Because of the importance of this issue, this comment is twice as long as my usual column posted on this page. Please give yourself a few extra minutes to read the entire column and responses eagerly expected and will be published as they come in (anonymously if you prefer.)

Back in 2011, the NRA got a law passed in the Gunshine State (Florida) which had the potential to criminalize doctors who warned patients about the risk of owning guns. The law sent shockwaves through the medical profession because the law potentially allowed non-doctors to set the terms for how physicians discussed medical issues with their patients, a practice which medicine fought long and hard to abolish more than one hundred years or so ago.

              The truth is that most physicians rarely raised the gun issue with their patients and the NRA’s promotion of this challenge to medical practice and authority was nothing more than a clever campaign to increase their public following and raise a few more bucks.

              That’s what you do when you’re a non-profit operation, which has been the status of America’s ‘first civil rights organization’ since the NRA was founded in 1871. You look for clever ways to increase public awareness about your existence, no matter whether that awareness has anything to do with reality or is just a clever advertising campaign.

              As the Florida gag law, a.k.a., Docs versus Glocks, made it way through the court system until it was finally thrown out in 2017, it also gave birth to a movement within medicine to promote more discussions and counseling between doctors and patients about the risks of guns. This took the form either of various medical societies issuing pronouncements about gun violence or attempts by medical groups to develop narratives which could be used in discussions about guns with patients, or both.

              Declaring gun violence to be a ‘public health problem’ was all fine and well, but in advancing strategies to respond to the problem, the various medical societies found themselves promoting all the usual gun-control laws (safe storage, universal background checks, etc.,) as if having an M.D. degree somehow gave them more or better license to pronounce on legal responses to reduce gun violence, which it does not.

              The role of the physician is to identify threats to health, figure out a medical response to the problem, and then get this response accepted and utilized by society at large. This is what every physician pledges to do before practicing medicine, a pledge which happens to be stated in the Hippocratic Oath.

              So, having decided that the proper response to gun violence was the adoption of certain legal procedures and regulations which have nothing to do with medicine at all, the medical profession then began to instruct itself on the best ways to persuade their patients to follow gun-control laws.

              Unfortunately, when doctors began to ramp up concerns about talking to their patients about guns, particularly after the Florida prohibition on medical gun counseling was thrown out, they discovered that most of their colleagues were reluctant and/or unable to conduct such clinical discussions, because they didn’t know much of anything about guns.

              Here’s an example of a recent attempt to educate doctors on guns, a curriculum developed by physicians at Massachusetts General Hospital (MGH) to teach new physicians – medical residents – what they need to know about guns and how to discuss risks to health with patients who own guns.

              The curriculum used in this training exercise is built around a series of ‘discussions’ between clinicians and a patient, Chris, who is a 35-year old married to Sam, and together they have a 4-year old son. They have two shotguns and a handgun in their home.

              The clinical encounters require that the clinician ask a series of questions about guns, including whether or not the guns are locked or safely stored, whether anyone in the home is suffering from depression, and whether the patient is aware of various laws which exist to help reduce gun risk, in particular laws which allow individuals to seek court orders for the removal of guns, known as ERPO (Extreme Risk Protection Orders) or ‘red flag’ laws.

              The treatment scenarios present the medical learners with narratives that can be used to discuss the various issues, along with taking care to always address the problem in non-judgmental ways, and how to respond if the patient exhibits any degree of anger or resistance when asked to talk about guns.

              Obviously, it is too early to determine whether such clinical encounters will have a positive impact on gun violence in the patient community which MGH serves. Nevertheless, I find these scenarios not only to be entirely insufficient when it comes to the medical reaction to gun risk, but the scenarios do not even follow from the most significant evidence-based research on gun risk, a protocol which physicians are supposed to follow in developing treatment practices to any medical risk or disease.

              The medical risk represented by guns was definitively stated in two articles published in the New England Journal of Medicine, which found a significant health risk from guns in the home. The articles did not qualify guns as to whether they were safely stored, or what types of guns were found in the home. The research simply stated unequivocally that guns represent a significant medical risk (homicide and suicide) and no serious medical researcher has ever denied the validity of this work.

              In the subsequent years since those articles appeared, there has not been one evidence-based study which shows any change in gun violence rates either through safe storage, or the other gun-control laws which have appeared on the books. Indeed, the studies which argue that states with more gun laws experience less gun violence do not, as a rule, compare violence rates before and after the laws were passed, because if they did, it would turn out that for every state which experienced a decline in gun violence after a gun-control law was passed, another state experienced an increase in gun-violence rates following the passage of a new law.

              The United States is the only country in the entire world which allows its residents to own and carry guns which are designed solely for tactical purposes (‘tactical’ being a polite way of describing the shooting of one person by another) and it is the existence of these guns –bottom-loading, hi-capacity, semi-automatic pistols chambered for military-grade ammunition – which is the reason we suffer from a gun-violence rate not found in any other advanced nation-state.

              If the medical community knew anything about guns – which they don’t (MGH teaching curriculum notwithstanding) they would address this threat to public health in the only way which it should be addressed, i.e., restrict the use and ownership of those highly-lethal, tactical guns.

              There is precedent for such a strategy by the way, which has been lawful procedure since the first federal gun law was promulgated in 1934. This law defined full-auto guns as too dangerous for commercial sale unless the buyer underwent a serious and prolonged review by both local and federal cops. A prospective buyer also could only purchase such a gun from a dealer who received clearance to sell such weapons, and there could be no personal transfer of such guns.

              Know the last time someone was killed in an assault where the attacker used a full-auto gun? Try 1947 or 1948.

              When the 1934 law was first proposed, the Attorney General, Homer Cummings, wanted handguns to be regulated in the same manner as machine guns were treated under this new law. The law was eventually passed without defining handguns as too great a risk for normal commerce and trade, but what’s stopping us from promoting this strategy again?

              And by the way, the fact that a ban on tactical handguns might be difficult, if not impossible to achieve, should not be the defining criteria for determining what physicians say and don’t say to patients about guns. Since when should physicians define health risks based on the vagaries of regulations and laws?

              If anything, the fact that our laws permit access to health threats of various kinds (e.g., tobacco) is all the more reason why physicians need to be particularly aware of how and what should be said to patients about the risk of legally acquired guns.

              Frankly, I am sick and tired of all these well-meaning physicians and public health professionals who honestly want to see this country no longer suffer the wholesale slaughter of our population with the use of guns but can’t bring themselves to promote or even mention the one, basic strategy that would bring gun violence to an end.

              And that strategy is to get rid of the guns whose use is responsible for most of the gun violence, or at least make the ownership of such weapons as highly regulated and controlled as we did with full-auto guns in 1934.

              To that end I am shortly going to announce the formation of a national organization which will first attempt to ban or tightly regulate semi-automatic handguns in various states, and as this effort gains traction, to begin pushing for a mandatory national buyback of such guns.

              I estimate that such a buyback would cost a minimum of $15 billion, or maybe $20-$25 billion at most. It is currently estimated that the bill for gun violence is currently around $300 billion every year.

              A one-shot payment of $20 billion to save 40,000 lives every year is chump change – wouldn’t you agree?