Physicians And Guns: Another NRA Sycophant Ignores The Truth.

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As physicians slowly but surely push their way back into the debate about gun violence, you can be sure that the NRA and its legion of willing sycophantic journalists will be right behind them attempting to explain why doctors should avoid any discussion with their patients about guns. The latest such effort comes from a right-wing blogger, Vic Khanna, who identifies himself as a health-care consultant and gun owner in an opinion-piece found on the Federalist blog.

The piece begins with the usual nonsense about how Obamacare is a threat to everything and that it threatens everyone’s individual liberties, most of all the liberty to own a gun. This is the standard crap that has been promoted about every liberal program or policy since the Republicans realized that protecting the 2nd Amendment was a good wedge issue for them to use at the polls. But Khanna then goes into detail criticizing the efforts by Adam Goldstein and other physicians to create standards for judging CCW fitness among patients, an issue for which Goldstein has published several important peer-reviewed articles over the last several years.

docs versus glocks Of course Khanna neglects to mention the fact that Goldstein, who happens to be Professor of Family Medicine at UNC-Chapel Hill, got into the CCW-competency business after receiving requests from sheriff’s departments in North Carolina who are required under law to consult a physician if a person’s mental or physical condition might make granting of CCW a risk. Now isn’t that amazing? North Carolina actually had the good sense to codify a requirement that recognized the unique competencies of physicians in diagnosing mental or physical impediments to carrying around a gun. What? Let those gun-grabbing, elitist doctors decide whether you or I can walk around with a gun?

But Khanna isn’t about to tell the truth and enlighten his readers to the fact that law enforcement is in kahoots with the medical establishment to keep North Carolina residents from carrying their guns. He’s also unwilling to honestly summarize the gist of Adam Goldstein’s publications on this issue, namely, the lack of clinical guidelines that physicians need to use when they diagnose all sorts of physical and mental conditions which might otherwise keep Americans from doing such non-essential activities as driving a vehicle or going to school. Perhaps in his role as a health care consultant Khanna tries to figure out ways to help parents avoid taking their children for the mandated health exam that most jurisdictions require before a kid can enroll in school.

Last year Adam Goldstein and other researchers sent out a questionnaire to 600 North Carolina physicians asking whether the recipients believed that they possessed sufficient medical knowledge to make a determination about the CCW fitness of individual patients. Of the 40% who returned the questionnaire, “a majority felt that they could not assess their patients’ physical capability to carry concealed weapons,” and nearly all the respondents felt that they needed special training before making medical assessments for CCW that might be required under North Carolina law.

Did Goldstein and his colleagues use these findings to promote the idea that issuance of CCW should be curbed or discontinued? No. Did they use these findings to challenge the rights of North Carolina resident to own guns? No. They did what the Hippocratic Oath requires them to do, namely, to raise concerns about their own ability to identify and reduce harm, in this case the harm that might occur if someone who was mentally or physically disabled could go around with a gun.

The NRA and its sycophant journalist crew like Vic Khanna have been playing fast and loose with the facts about physicians, patient care and gun ownership for the past twenty years. They’ve gotten away with it quite simply because most people visit doctors for medical conditions that don’t involve guns. But the tide is beginning to turn, and when the American College of Physicians urges their members to ‘educate’ patients about guns, physicians like Adam Goldstein won’t be turning to the likes of Vic Khanna in order to figure out how to respond.

 

Why Should Doctors Talk To Patients About Guns? Let The NRA Do It.

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When the 11th Circuit re-instated the Florida gag law on physicians talking to patients about guns I knew that sooner or later we would hear from Timothy Wheeler and his gun-promoting group which believes that 19,000 gun suicides, 11,000 gun homicides and 50,000 (or more) intentional gun injuries each year shouldn’t concern physicians at all. Wheeler is the doctor who began promoting the idea that doctors who inquire about gun ownership are their patients’ worst enemies, and his organization is rolled out by the pro-gun lobby whenever they need additional ammunition to keep America from adopting a common-sense approach to the issue of gun violence.

Wheeler’s organization, for which his claim of having thousands of members has never been verified in any way whatsoever, has just launched a small campaign to support the Florida gag law, at the same time that a coalition of medical associations and advocacy groups are going back to the 11th Circuit to ask the entire court, en banc, to overturn the recent ruling. Which is exactly why Wheeler and his buddies in the gun-blogging community are trying to tilt public opinion the other way.

docs versus glocks In the interests of full disclosure, I should state that I am married to an attending pediatrician, and am also a member and certified gun trainer for the NRA. I have no issue with private ownership of guns but I take personally these indecorous attacks on physicians who are required to speak with patients about any matter which they feel might pose a medical risk, particularly involving something as potentially lethal as a gun. The shabby attempt by physicians like Wheeler to pretend that guns do not constitute a health risk reminds me of the pathetic charades conducted back in the 1950’s by a few physicians and scientists who publicly disavowed any link between smoking and cancer.

Of course Wheeler and his cronies, in this case a psychiatrist named Robert Young, don’t want their audience to believe that they are against safe use and storage of guns. After all, everyone’s in favor of safe gun use these days, just ask the NRA and they’ll tout their gun safety program, aka Eddie Eagle which has “reached more than 26 million children in all 50 states.” The same website that contains this information about Eddie Eagle also states that the NRA is “not affiliated with any firearm or ammunition manufacturers,” which is, simply put, a lie. But Dr. Young seems oblivious to the requirement in his own medical profession to base clinical decisions and strategies on evidence-based information, since he advises his medical colleagues to use the Eddie Eagle handouts in contacts with patients who might or might not own guns.

I saved the best part for last. Although Dr. Young believes in educating children in safe behavior around guns, he also wants to make sure that the safety of children is balanced out by the requirements for self defense. And I quote: “Even the sound practice of storing guns and ammunition in separate, locked places isn’t always right if they are intended to be used for emergency protection.”

This guy’s a physician? This guy took the Hippocratic Oath which requires him to counsel patients about risks to their health? There is not one single piece of credible research which shows that keeping a loaded, unlocked gun around the house creates protection from crime that outweighs the risks of injury or death from the existence of that gun.

People like Robert Young and Timothy Wheeler find media outlets for their destructive ideas because we really are committed to the idea of hearing “both sides” in the public policy debate. But I don’t think that there are two sides when it comes to discussing a health issue which claims 80,000 or more victims each year. Unless, of course, you’d rather believe that mortality and morbidity at those levels has nothing to do with health at all.

Docs Versus Glocks - Round 2 About To Begin

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In 2011 the Florida legislature passed a law to protect the state’s gun owners from having to divulge any information about gun ownership during the course of a medical exam. The law, which became known as ‘Docs Versus Glocks,’ soon became one of the main poster children of the pro-gun, anti-gun argument that really heated up after the carnage at Sandy Hook. On one side stood the NRA, which touted the law as a defense of 2nd Amendment rights; on the other side was Brady and the medical community which viewed the law as interfering with the doctor’s right to know. The law was struck down in 2012 by a Federal District Judge and was immediately appealed by the Gunshine State to the 11th Circuit which held a hearing in July, 2013. Everyone’s expecting a ruling soon so I thought I would take the opportunity to discuss the case before all the real experts get into the act.

logomdThe law doesn’t completely deny physicians the ability to talk to patients about guns. What the law actually says is that a physician “shall refrain” from inquiring about firearm ownership unless the practitioner “in good faith believes that this information is relevant to the patient’s medical care or safety, or the safety of others….” Yet despite this caveat, the medical community attacked the law, declaring that its language would have a chilling effect on the ability of physicians to talk to their patients about all kinds of safety and health issues, not just about guns. The District Court sided with the docs, calling the law a “legislative illusion” because there was no connection between questions asked about gun ownership and protecting the 2nd Amendment right to own guns.

logo glockWhile arguments over gun control at the federal level get all the headlines, it’s what happens at the state and local levels that really determines whether or not gun owners can get or keep their guns. The Sullivan Law has been in existence since 1908, it’s almost impossible to own or carry a gun in New York City and 2nd Amendment ‘rights’ can go fly a kite. In total dollars the NRA gives out less than half a million to state-level candidates and parties, but this is 30 times more than gun control groups give to the same races. And in a state-level race where 200 or less votes can make the difference, getting your hands on an NRA phone list may carry the day. I’m not sure that the Florida legislators who voted for the gun bill knew or even cared what the law said. But they didn’t want to be ‘scored’ by the NRA in the next election because they voted the wrong way. Before the Tea Party showed up it really didn’t matter whether a Republican toed the line on gun issues because the NRA wasn’t about to support any Blue candidates anyway. But now that a growing number of Republican office-holders face primary challenges from the Right, everyone on the Red side of the aisle is listening to the NRA.

As for doctors, it took them nearly a century after 1850 to become a self-regulating profession whose guidelines for practice and behavior were largely established and maintained by themselves. And even though their professional autonomy has of late come into conflict with the market imperatives of insurors and other for-profit enterprises, they still retain sovereignty over defining how to deliver their services at the point that such services matter most, namely, in consultations with patients. The fact that the Florida legislature didn’t bother to ask their own state Health Department for a recommendation on physicians talking to patients about guns tells me that the motive behind the law had nothing to do with concerns about the delivery of health care at all. For that matter, it wasn’t that the law threatened doctors who talked to their patients about guns per se, it was the fact that any law which infringes on the professional autonomy of physicians to communicate with their patients threatens the validity of the Hippocratic Oath.

Let’s hope that the 11th Circuit understands what this argument is really all about.

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