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

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.

Advertisements

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.

A Medical Voice From The Past Explains Gun Violence In The Present.

I don’t usually applaud anything that the quack physician, Timothy Wheeler,  posts on his Doctors for Reponsible Gun Ownership website, but he’s done us all a favor today by digging up a remarkable article that was originally published in 1980 by Lester Adelson, who served for many years as the Deputy Coroner of Cuyahoga County.  In case you don’t know it, Cuyahoga is a.k.a. Cleveland, which means that Dr. Adelson knew a lot about gun violence.  I’ll ignore the usual stupidities of Wheeler and get right to what Adelson said, because thirty-five years after the fact much of what Adelson observed then remains relevant today.

Adelson confronts us first not with the issues of mortality and morbidity from guns, but with a much more profound problem, namely, the quality of life experienced by those who survive a gunshot wound.  He notes that an increasing number of gun-violence victims survive the assault, which is even more true today than it was thirty years ago.  But he then raises the post-trauma quality of life issue of which we know very little.  Adelson mentions in passing that survivors of gun violence have shortened lives, but he offers no data and I can’t recall a single study which sheds information on this fact.  He also talks about post-incident psychological trauma, again an acknowledged result of being at the wrong end of the barrel when a gun goes off, but we lack specific data to better understand this issue as well.

conference program pic                Think about this: there may be more than 1.5 million of us alive today who at some point endured the pain, suffering and physical/psychological damage caused by a bullet puncturing and exiting our bodies or remaining inside.  What kind of lives do these folks lead after they are discharged from the hospital and told that everything’s “o.k.?”  Can they go back to work?  Will they live out a normal life-span or expire at an earlier age?  We keep very good records on cancer patients in order to determine whether the treatment they received kept their cancers in remission or resulted in reappearance of the “emperor of all maladies.”   But the survivors of gunshot wounds, unless they come back to the hospital with another gunshot wound, are largely on their own.

Two other points from Adelson’s article deserve mention.  First, he confronts the degree to which we are immune to the issue of gun violence, noting that if Cuyahoga County experienced as many deaths each year from typhoid fever as they did from guns, there would be “mass hysteria.”  And Adelson wrote this article in 1980, well before shooting deaths in Cleveland and other major cities peaked in the 1990’s.  But this comment struck a chord because I recall that we started rushing medical supplies to Central Africa to ward off Ebola which, if it killed the same number of people in a year who are killed by gunshots in America (roughly 30,000), would have been considered an epidemic by the WHO.

The second, and perhaps more important point raised by Dr. Adelson is the recognition that gun homicides and crimes aren’t the same thing.  The idea that gun violence and crime are synonymous has been a convenient way for the pro-gun folks to distinguish between ‘law-abiding’ gun owners who shouldn’t have their guns regulated, as opposed to criminals who do the bad things with guns and just need to be locked away.  Adelson cuts right through this nonsense when he says, “The accessibility of a firearm permits the instantaneous metamorphosis of a law-abiding (hot-headed?) person into a murderer,” citing data which shows that most homicides are not associated with other felonies and often erupt in the context of a domestic dispute.

Adelson’s brilliant and prescient article underscores one thing that is true beyond a shadow of a doubt: guns are very, very lethal and no matter what an idiot like Tim Wheeler says, putting one into someone’s hands creates medical risk.  That’s not just a problem for gun owners per se, it’s an issue that physicians always need to address.

 

When It Comes To Guns, Physicians Should Forget The Hippocratic Oath.

Now that America finally has a Surgeon General, you would think that the debate over his appointment would give way to an honest and serious effort to evaluate Vivek Murthy’s performance as he leads the nation’s public health effort for at least the next two years. But there’s one guy out there who simply can’t leave the issue behind, and as he continues to fulminate over Obama’s choice for Surgeon General, the hot air and the lies continue to expand.  I am referring to Tim Wheeler, the sometime head of an alleged organization which claims to represent thousands of physicians who support ‘responsible’ ownership of guns.  The NRA has been pushing this quack into the public arena ever since the gun lobby decided that the listing of gun violence as a public health problem meant that physicians had become, to gun owners, Public Enemy Number 1.

      Vivek Murthy, M.D.

Vivek Murthy, M.D.

I didn’t notice the automobile industry attacking physicians when car accidents made the list as a public health problem.  In fact, Detroit collaborated with public health researchers when it came to designing and producing safer cars.  The same could also be said of the household recreation industry which helped craft legislation passed by state after state which mandated that fences be installed around all in-ground, backyard pools.  But somehow the gun industry decided that its products not only did more good than harm, but decided that they did so much more good than harm that the issues of lethality and safety risks didn’t need to be discussed at all.  Enter Timothy Wheeler, who has doggedly led the fight to disconnect physicians from any public discussion or publicly-funded research about guns.  And if you doubt the validity of anything he says, remember, this is a guy who claims to be an M.D.

Now I’m not an M.D. but I can do simple math.  And if guns are the method of choice in 100,000 fatal and non-fatal but serious injuries each year, then we’re not talking about chopped liver in medical terms.  We’re talking about a medical condition which costs countless lives, billions of dollars and untold family trauma each year, the human results of which inevitably end up in a critical-care treatment bay with the terrified family and friends waiting to be told whether they’ll ever be able to speak to the shooting victim again.

 

Wheeler’s latest effort to spread misinformation and stupidity about the role of physicians in gun violence is an op-ed on the National Review website which features his bizarre frothings from time to time. In this particular effort, he not only takes aim at Murthy and the potential danger that he represents for gun owners over the next several years, but he also repeats the fiction that physicians have no right to invade patients’ privacy by advocating “gun control” in the examining room.

If Wheeler is so lacking in the most rudimentary understanding of how medical professionals attempt to asses patient risk he can be excused if only because he may not know how much disinformation he’s handing out.  But if he’s aware of how physicians are trained to assess medical risk then he’s just pandering to an audience who can be excused for not knowing what Wheeler’s supposed to be talking about.

Physicians usually begin an examination by asking the patient how he or she feels.  The answer to that question prompts the next question,  the answer to the next question prompts a third, a fourth and as many questions and answers as the physician needs to ask in  order to assess the health risk of the patient sitting in the examination room.  To place any limits on the doctor-patient exchange of information is to ask a physician to violate the Hippocratic oath.  But Wheeler’s not interested in the method that physicians use to reduce harm.  He’s interested in helping the NRA marketing team, which means he’ll say whatever the gun industry needs to have said in order to sell guns.  He’s a good salesman from that point of view; as a physician he says things that simply aren’t true.

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.

Think Doctors Shouldn’t Ask Patients About Guns? Think Again.

English: A roadside sign at Santa Clara Valley...

English: A roadside sign at Santa Clara Valley Medical Center in San Jose. This sign is an example of how the U.S. state of California requires all hospitals with emergency rooms to include text like “Comprehensive Emergency Medical Service” and “Physician On Duty.” (Photo credit: Wikipedia)

There’s been a lot of talk in and out of gun circles about the attempt by Florida to criminalize physicians who ask patients whether or not they own guns.  The law, passed in 2011, was  overturned in Federal Court but now is headed for another hearing in the 11th Circuit.  At issue is whether physicians can inquire about the ownership of guns, even if no clear threat to health is perceived. Supporters of the law insist that because most physicians are anti-gun, what they are really trying to do is disarm law-abiding Americans.  To quote the NRA-sycophant Dr. Timothy Wheeler:  “doctors are following a hidden agenda laid out for them years ago by the American Academy of Pediatrics — an agenda that would take guns away from Floridians.”

But the question is not whether physicians are following some hidden agenda.  The real question is whether they are following federal law.  And the law I am referring to is the law that covers all hospitals and physicians delivering medical services covered by Medicaid and Medicare, which in the case of hospitals basically covers every hospital treatment facility in the United States.  This law is regulated by an agency known as the CMS, whose treatment manuals define medical care.  And here is what the CMS has to say about what a physician must do when a patient walks into an Emergency Department and requests care: “In such a case, the hospital has incurred an obligation to provide an appropriate medical screening examination (MSE) for the individual and stabilizing treatment or an appropriate transfer. The purpose of the MSE is to determine whether or not an emergency medical condition exits.”

Notice that I say “walked” into the emergency room.  Obviously if someone is wheeled into the emergency room bleeding from a gunshot wound, the attending physicians don’t have to figure out whether an emergency medical condition exists.  But most people who visit emergency departments don’t present such obvious symptoms of distress.  Rather, they show up because they “don’t feel good,” or have a pain here or a pain there.  Many are suffering from mental distress, others have been victims of domestic violence that, if left untreated, might get much worse.

How many of these patients are caught in a vortex of physical or mental deterioration that could wind up in a gun being shot off?  According to Megan Ranney, an emergency room physician in Providence, patients who are treated for gun wounds have a one-in-five chance of returning with another gunshot wound within five years. Wouldn’t there be a good possibility that many of these patients would re-appear in an emergency room in the intervening period and shouldn’t an attending physician need to know whether that individual had access to a gun?

Let me quote a little further from the CMS: “Individuals coming to the emergency department must be provided an MSE appropriate to the individuals’ presenting signs and symptoms, as well as the capability and capacity of the hospital. Depending on the individual’s presenting signs and symptoms, an appropriate MSE can involve a wide spectrum of actions….” So what should a doctor do when a patient says that he or she feels “depressed” or “upset,” or reports some other sign of mental distress.  Should the attending physician ignore all the data that indicates a clear correlation between household gun ownership and successful suicide attempts?

It’s time to set aside all the nonsense about how physicians have some kind of secret agenda to take away the guns.  Let’s remember that it was the CDC’s announcement in a 1981 morbidity report regarding deaths from an “unknown” lung infection that eventually led to treatments for AIDS.  If the NRA wants to pretend that 31,000 annual deaths and 75,000 injuries don’t constitute a health issue that’s fine.  But I’ll close this post with a quote from the novelist Walter Mosely: “If you carry a gun, it’s bound to go off sooner or later.”  Physicians need to figure out if the gun is going to go off, and when it does, what to do about it. That’s not a secret agenda, that’s the law.