Know What Ben? It’s Time For You To Shut Up.

Ben Carson isn’t the first physician to run for President and, in fact, isn’t the only doctor trying to get into the White House in 2016.  He may be the only board-certified doctor, because it’s not clear whether Rand Paul is certified or not.  Carson certainly is.  All the more reason that when he says something which violates the Hippocratic Oath we should ask whether he has the credentials even to claim that he’s a bone-fide physician, never mind credentials to be the next President of the United States.

Let me make one thing clear about the Hippocratic Oath.  It’s not mandatory either to subscribe to it or to follow it.  There are some medical schools that don’t, in fact, administer the oath to new graduates, there are also various versions of the oath floating around.  But the Hippocratic Oath is a reminder that medicine is a profession whose effective practice requires attention not just to science and learning, but to compassion and ethics as well.  After all, we vest the responsibility and often the authority for making life and death decisions within the medical profession.   So it’s heartening to know that this profession expects its members to think and behave according to certain basic and well-tested rules.

hippocratic                And rule number one is: Do No Harm.  Now these words aren’t, in fact, found in the text of the oath itself.  But ask any physician to tell you what it means to subscribe to the Hippocratic Oath and he or she will state either those exact words or words to that effect. Which brings us to the recent statements made by Ben Carson following the slaughter at Umpqua Community College that produced a sickening amount of harm.

The first statement was on Ben’s Facebook page, although he scrubbed it when the responses began pouring in.  Nevertheless, here’s the exact quote:  “I never saw a body with bullet holes that was more devastating than taking the right to arm ourselves away.”  In other words, if Carson was practicing in a locality that had very strict gun-control laws like, for example, Washington, D.C., he would claim that the inability of a D.C. resident to carry around a handgun was a greater medical risk than if that same individual was brought into the ER with a bullet lodged in his head. So much for Carson’s ability to stratify gun violence risk, adopt the proper medical response and thereby reduce harm.

Just to make sure that ol’ Ben keeps his bone fides alive with the pro-gun crowd, he then went on CBS and said that if he were facing a mass shooter, the first thing he would do is put up a fight.  He would also advise other people in the vicinity to do the same thing. Of course macho man Carson has absolutely no idea of the degree to which such behavior increases risk, and if you don’t believe me, just take a look at the active shooter guidelines issued by the Department of Homeland Security: Run, hide, if all else fails, fight.

Every time Carson opens his mouth about gun violence, he says something that increases risk.  If he wants to say something stupid, that’s fine.  But when he advises people to do something that increases risk, he’s not just being dumb, he’s violating the Hippocratic Oath.  The Coalition to Stop Gun Violence has posted a petition asking Carson to apologize to the survivors and victims’ families at Roseburg because of the comments he made on Facebook and ABC.  The petition says that Carson’s remarks are “offensive and beyond the pale.”

I think it’s now time for the medical community to tell their colleague Ben Carson that he should stop putting the initials ‘M.D’ after his name. Because no doctor who takes his work seriously would make statements like that. Ben doesn’t  just offend the Umpqua survivors, he offends the profession which he claims to represent.  Shut up Ben, just shut the f***up.

 

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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.

Physicians And Guns: Another NRA Sycophant Ignores The Truth.

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.

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

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.