown into the legal trash basket by the 11th Circuit, after which doctors became much more vocal about the need to join the campaign against gun violence that emerged following Sandy Hook.

ER1             The engagement of doctors in the gun violence prevention (GVP) movement took a major step forward in 2015 with the publication of a manifesto ‘A Call for Action’ calling for more involvement by physicians, a document signed by 7 national health organizations, along with the American Public Health Association and the American Bar Association. At the same time, many health organizations issued statements about gun violence, one of the most active organizations in this respect being the American College of Emergency Physicians (ACEP.)

Not only has the ACEP gone on record multiple times supporting various programs to reduce gun violence, but in 2013 the organization adopted a “Firearm Safety and Injury Prevention policy that included including investigating socioeconomic and other risk factors that lead to firearm injury, promoting access to affordable mental health services and supporting universal background checks, among other recommendations.

It should not come as a surprise that ACEP would take the lead in gun violence medical advocacy. How could it be otherwise, given the fact that the organization represents physicians who, more than any other medical specialty, deal with gun injuries as a frequent part of their job. Not only are more than 75,000 people with bullet wounds transported into emergency medical facilities each year, but many ER doctors also find themselves counseling numerous patients suffering from mental distress who are often at high risk because they happen to own guns.

But before we give ACEP a collective pat on its organizational back, let me tell you something else about what this group is doing regarding gun violence, because what they are also doing is promoting gun violence in a cynical and self-serving way. What I am referring to is the fact that only 4 other medical organizations, including the AMA, donated more money in 2016 to Republican politicians, many of whom support pro-gun laws.

That’s right. In 2016 the ACEP gave political donations through its PAC to 128 House Republicans, many of whom also receive money from the NRA.  Among these recipients was Joe Wilson from South Carolina, he’s the one who called President Obama a ‘liar’ from the House floor. After the Charleston church massacre, Wilson said he saw no real reason to make any changes to NICS. Another recipient of monies from both the NRA and the ACEP is Wilson’s South Carolina colleague, Jeff Duncan, who happens to be the sponsor of the bill to remove gun silencers from NFA controls. Want a third glowing example of NRA-ACEP largesse? Try David Joyce (R-OH) who says he’s a steadfast supporter of the 2nd Amendment because “we must ensure that all Americans are safe and secure from radical Islamic terrorists and other national security threats.”

The fact that a national organization representing physicians who have called for reducing gun violence takes the money they collect from these doctors (ACEP annual dues run $600+ a year) and gives this money to jerks like Wilson, Duncan and Joyce isn’t just a ‘mistake.’  It’s scandalous, downright offensive and should be stopped.  The ACEP is not the only medical society that signed off on the 2015 manifesto but continues to give aid and comfort to the Congressional enemies of sensible initiatives to reduce violence from guns, but in terms of dollars, ACEP is by far the worst.

The ACEP membership to do the right thing and stop contributing this blood money right away. You don’t need to engage in an evidence-based, longitudinal study to know the difference between right and wrong.

 

 

 

 

 

Is Gun Violence A Recurring Disease? A New Study Says ‘Yes.’

What are the odds that someone who is discharged from a hospital after treatment for a gunshot injury will return to the hospital with another serious injury or will be arrested for committing a serious crime?  For the first time a study attempts to answer that question based on enough data to discuss how the medical community should respond to people who seek medical help after being assaulted with a gun.  The Annals of Internal Medicine contains a study of more than 9,000 patients who were admitted to hospitals in Washington State with violent injuries in 2006-2007 and were then followed through December, 2011 or to their next subsequent hospitalization, arrest, or death, or whichever came first.  The findings about this group were then compared to 68,000 patients who were discharged during the same two-year period but had been treated for non-violent injury, along with a comparison to 180,000 patients comprising the general population.

conference program pic                Before we compare the long-term experiences of all three groups, let’s look at the composition of the violent injury group itself.  Of all patients treated between 2006 and 2007 for violent injury, roughly 7.5% were admitted for injuries involving guns, or what the researchers refer to as firearm-related hospitalizations or FRH.  But the FRH number was actually 21% of all assaults, since 65% of all serious injuries were self-inflicted (accidents and the like.)  The ratio of one out of five assaults in which a gun was used is no different from what the FBI reports across the nation as a whole.

Patients admitted in 2006-2007 for gun injuries were also typical of this population in general, with nearly 75% being less than 40 years old, and 85% being male.  Racial data was not available for this study, but interestingly, one-third of all victims of gun violence in Washington State paid their hospital bills with private insurance, whereas the Urban Institute recently calculated that less than 5% of all hospital admissions for gun-related violence were covered by private plans.

Here’s the bottom line.  A patient who was treated and discharged for a gun injury in 2006 and 2007 had a significantly higher chance of then being killed with a gun or being arrested for some kind of violent assault.  A history of criminality prior to the hospitalization increased the likelihood of post-discharge victimization or criminal behavior even further.  The point is that a medical encounter for the treatment of gun violence does not just represent a challenge to respond to the injuries caused by the specific gun-related event.  It is also a harbinger of further medical challenges to come and should be understood and responded to in the context of an ongoing and continuous medical risk.

Other studies have also shown that violent injury is a recurring disease.  Earlier this year JAMA Pediatrics published an article which showed a clear division between two youthful populations, ages 14-24, who were treated by Emergency Departments in Flint, MI.  The groups were divided between those patients whose first visit to the ER was for violent injury, the other group came to the ER for something else.  What then happened was that a significant number of the patients who first sought medical care for injury returned to seek care for the same problem again. Not a single member of the latter population that came to the ER for something other than violent injury ever sought medical care for any kind of serious assault.

The Annals issue containing the study on violent recidivism also held an editorial in which eight of the major medical associations (ACP, AECP, AAP, ACS, etc.,) called for stronger physician commitment and endorsed a list of public health initiatives to deal with the medical risks of guns.  But I think that physicians need to do more than just support public health strategies in this regard.  What they really should do is develop effective medical strategies based on research like the articles cited above.  After all, it’s ultimately what the doctor tells the patient which makes any difference at all.

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