Michael Siegel: Why Did Wisconsin Physician and Emergency Physician Groups Combine with the NRA to Fight Universal Background Checks in Wisconsin?

They say that politics makes strange bedfellows, and here we have a perfect example of that. Two of the major physician groups in Wisconsin—the Wisconsin Medical PAC and the Wisconsin Emergency Medicine PAC—joined the NRA in financially supporting the gubernatorial campaign of Scott Walker over his challenger, Tony Evers, who was opposed by the NRA primarily because he supports state legislation that would require universal background checks for gun purchases in Wisconsin. Despite the best efforts of the NRA and these Wisconsin physician organizations, Evers defeated Walker and so the prospect of meaningful firearm violence prevention legislation in Wisconsin remains alive.

In addition to the NRA, which gave Governor Walker an A+ rating in 2014, other major contributors to his gubernatorial reelection campaign for the 2018 cycle, according to an open secrets project run by the Wisconsin Journal Sentinel, included the Wisconsin Medical PAC, which represents the Wisconsin Medical Society, and the Wisconsin Emergency Medicine PAC, which represents the Wisconsin chapter of the American College of Emergency Physicians (ACEP).  

Given that physician organizations such as the American College of Emergency Physicians, have been boasting about their commitment to preventing firearm violence and that individual physicians are orchestrating a campaign (#ThisIsOurLane) to convince the public that gun violence prevention is appropriately in our domain, it is shocking to see that behind the scenes, these physician organizations have been fighting against the very causes they purport to champion. While ACEP, for example, has endorsed universal background checks, Wisconsin ACEP has been working against the implementation of this policy by contributing to the NRA A+ rated Scott Walker, who Wisconsin ACEP knows would never sign such legislation. And while most major national physician groups purport to champion gun violence prevention policies, the Wisconsin Medical Society has also worked behind the scenes to help ensure that these policies never see the light of day in the state of Wisconsin.

What could possibly explain this level of hypocrisy?

As I teach my public health students, when you see organizations sacrificing their stated principles like this, it usually amounts to one thing: money. In fact, the major reason why physician organizations in Wisconsin and throughout the country are supporting NRA-backed candidates is that at the end of the day, these candidates will protect physician salaries by opposing wholesale adoption of universal health coverage or mandated insurance coverage systems that might otherwise pose a threat. And clearly, these groups are placing a higher priority on protecting physician salaries than on fighting gun violence.

By the way, I have no problem with that decision. I do not begrudge anyone or any organization the right to place a high priority on self-protection of their financial well-being. HOWEVER, what I do not accept is for those organizations to make such a decision and then tell the public that they are working to fight gun violence. You can’t have it both ways. Either you make fighting gun violence a priority, or you don’t. And if you don’t, then you can’t come out here and tell the public that you are a public health champion when it comes to preventing gun violence.

If gun violence prevention is truly “our lane,” then in 2019, there is a course of action that every national and state physician organization should take. And every physician who is promoting the #ThisIsOurLane movement should put pressure on their national organizations and state chapters to take this action.

The action is simple: pledge to never again make financial contributions to any political candidate who takes NRA money. Divest from NRA-backed candidates. This would send a powerful message to the public. It would show that medical organizations are willing to put their money where their mouth is. It would demonstrate that physician organizations will no longer act like hypocrites and say one thing while doing the exact opposite behind the scenes. Most importantly, it would have a profound effect on the NRA’s ability to influence public policy.

Federal policymakers receive more money from medical and physician organizations combined then they do from the NRA. If it became clear to federal candidates that by taking NRA money, they would be sacrificing their ability to receive any donations from physician groups, they would seriously think twice about accepting that money. The physician groups have a tremendous amount of leverage with their campaign contributions.

This is why I am working with several other physicians to initiate a campaign in 2019 to encourage all physician organizations to pledge to discontinue financial contributions to candidates who take NRA money.

This idea is not a new one. Dr. Joshua Sharfstein, a former Baltimore City health commissioner, state of Maryland health department secretary, and deputy FDA commissioner, who is now a Professor at the Johns Hopkins Bloomberg School of Public Health, published a paper with his father – Dr. Steven Sharfstein – in 1994, criticizing the American Medical Association for contributing to federal candidates who opposed handgun regulation, supported federal subsidies to promote tobacco sales, and promoted a ban on abortion counseling at federally funded clinics. Dr. Sharfstein went on to write an article promoting divestment of physician PAC contributions from political candidates who took money from Big Tobacco.

If we as physicians want to be able to sincerely claim that gun violence prevention is our lane, then the first step is to ensure that the organizations that represent us – all national and state-level physician associations – stop giving money to politicians who are financially backed by the NRA and who we know will oppose any and all gun violence prevention policies. Enough is enough. We can’t have it both ways any longer.

Michael Siegel, MD, MPH

Professor

Department of Community Health Sciences

Boston University School of Public Health

801 Massachusetts Avenue, 3rd Floor

Boston, MA 02118

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Doctors Selling Products To Respond To Mass Shootings? That’s Nonsense.

Twice in my life I had the good luck and fortune to be able to ask a doctor about a serious medical issue affecting myself or a close family member, and in both instances, I received what turned out to be timely and accurate advice. So, I have always believed that physicians should be judged by a different standard, which is one of the reasons that I go out of my way to write about the necessary role doctors play in dealing with gun violence, which occasionally is not appreciated or understood.

trauma-stop-the-bleed             On the other hand, every once in a while I come across an example of physicians behaving in ways which fill me with dread. And what I mean by that is when they use their intelligence, training and public trust to promote some crazy idea or worse, huckster some product that has no earthly wellness value at all.

There is a group out there who call themselves BleedingControl.org., and their goal is to ‘train every American in bleeding control techniques.’ It started in Connecticut following Sandy Hook and is now connected in some way to the American College of Surgeons and claims to have trained 15,000 instructors and 125,000 individuals in bleeding-control techniques throughout the United States.

Would an organization like this even exist were it not for the anxiety and fear created by mass shootings at Parkland, Las Vegas and Sandy Hook?  After all, we have been fighting the ‘War on Terror’ since 2001, a day hasn’t gone by since the Twin Towers came down that we didn’t hear about some kind of terrorist attack or threat. No, this is clearly a response to mass shootings, and an attempt to market products based on fear.

What products does this group market?  Just go to their website and you can fund a handy-dandy Personal Bleeding Control Kit for $69 bucks, a Portable Bleeding Control Bag for $650 and a wall-mounted Bleeding Control station for $800 bucks.  I guess the wall-mounted kit can go next to the fire extinguisher, right? Of course every kit contains an instruction manual and frankly, I’m surprised that they don’t yet have a CD-ROM. But instead of a disc, you can always buy a t-shirt which contains basic blood-control instructions embedded into the cloth. How thoughtful.

I recall that at some point during a gym class in high school, the school nurse came in and gave us a demonstration of CPR. Now we didn’t do a live drill because that would have required each of us to put our mouths over someone else’s mouth which is something the boys wanted to do to the girls but not for the purpose of saving anyone’s life. I can tell you that if, God forbid, I came upon someone lying in the street today who needed immediate resuscitation, I wouldn’t have the faintest idea of what to do. Because you don’t learn a medical technique by just reading an instructional manual or going to one class. You learn by doing it again and again. Right now, you can attend a free class in ‘bleeding control basics’ which lasts for two hours and meets once. Once.

When the bombs exploded at the 2013 Boston Marathon, more than 260 people were injured but only 3 victims died. This remarkable life-saving effort occurred because the explosions took place at the finish line which happened to have a medical tent, fully staffed by physicians who attended to runners coming to the end of the race and needing some degree of medical support. There are two reports, covering the medical response to the bombing, one online, the other can be downloaded here,  Neither of these reports claim that any degree of life-saving work was done by civilian volunteers.

I’m not saying that a well-trained individual couldn’t save the life of a mass-shooting victim. What I am saying is that physicians shouldn’t be appealing to our fears to sell some products that can only be used by people who are very well trained. After all, doesn’t the NRA promote gun ownership based on fear?

 

 

Physicians Shouldn’t Be Concerned About Gun ‘Rights.’

Now that the Republican Party has decided the Affordable Care Act will simply ‘implode’ without their help, stories are appearing about out how the majority party in both Houses of Congress and also sitting behind the HMS Resolute desk in the Oval Office couldn’t get it done. This morning David Leonhardt, an op-ed writer for The New York Times, penned a piece in which he celebrated the efforts of a wide swath of citizens who were the activists behind the Republican legislative demise. And one of the groups he singled out for praise were physicians, whose professional organizations really stood up and helped lead the fight.

docs versus glocks             The idea of doctors being politically in a partisan way is a relatively new thing. Referring to a public statement by the chief of Mass General Hospital decrying Trump’s attack on transgender military troops, a primary care doctor at Mass General said it like this: “Traditionally, health professionals have not commented so boldly on the actions of politicians.” She then went on to say that, “many of the most critical current threats to our health — including poverty, lack of access to affordable health care, gun violence, the opioid epidemic — cannot be eliminated by individuals, no matter how well-meaning.”

I have no expertise in affordable health care or opioids, but I do know a little something about guns. And I have been watching and helping physicians deal with gun violence on the individual, i.e., clinical level for a number of years. And what concerns me about the medical approach to gun violence is that, unfortunately, it doesn’t appear to be rooted in the elimination of a public health issue which kills and injures 125,000+ people every year. Rather, the medical response to gun violence views the problem as one that needs better controls, which is not the same thing as getting rid of it altogether – not the same thing at all.

Last year the Massachusetts Attorney General and the Massachusetts Medical Society collaborated on the production of informational resources that physicians could utilize to become better informed on how to talk to patients about guns. Here’s what is suggested as an approach for counseling patients on gun risks:

Meet patients where they are. Where there is a risk, see if you can brainstorm harm-reduction measures with the patient, as opposed to prescribing one specific solution. For example, rather than advising a patient to get rid of a gun, you could suggest that there are a number of different ways to make guns less accessible, ranging from selling/surrendering the gun, to disposing of ammunition, to temporarily storing the gun outside the home.

 

This statement embodies what one of the most noted physician researchers, Dr. Garen Wintemute (along with several colleagues) suggested was the proper way for physicians to engage in gun discussions, based on the idea that “conversations should acknowledge local cultural norms,” with the desired outcome being “firearms are stored unloaded and locked, with ammunition stored separately.”

So the bottom line is that the new-found, public advocacy by physicians about gun violence should occur within certain, self-imposed constraints, the chief one being that doctors, unless there is an immediate and verifiable risk, should find ways to communicate with gun-owning patients which avoids the basic issue, namely, that guns, no matter how safely stored, are a serious risk to health. Period. End of story. Enough is really enough.

We have made remarkable strides in reducing smoking, another clear health risk. According to the CDC, the percentage of adult smokers is now less than 20%, when I was a kid, everyone smoked. This didn’t happen because doctors told patients that perhaps they should smoke less. It happened because no physician would ever dare tell a patient that smoking is anything other than a clear threat to health.

You think guns are any different? If someone wants to be ‘safe’ with their guns, they can always take one of those phony safety courses offered by the NRA. Physicians shouldn’t be promoting the idea that a gun isn’t harmful to health.

 

Why Don’t Doctors Worry About Dog Bites And Leave Guns Alone?

One of these days, public health researchers will stop getting all hot and bothered about gun injuries and turn their attention to serious threats to health, like fatalities from dog bites (20-30 per year,) or deaths from bee stings (upwards of 100 per year,) or worst of all, getting strangled by a Python – it happened to a guy in 2006.  It really did.

md-counsel              But gun injuries, particularly injuries to kids?  Give me a break. Everyone knows that guns don’t hurt people. People hurt people. And this isn’t just a scientific fact. You can also find this evidence in Biblical texts. Don’t believe me? Just take a look at this survey conducted by the American Culture and Faith Institute conducted in 2012.

So why do these public health researchers and those meddlesome doctors keep bugging us about the so-called risks of guns to children’s health? Because, according to our friends at the NRA, what the medical profession really wants to do is “advocate for handgun bans/registration and licensing/storage restrictions.” In other words, get rid of our guns.

Now the fact that guns protect us from crime, the fact that every time we pick up one of our guns we are expressing and fulfilling our civil rights, that’s entirely beside the point. Everyone knows that Muslim Obama and his gun-grabbing friends have been trampling on the Constitution for the last eight years; everyone knows that disarming America is the first in a series of steps to spread Socialist controls. And don’t take my word for it – you can get all the true facts from Breitbart, Alex Jones or the American Renaissance.

This may come as a surprise to some of the more rational people who read my columns, but the NRA has lately become entrenched within the alt-right media universe to the point that some of their messaging is clearly moving beyond the fringe. I put this down to the drop-off in sales and interest in guns since Trump moved into the White House, the latest data from FBI-NICS shows a decline in background checks from April to May of 12%. To be honest, gun sales always slow down as we get into May because protecting ourselves from all those criminals and street thugs just isn’t as much fun as a day at the beach. But don’t expect Smith & Wesson to be hanging a ‘Help Wanted’ sign out front when Summer comes to an end.

Anyway, back to the pediatricians from Mt. Sinai Hospital in New York City who discovered again what we already know, namely, that if you put a loaded gun in the hands of a kid, someone’s going to get badly hurt. And what I love most of all about how the NRA responded to this remarkable state of medical affairs was their comment that the study is entirely bogus because anyone who knows anything about medicine knows that kids above the age of fifteen aren’t kids.  That’s right – the Mt. Sinai research covered everyone between the ages of zero to nineteen who was admitted to a hospital with an unintentional gun wound, and since more than 80% of the patients were between 16 and 19, this proves that guns aren’t dangerous at all to the younger set.

Let me say it as bluntly as I can: the attempt by the NRA to discredit medical concerns about gun violence is completely and totally a crock of you know what. First, pediatric practice always covers patients up to age 18, some practices go several years higher, but none go below. Second and more important, denying that guns hurt people panders to the same, alt-right stupidity which denies global warming or claims that Sandy Hook was a hoax.

Come to think about it, the NRA has been attacking medical science for at least twenty-five years. If anything, their recent descent into alt-right lunacy isn’t a case of catching up with the mob that follows Trump. When it comes to denigrating facts and scientific thinking, the NRA has been leading the charge.

 

 

 

 

Some Physicians Talk About Their Experiences With Gun Violence Victims.

There’s a cute little website out there called Dr. Oz – The Good Life, which purports to be one of those ‘wellness’ websites that gives you information on diet, exercise, skin care, you know what I mean.  Dr. Oz is actually a television personality named Dr. Mehmet Oz whose medical advice over the years has been attacked by other physicians as ‘pseudoscience’ and ‘quackery,’ even though he still retains his position as Director of Integrative Medicine at Columbia University. His online CV he lists his highest honor as his Emmy Award for Best Daytime Television Host, which is what ‘integrative medicine’ is really all about.

md-counsel              The website is really a vehicle for health and wellness advertising, the products you can purchase to help you lose weight, gain control over your thinning hairline, etc., etc., etc., just abound. But the website also contains an occasional article of some medical value, with a current article entitled, “When Bullets Meet Bodies: What Doctors Think About Gun Violence” written by a faculty member from the Johns Hopkins Bloomberg School of Public Health. The article is a series of interviews with professionals who have treated gunshot victims, including a several surgeons, an occupational therapist, a pediatrician and an EMT chief.

As you can imagine, these interviews reflect the reality of gun violence at the level at which it really occurs, namely, in the medical facilities that have to deal with the people who get shot and whose lives often hang in the balance based on whether the attending medical staff gets it done timely and gets it done right. Gunshot wounds are probably the worst kind of injury because a bullet can and will travel through the human body damaging multiple organs at the same time. So a bullet that enters someone’s torso might go through a lung, sever an artery, smash a rib or two – what do you work on first? Most of the stories collected by the writer, Jennifer Wolff, are first-hand accounts of the difficulties and dangers involved in patching someone up.

Every physician interviewed for this story advocated stricter controls over firearms and clinical interventions by physicians to reduce gun violence before it occurs except one. And the one doctor who felt that his colleagues should basically stay outside of the gun debate is a psychiatrist named Robert Young, who happens to be affiliated with something called Doctors for Responsible Gun Ownership, which claims a national membership of physicians except they have never given out an actual number of the size of their organization, even though they have managed over the past twenty-five years to inject their stupid views into all kinds of public discussions about doctors and guns.

I say ‘stupid’ because not only do their uninformed, pro-gun views clash directly with the stated positions on gun violence published by every, professional medical society in the land, but when they get up and say something in public they just as often get it wrong. In the OZ interview, Young states that the Florida gag law which criminalizes doctors who talk to patients about guns is “under appeal and not yet enforced.” Well I guess Dr. Young hasn’t yet heard about the decision of the 11th Federal Circuit on February 17 which overturned the Florida gag law for good. But the even more remarkably stupid thing he says is that if he has a suicidal patient, “I make a plan with whoever else lives in their house to keep them from potentially lethal things. That includes firearms, but it also includes knives.” Is he joking? Is he comparing the lethality of a gun to the lethality of a knife?

I suspect that the reason Jennifer Wolff gave Dr. Young some space is that she didn’t want to be accused of only hearing from one side. But with all due respect to the canons of journalistic practice there is only one side with respect to the medical risk caused by guns. And except for a few brainless physicians like Dr. Young, this is something which, thankfully, the medical community fully understands.

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.

Physicians Need To Be Engaged In Preventing Gun Violence Right From The Start.

In 1969 I was a caseworker for the Cook County Welfare Department, working out of the West Madison office near Garfield Park in Chicago’s West Side.  The neighborhood, then and now, was considered one of the city’s more troubled areas characterized by high levels of crime and low levels of economic opportunity; not quite as bad as some other Chicago neighborhoods but not a place where I would ever feel comfortable or at home.  And when I recently looked at the Chicago Tribune’s crime map, it hardly came as a surprise that East Garfield was still a place where getting shot or shot at is a regular feature of life in that part of town.

Actually, Chicago is right now enjoying a slight respite from the gun violence of the past few years with 2015 shootings running about 20% lower than in 2014.  I’m not sure, however, that the word ‘enjoying’ actually fits what happened this past weekend because so far during the holiday there have been 9 killed and 32 others wounded by gunfire and Memorial Day celebration still has one more day to go. Is it actually possible that a city of 2.7 million could end up with 50 shooting victims in just 3 days?  Last year, New York with twice as many people experienced 10 shootings over the holiday weekend and the media called it a “shooting spree.”  When it comes to gun violence, Chicago is hardly the “Second City,” that’s for sure.

conference program pic                 Of course the crime numbers on Chicago’s West Side are appreciably different from where Barack and Michelle live in the South Side neighborhood known as Hyde Park.  This area surrounding the University of Chicago and counting about the same number of residents as east Garfield recorded only 6 violent crimes in the past month.  I suspect that crime in Hyde Park will drop even further in 2017 when the President comes home to live full-time surrounded by a phalanx of Secret Service agents complete with dogs, anti-crime patrols, choppers, the whole Presidential security bit.

In addition to the Obamas, Hyde Park is also home to the Chicago Crime Lab, a research and think-tank at the University supported by a who’s who of America’s glitterati foundations and various government funding sources.  The Lab has published significant research on gun violence, much of the work conducted by Philip Cook and Jens Ludwig and one of their reports, Gun Violence Among School-Age Youth in Chicago, stands out as a model for public health research of this kind. The report deserves to be read in its entirety, but my self-imposed space limitation requires me to focus on only one major theme, namely, the fact that youth who engage in gun violence can usually be spotted at a very young age.

The report argues that children start to exhibit behavior that pushed them to get their hands on guns by the time they reach middle school years; i.e., the eighth grade.  This report was published in 2009 but America’s foremost criminologist, Marvin Wolfgang, basically made the same argument in his remarkable book, Delinquency in a Birth Cohort, published in 1972. Wolfgang didn’t tie delinquency to gun violence per se, but you don’t have to be a rocket scientist to assume the connection between repeated delinquency, serial criminality and access to guns.

If, as Cook and Ludwig argue, behavior predictive of gun violence begins to appear at a young age, their call for interventions by school authorities and community programs lacks one vital piece.  Every young child in cities like Chicago is examined by a physician at least once each year.  And who better than physicians are trained to diagnose youth behavior that might create risk? When it comes to children’s health, we need to think of gun violence not just as a socio-economic phenomenon, but as a medical condition whose diagnosis and treatment should be handled by the same medical professionals who make sure that kids are immunized against measles, mumps and the flu.