American medical organizations agree: It’s time for modest gun restrictions

Last month, the American College of Physicians (ACP) published a paper in the Annals of Internal Medicine titled, “Firearm-Related Injuries and Death in the United States: A Call to Action From 8 Health Professional Organizations and the American Bar Association.” In it, the authors list a series of proposals that their organizations support concerning limiting the negative health consequences that can occur due to firearms.

The authors are leaders of a number of medical professional societies in that represent the vast majority of all physicians in the United States. The groups involved include the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Emergency Physicians, the American Congress of Obstetricians and Gynecologists, the American College of Physicians, the American College of Surgeons and the the American Psychiatric Association. The American Bar Association and the American Public Health Association also participated, and while neither are made up exclusively of physicians, both added important input.

The ACP previously did a survey of some of its members concerning this very issue about a year ago. Also published in the Annals of Internal Medicine, it found:

Most internists who responded to our survey believed that firearm-related violence is a public health issue. In addition, most respondents favored policy initiatives aimed at reducing the problem. Most responding internists believed that physicians should have the right to counsel their patients about firearm-related violence. Despite that, few internists reported currently engaging in such patient counseling. These data may be useful in the development of policy initiatives and educational resources.

Note that the push to make changes to gun laws by medical professional organizations is not new. The American Academy of Pediatrics, the American College of Emergency Physicians and others have come out in support of changing gun laws in the past. But this is the first time that such organizations have come together to present a united front on the issue.

The authors who crafted the recommendations in the above paper, writing as representatives of their respective organizations, endorse a series of proposals concerning firearms and patients’ health issues.

These groups reviewed data on firearm-caused injuries and deaths in the United States and the current state of gun regulations. They noted that there are over 32,000 deaths each year related to firearm-related violence, suicides and accidents, along with over 70,000 injuries. That averages out to over 85 deaths and 190 injuries per day. A recent report released by Mother Jones shows that the United States pays over $229 billion dollars a year in costs associated with gun injuries and deaths.

The authors of the ACP paper state:

Our organizations support a public health approach to firearm-related violence and prevention of firearm injuries and deaths. Similar approaches have produced major achievements in the reduction of tobacco use, motor vehicle deaths (seat belts), and unintentional poisoning and can serve as models going forward. Along with our colleagues in law and public health, those of us who represent the nation’s physicians are aware of the significant political and philosophical differences about firearm ownership and regulation in the United States.

These organizations have proposed a number of recommendations that are geared to help prevent firearm-related injuries and deaths. These recommendations consist of the following:

Background checks: Some gun sales occur without suitable background checks on the prospective purchaser. Weapons purchased at gun shows and weapons sold between individuals often escape background checks. These groups support requiring background checks to be carried out for all gun purchases.

Repeal of physician “gag laws”: Some states prohibit physicians from asking patients questions about gun ownership and gun safety, which can be critical information for a doctor to have. For example, if a severely depressed patient is known to have access to a firearm, the physician may use a different treatment plan than he would with someone who does not have easy access to a gun.

Being able to ask that question and respond accordingly is critically important, as almost 80 percent of successful suicides in the U. S. are male and, of those, well over 50 percent use a firearm to kill themselves. Relatedly, simply having access to a gun makes a man four times more likely to kill themselves compared to if they did not have access.

The American Medical Association is endorsing a gun education program for physicians to help them become familiar with weapons safety and other issues with firearms.so that they can better evaluate patients’ responses to questions about gun safety.

Limiting access based on mental health of substance abuse issues: While stopping far short of calling for a prohibition on patients with mental health or substance abuse issues having firearms, the authors suggest limiting access for individuals who are at risk of harming themselves or others. Limited access to guns would be tied to increased opportunity for accessing mental health treatment and follow up care.

Reporting laws: Reporting laws are requirements that physicians inform law enforcement agencies if a patient is suspected of being a danger to himself or others.

The authors want legislators to carefully design any mandatory reporting law so as not to cause these reported individuals to avoid medical or psychiatric help in the future. That is, to not label them as patients with severe psychological issues that might permanently stigmatize them. Additionally, the American Medical Association is endorsing a gun education program for physicians to help them become familiar with weapons safety and other issues with firearms.

Assault weapons: The paper calls for federal laws that would prohibit private citizens from owning military-type assault weapons and excessively large magazines to the extent allowed under the Constitution. The American Bar Association affirmed that it doesn’t think that the recommendations made in the paper infringe on Second Amendment rights.

Research: They authors want support for research by the National Institute of Health, Centers for Disease Control and other organizations to do studies on the health and safety issues surrounding firearms.

The proposals they make are reasonable, but some would be difficult to craft. For example, formulating reporting laws that at once both act to protect the patient and others, yet not lead to a permanent stigma, would be difficult. Others recommendations might be easy to enact but difficult to enforce, like background checks on individual-to-individual gun sales. Most of those transactions would probably never surface unless the weapon was involved in a crime and traced to the original owner, if the firearm was ever registered at all.

Doctor and gun via Shutterstock

Doctor and gun, via Shutterstock

Also, the authors intended to tread lightly around the term “Second Amendment rights,” but that has proven to be impossible. To many of the Second Amendment’s more avid proponents, any regulation at all — be it background checks, magazine sizes or restrictions on individuals with mental health or substance abuse issues — constitutes an unconstitutional violation of fundamental rights. There is simply no room for suggestion, let alone conversation, on that front.

In spite of this, this coalition is looking to start a public health educational campaign to target the changes they propose. They are looking to raise public awareness and push for change much as the campaign against drunk driving did. They may also be thinking of exploring alliances with other groups that are already active in the campaign to make changes in gun laws.

Since the article was published, there has been blowback on the Internet and in other arenas from physicians. Though the number of these physicians seems to be in the minority, some are very much against almost all of the recommendations presented in the paper.

Some argue that their patients’ Second Amendment rights would be denied. Others feel that both their patients’ and their own Second Amendment rights would be violated. Still more feel that physicians have no reason to ask patients about guns, as gun ownership probably has no bearing on the reason for the visit and time with the patient is limited.

While I couldn’t find a statement from the NRA in response to the paper, I did find a comment from the ACP’s Executive Vice President, Steven Weinberger, M.D., addressing the NRA’s reaction. Per MedPage Today, Weinberger felt that:

…the NRA did not appear to be interested in a “professional discussion.” He added, “When the original paper came out, they [the NRA] posted something on their website that was an acknowledgement but not a respectful analysis.”

Weinberger also pointed to the NRA’s efforts to block the nomination of Vivek Murthy, M. D., as U.S. Surgeon General “because Dr. Murthy said gun violence was a public health concern.”

There are hundreds of thousands of physicians affiliated with the organizations that have authored and signed on to the ACP paper. Based on that and the survey that the ACP presented last year, it seems that the majority of physicians are in favor of changing gun laws. In that respect, they are in concert with the majority of Americans, who feel the same.


Mark Thoma, MD, is a physician who did his residency in internal medicine. Mark has a long history of social activism, and was an early technogeek, and science junkie, after evolving through his nerd phase. Favorite quote: “The most exciting phrase to hear in science... is not 'Eureka!' (I found it!) but 'That's funny.'” - Isaac Asimov

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  • RGnome

    They’re free to advocate whatever they want, but they aren’t admitting that they are playing a biased political game. That’s just dishonest.
    They deserve to be called on it. And if they didn’t make it seem like they were selling their integrity they might have some actual impact.

  • Moderator3

    Remember: Don’t feed the trolls.

  • Abraham Collins

    Ignorance would be obsessing over “gun deaths” rather than death in general. States with permissive gun laws do not have higher rates of homicide.

    I refuse to accept a punishment for the errors of others and the federal government has no business being involved in intrastate firearms commerce. “Universal background checks” are a gun registry in disguise.

  • Abraham Collins

    The elections have already been held and now both the Senate and House are controlled by pro-gun politicians. You’ve already lost.

  • gratuitous

    Then let’s put it to a vote. Democracy, you know. Just take your yammering and complaining somewhere else when you lose. We the people aren’t going to be held hostage any more.

  • sophie

    Perhaps some of those “professional groups” are tired of watching Americans being injured or slaughtered by too many unhinged people with guns. The unfathomable ignorance being displayed by gun fetishists is amazing. There is nothing wrong with having background checks, (states that have them have lower rates of gun deaths and injuries), or other safety regulations. The highest rates of gun mortality are in “red” states, which have fewer gun laws.
    Ignorant people who have not seen the damage done by lax gun policies only care about their ‘Murican 2nd. amendment bullshit. How many people have to die before the NRA gets kicked out of state houses and politicians stop being political whores for right wing gun extremists?

  • Abraham Collins

    An AR-15 is not an automatic weapon. An M16 is and they’re virtually impossible to own.

  • Abraham Collins

    That isn’t going to work. We vote.

  • Abraham Collins

    I am militia according to Title 10 of the US Code, Chapter 13, Section 311.

    It doesn’t matter, though, because rights are for us all, not a privileged class.

  • Abraham Collins

    200,000 American lives are lost annually because of preventable medical errors. Clean up your own back yard before coming after my rights.

  • gdogs

    When more people are killed by firearms than medical malpractice I’ll
    start listening to what doctors have to say on the matter – though I
    still won’t go along with gun bans or the gun registration scheme known
    as universal background checks. You are far more likely to die at the
    hands of a physician than a gun. Just a little reality for all of you.

  • One of the things I find the most heinous are the gag laws. Not just in the context of gun control, but they’re used widely in places where Republicans have had control to deny the public access to basic information and education on all manner of things. They don’t even just limit the access of information, they often prohibit the collection of any kind of statistical information that would aid in determining if there even were a problem that should be brought to the public’s attention. And the gag laws evil cousin, the lie to people laws – where doctors and educators have to read from some kind of government-provided script, often one that has no basis in anything resembling factual information, instead of being honest. They actively seek to not just ignore problems, but to actively hide them. The Department of Transportation just did it with bomb trains, the public is no longer allowed to know when they are traveling through their communities for “security” reasons.

  • RGnome

    Advocating the banning of of an item that is misused less while not doing so for items that are overwhelming misused certainly does seem like “Tailoring your message to what you think might be possible”. Though I’ll admit that I don’t know exactly how the recommendations came about. I do have my suspicions. Were you privy to why ‘assault weapons’ needed banning while handguns weren’t?
    And the larger portion of the opposing views that I have read (I’ll admit to being anecdotal here) from organization members deal with concerns about professional groups playing politics with subjects outside of their area of expertise. That doesn’t give me a whole lot of confidence in the views of people advocating restrictions.
    Perhaps you can explain why the medical and legal professions have expertise in this public policy debate and where that expertise ends.
    Because I’ve been getting the impression that professional groups have been taking a natural interest in the horror of criminal assault, specifically tying it to guns, and making some suspiciously biased policy recommendations.

  • docsterx

    Their proposals cover all forms of firearms: shotguns, rifles, pistols, etc.

    They did “go after” pistols. Pistols are included in the recommendation on background checks, in the point they make on the repeal of gag laws, in limiting access to guns for those with mental health issues, in their research proposal, in their suggestions on reporting laws and even in their proposal regarding overly large magazines. Some pistols can have very large magazines. You only focused on the automatic weapons proposal and seem to have missed the rest. Their proposals cover all forms of firearms. Perhaps I needed to be more clear, but I thought that the use of the word “firearms” several times showed their proposals to be about all forms of guns.

    The number of assault weapons or their prevalence in crime wasn’t addressed. The fact that they need regulated and have caused personal injuries are the topics that the group focused on.

    As I mentioned, some of their suggestions might be extremely difficult to legislate or enforce because of pressure from the NRA, its followers and others of for other reasons. That’s hardly “Tailoring your message to what you think might be possible.”

  • Indigo

    The three matters that had American Puritan attention after the Revolution were firearms, tobacco, and alcohol. They wanted all three prohibited by the Constitution. That didn’t fly but the bureau of Alcohol, Tobacco, and Firearms quickly came into existence and went to work. The FBI came later, then the CIA, and then that strange NSA but those early issues, a deep concern for American Puritans in the 18th century, are those same three issues we’re still at logger-heads about. We tried Prohibition and agree that it didn’t work but alcohol consumption remains a topic of dispute. The firearms were written into the constitution under the rubric of a “well regulated militia.” Do we even have one of those? And as for tobacco, the current consensus is that it’s so medically bad that we excommunicate tobacco users from polite society. As far as I can see, the old-time Puritans identified those three hot buttons, they have remained constants that are with us now and most likely well into the future. We really need to get a grip on those topics, get past the rhetoric of good and bad, and settle into an accord that respects the wisdom of diversity. If you want to drink, drink in moderation. If you want to smoke, smoke in private. If you want to shoot a gun, join a “well regulated militia.”

  • gratuitous

    We’ll continue to have this problem until we learn to ignore gun fanatics and their obstinate ways. Their only contribution to the problem is to say no, and doing nothing isn’t working. We’re going to need to do something, even if gun fanatics yammer and complain. But gun fanatics are always yammering and complaining. Ignore them, and let’s have the rest of society move ahead on this.

  • RGnome

    It’s called politics.
    And if you want proof of that then look no further than the fact that they support banning ‘assault weapons’. Anyone who follows the gun gun control debate at all knows that assault weapons make up a tiny fraction of firearms misuse.
    If they truly wanted to cut down on loss of life they’d go after pistols. But since that isn’t going to happen… Tailoring your message to what you think might be possible is almost the definition of politics.
    The positions taken by these groups are controversial even within their own membership.

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