Want To Be Told That Guns Aren’t A Threat To Health? Publish Research Which Shows That They Are.

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It didn’t take seventy-two hours following the publication of a reasoned and respectful JAMA editorial on physicians counseling patients about guns before the self-appointed NRA medical sycophant, Timothy Wheeler, issued his usual pronouncement that doctors represent the enemy when it comes to anything having to do with guns. Actually, I blame the Hospital and Health Networks blog for letting Wheeler crawl out from underneath his proverbial rock, because the truth is that to present him as some kind of medical authority on gun violence is to grant him a level of professional credibility that he doesn’t deserve.

The JAMA editorial, co-authored by two noted gun researchers, Drs. Marion Betz and Garen Wintemute, represents a very important step forward in the discussion about doctors and guns. It follows from a “call to action” issued in April by eight professional medical organizations (plus the American Bar Association) that urged physicians to become more engaged in the issue of gun violence, notwithstanding the heavy-handed effort by the gun lobby to legally de-franchise medical professionals from any connection to this issue at all.

conference program pic The NRA has been pissing and moaning about public health and clinical views on gun violence for more than twenty years, and Wheeler is often quoted whenever relevant research is published and, in time-honored fashion, the media needs a comment from the “other side.” I wouldn’t mind if Wheeler had ever conducted any research at all to justify his views on guns, but in fact he is a polemicist pure and simple whose pro-gun opinions come right out of the NRA playbook but are delivered with heightened authority because his name is followed by the initials ‘M.D.’

His latest salvo, written in response to the JAMA editorial, asserts that, “Physicians get no training in firearm mechanics, safety, or tactics in medical school or residency. They simply are not qualified to counsel patients about firearms.” There was a time when physicians didn’t focus on health risks like obesity and tobacco companies routinely showed doctors inhaling a Lucky Strike cigarette in their ads. When the medical community decided that enough research had been conducted to classify obesity and tobacco as risks to health, doctors learned how to counsel patients by asking questions and, based on responses, dispensing appropriate medical advice. Wheeler has never attempted to deny the reams of medical research that shows that the risks of gun ownership far outweigh the gains. Instead, he pompously and falsely accuses physicians of using that research to promote a ‘political’ point of view.

What kind of advice does Wheeler feel is appropriate for doctors to share with patients about guns? You can find the answers in a book he published, Keeping Your Family Safe. Most of the book is devoted to a warmed-over version of NRA training materials that describe how guns work, how they should be cleaned and how they should be stored. Wheeler, incidentally, has absolutely no professional credentials in any of these areas, nor in self-defense laws and self-defense tactics, both of which are covered at length in this book.

I have absolutely no issue with anyone pushing guns as a means of self-defense; what offends me is the notion that guns represent the only or even the most effective way to respond to a possible or actual criminal event. It’s not true, and there is no evidence-based research that proves it to be the case. In fact, the latest research demonstrates that using a gun for self-protection is not only a rare event, but is no more effective than other protective actions, such as running away or calling 911.

After medicine took the lead in anti-smoking campaigns, the end result was that one out of two adults who smoked dropped to one out of five. Imagine what would happen to the gun industry if gun ownership followed a similar trend. If Wheeler wants to save the gun industry, he should stop pretending to be a medical expert and do what he does best, which is to figure out ways to sell guns.

What Do Doctors Need To Tell Patients About Guns? That Guns Are Lethal No Matter How Safe You Are.

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This week the online version of JAMA contained an important editorial by two noted gun violence researchers. Their editorial followed from a February “call to action” issued by the eight leading professional medical organizations promoting the idea of greater physician engagement in dealing with gun violence, notwithstanding the attempts by the NRA to legally de-legitimize the ability of doctors to talk to patients about guns.

The authors of the editorial, Drs. Marion Betz and Garen Wintemute, believe that physicians need to develop what they refer to as better ‘cultural competencies’ in order to overcome the alleged suspicions that gun owners harbor about medical professionals who try to talk about their ownership and/or use of guns. I say ‘alleged’ because I have yet to see a single, bone-fide survey that actually quantifies the anti-physician attitudes the NRA has worked so hard to stir up. The fact that a group of red-meat Florida legislators say “yip’ every time that the NRA lobbyist Granny Hammer says ‘yap,’ doesn’t prove anything at all about how the average gun owner would feel if his doctor initiated a conversation about guns.

jama Betz&Wintemute present no data on the attitudes of gun-owning patients but there are surveys of physicians which indicate that the majority of medical professionals don’t know enough about guns to feel comfortable raising the issue of gun violence within the context of clinical care. And the authors are certainly correct in calling for the medical community to find ways to remedy their lack of communication skills. But with all due respect to the very important research conducted by Betz&Wintemute over the years, I am still not convinced that a growth of cultural competence in the area of gun violence should primarily focus, as they suggest, on counseling about the safe use and storage of guns.

In 2013, as the authors note, 117,894 men and women were killed or wounded with guns. But less than 15% of these injuries were considered accidents, or what the CDC calls unintentional events. Now don’t get me wrong: 17,369 accidental shootings is a serious health issue in and of itself. And anything that can be done to lessen the impact of these events on the victims, their families and the medical system which has to respond to the problem should certainly be put into effect. But what makes gun violence such a disturbing social and medical phenomenon is the fact that each year at least 100,000 among us make the conscious, often impulsive decision to pick up a gun and use it to shoot ourselves or someone else. Last year the CDC called 24,000 Ebola cases in Central Africa an “epidemic.” What do you call 100,000 cases of gun violence in the U.S. every year? A day at the beach?

If the medical community is going to take a more dynamic approach to gun violence, I think that increasing communication skills regarding safe storage and gun safety is putting the cart before the horse. Betz&Wintemute are correct in suggesting that effective counseling has to reflect the individualized nature of every clinical interaction, but the real problem that physicians face is not learning how to tell a gun-owning patient to lock up or lock away the guns; it’s learning how to identify patients who are prone to engage in gun violence, regardless of how they store their guns.

Adam Lanza’s mother dragged him from one shrink to another. At no time did a medical professional ask why her home was virtually littered with guns. Elliott Rodger, who shot 17 people in Isla Vista, California, had been seeing therapists since he was eight years old. Not a single medical society has yet to adopt clinical guidelines to help physicians identify at-risk patients before they pull out a gun. Doctors are hardly the only group who can give advice on safe storage of guns. But what only they can do is identify and treat risks to health. And anyone who believes that a gun doesn’t represent a health risk doesn’t know much about either one.

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