Docs Versus Glocks: Now It’s Round Four.

Last month a three-judge panel of the 11th Federal Circuit reinstated Florida’s gag law that prevented physicians from talking to patients about guns, a law that had been initially struck down at the Circuit Court level in 2011. Now the physicians have asked for an en banc rehearing of that decision by the entire 11th Circuit which, if the panel decision is affirmed, may move this case one step closer to a hearing before the Supreme Court.

The plaintiff’s brief, whose amici reads like a Who’s Who of virtually every medical association beginning with the AMA, notes that “there is no disagreement within the medical community that providing patients with information about firearm safety is a valid aspect of preventive care and thus beneficial to public health.”  They contend that the state’s gag order not only prevents physicians from delivering proper medical care, but opens the door for other limitations on physician-patient discussions because “once it is known that physician communications can be compromised in one area, then politically empowered interests will be emboldened to compromise it in others.”  Florida’s legislature, for example, could use a similar justification to limit whether a physician can ask a patient about whether they smoke cigarettes, drink alcohol or consume red meat.

glock logo                The gun lobby’s answer to this problem, which was echoed by the panel decision majority, was that physicians are always free to hand out gun safety pamphlets which, of course, the NRA is always happy to provide.  But the NRA’s support of gun safety information is disingenuous at best and consciously deceptive at worst, because this same organization is on record as opposing laws that would really increase gun safety by requiring that guns either be locked or locked away.  Arizona was the 50th and last state to legislate protective barriers around backyard pools in homes where minor children live.  Want to guess why there are still 22 states that do not mandate any kind of safe storage of guns at all?  Last year in Kentucky a five-year old boy shot and killed his two-year old sister and the County Judge drily observed that “there’s probably not a household in this county without a gun.”

I’m not surprised nor really upset that the gun lobby would try to keep physicians from talking to patients about guns.  After all, if the medical associations are on record as believing that gun ownership is a health risk, then they will line up some way or another as being against guns.  And the fact is that physicians have reams of peer-reviewed studies that link higher levels of gun mortality and morbidity to ownership of guns.  Even without the studies, you don’t have to be a rocket scientist to figure out that the more guns there are in everyone’s homes, the greater are the odds that more of them will be left around unlocked, and as the novelist Walter Mosley says, “If you carry a gun, it’s bound to go off sooner or later.”

But even though virtually every medical association acknowledges that guns constitute a risk to health, somehow this message still hasn’t gotten back to the feds. In response to a call from President Obama after Sandy Hook, the Institute of Medicine published a report listing the major gun violence issues that needed further research over the next 3-5 years, including the influence of video games, interventions and strategies, risk and protective factors, safe guns and, most important, “characteristics of firearm violence.”

With all due respect, I would like someone to explain to me why we need more research on the characteristics of gun violence to understand why 100,000 deaths and injuries from guns each year constitutes a risk to health.  I don’t believe there would be such unanimity among the national medical societies on this issue if it were just because most doctors don’t like guns. But as long as the federal government can pretend that the ‘jury Is still out’ on the medical risks of gun violence, jurors like the panel majority of the 11th District can tell physicians not to talk to their patients about guns.

 

 

 

Where To Look For Gun Violence? Start With The Kids

Last year after Sandy Hook, the American Academy of Pediatrics (AAP) and their Past President, Judith Palfrey, came in for an extended and indecorous series of attacks by the NRA and other supporters of the gun lobby.  In particular, the AAP and Dr. Palfrey were attacked for voicing the bizarre idea that guns in the home were a danger to children’s health.  And since the only way to get rid of all those guns would be to confiscate them or worse, the AAP became Public Enemy #1 in the eyes and mouths of people and organizations sworn to defend the right of all law-abiding Americans to own a gun.

This campaign to create a cordon sanitaire between pediatricians and the American family had already been elevated to a level far beyond nasty rhetoric when the State of Florida decided to criminalize physicians, mostly pediatricians, who had the audacity to ask their patients about guns. The law was first passed in 2011, was overturned at the District level in 2012, and recently reinstated by the 11th Circuit, and now is probably on its way to the Supreme Court.

docs versus glocks               The attempt to keep physicians out of the gun debate can only be understood if we look at the issue creating the argument in the first place.  Which goes like this.  Each year roughly 100,000 Americans are killed or injured by guns, which is 4% of violence-related injuries and deaths that occur each year.  Of this total, roughly 20,000 are gun suicides and the remaining 80,000 are either homicides or aggravated assaults.

Both sides in the gun debate agree that the way to deal with the suicide problem is to “fix the mental health system,” whatever that means.  On the other hand, both sides also agree that people who use guns to consciously hurt others have committed a crime. Tap the average gun owner on the shoulder and ask what to do with people who commit a gun crime and he’ll probably say, “Lock ‘em up and throw away the key,” or words to that effect.  Tap the average non-gun owner on the shoulder, ask the same question and you’ll probably get, ”We have too many guns,” or words to that effect. Guns don’t kill people, people kill people says the NRA; hence, control the people.  Guns kill a lot more people than if we didn’t have guns, says the Violence Policy Center; hence, control the guns.  That’s where the gun argument begins and ends.

Both of these arguments obscure the reality of the problems they seek to correct.  Increasing the severity of punishments assumes that one can stick the perpetrators in one category and the victims in another, when in fact most violent crime, in particular gun homicides, usually occurs because both the perpetrator and the victim are contributors to the criminal act.  As for getting rid of the guns by registering transactions, what do you do about the more than one million guns that are reported stolen or lost each year and are overwhelmingly the guns that show up in cases of murder and aggravated assault?

In a brilliant study Marvin Wolfgang found that 6% of all juvenile offenders committed more than half of all juvenile crimes.  And guess what happened when they became adults?  The chronic juvenile offenders became the chronic adult criminals and committed the most violent crimes. Wolfgang looked  at juveniles over the age of ten. What’s missing in the debate about guns and violent crime in is what Wolfgang did not incorporate into his work, namely, whether or not interventions occurred with kids who became chronic offenders before their delinquent behavior took place.  And where could such interventions have happened?  During consultations with pediatricians who are trained to look for anti-social behavior during pre-school years.

Pushing pediatricians out of the orbit of caregiving for children means eliminating contact with a professional committed to reducing harm that puts a child’s health at risk.  Anyone who wants to put their 2nd Amendment ‘rights’ ahead of their child’s health better hope they have lots of luck.