The Big Scam Known as Gun-Safety Training.

              Yesterday I began to write a series of columns in which I stated some strong opinions about the strategies being promoted by Gun-controlNation to reduce the violence caused by guns. Let me repeat again what I said yesterday, namely, that I have never (read:never) been opposed to any public policy that will reduce gun violence; my role,as I see it, is to raise questions about the research and information used tocraft and justify these policies when/if I see gaps in the research or theinformation which need to be filled.

              That being said, today’s topic covers one of the truly great scams both within and without the gun world, namely, the idea that an activity referred to as ‘safety training’ does anything to reduce gun violence at all. Which groups and organizations support training in the use of guns?  Every group on both sides of the debate. The NRA of course is in favor of training, that’s why America’s ‘first civil rights organization’ was formed. As for the other side, the latest bromide can be found in a recent policy statement from the American College of Physicians: Sales of firearms should be subject to satisfactory completion of a criminal background check and proof of satisfactory completion of an appropriate educational program on firearms safety.”

              The difference between Gun-nut Nation and Gun-control Nation as regards safety training is that the latter groups want such training to be mandated (i.e., required) as a requirement for gun ownership; as far as the former coalition is concerned, nothing involving 2nd-Amendment ‘rights’ should be mandated at all. Okay, so the NRA gave in on background checks back inn 1994, but in fact the requirement that gun owners be law-abiding has been in statute since 1968.  If anything, the ability of the NRA to portray its members as the most law-abiding citizens has been a master-stroke in terms of promoting the value and benefit of guns. Back to the issue of training.

              I may have a rather weird view of things, but I always thought that ‘training’ is a process whereby someone learns how to do some kind of activity correctly every single time. And it doesn’t matter whether what you are doing involves driving a car, or working on a computer, or cutting into someone’s chest, either you can always do it the same way, or you can’t. And the way we go about validating someone’s training experience is to test their performance to make sure that when actually engaged in the process for which they have been trained, they won’t make a mistake.

              Now if someone makes a small mistake, like not putting on a turn signal at the intersection or not shutting down the computer while an app is still running, it’s usually no big deal. But if someone makes a mistake with a gun, the result not only can be horrendous, but the odds that one can mitigate the effects of the mistake will often be zero to none.

              There is not one, single jurisdiction anywhere in the United States, even jurisdictions which mandate gun-safety training, where the proficiency validation even remotely begins to show that the person who has received training can be expected to safely use a gun. Sorry, but standing in front of a stationery target and shooting a few rounds downrange doesn’t prove anything at all. A study of live-fire requirements in all 50 states found that some states required a smattering of live-fire for a concealed-carry license, but rarely do any jurisdictions require live fire for simply owning a gun.

              If medical organizations like the American College of Physicians want to announce their support for gun safety education, the least they could do is take the trouble to learn what they are talking about. Ditto Gun-control Nation, which seems to assume that anything which smacks of mandated (government) gun regulations is a good thing. Sorry, government mandates are basically useless if they require activities that have no value at all. Which happens to be the case with gun training today.

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Health Professionals Should Not Fund Gun Violence.

Last week gun-control advocates were singing the praises of the American Medical Association (AMA) whose delegates passed a series of gun-control recommendations at the annual meeting in Chicago. The wish list for more effective gun regulations was not that different from what 8 medical organizations plus the American Bar Association published in 2015. However, for most Americans, what the AMA says is what doctors say, so last week’s news was a very big deal.

buybacklogo            The health industry didn’t always speak out so clearly and forcefully about gun violence. When Obama nominated Vivek Murthy to be Surgeon General, the idiot from Kentucky, Rand Paul, mounted a filibuster against the nomination because he claimed that Murthy promoted the idea that guns were a threat to health. When Judith Palfrey, past President of the American Academy of Pediatrics, had the audacity to suggest that guns in a home with children were a risk to the health of those kids, the pro-gun noisemakers raked her over the coals. And worst of all was the Florida gag law, which criminalized physicians who counseled patients about gun violence, a law which the 11th Circuit finally threw out.

The only problem with this newly-energized activism on the part of health professionals is that it isn’t exactly shared by the professional organizations to which they belong.  What somehow passed unnoticed by the entire media covering the meeting of the AMA, was the fact that the organization’s political action committee gives out more than $1.4 million to various Senate and House members, of which two-thirds of the dough goes to Republican office-holders, some of whom happen to be the legislative shock troops for the NRA.

In every election cycle, the NRA’s political arm, known as the Political Victory Fund (PVF) rates every Federal office-holder and candidate in every race, the good guys (and gals) getting an ‘A’ for their stalwart defense of 2nd-Amendment ‘rights,’ while the bad guys (and gals) get an ‘F.’  Most of the A-rated politicians represent Republican districts and they vote the party line on every issue, so the NRA gives them the usual $1,000 bucks every two years.  But then there are roughly 20 Congressional members who receive a coveted ‘A+’ rating, and they can be rewarded to as much as $10,000 grand each year.  Who are some of these clowns:

  • Paul Ryan, because he’s the Speaker of the House, gets $10,000 from at least half of the medical PACS whose total donations to him amount to more than $250,000 each election cycle. Ryan is pulling in more than a quarter of a million from the health care profession which openly calls for gun-control legislation that he will oppose.
  • Ditto the Republican Majority Leader, Kevin McCarthy about whom the NRA said, “Kevin has a proven pro-Second Amendment record and is committed to protecting your gun rights!”
  • Ditto the Republican House Whip, Steve Scalise, who after he took a bullet in his rear end, announced that the experience had “fortified” his support of gun ‘rights.’
  • Ditto Don Young (R-AK) the longest-serving House member, who in a public appearance back in February linked gun control to the Holocaust, saying, “How many Jews were put in the ovens because they were unarmed?” Talk about a dumb schmuck.

These are just 4 of the 20-some Federal office-holders who walk and talk the pro-gun line, not just because it’s something that you do if you’re a Republican, but because they really believe that all the crap about gun control as being a threat against the American way of life is true. And here we have well-meaning physicians paying dues each year to the self-same organizations which take this money and reward guys like Ryan, McCarthy and the others for making sure that not the slightest bit of gun-control legislation will ever see the light of day.

Too many physicians, health professionals and public health researchers have devoted their time and effort to reducing gun violence only to see medical organizations promoting gun violence reduction on the one hand, while funding the efforts of the gun ‘rights’ movement on the other.

This has got to stop. It’s got to stop – now!  Stay tuned.

What Do Doctors Tell Their Patients What To Do With Their Guns? No Surprise – It Depends On The Doctor.

A new study by Eitan Hersh and Matthew Goldenberg is making waves both in the medical and wider media because it appears to say what Gun-nut Nation has been saying forever about doctors and guns; namely, that doctors don’t like guns.  And since doctors don’t like guns, according to this line of non-thinking, they shouldn’t talk to their patients about guns.  And if they didn’t talk to their patients about guns, to follow this non-thinking line to its absolute conclusion, there wouldn’t be anything known as ‘gun violence,’ because everyone knows that gun violence is a figment of the CDC’s imagination anyway.

docs versus glocks           Okay, let’s get back to reality.  To gather, analyze and understand their data, the authors first created a patient ‘vignette’ which described an initial screening interview between a male or female patient and a primary care provider (PCP.)  During the interview, the patient admits to nine not-atypical health factors (tobacco and alcohol use, depression, etc.) that can cause medical problems, one of them being access to guns.  The roughly 300 physicians who participated in the study were then asked to rate how much they considered each of these health factors to represent medical risk, as well as how they would respond to each one. Their responses were then evaluated based on additional data which matched each respondent with voter registration; a process that was not mentioned to survey respondents so as to avoid the possibility that survey answers would be biased based on how respondents felt their answers might be judged.

To quote the conclusion of the study: “Our findings suggest that Republican and Democratic physicians differently assess the seriousness of patient health issues that are

politically salient. Republican physicians also differ from Democratic physicians in the treatments offered to patients who present with those health issues.” And of the nine issues that comprised the health vignettes, on which particular issue did physicians identified as Republicans versus physicians identified as Democrats differ most widely regarding degree of risk?  You got that one right – access to guns.  Grouped by political affiliation, the two groups more or less agreed on the same degree of risk when it comes to helmets, obesity, tobacco, depression, alcohol and professionally-furnished sex.  Republican-affiliated physicians rated abortion and marijuana use as their greatest concerns, Democratic-affiliated doctors viewed these two issues as having little or no concern at all.  For blue doctors on the other hand, they were most concerned about access to guns, in the case of red doctors gun ownership did not register as a concern.

So far the survey results in terms of the correlation between political affiliations and views about the health risks posed by guns holds no surprise.  After all, most gun owners are Republicans, most gun owners do not consider their guns as a risk to health, so there’s every good chance that many physicians who are affiliated as Republicans will also own guns.  Or at least may share similar views on gun access with their patients who own guns.

Ready?  Here’s the rub.  Recall that the survey not only asked participating doctors to assess the degree of risk, but also asked them to describe a treatment plan for each risk vignette.  And when it comes to firearms, both blue and red doctors would discuss gun risks, but the Democratic-affiliated physicians would counsel patients not to keep firearms, the GOP-affiliated physicians opted for ‘safe storage’ plans.

What this survey reveals is that even though physicians may differ on whether gun ownership poses a health risk, there appears to be across-the-board consensus that patients should be counseled about access to guns.  Where the partisan divide appears is not on the issue of gun-risk per se, but on the most effective strategy for mitigating that risk.  And this is a very important finding because if you listen to Gun-nut Nation, they’ll tell you that guns don’t pose any risk to health at all.  And after all, who really knows more about health – the AMA or the NRA?

What Can A Physician Do When A Patient Shows Up Carrying A Gun? In Some Places, Not Very Much

Can a physician make his office a gun-free zone?  That may seem like a question with an obvious answer but it’s not.  And the answer isn’t obvious because of a pending bill that would extend concealed-carry privileges on a reciprocal basis to all 50 states.  And the bill doesn’t carry an opt-out provision at the state level.  In other words, if I can carry a concealed weapon in my state of residence, I can basically carry it anywhere in the United States, even if the requirements for getting a concealed-carry license are different in my home state than in the state where I happen to be.

docs versus glocks           I was drawn to this issue today because of an article published by a physician in who found herself confronted in her practice by a patient carrying a gun. Actually, he was carrying two handguns, both loaded, which he took off in order to be given an EKG.  And the existence of the guns didn’t particularly concern Dr. Becher per se, because she practices in West Virginia where, as she put it, everyone including herself owns guns. But she just didn’t feel comfortable around this guy and her discomfort became intense when he made a threatening remark about a subspecialist to whom Dr. Becher had referred him the previous week.

She then learned from contacting law enforcement that she could not prevent him from coming into her practice until and unless he was told to his face that he could show up with guns, even if there was a sign on the office door stating that the office was a gun-free zone.  She could send him a letter dismissing him as a patient but this still could not prevent him from simply walking through the front door.

The national concealed-carry reciprocity bill, which now has almost enough sponsors to guarantee that it will pass a House vote, actually makes Dr. Becher’s situation a national policy if it becomes law. Because the bill says that it does not ‘supersede or restrict’ any private property owner from denying access to their property by anyone carrying a gun.  But notice that in West Virginia the state law still requires a property-owner to confront the armed citizen face-to-face in order to maintain the property as a gun-free zone.

Now believe it or not, there actually are a few deranged individuals claiming to be physicians who believe that Dr. Becher and all physicians will be safer and more secure if they allow anyone and everyone to enter their practice carrying guns.  In fact, these fools actually take the position that physicians should encourage their patients to carry guns.  I am referring, of course, to the pathetic bunch known as Doctors for Responsible Gun Ownership (DRGO) who have been parroting the NRA attacks against medicine since the AAP and other medical groups had the temerity, the unmitigated audacity to state the obvious, namely, that guns represent a health risk? How in God’s name could a quarter-ounce piece of lead that hits soft tissue faster than the speed of sound be a threat to good health? And yet on the same day that Dr. Becher raised her concerns about how to deal with the threatening patient carrying two weapons, an online medical blog that caters to a right-wing readership published a DRGO screed calling for doctors to avoid any discussion with patients about guns.

There are two problems here that need to be addressed.  First is the fact that physicians cannot act alone when it comes to protecting themselves and their patients from gun violence – they need help from law enforcement, from the public, and most of all, from reasonable and responsible politicians who draft and enact laws.  Second is the fact that the sponsors of the national CCW-reciprocity bill aren’t behaving responsibly at all.  They may believe they are making it easier for citizens to protect themselves, but what they are really doing is creating risk. Which has to stop – now.

Should Doctors Talk To Patients About Guns? They Talk About Other Risks, Don’t They?

This week Dr. Garen Wintemiute and several colleagues published an article that detailed both the legal and clinical issues involved in counseling patients about guns. Not only did the article summarize the current legal environment surrounding doctor-patient communications, but it also presented a schema for helping doctors to determine how to respond to a patient’s access to guns based on factors such as depression, substance abuse and other known causes for violence against oneself or others.

docs versus glocks           The article received significant exposure both within and without the medical community, so it didn’t take long for a few physicians whose self-appointed task is to defend gun-owning America against the evil intrusions of gun-grabbing physicians to respond.  The first response was by a physician in California who claims that asking patients about gun ownership infringes on their 2nd-Amendment rights.  So, according to this logic, the 2nd Amendment only allows Americans to own guns, it prevents any discussion about guns.

This gun-loving doctor, Arthur Przebinda, agrees with Wintemute that doctors should be allowed to engage in gun counseling if the patient “shows signs of mental illness,” but he nevertheless finds Wintemute’s report ‘misleading’ because – are you ready for this one? – it is based on Wintemute’s own research. [My italics.]

Is this guy serious?  Does he expect a single medical professional to take him seriously because he claims that Wintemute’s article is in error because it is based on Wintemute’s own research?  What should a peer-reviewed article in a medical journal be based on?  No research?

But the truth is that Przebinda isn’t interested in communicating his nonsense to the medical community; his sole agenda is to try and influence the thoughts of gun owners, some of whom might otherwise be tempted to actually take seriously what medicine believes to be the problem with guns.  And the problem with guns is very simple: they constitute a risk.  How much of a risk?  This remains a subject of debate because thanks to the twenty-year freeze of CDC gun research, a freeze that Dr. Przebinda wholeheartedly supports, sufficient research has not been accomplished to determine exactly the degree to which gun ownership increases the possibility of deaths or injuries from intentional or unintentional use of a gun.

“They’re trying to identify gun ownership as a risk factor, the same way they would define smoking inside the house,” says Przebinda, and that’s exactly the point.  Because smoking is harmful. And so are guns. Period. End of story.  What does Dr. Przebinda think happens to human tissue when it is struck by an ounce of lead travelling faster than the speed of sound?

Now don’t get me wrong.  I’m not saying that it’s wrong to own a gun.  And if someone believes, massive evidence to the contrary, that keeping a gun in their home makes them safe from crime, then they can believe it all they want.  And they can also own a gun. But when was the last time doctors made a decision about what constitutes medical risk based on whether a marketing organization like the NRA agreed with them or not?  Did doctors refrain from asking patients whether they smoked before cigarette companies admitted that smoking causes cancer and other serious disease?

A rational and reasonable medical response to Pzrebinda’s pro-gun stance is provided by Dr. Eric Fleegler from Boston Children’s Hospital who says that discussions about guns should be “delicate conversations.”  But let’s remember that many discussions between doctors and their patients are delicate, which is exactly why such conversations are protected from public disclosure no matter what the NRA and their pro-gun acolytes would like gun owners to believe.

Physicians engage in very private and very delicate discussions all the time: an elderly parent is losing his mind, a teenage child is into drugs. These are medical risks that only doctors can evaluate and help patients to better understand. Which doesn’t mean the patient has to ever go along with what the doctor says. But it still has to be said. Guns are a risk.

The 11th Circuit Creates A Fiction To Justify Gagging Florida Doctors Who Talk About Guns.

Nobody in the GVP or medical communities (except Rand Paul) is happy with the decision by the 11th Circuit to continue upholding the Docs-Glock statute enacted in the Gunshine State.  But there was a comment in the latest decision which may, in the long run, make the argument in support of the law null and void. But before I explain why I think there may be a silver lining, I should spend a few words discussing where the case stands right now.

docs versus glocks              As you probably know, the original law was enacted in 2011 and similar statutes have been introduced but not voted in at least 12 other states.  Basically the law prohibits physicians from asking patients about gun ownership unless the physician believes that access to guns poses an immediate health risk. But by asking physicians to limit inquiries about any matter unless they have already decided that such inquiries might reveal a medical risk is to stand the entire methodology for assessing patient health on its head.

The pro-gun bunch has been trying to push medicine out of the gun debate ever since physicians first began talking about guns as risk to health.  The gun industry continues to pretend that we should ignore endless studies which show that gun ownership is linked to increases in both homicide and suicide rates; in fact, they promote the fiction that guns are a positive social element because it’s an armed citizenry that protects us from violence and crime.

Much of the latest decision upholding the Florida law simply repeats the rather dubious claims about 2nd Amendment rights that littered the original 11th Circuit majority decision handed down last year.  In that decision, the two-to-one majority hearing the case decided that asking a patient whether he or she owned a gun put the physician in the position of deciding whether that particular patient should have guns at all; hence, a restriction on the Constitutional right to own a gun.

This seems to me and to most scholars who have examined the decision to be a stretch.  And not just a little bit.  After all, Florida law doesn’t prohibit doctors from asking patients if they engage in sex, even though sexual activity is protected under the Constitutional rights to privacy that were enunciated in Roe versus Wade. But the reason that the doctor’s 1st Amendment right to ask any and all questions is trumped by the 2nd Amendment is really based on the fact that “the balance of power between doctor and patient will often make a patient feel as if he has no choice but to listen and answer a doctor’s questions.” Hence the 11th Circuit is protecting the patient who otherwise might feel vulnerable or threatened in asserting his 2nd Amendment rights.

Judge Gerald Tojflat (who wrote the majority decision) was fresh out of law school in 1963 when the Nobel prize-winning economist Kenneth Arrow published a paper in which he claimed that health care could not be understood as just another form of market economics because of the special relationship that existed between the seller (doctor) and purchaser (patient) of health products, procedures and advice.  Basically Arrow argued that patients could not exercise market decisions when choosing a doctor because of the physician’s superior knowledge and special skills.

That was 1963.  This is almost 2016. I don’t know which planet Judge Gerald Tjoflat inhabits, but he’s simply out of step with modern times. The idea that the average patient walks into a doctor’s office believing that he can’t or won’t speak up at every possible moment during a medical exam may have been typical of the doctor-patient relationship when Tjoflat was just starting his legal career, but it sure as hell isn’t true today.

Between the internet, alternative medicine, patient-centered care, patient’s bill of rights, and HIPAA, Judge Tjoflat’s notion that today’s patient feels vulnerable and helpless in relation to his physician is a relic of the distant past.  But he also probably believes that guns protect us from crime.

 

Doctors for Responsible Gun Ownership Are Actually Totally Irresponsible.

Sooner or later I knew that Tim Wheeler, who runs a blog called Doctors for Responsible Gun Ownership, would come out and say something that reveals how far away he is from thinking like a serious physician.  Or thinking like any kind of physician, for that matter.  Since he started his so-called organization, which is basically just a blog, he has spent his time promoting one stupid and/or senseless notion for the gun industry after another stupid and/or senseless notion.  From denying that physicians should question patients about guns, to advocating that physicians should hand out gun safety information that has never been reviewed by the medical academies, Wheeler pushes out opinions that pander to the lowest common mental denominator and misrepresent the role of doctors in dealing with health issues, guns or no guns.

Wheeler has now trained his sights on a situation in New Jersey where the legislature is thinking of amending a ‘smart gun’ law that was passed in 2002 but has never been implemented because no manufacturer could deliver a smart-gun product that both worked and was made available for retail sale. A brief attempt was made to sell one of these models in California, but the gun shop in question quickly removed the produce from its shelves when local gun nuts threatened a boycott of the store or worse.

hippo                Wheeler refers to smart-gun technology as a “sweeping infringement” of the 2nd Amendment, a judgement obviously based on his expertise on the area of Constitutional law.  If he would bother to actually read the 2008 Heller decision, he might notice that Scalia explicitly states that “nothing in our opinion should be taken to cast doubt on … laws imposing conditions and qualifications on the commercial sale of arms.” [p. 54]  Notice the phrase, ‘commercial sale of arms,’ which even a jerk like Wheeler must know means that the government can decide what types of guns can and cannot be sold.

Smart guns were first hyped during the Clinton administration when the government awarded R&D grants to various inventors and entrepreneurs to develop new gun-safety technologies.  You can get a very complete overview of the history and development of smart-gun products by reading a report published by the Department of Justice in 2013. The report brought together representatives of federal agencies and test labs, law enforcement bodies, technology institutes, public health researchers, and was discussed with staff from Smith & Wesson, Colt, FN and Ruger, among others.

If Wheeler read the report, perhaps he would have noticed right up front that the primary group of users for whom such technology is being developed is “people responsible for public safety (i.e., law enforcement personnel.)” [P. 8]  I think that Wheeler only blogs about issues, like Heller, for which he hasn’t read the relevant texts, but why should a physician depend on anything other than his own opinions, correct?

Wheeler not only believes that smart-gun technology represents an ‘infringement’ on the 2nd Amendment, but worse, is a solution in search of a non-existent problem; i.e., accidental deaths of children from firearm misuse.  He refers to these deaths as “miniscule,” claiming a “few dozen” lives each year.   In fact, more than 75 children under the age of 18 died from accidental shootings in 2013, and more than 560 were treated for gunshot wounds.

But worse than understating the numbers is what this says about Wheler’s approach to medicine.  Let me break the news to him gently: physicians don’t define a medical problem by how many patients present a particular symptom during an exam.  The role of the physician, according to the Hippocratic Oath, is to reduce harm. And this applies to every single patient, whether the harm comes from something which is nearly universal, or is something that a physician might see only once.

Wheeler’s attempt to make readers believe that the severity of a problem is in any way based on its frequency is a conscious misstatement of the role of the physician and shows him to be the crackpot and gun industry mouthpiece that he really is.

Docs Versus Glocks: Now It’s Round Four.

Last month a three-judge panel of the 11th Federal Circuit reinstated Florida’s gag law that prevented physicians from talking to patients about guns, a law that had been initially struck down at the Circuit Court level in 2011. Now the physicians have asked for an en banc rehearing of that decision by the entire 11th Circuit which, if the panel decision is affirmed, may move this case one step closer to a hearing before the Supreme Court.

The plaintiff’s brief, whose amici reads like a Who’s Who of virtually every medical association beginning with the AMA, notes that “there is no disagreement within the medical community that providing patients with information about firearm safety is a valid aspect of preventive care and thus beneficial to public health.”  They contend that the state’s gag order not only prevents physicians from delivering proper medical care, but opens the door for other limitations on physician-patient discussions because “once it is known that physician communications can be compromised in one area, then politically empowered interests will be emboldened to compromise it in others.”  Florida’s legislature, for example, could use a similar justification to limit whether a physician can ask a patient about whether they smoke cigarettes, drink alcohol or consume red meat.

glock logo                The gun lobby’s answer to this problem, which was echoed by the panel decision majority, was that physicians are always free to hand out gun safety pamphlets which, of course, the NRA is always happy to provide.  But the NRA’s support of gun safety information is disingenuous at best and consciously deceptive at worst, because this same organization is on record as opposing laws that would really increase gun safety by requiring that guns either be locked or locked away.  Arizona was the 50th and last state to legislate protective barriers around backyard pools in homes where minor children live.  Want to guess why there are still 22 states that do not mandate any kind of safe storage of guns at all?  Last year in Kentucky a five-year old boy shot and killed his two-year old sister and the County Judge drily observed that “there’s probably not a household in this county without a gun.”

I’m not surprised nor really upset that the gun lobby would try to keep physicians from talking to patients about guns.  After all, if the medical associations are on record as believing that gun ownership is a health risk, then they will line up some way or another as being against guns.  And the fact is that physicians have reams of peer-reviewed studies that link higher levels of gun mortality and morbidity to ownership of guns.  Even without the studies, you don’t have to be a rocket scientist to figure out that the more guns there are in everyone’s homes, the greater are the odds that more of them will be left around unlocked, and as the novelist Walter Mosley says, “If you carry a gun, it’s bound to go off sooner or later.”

But even though virtually every medical association acknowledges that guns constitute a risk to health, somehow this message still hasn’t gotten back to the feds. In response to a call from President Obama after Sandy Hook, the Institute of Medicine published a report listing the major gun violence issues that needed further research over the next 3-5 years, including the influence of video games, interventions and strategies, risk and protective factors, safe guns and, most important, “characteristics of firearm violence.”

With all due respect, I would like someone to explain to me why we need more research on the characteristics of gun violence to understand why 100,000 deaths and injuries from guns each year constitutes a risk to health.  I don’t believe there would be such unanimity among the national medical societies on this issue if it were just because most doctors don’t like guns. But as long as the federal government can pretend that the ‘jury Is still out’ on the medical risks of gun violence, jurors like the panel majority of the 11th District can tell physicians not to talk to their patients about guns.