Don’t Be Surprised If Your Physician Supports Gun ‘Rights.’

Just about everyone who reads this column will also at some point make a visit to their internist for their annual check-up or to follow up some medical issue of concern. I visit my internist several times each year because I happen to like him very much and I kid myself into believing that getting on his office scale will somehow translate itself into me losing weight. Yea, right.

acp              But the next time I visit him, I’m going to ask him if he happens to be a member of the American College of Physicians, which is the national organization which represents internists, and I suspect the answer will be ‘yes.’ At which point I’m going to bring to his attention the fact that the organization to which he belongs and pays dues is guilty of a degree of professional malfeasance which needs to be stopped. And it needs to stop now.

I am referring to the practice followed by the ACP, along with many other professional medical organizations, to pretend that they are very, very concerned about gun violence while, at the same time, utilizing the dues paid by their members to promote the pro-gun narrative and messaging developed by the NRA.

Specifically, this takes the form of donating to the campaigns of Senate and House members who not only vote against all legislative proposals to reduce gun violence, but also speak out in favor of gun ‘rights.’  In this respect, the ACP’s behavior isn’t quite as nefarious as the behavior of the American College of Emergency Physicians; that bunch is the second-highest funder of pro-gun politicians of all the medical societies. In fact, the ACP actually gives more dough to Democrats than to Republicans, so far this year the split is 60-40 in favor of the blue team. Nevertheless, when it comes to supporting a pro-gun politician, some of the candidates who benefit from ACP largesse represent the worst of the worst.

  • Andy Barr (R-K) has received $3,000 from ACP to date. In response to Obama’s mild attempt to promote more gun regulations after Sandy Hook, this is what Barr had to say: “I’m not convinced that President Obama’s proposals would either protect the American people from crime or safeguard the constitutional rights of law abiding citizens.” That statement was right out of the NRA press kit, literally word for word.
  • Kevin Brady (R-TX) is so far spending $5,000 on his campaign courtesy of ACP. He not only voted in favor of the PLCCA law that immunizes the gun industry from torts, he also is a co-sponsor of the bill that would allow concealed-carry licensees to take their gun into all 50 states.

I could list a few more of the dumbest of the dumb Members of Congress whose fervent belief in gun ‘rights’ finds favor with the internists but I think you get the point. In case you don’t, however, read what the chief mouthpieces for the ACP have to say.  Here’s the most recent pronouncement from Ana Maria Lopez, MD, who happens to be the President of ACP: “It’s more important than ever that our nation’s leaders implement common-sense policies that ban the sale of automatic and semi-automatic military-style ‘assault’ weapons that are designed to kill as many people as possible, as quickly as possible.”

Let’s leave aside the fact that neither Dr. Lopez nor anyone in the ACP press office knows the difference between a full-auto and semi-automatic gun. The bottom line is that this same bunch of cynical fools are giving campaign contributions to office-holders like Barr and Brady whose presence and activity in Congress virtually guarantees that no assault weapons ban will ever see the light of day. And if Dr. Lopez doesn’t know who receives campaign contributions from her organization’s PAC, there has to be a complete breakdown between what she does and what she says.

Here’s the bottom line. When it comes to physicians giving a single dime to any political candidate who will vote in favor of guns, this sh*t has got to stop. It has to stop now. Now.

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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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