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 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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