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

January 8, 2025

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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.

Between Bushmaster And Murthy It Wasn’t Such A Great Week.

December 17, 2024

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It hasn’t been such a great week for the gun business. First and most important, gun sales are really in the tank and don’t show any signs of improving. Ruger stock, which hit an all-time high of $85 a share back in January, closed yesterday at under $35. Smith & Wesson, which was at $17 in June, is now selling for around $9. Nobody expected these companies to maintain the sales numbers they posted over the last several years when everyone believed that a new gun bill would somehow squeak through in DC. But nobody also thought that the industry would bottom out so deep and so fast. I walked into a gun shop on the North Shore this past weekend and walked out with a Colt H-Bar AR-15 for a little over seven hundred bucks. It was used but mint and six months ago the same gun would have fetched at least a grand.

Talking about black guns, the long-rumoured lawsuit by parents of children shot by Adam Lanza at Sandy Hook was filed just before the deadline that would have made such wrongful-death claims null and void. The suit goes after Bushmaster, the manufacturer of the XL-15 that Lanza evidently used with terrible results the day he walked into the school. The good news for the plaintiffs is that Bushmaster is owned by a private investment group, Cerberus, which has some really deep pockets. The bad news is that the suit has to somehow get around the 2005 law which immunized gun makers from most claims of negligence or product liability and stymied other victims of mass shootings, such as the Aurora Theater massacre, from seeking damages from the gun maker even though suits against the theater and the seller of the ammunition used by James Holmes have gone forward.

Vivek Murthy, M.D.

Vivek Murthy, M.D.

What’s different about the Bushmaster suit, however, is that it takes issue with one of the most cherished missives in the gun industry, namely, the idea that the AR-15 is a perfectly-acceptable weapon for civilians because, as opposed to its military likeness, the M-16, it fires only one shot every time the trigger is pulled, whereas the M-16 is a machine gun that fires a massive amount of ordnance and therefore is unsuited and illegal for civilian use. The moment the lawsuit was filed, various gun experts began pushing the semi-auto versus the full-auto story to explain why the legal argument wouldn’t work. The only problem with the alleged difference between the M-16 and the AR-15 is that it’s simply not true. Most of the M-16 rifles currently carried by U.S. troops in Iraq and elsewhere are semi-auto guns (a small number can also shoot 3-shot bursts) because the military long ago discovered that automatic fire was not only inaccurate and a waste of ammunition, but also would heat up the barrel to unacceptable temperatures leading to battlefield failures of the gun. Bushmaster touts the sale of its rifles to the U.S. military on its website – the gun purchased by Nancy Lanza was one and the same thing.

The other piece of bad news for the industry was the confirmation of Vivek Murthy as Surgeon General, an appointment that was contested loudly and continuously by the NRA and its most ardent Senate supporters, in particular Rand Paul and Ted Cruz. These two guys started taking pot-shots at Murthy because they saw it as a quick and easy way to begin building support among the conservative, Republican base as a possible step towards a White House bid in 2016. The NRA has been trying to push physicians away from any discussion about guns because virtually every medical society has for years confirmed the bizarre idea that maybe, just maybe guns are a threat to health. Now the fact that more Americans have died from gun violence in the last ten years than died during World War II doesn’t mean that guns are necessarily harmful, does it? If you want to agree with the NRA on that one, you probably also believe that last week didn’t hurt the gun industry at all.

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For sale on Amazon.

Physicians Need To Stop Talking Just To Each Other About Guns

October 18, 2024

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Gun owners, particularly the more activist gun owners, tend to be prolific bloggers. Partly this is because they often believe themselves to be an “oppressed minority,” whose vies on guns aren’t reliably reported by the media; partly because guns still aren’t a “mainstream” item in many areas which prompts gunnies to create their own, alternate communication channels. You can catch a flavor of this mentality in Brian Patrick’s The National Rifle Association and the Media, a book whose arguments I don’t necessarily agree with, but it nevertheless gives some good insights into the gun-owning frame of mind.

I make a point of reading several gun blogs every day to keep up with what the “other side” has to say. Many of the blogs are basically advertising vehicles whose content is comprised mainly of cut-and-paste entries from other blogs or sites. My personal favorite is CalGuns, which seems to attract a fairly literate audience that not only refrain from much of the in-your-face rhetoric that characterizes so much of the current gun discussion (thanks to Ted Nugent, et. al.) but also gives space to interesting and informed questions that do need to be confronted in the gun debate.

docs versus glocks For me and many of the readers of my blog, a major issue involves the role of physicians in dealing with the violence caused by guns. I don’t really think there’s any connection between the NRA’s opposition to Vivek Murthy as Surgeon General and the possible outbreak of Ebola in the United States. But I do believe that a pernicious trend exists to prohibit medical inquiries about gun ownership now that the Florida gag law has appeared in Missouri and will surely spread beyond. It’s pernicious first of all because it fosters a wholly uninformed, stupid and reactionary view of the role of physicians in their everyday work, and it’s also pernicious because it is the foundation of a cynical marketing strategy to make consumers believe that guns are just another, all-American way to have fun. I beg to differ with the NSSF, but the AR-15 just isn’t the Millennial version of the Daisy Red Ryder and we shouldn’t be creating a generation that will hope to find one on Christmas Day sitting under the tree.

In that respect the CalGuns blog posted an interesting thread yesterday that read: “My sister took my niece to the doctor the other day and they asked her if there are firearms in the house. Is that legal in California?” The writer went on to reference the Florida gag law which, if nothing else, shows that he has some awareness of events beyond himself, and most of the responses he received were also fairly cogent and informed. One writer differentiated between “legal” as opposed to “appropriate,” another suggested that the patient ask the physician “in a nice manner” why the question was being asked, a third poster stated that he would be concerned that perhaps the doctor suspected “foul play.”

These comments demonstrate to me that there are lots of gun owners who simply don’t understand the reasons why, medically speaking, physicians need to ask patients about access to guns. And it doesn’t work to simply explain this lack of understanding because of the NRA’s demonizing of physicians over the past twenty years. It seems to me that physicians, medical organizations and the medical establishment in general need to do a better job of explaining their role and responsibilities in dealing with the violence or potential violence caused by guns. When the American Academy of Pediatrics publishes a statement about gun violence on their website, do they ask themselves whether the commentary will be picked by the readers of CalGuns? As long as physicians only talk to other physicians about gun violence the NRA will own the argument about physicians and guns.

When Is An Epidemic Not An Epidemic? When It’s Caused By Guns

October 2, 2024

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It was back in 1996 that Congressman Jay Dickey (R-AR) inserted language into the 1997 budget that prohibited gun research funded by the CDC. And from that time forward, physicians and public health researchers have been a favorite target of the NRA. The most public example of this attempt to demonize the notion that guns constitute a health risk is, of course, the Florida law (“Docs versus Glocks”) which potentially criminalizes physicians who ask patients about guns. Yet another instance in which gun “rights” were used to distort the role and value of physicians was the successful attempt by Rand Paul, the self-certified opthalmologist from Kentucky, to block or at least temporarily derail the appointment of Vivek Murthy to be head of the CDC.

Rand’s opposition to Murthy’s nomination was nothing except an attempt to pander to a receptive audience, i.e., hard-core NRA members and other right-wing folks, whose support he will surely need if and when he announces a bid for the White House in 2016. I actually have no issue with Paul or any other political candidate saying whatever has to be said to get his ducks lined up in the water in order to try and latch onto the gold ring. But when Rand politicizes the importance and value of public health as regards guns or anything else, he’s stepped across a line that ordinarily demarcates stupidity from common sense.

Ebola virus

Ebola virus

Last week the first case of someone infected with Ebola was confirmed. It turned out to be a man who came into contact with an Ebola patient in his native country of Liberia shortly before coming to the United States. And while he evidently told hospital staff in Texas that he had recently been in an infected zone, the hospital in Dallas mistakenly released him back into the general population and God knows how many individuals may have come into contact with this poor guy before he was properly diagnosed.

The challenge now facing Texas Health Presbyterian Hospital is to identify every person with whom this patient may have had contact, get them isolated and tested and hope that the disease hasn’t spread. But I’ll tell you this: If there’s even the slightest hint that the Ebola virus might appear in Dallas or elsewhere, guess which agency the entire American population will expect to step in? It won’t be the NRA, that’s for sure. Despite the fact that the penultimate guardians of the 2nd Amendment, along with Rand Paul, claim to know what doctors should and shouldn’t do, the burden of dealing with Ebola will fall right where it should – on public health researchers and the CDC.

I’m not saying that gun violence is as much a threat to public health as Ebola. In roughly a month, the WHO estimates that the “epidemic” has killed more than 3,000 people in Liberia, Guinea and Sierra Leone. Representatives from more than twenty countries are now meeting in London to figure out how to get more medical aid and resources to contain the deadly spread. In Sierra Leone there are five new cases reported every hour of every day.

Hey, wait a minute. The Ebola mortality rate is estimated at 50%, which means that 30 people will die each day from the virus in Sierra Leone, which is about one-third of all the cases that are being reported throughout West Africa at this time. Do the arithmetic, as Bill Clinton said, and this adds up to 30,000+ Ebola victims in West Africa over a full year. Isn’t that roughly the same number of people who die from gun violence each year in the United States?

But let’s not forget that the CDC isn’t allowed to figure out what to do about gun violence and if it were up to the NRA, every state would follow Florida’s lead in gagging doctors who want to talk to their patients about guns. If 30,000 Ebola deaths in Africa constitutes an epidemic, what do you call 30,000 gun deaths which have occurred every year in America for the past twenty years?

 

He’s At It Again: Rand Paul Protects Gun Owners From Nothing

April 9, 2024

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In February I wrote a post about Rand Paul’s effort to block the nomination of Vivek Murthy to be Surgeon General because of Murthy’s comments about guns. Paul’s early efforts to inject himself into the 2016 Presidential race is being run on a shoestring, all the more reason why he needs to pander to groups like the NRA. But now Paul has taken several more steps to the Right and is sending out fundraising appeals for a lobbying organization - The National Association of Gun Rights - which calls itself the “conservative alternative” to the NRA.

paulThis time around Paul is taking aim at an old enemy, the United Nations Small Arms Treaty and its outgrowth, a UN-sponsored project known as the International Small Arms Control Standards, a.k.a. ISACS. The task of the ISACS is to create the actual methods and mechanisms to be used by treaty signatories on a voluntary basis to monitor and control illicit manufacture and shipments of small arms. Despite the howling and yowling about the treaty by pro-gun groups, including the NRA, virtually all of the standards being developed to identify and track illicit movements of small arms are already in place for anyone who wants to bring guns into, or ship guns out of, the United States.

But even if the U.N. Small Arms Treaty never gets passed by a two-thirds Senate vote, the U.N. (and of course Obama) are already “plotting” the next step, namely the imposition of the following “radical anti-gun initiatives” on every nation that signs the treaty including: (1). National “screening’ for everyone who wants to own a gun; (2). licenses required for all sales of guns and ammunition; (3). restrictions on the number and amount of guns and ammunition that anyone could own; (4). bans on magazines with capacities of more than ten rounds; (5). bans on concealed-carry licenses for self defense.

According to Senator Paul, this treaty and the Control Standards being implemented behind it amount to a complete loss of national sovereignty and an end to gun ownership in the United States. Incidentally, the Senator not only knows what the treaty and the standards document contain, he also knows that the United Nations is “plotting” to put it all into effect. The only person I know who sees more plots going on around him than Rand Paul is Glenn Beck. In the case of the U.N. Small Arms Treaty and ISACS, however, it’s simply not true.

There is not a single word in either the treaty or the standards that have been drafted to date that mandates or even talks about anything having to do with legal, private ownership of small arms. The whole point of the U.N.’s small arms effort is to help countries, particularly in underdeveloped areas, control the shipment of small arms because so much of the anti-government violence and instability in these countries is fueled by underground or black-market supplies of ammunition and guns. Many third-world governments (e.g., Somalia) simply do not have the resources to either monitor their own borders or maintain stability because it’s so easy to transport and distribute small arms. Recall that our troops paid a heavy price because even we couldn’t control shipments of illicit small arms into Afghanistan and Iraq.

I have no objection to Rand Paul seeking aid and comfort from political allies like the NRA or the NAGR. I donate money to the candidates of my choice, so why should I be upset when a politician whom I don’t particularly respect hits up people who might be aligned with his point of view? But going after the gun vote is one thing, inventing reasons for my support out of whole cloth is something else. There is not a grain of truth to what Rand Paul is saying about the U.N. Small Arms Treaty, and he’s insulting me and every other NRA member by sending out a fundraising appeal loaded with statements that are just wide of the mark.

 

 

An Inmate Takes Over The Asylum: Rand Paul Says Guns Aren’t A Public Health Issue

February 28, 2024

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This week President Obama submitted his nomination for Surgeon General to the Senate, a Yale-trained physician named Vivek Murthy, and Rand Paul announced he had put a “hold” on the nomination because of Murthy’s opposition to the 2nd Amendment and his membership in organizations like The Center for American Progress which want to impose stricter controls over guns.

Paul is trying to ferret out every conservative and Tea Party vote to help him win the 2016 Republican presidential nomination, so it’s not surprising that he would pander to the views of the NRA, which immediately sent a message to the Senate supporting Senator Paul’s stand. But Rand Paul is also a licensed physician, an opthamologist, so you think he would at least have the honesty to admit that his declaration that guns do not represent a “public health issue” is nothing more than election-year nonsense even before the election year has arrived.

But why let facts stand in the way of your opinions, particularly when you believe that the loonier your opinions, the better chance you have of ending up living at 1600 Pennsylvania Avenue for at least four years? The only problem is that if Paul really believes that guns aren’t a public health issue, then he’s woefully ignorant of the determinations made by his own medical profession whose uncontested views and guidelines on gun violence have been on public record for more than thirty years.

The CDC, which is required under law to define and track progress on issues that affect public health, has listed gun violence as an issue since the publication of “Healthy people: the Surgeon General’s report on health promotion and disease prevention” in 1979. This publication, which is updated every ten years, defined gun violence as a public health issue because it was the major cause of homicides which are a significant part of a broad category of public health threats known as unintentional injuries and accidents, which also includes, among other health impairments, vehicular accidents, residential fires, drownings and physical assaults.

The interesting thing about gun violence, is that the two categories in which its occurrence is tracked by the CDC - firearm-related deaths and nonfatal firearm-related injuries - have each shown progress in the CDC report, as opposed to health threats like falls, child maltreatment, school physical education injuries and overall homicides, the last of which has moved further away from the targeted goal that was set in 1998.

If Rand Paul was really interested in making an honest contribution to the gun debate, he would cite the 2010 CDC Healthy People report as an example of how firearm owners are doing the right thing when it comes to safe use of their guns. Because that’s exactly what the CDC report says. But Paul isn’t interested in an honest debate, he’s trying to out-lunatic the lunatics in order to make sure that nobody else (example: Ted Cruz) can challenge him from the Right. Of course the NRA isn’t any more interested in injecting reality into the debate. I just received a fund-raising appeal from them telling me that gun ownership was heading towards Armageddon in 2014. Don’t worry, I get the same kind of emotion-laden appeals from Moms Demand Action for Gun Sense telling me that gun-carrying Americans are out of control.

I think it’s gotten to the point that you can’t talk about guns in rational terms. There’s too much at stake and what’s at stake is political ambition and money, lots of money, which is used to keep people’s minds focused on things that have noting to do with health, or safety or whether Americans should own guns.

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