The American Medical Association Needs To Be Clear: Guns Are A Risk To Health.

Our friends at The Trace emailed an article yesterday about the decision by the American Medical Association to debate and possibly adopt some gun-control measures when the organization gets together for tor their annual meeting in June. According to the AMA President, David O. Barbe, a family physician out of Missouri, the grand poo bah of all grand medical organization poo bahs will debate a nearly a dozen proposals to reduce gun violence and then put its “considerable lobbying clout behind legislation heading into November’s mid-term elections.”

md-counsel             The AMA is already on record backing such ‘commonsense’ strategies as comprehensive background checks, handgun licensing and waiting periods and ‘mandated penalties’ for gun crimes, whatever ‘mandated’ means. According to Doctor Barbie, this year’s grab-bag of proposals includes banning bump stocks, strengthening the background check system, banning assault rifles and high-cap magazines, and increasing the legal age for gun purchases from 18 to 21. All of these ideas and others stem from a basic notion, says Dr. Barbie, that “gun violence in America today is a public health crisis, one that requires a comprehensive and far-reaching solution.”

I am going to be rather blunt and somewhat descriptive by saying that I think Dr. Barbie and his AMA colleagues are once again reducing the issue of gun violence to just another talking-point which, if debated and adopted at the annual meeting, will accomplish absolutely nothing at all. In other words, it’s a load of crap. God knows we have enough decent, dedicated and devoted gun-control advocates and organizations promoting these same issues all the time. Why should the medical profession, which represents the most objective and science-based approach to how their responsibilities and practices are defined, just get on line behind everyone else who wants to do something about the 125,000 deaths and injuries suffered each year because of guns? What the AMA should be doing is insisting that the issue of gun violence be taken seriously within the practice of medicine itself.

Every medical school curriculum contains teaching modules about violence – how to define it, how to spot it, how to counsel about it and who needs to be contacted if the patient is at immediate risk. Guess what?  You can search all these treatment protocols and you won’t see the word ‘gun’ or the term ‘gun violence’ even once. And gun violence isn’t the same thing as picking up a baseball bat and whacking your younger bother over the head. It’s not the same thing as getting into a fight. It’s a random and highly lethal type of behavior that creates a level of injury which at best requires a significant outlay of medical resources and at worst leaves the victim dead.

What do we get from the medical profession these days when it comes to discussions about what to tell a patient who says that he or she has access to a gun?  We get this nonsensical and ill-advised bromide about safe storage because, after all, we need to ‘understand’ and ‘appreciate’ the culture of patients who believe they are safe if they own a gun.

The studies which show that guns are a risk to safety and health do not distinguish between stored and unstored guns. And as far as I’m concerned, a physician who does not advise patients to get rid of their guns, pari passu, is teetering on the brink of violating the Hippocratic Oath, which does not (read: not) make exceptions for patient ‘culture’ as regards the doctor’s responsibility to reduce harm. Doctors should join and lead the gun-violence discussion by talking about what they know, which is the issue of medical risk. And medical organizations like the AMA should be promoting one very clear message, namely, that guns are a risk to health. This means all guns, no matter how they are stored or how many background checks are required before owning a gun. I know this, and even though I’m also a doctor, I’m just a lowly Ph.D.

 

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Another State Wants At-Risk Gun Owners To Protect Themselves From Their Guns.

Last week I wrote about a bill in the Oregon legislature that would allow family members to petition a court for removal of guns in cases where a gun owner was an immediate risk to himself or someone else.  The bill, known as a measure to be used only in instances of ‘extreme risk,’ would require the gun owner to surrender his firearms for up to one year, but the gun owner could also appear in court and present evidence that his access to guns no longer represented a risk to himself or anyone else.

gun-suicide             The Oregon initiative follows the adoption of a similar law in California, which allows family members to ask for a restraining order on access to guns. But this week the virus seems to be spreading to the other coast, because a similar measure has just been introduced in the Massachusetts House, and it appears to have enough sponsors to be taken seriously when and if the Massachusetts legislature stops arguing over the annual budget.

I learned about the Massachusetts law because of an email I received from my friends at the NRA, which linked to a statement about the law by the NRA-ILA.  According to America’s oldest civil rights organization, the Massachusetts law, if enacted, would “result in the immediate suspension and surrender of any license to carry firearms and firearms identification card which the respondent may hold.  The respondent would also be required to surrender all firearms and ammunition.” The NRA then goes on to repeat the usual canard about how such an order would be issued based on ‘little, if any real evidence,’ but that’s simply not true.

But the best part of the NRA’s attempt to explain Constitutional law to its membership is the sentence which reads: “Constitutional rights are generally restricted only upon conviction of a felony.”  Did the legal geniuses at Fairfax ever hear of something called ‘prior restraint?’ The rights enumerated in the Constitution are all subject to ‘reasonable’ restrictions imposed by governmental authority, as long as those restrictions meet basic tests regarding the intent and result of what government intends to do. Such restrictions are even explicitly stated in the landmark Heller decision, which states that “Like most rights, the right secured by the Second Amendment is not unlimited, and “nothing in our opinion should be taken to cast doubt on longstanding prohibitions on the possession of firearms by felons and the mentally ill.”

Which is exactly what these ‘extreme risk’ laws are designed to do, namely, keep guns out of the hands of individuals who have shown a disregard for the traditional rules of behavior under which we all live. Sorry, but telling someone that you are depressed to the point of wanting to commit suicide isn’t just an idle threat. Ditto stalking or threatening someone who told you to leave them alone. The Constitution doesn’t enshrine such behavior and such behavior becomes a much greater threat when it might involve a gun.

But remember who we are dealing with here, namely, an organization which increasingly promotes the idea that there should be no restrictions of any kind on the ownership or use of guns. Believe it or not, I would have no problem with the NRA or any other pro-gun advocacy group if they would just drop the nonsense about how guns aren’t really dangerous because we can use them to protect us from crime.  If the NRA would admit the truth, namely, that guns are extremely lethal and that access to a gun increases risk, I would fold up this website immediately, stick my guns, my wife and my cats in the Subaru and take off to a trailer park in the Florida Keys.

The fact that something is dangerous doesn’t mean it shouldn’t be owned. I know a guy who keeps rattlesnakes but treats them with extreme caution and care.  Are we asking too much of my gun-owning friends to behave the same way with their guns?

How Do You Convince People That Guns Are A Risk? Maybe By Not Talking About Guns.

conference program pic           In the face of more than 100,000 serious injuries and deaths every year, it’s pretty difficult to accept the idea that gun violence isn’t a public health issue, yet promoters and defenders of gun ownership continue to insist otherwise.  And while it would be easy to assume that such warped thinking is the product of infantile and/or uninformed minds, medical and public health communities have been spectacularly unsuccessful trying to convince Americans that guns constitute a risk to health.  In fact, both Gallup and Pew polls indicate that a majority think that guns protect us from crime, even while the same majority also support expanded background checks.

In light of the divergence between public health research findings on the one hand, and public opinion in the other, I am beginning to think that perhaps the problem lies not in the power and messaging of Gun Nation, but reflects the possibility that perhaps public health research should stop focusing so much energy on the public aspects of gun violence and spend more time thinking about the health aspects of the problem, in particular, the issue of why people own and use guns.

Because there would be no gun violence if a certain number of people each year didn’t misbehave with their guns.  And the issue of behavior is never far removed from the manner in which the medical profession deals with disease. The mortality numbers for serious illnesses would be much different if we changed behaviors like smoking, excess eating and drinking which cause heart disease and cancer which leads to medical distress.

The medical response to behavior which leads to gun morbidity, however, seems to largely put the cart before the horse. Doctors are being advised to counsel patients on safe gun storage, as if gun violence will be ‘cured’ by locking the guns up or locking them away.  I’m not against safe storage, but less than 4% of gun injuries occur because a child grabbed an unlocked, loaded gun.  The overwhelming amount of gun violence, for which the medical costs alone are estimated to be at least $50 billion each year, takes place because someone made the conscious decision to use their gun to injure either themselves or someone else.  And that decision is rarely going to bear on whether the gun is locked away.

Last year a public health research team conducted a survey of 4,000 adults of whom one-third reported owning guns.  Half of the gun-owning group also reported that they engaged in social activities involving guns with either family members or friends. Which meant that for these folks the ownership of guns goes far beyond believing that guns make them safe.

To people for whom gun ownership is how they create their social milieu, guns represent honesty, patriotism, family and other cultural artifacts which form a basis for self-expression and communication between family members and friends. So when such folks perceive a threat to their ownership of guns, this perception quickly becomes a threat to their self-identity as well.  Which means that trying to prove that guns are a risk will only push such individuals to harden their resistance against losing their guns.

“If individuals adopt one position or another because of what guns mean instead of what guns do, then empirical data are unlikely to have much effect on the gun debate.”  To me, this statement by Don Braman and Dan Kahan neatly sums up much of what has characterized the gun debate over the last several decades.

Please don’t misunderstand – I’m not opposed to empirical research. But it’s one thing to argue the case for gun risk by citing data which shows that gun injuries increase in homes where there are more guns; it’s another thing to convince individual gun owners that such a finding might apply to any of them. Want to counsel a patient about whether his guns represent medical risk?  You’ll have to figure out how to do it using language which isn’t perceived as a threat.