Home

Should Doctors Talk to Patients About Guns?

September 19, 2023

mikethegunguy Blogs , , 2 Comments

Dear Readers:

              Let me warn you that today’s column is longer than my usual 600-700 words. So, I hope you will set aside a bit of time to read the entire thing and spend a moment reflecting on what it says.

              Before I get into the specifics, I want to say that on at least two occasions, I had the great fortune to be able to talk candidly and completely with skilled and responsive physicians about disquieting medical symptoms which were affecting me and one of my kids. I couldn’t have gotten this kind of advice and foreknowledge from anyone else, and I will never (read: never) join with any of those shitheads, including a former President, who rant and rave about the ‘fraud’ of modern medicine or how immunizations should all be banned.

              However, I also believe that if doctors are going to deliver remedies to medical risks, then they need to understand what those risks really involve, and in the case of gun risk, doctors don’t know enough about guns to promote themselves as the professionals whose beliefs and treatments should be accepted in that regard.

              I refer to an article which just appeared in a medical journal, “Firearm Screening and Counseling in General Medicine Primary Care Clinics at an Academic Medical Center” and can be downloaded here.  The article’s authors asked 109 medical providers in 10 Michigan clinic sites to answer questions about counseling patients on gun risk and found “a generalized resistance from patients and providers alike to discuss firearm safety,” which is similar to other, similar studies on gun counseling conducted over the past years.

              For guidance in creating this survey, these researchers cite an article published by one of the gurus of gun violence prevention, Garen Wintemute, along with several other alleged gun  violence experts, an article which has become the non plus ultra resource for helping doctors learn how to talk about guns, and you can download that article here.

              How do Wintemute and his colleagues advise physicians to counsel patients about guns? First, they present an ‘epidemiology’ of gun risk, which is totally based on the demographics of people who are shot with guns. Now I’m not an M.D., I’m only a lowly Ph.D., but I always thought that epidemiology is a method which is used to help determine how a threat to health moves from one victim to another, which when it comes to gun violence, you won’t get even the slightest hint if your data only covers information about the people who get shot.

              The WHO defines violence as any conscious attempt to injure yourself or someone else. But when it comes to gun violence, less than 20% of all shootings involve the victim also being the person who shoots the gun. So, if you do research on gun violence and only look at the demographic profile of people who get shot with guns, you happen to be missing at least 80% of all gun violence events.

              The Wintemute group then goes on to tell us about why people own guns, the idea being that if you are going to counsel gun owners about gun risk, you need to deal with their interests, concerns and fears which made them go out and buy a gun. And what data is used to figure this problem out? The same data which has been used in virtually every research done on guns over the past twenty years that shows a majority of gun owners buy a gun in order to protect themselves.

              The next sentence is the single, most important sentence in this entire column, so please read it slowly, perhaps read it several times and spend a few moments thinking about what the sentence says, okay?

              There has never been one, single study produced by public health, physicians or medical caregivers about guns which asks gun owners to describe the type of gun which they own. Not one. Not one, single study.

              And unless you know what kind of gun(s) you are talking about, getting into a discussion with a patient about gun risk is a total and complete waste of time. Because even though all guns represent some degree of health risk once they are loaded with ammunition that really works, the difference in lethality of different kinds of guns can be extreme.

              You don’t buy a Glock 17 with a hi-cap magazine which holds 16 rounds of tactical ammunition (the word ‘tactical’ is a polite way of saying that someone might get killed) to knock a birdie out of the tree. You also don’t buy a 22-caliber, bolt action, single-shot rifle to walk around the neighborhood carrying a gun.

              Gun owners are very sensitive to this issue and love to walk into a gun shop and talk on and on with anyone else in the shop about the design and use of different kinds of guns. I know this because I have sold guns to somewhere around ten-thousand-gun owners in the gun shops I have operated in three states.

              Physicians admit in survey after survey that their reluctance to counsel patients on gun violence often stems from their lack of knowledge about different types of guns. Does Wintemute’s article or the study out of Michigan even raise this point or God forbid advise doctors to spend some time learning about the different types of guns? Of course not.

              There must be a couple of hundred books on gun design listed on Amazon. There are also YouTube videos, including this very informative, hour-long video by a clever, young man which could easily be converted into a one-credit CME online course, if one of the so-called medical gun experts would even mention anything about why doctors should learn at least a few specifics about the guns which create the risk about which they are so concerned.

              And what is the remedy for gun violence that these medical and public health experts promote clinicians to advance? Store those guns safely – that will do the trick. Now the fact that there has never been one, single study showing any change in gun violence rates after a control group of patients reports they are paying more attention to gun safety than before, big deal, right?

              Probably the most detailed study of how and why Americans own guns was published by the Harvard gun-research group in 2015. You can download that article right here. This piece goes into great detail about how many Americans own guns, what kinds of guns do they own, when was the last time they purchased a gun and when was the last time they sold or gave one of their guns to someone else.

              This article made all kinds of noise in the media because it identified a group of ‘super owners,’ representing just three percent of the adult population who together own half the country’s guns, for an average of 17 guns apiece.

              There was only one little problem with this article, a problem which basically renders the research totally meaningless for understanding or counseling on the risk of guns. Men and women who are legal gun owners by and large rarely commit violence of any kind with their guns. Maybe once in a great while some gun owner and his wife get into a brawl, and he decides to finally get the old lady out of his hair by popping her with a gun.

              But the reality of guns as representing a threat to health happens to be when someone who is unable to legally own a gun gets their hands on a gun. Who are these individuals and what kinds of questions do they need to be asked in order to determine whether they represent any degree of gun risk? You won’t find one, single word about this problem in any published research from the medical community which allegedly explains to clinicians how they should talk to patients about guns.

              Last point. I don’t see in any of the advisories about how health professionals should discuss gun risk any mention simply to get rid of the guns. Which, by the way, happens to be the one, guaranteed strategy that will reduce gun violence.

              Oh, I forgot.  My bad. Americans have a Constitutional ‘right’ to own guns. Know what? Article 1, Section 8, Clause 3 of the Constitution also gives Americans the ‘right’ to buy and smoke cigarettes. It’s called the ‘commerce clause.’

              So how come physicians have no trouble telling their patients who smoke to get rid of the cigarettes?

Should physicians talk to their patients about guns? Maybe they should first take the trouble to learn something about what they want to say.

Open Letter to the National Academy of Medicine.

April 26, 2022

mikethegunguy Blogs , 5 Comments

Yesterday I attended an online seminar co-sponsored by The National Academy of Medicine and Northwell Health, “Facilitating the Integration of Firearm Injury Prevention into Healthcare Through Community Collaboration.” One of the panelists was Jake Wiskerchen, who was identified as the Founder and CEO of Zephyr Wellness, a mental health practice in Nevada which claims to be “bridging the gap between the mental health profession and the firearms community.”

One of Zephyr’s collaborating organizations is a group called Walk the Talk America, which has joined in an ‘official partnership’ with Zephyr to “advance the dialog about gun ownership and mental health care to demystify and destigmatize both fields for the advancement of the safety and health of all Americans.”

Here are some of the Board Members of Walk the Talk America:

  • John Renzulli, whose law firm defends gun manufacturers when their products are used inappropriately to injure or kill someone.
  • Dustin Jones, whose company, Armscor, imports handguns from the Philippines, which are advertised as being designed primarily for armed, self-defense.
  • Colion Noir, a former media personality who worked for NRA-TV and now has his own media presence where he advocates using assault rifle for protection individuals and their homes.
  • Rob Pincus, a gun trainer who uses personal appearances and video products to promote the idea that communities would be safer if everyone were walking around with a gun.

I would appreciate it if someone from the National Academy could explain to me how any medical group or organization could give free time, space, and audience to someone who earns his living by advocating using guns for anything other than hunting or sport.

The guns which individuals like Rob Pincus and Colion Noir use in their advocacy of armed, self-defense are guns that are only designed to do one thing – shorten a human being’s life. And since the whole reason for working in medicine is to lengthen and prolong human life, what is any medical organization doing showcasing an individual who promotes an organization which is working at cross-purposes to what doctors should do?

The idea that someone like Jake Wiskerchen could attempt to foist his support of armed, self-defense on a medical audience as a ‘responsible’ and ‘proper’ behavior only demonstrates how far from reality the discussion about gun violence among physicians appears to have gone.

This may come as a shock to my friends in medicine, but the WHO’s definition of violence does not (read: not) distinguish between violence as a good thing or a bad thing. The WHO doesn’t appear to share the idea promoted by Wiskerchen and his Walk the Talk buddies that violence is something we should learn how to administer in a properly by first going out and buying a Glock, or a Beretta, or a Sig, or an AR-15.

Let me make it clear that I am not some tree-hugging liberal who hates guns.  At the moment I happen to personally own 60 guns or a few more. I have trained over 700 residents of my state (Massachusetts) in the so-called safety course required before someone can legally own a gun, and I conduct lethal-force certifications for local, state, and federal law-enforcement groups.

That being said, I would never get up in front of a medical group, or any group for that matter, and promote the idea that a gun should be carried around for self-defense. There is not one, single study which finds the slightest connection whatsoever between community members walking around with a concealed weapon and a reduction in violent injuries in that community or anywhere else.

If the Academy wans to inform an audience with a valid and meaningful message about gun violence, they could post this video on their website: Sandy Hook Families Reach Settlement With Gunmaker Remington – The New York Times (nytimes.com).

I have no problem with physicians or medical groups reaching out to gun owners in order to find common ground on which to discuss violence caused by the use of guns. But the idea that any medical organization, particularly the National Academy of Medicine, would reach out to a conscious and active promoter of armed, self-defense like Jake Wiskerchen, sends a message out to the public which is an egregious mistake.

The Academy can and should do better than that.

Does ‘Safe Storage’ Protect Us From Gun Violence?

December 10, 2021

mikethegunguy Blogs , , 3 Comments

              So, here I am at the Pri-Med East meeting in Boston, attended by more than 1,600 primary-care medical professionals who come to learn about all the latest research and practical issues that impact primary care.

              I am here as an exhibitor to distribute publications about gun violence that have been created by a stellar group of physicians, public health researchers, criminologists, media and legal experts who are listed here. The group, No Guns Healthy Lives, Inc., was founded (by yours truly) to bring more informed information about guns to the medical community. It is a 501c3 but we don’t solicit donations because then I would have to put together a much more complicated tax return. We are entirely self-funded, largely by my wife.

The Pri-Med conference is attended by primary-care medical professionals who need to know the latest information and practical approaches to treating patients under their care. The role of the physician, as defined by the Hippocratic Oath, is to figure out and prevent health problems, in other words, to be what our friend Jeff Nugent calls ‘first preventers’ before the gun injury occurs. Other medical specialists – emergency physicians, trauma surgeons – deal with gun violence as first responders, treating non-fatal gun injuries which occur probably more than 85,000 times every year.

              Hence, my appearance at Pri-Med this year because primary physicians are truly the front line when it comes to the medical response to guns. Unfortunately, when talking to patients about guns, most primary-care physicians take the same approach that has been adopted throughout the medical profession, an approach to reducing gun risk which sounds logical and informed but happens to be wrong.

              Back in 1993-94, two stellar researchers, Art Kellerman, and Fred Rivara, published research in the New England Journal of Medicine which found that the presence of a gun in the home created a suicide and homicide risk. It was this research which got pro-gun members of Congress to eliminate CDC funding of gun research.

              Frankly, I can’t blame the NRA and other gun organizations for wanting to squelch such research. How would you feel if your livelihood were dependent on selling a product that was considered a health risk? At least with a bicycle, all you have to do to reduce risk is wear a helmet. Has anyone designed a helmet that will stop a 9mm bullet from going through someone’s head?

              To avoid being chastised as anti-gun, medical organizations and groups now promote the idea that it’s okay to have a gun around the house, as long as it is safely stored. These organizations and groups use all kinds of euphemisms to describe their stance. They call themselves ‘consensus-builders,’ or trying to connect to ‘responsible’ gun owners, or just wanting every gun owner to be ‘safe.’

              This is nonsense. It’s just as nonsensical as the malarky being promoted by Gun-nut Nation about how a gun is an effective ‘tool’ for self-defense. Please read the next sentence very slowly, okay? The research published by Kellerman and Rivara did not (read: not) differentiate risk from guns based on whether the guns were safely stored or not. The evidence-based research simply found that a gun in the home creates medical risk.

              One of the leading public health researchers, Ali Rowhani-Rahbar, reviewed the medical and public health research on the efficacy of safe-storage programs. What he found was that half the programs led to an increase in household storage techniques, the other half didn’t change household gun-storage behavior at all.

              But note that Rowhani-Rahbar’s research did not (read: not) compare gun violence events before and after gun owners were given instruction in safe storage. The research simply looked at whether gun owners reported more safe-storage behavior after they enrolled in a safe-storage class. Sorry, but the idea that locking your guns away means, ipso facto, that less gun violence will occur is an assumption, not a proven or evidence-based fact.

              I first started writing about guns and gun violence in 2012 when the NRA attacked our friend Judith Palfrey when she was President of the American Academy of Pediatrics (AAP) and had the audacity, the temerity, to suggest that guns and children in the same home don’t mix. The NRA used Judy’s statement to launch an aggressive campaign against physicians who didn’t support the ownership of guns.

              How did the medical community respond to this assault, including an crazy attempt to criminalize doctors who counseled patients about guns? For the most part, they ignored the evidence-based research of Kellerman, Rivara and Rowhani-Rahbar and began pushing a ‘consensus’ approach based on the totally-unproven assumption that safe storage reduces gun violence. This is simply not true.

              I have taught the required gun-safety course to more than 7,000 residents of my state – Massachusetts – and I now conduct lethal-force certifications with officers from local, state, and federal law-enforcement agencies. I begin every class by putting a gun out on the table and telling the attendees that the moment they touch that gun, they are putting themselves in a risk situation for which there is no (read: no) mitigating behavior at all.

              Now the fact is that we all accept various risks in our daily lives. When was the last time you didn’t run a yellow light because you were late to work, and the coast was clear?

              And by the way, a majority of those 300 million or 400 million guns that are floating around the United States do not represent the kind of risk which creates 100,000+ instances of gun violence every year. Nearly all the intentional shootings are the product of someone using a gun that was specifically designed to inflict injuries on human beings – bottom-loading, semi-automatic pistols and bottom-loading, semi-automatic rifles.

              Want to reduce gun violence in a meaningful way? Stop promoting silly, non-factual notions about ‘safe storage’ or ‘responsible gun ownership’ and regulate assault rifles and semi-automatic pistols the way we have been regulating machine guns since 1934.

              How many full-auto guns are legally owned in the United States today? Try at least 60,000, maybe more. When was the last time that someone intentionally shot someone else with a machine gun? 1947.  Get it?

The Medical Plan To Reduce Gun Violence That Doesn’t Work.

March 4, 2021

mikethegunguy Blogs , 3 Comments

              Doctors for America is a liberal advocacy group that was formed in 2008 to help promote the Affordable Care Act and now continues to push for all kinds of goody-goody medical things. One of their goody-goody’s is reducing gun violence for which they have produced a video which depicts a physician talking to a gun owner about how he stores his guns.

              The gun owner is a young married guy with a daughter in the home. The physician asks him where he stores the guns when he’s not hunting, and he claims he puts them on a high shelf which is out of his daughter’s reach. The doctor tells him that what he should really do is lock the guns up because they otherwise there’s a risk of suicide or accidental injury. The guy playing the role of the patient agrees.

              There is not one, single study ever produced which shows any direct connection between safely storing guns and eliminating or even reducing gun violence – not one. The idea that safe storage represents an effective response to gun injuries is an assumption promoted by physicians and medical advocacy groups who actually believe that they can gain the confidence of gun owners by pretending that it’s okay to own a gun.

              It’s not okay. The research by Art Kellerman, Fred Rivara and their colleagues published more than a quarter-century ago clearly proves that access to a gun in the home represents a medical risk, and this research did not qualify those guns in terms of whether they were stored safely or not.

              The Hippocratic Oath requires physicians to identify and then work to reduce medical risks. Simply put: Medical groups which promote the safe storage nonsense are violating the Hippocratic Oath. They get away with this crap because their members and their audiences know as much about guns as they know about guns – zilch.

              Want to see another example of how the medical community is completely and totally divorced from reality when it comes to talking about guns? There’s an organization called UpToDate that publishes an online reference database which physicians can use to read the latest studies on any medical problem, as well as print out simple summaries and advice for patients to read. The website is probably accessed by just ab out every primary-care doctor in the United States.

              Here is how UpToDate describes what it does: “a global community consisting of thousands of physician authors and editors who share a singular passion: writing and editing evidence-based information that helps clinicians everywhere practice the best medicine.”

              So now let’s look at the section on gun violence and, in particular, the handout that physicians can print and give to patients regarding the risk of their guns: Patient education: Gun safety for families (The Basics) – UpToDate. Scroll halfway down the page and you’ll see what UpToDate believes a parent should tell a child in order to teach the kid about gun safety: Do not touch the gun. Move away from the gun. Tell an adult. 

              Now take a look at what the National Rifle Association says is the proper way to teach your child gun safety. You can see it right here: Eddie Eagle | NRA Explore.  Scroll down slightly and guess what you’ll see? You’ll see the exact, same safety message for kids that you’ll see on the UpToDate page.  The NRA has been pushing this nonsense for years but now they have an ally in the medical community to help spread their message around.

              How can any doctor utilize any messaging about guns which was developed by the same organization which got a law passed in Florida that would have criminalized any physician who counseled patients about gun risk? Groups like Doctors for America should be ashamed of themselves for even thinking that there’s some kind of common ground which they can occupy with gun owners to reduce gun risk without getting rid of the guns.

              If any physician would like to explain to me how promoting ‘safe storage’ of guns isn’t a violation of the Hippocratic Oath, I’m all ears.

An Important Reference Work On Gun Violence.

February 28, 2021

mikethegunguy Blogs , , 1 Comment

              I have just finished reading and studying a collection of articles which together constitutes the most important reference work on gun violence which currently exists. The book, Pediatric Firearm Injuries and Fatalities, is a collection of 15 articles edited by Eric Fleegler and Lois Lee, both of whom are pediatric-ER doctors at Boston’s Children’s Hospital, so they’ve seen plenty of gun injuries over the years. You can buy the book here.

              The collection is described as a ‘Clinician’s Guide to Policies and Approaches to Firearm Violence.’ Each contribution is a summary of research on a particular aspect of gun violence, along with copious footnotes and ‘Take Home Points,’ the latter lists some basic strategies that clinicians can use for responding to injuries caused by guns.

              Let’s be clear. This isn’t a collection of original, evidence-based articles. It’s a collection of articles which summarize all of the research which has been done to date on specific aspects of gun violence, in particular gun violence which impacts kids. And don’t make the mistake of thinking that by limiting the contents to pediatrics, that you won’t get an overview of gun-violence issues as a whole. Because pediatrics happens to include everyone up to age twenty-four, and by that age you are looking at a majority of the gun-violence events which occur every year.

              This encyclopedic work is divided into two sections: risks and interventions. The risks are homicides and assaults, accidents, suicides, international comparisons, and school shootings. The interventions cover counseling patients before and after shootings, community-based programs, safety design for guns and legislative advocacies.

              Together, these articles cover just about every aspect of what clinicians need to know in order to develop effective responses to gun violence. Together, the articles cite more than 700 references to evidence-based research which means that this work is not ground in opinion but in facts, a welcome change from the way most gun discussions are framed.

              That being said, as usual I have several issues with specific content in this valuable collection which need to be raised. First and foremost is the degree to which public health gun research continues to focus the research on every issue except what I consider to be the most important issue, namely, how, and why gun violence actually takes place.

              The articles which define gun risk are overwhelmingly based on CDC data which tells us all about the victims of gun violence but nothing about the perpetrators of same. I don’t understand how public health researchers can refer to the ‘epidemiology’ of this particular health threat when little, if any time is spent trying to figure out how and why a certain population uses a gun in what the gun industry would call an ‘inappropriate’ way. After all, shooting someone isn’t the usual way that a dispute between two people is resolved.

              Because we know very little about who actually shoots guns inappropriately, how can we really create effective public policies and clinical procedures for reducing such behaviors? I don’t think, in fact, that we should assume that evidence-based research on gun violence can guide our policy strategies when the evidence tells us little, if anything about the people whose behavior we are trying to change. I should add, by the way, that in 4 of the 5 states which implemented comprehensive background checks after Sandy Hook, gun violence rates went up, not down.

              Finally, I have a big problem with the degree to which the entire gun-control community – physicians, researchers, advocates – invariably propose linking up to every relevant ‘stakeholder’ in the gun violence debate with the exception of the most important stakeholders of all – the companies who manufacture the guns.

              If you believe that companies like Glock or Smith & Wesson aren’t concerned about gun violence and gun safety, this only demonstrates that you haven’t gone into a gun shop and purchased a new gun. Because every gun shipped from a factory to a retailer must have a warning which says that the gun, if misused, could result in injury or death. And the warning is printed in big, red letters, okay?

              I’m not saying the gun industry isn’t culpable for many of the injuries and trauma caused by the products they make and sell. What I am saying is that I don’t understand how you can regulate any industry without bringing the representatives of that industry into the discussion as well.

              Those caveats aside, Fleegler and Lee have published a volume which everyone needs to read.  Got something better to do in the Age of Covid-19?

Want To Reduce Gun Violence? Try The ‘Non-Partisan’ Approach.

December 16, 2020

mikethegunguy Blogs , , Leave a comment

              There’s a bunch of ER doctors out there who are promoting themselves as a group of gun experts who want to teach other doctors how to counsel patients about gun risks. The group says it has developed a ‘non-partisan’ approach to gun violence, shorthand for a narrative that will appeal to both sides.

               The head of this group, Chris Barsotti, claims to be a gun owner. In fact, the one gun he owns is an old hunting rifle that belonged to his father; a gun he has never shot. How do I know this? Because I gave him the ammunition for the gun.

              The other group leader, Megan Ranney, explained to me that the reason she never speaks out against the hundreds of thousands of dollars that the American College of Emergency Physicians donates every year to the political campaigns of pro-NRA Members of Congress is because “change takes time.”

              These self-righteous and arrogant promoters of themselves and a few other ER docs are going to hold a virtual seminar next month to explain how doctors and other caregivers should talk to gun owners about their guns. They claim to be developing a ‘preferred terminology’ so that clinicians can prevent firearm injuries and deaths.

              Let’s go back to the beginning, which is 1992 and 1993.  This is when two medical researchers, Fred Rivara and Art Kellerman, published evidence-based research which clearly and indisputably found that access to guns increases risks to health.

I read these articles when they first appeared in print and frankly, didn’t understand why this research needed to be done at all. Was there anyone out there who didn’t understand that if you pick up a loaded gun, particularly a handgun, and point it at yourself or someone else, that such an action wouldn’t increase risk? Isn’t that exactly what my Glock M-17 pistol is designed to do? Duhhh….

              How do you take a product like my Glock and reduce the risk inherent in its design and function without getting rid of the gun? You come up with some stupid or silly workaround like ‘safe’ guns or safe storage of guns or some other nonsense like that. And then you peddle that crap to a largely unsuspecting and ignorant audience and pretend that you have come up with a ‘consensus’ approach to reducing gun risk.

              There’s only one little problem, a problem which happens to make this approach not only wrong from a product design point of view, but also happens to be a violation of the Hippocratic Oath.

The Hippocratic Oath requires all physicians, even these ER docs, to use evidence-based research that will define medical risks, and then use the research to come up with a plan to reduce the risk.

              If you take the trouble to read the articles by Kellerman and Rivara cited above, you’ll notice that in neither category of gun risk – suicide, homicide – did the researchers find that gun risk was mitigated by adopting some kind of expedient like safe storage which would reduce the risk but still let a gun owner have access to his guns.

Not only do these ER docs intend to hold a seminar to explain a ‘consensus’ approach to gun risk which has no basis in evidence-based research, but the seminar also features an appearance by a guy named Rob Pincus, described as an “educator with 20 years of experience in the gun industry.”

Pincus’ educational activity consists of peddling a bunch of books and CD-ROMS on his website which promise to show the average gun owner how to protect himself, his family and his home with a gun. Want to reduce gun risk? Go out tomorrow, buy yourself a Glock or a Sig, then sit on your rear end and watch a video and you’re good to go.

The physicians who are promoting this nonsense should be ashamed of themselves. I can’t say it any other way.

If any of them would like to reply to this column and explain why they believe they are doing what needs to be done to reduce gun violence, I’ll give them all the space they want. 

Don’t hold your breath, folks.

Is COVID-19 Social Distancing A Template For Dealing With Gun Violence?

April 13, 2020

mikethegunguy Blogs , , 5 Comments

For all the talk by physicians about gun violence, the only doctor in the entire United States who is actually doing something tangible to reduce this public health threat is Mike Hirsh, a pediatric surgeon at the University of Massachusetts Medical School in Worcester. He has been running a region-wide gun buyback which is now in its 18th year. The city of Worcester is now into its third year without having suffered a death from penetrating trauma, and while the buyback is certainly not the only reason for the city’s lack of gun violence, what Mike has really achieved is a remarkable degree of coordination and respect between physicians on the one hand, and uniformed services on the other.

If there is one thing about the public health and medical response to gun violence which I find wrong to the point of absurdity, it’s the refusal of both groups to talk about the fact that more than 80% of all gun injuries happen to be crimes. What I hear the gun-control medical groups and public health folks saying again and again are variations on the theme of ‘we need to do more research.’ What I never hear them saying is ‘we need to work with the cops to deal with the illegal use of guns.’

The story in Worcester is very different. The story in Worcester is that every year there is an active collaboration between doctors and cops to spread the word about gun risk which now occurs not just in the city of Worcester, but in more than 20 surrounding towns. It didn’t happen overnight. It wasn’t just a one-shot deal.  It took a year-after-year commitment on the part of white coats and blue coats to bring this about.

This year Mike Hirsh was named Medical Director for Worcester and has found himself in the middle of a new threat to community health which still doesn’t seem to be understood as a threat by Schmuck-o in the White House. But at least in Worcester and surrounding towns, a coordinated effort is being done to make sure that everyone who has to play a frontline role in responding to the COVID-19 virus knows what they have to do. Whether it’s responding to emergency calls, or organizing and coordinating facilities, or getting the word out via social media and other communication venues, the bottom line is that the Worcester hospitals have not experienced the kind of patient ‘crush’ that is happening elsewhere and creates serious roadblocks for dealing with this disease. In other words, the degree of citizen compliance seems to be having a positive effect.

Yesterday, the State Board of Health updated their numbers on viral infections and mortality and reported 8 new deaths in Suffolk County (Boston) and 2 new deaths in Worcester County. The population of both counties is roughly 800,000 and of course these number could change. But Boston doesn’t have anyone coordinating the activities of all medical and uniformed first responders, even though the city has 1,200 employees working for its Health Commission, Worcester has 28.

The more I think about how to implement and manage a social distancing strategy to deal with COVID-19, the more I think it’s what we should be doing about gun violence as well. After all, social distancing simply means that we take it upon ourselves to behave in a certain way based on an informed awareness of what needs to be done. Isn’t that what everyone should be doing in response to gun violence – behaving in a certain way with guns based on an informed awareness that guns represent a risk to health?

If the latest estimates are correct, the COVID-19 virus will begin to disappear after we suffer some 60,000 deaths. We suffer more than 100,000 deaths and serious injuries from guns, year after year after year. Maybe what Mike Hirsh is doing in Worcester for COVID-19 could become a national template for dealing with guns.

The ‘Consensus-Based’ Approach To Gun Violence Is Wrong.

February 13, 2020

mikethegunguy Blogs , , 11 Comments

              Now that physicians no longer have to fear being prosecuted for talking to their patients about guns, a whole cottage industry appears to have sprung up within the public health and medical communities to explain to doctors how they should talk to patients about guns. Because most doctors don’t own guns, and while the medical associations have all issued statements deploring gun ‘violence,’ such statements don’t give doctors any real insights into talking about a particular consumer product found in many of their patients’ homes. It’s easy to talk about seatbelts – every doctor drives a car. It’s not so easy to talk about guns.

              Now it just so happens that guns as a medical risk has been understood for more than twenty-five years, thanks to the two New England Journal of Medicine articles published by Kellerman, Rivara and colleagues in 1993 and 1994. When these two articles appeared, Gun-nut Nation went on the offensive, a political assault which included getting CDC gun-research money thrown out. Nevertheless, from a medical point of view, what Kellerman and Rivara said back then still stands now.

If only the current-day physicians clamoring most loudly for increased concern about gun violence would follow the evidence-based findings of Kellerman and Rivara – but they don’t. Instead, the narrative being promoted within the medical community is to take a ‘consensus-based’ approach to counseling patients about guns.

              With all due respect to my many friends in the medical and public health communities who are trying to find some way to reduce the 125,000+ intentional and unintentional gun injuries which occur every year, this ‘consensus-based’ approach is not (read: not) supported by any evidence-based research. Instead, it reflects the adoption of a narrative designed to shield these physicians from what they believe would otherwise be another assault from Gun-nut Nation and the alt-right.

              If doctors actually believe that by saying they respect the ‘rights’ of their patients to own guns, they will somehow protect themselves from criticism from gun-rights groups, they have absolutely no idea how Gun-nut Nation views any attempt to question access to guns, particularly by people who, for the most part, don’t own guns. Much of the evidence-based data on gun violence comes from solid studies done at the Bloomberg School. That’s B-L-O-0-M-B-E-R-G.  You think there’s a single gun owner out there who would ever believe anything coming from a program funded by the person now being referred to in gun magazines and gun blogs as the head of the ‘nanny state?’

              And once the physician who wants to counsel his patients on gun risk makes it clear that he ‘respects’ the patient’s ‘right’ to own guns, he then can continue building his consensus-based approach by telling the patient that all he has to do is safely store his guns. To be sure, there are studies which find that when patients are counseled about safe storage, they go home and sometimes store their guns in a safer and more secure way. Is there one, single study which compares before-and-after safety counseling to changes in gun-violence rates? Not one. The assumption that safe storage leads to a significant decrease in gun violence is a nice idea, but medical treatments and counseling aren’t based nice ideas.

              Let me break it gently to all my medical friends who find it easy and convenient to believe that once they tell a patient to go home and lock up his guns, that they have done what they need to do in this area of public health.  The Kellerman/Rivara studies which indisputably found both a suicide and homicide risk from guns in the home did not – ready? – did not find any significant difference between stored and unstored guns. A slight difference perhaps in suicides; no mention of storage issues in homicides at all. Nor is there any mention about the need to be concerned about those beloved 2nd-Amendment ‘rights.’

              Take it from a lifetime gun-nut like me. Want to reduce gun violence? Cut the bullsh*t. Get rid of the guns that create this violence – semi-automatic pistols, assault rifles and tactical shotguns.

That would only leave about 250 million guns floating around the United States.  That’s not enough?

What Should Doctors Say To Patients About Guns?

December 12, 2019

mikethegunguy Blogs , , 11 Comments

Today a group of well-meaning and thoroughly ignorant physicians are getting together in New York City to discuss for the umpteenth time the appropriate medical response to what is called a ‘national public health crisis;’ i.e., injuries caused by guns. They will no doubt draft yet another set of proposals to deal with the problem which will include all the usual things – more research funding, comprehensive background checks, ‘red flag’ laws, assault rifle ban, maybe even a mandatory delay in gun transfers or mandatory training before someone can walk around with a gun.

The reason I say these medical professionals are ‘thoroughly ignorant’ is because none of them know anything about guns. If they did know something about guns, they would understand that you can’t make something ‘safe’ which is designed not to be safe. How do we define the word ‘safe?’ It means that when we use something the way it’s supposed to be used that no injury occurs.

That being said, let me break the news gently to all those folks shooting their mouths off at today’s meeting in New York: The guns which are used to commit virtually every act of gun violence happen to be designed for one purpose and one purpose only – to kill or injure either the user of the gun or someone else. To use such guns in a ‘safe’ way is to invent a narrative that could only be taken seriously by people who know absolutely nothing about guns.

Want to ban assault rifles? Fine. Such a ban might result in reducing the number of people killed or injured with guns by, at best, 2 percent. What about the other 98 percent? Oh no, we can’t ban Glocks, we can’t ban tactical shotguns, the Constitution says Americans can own  those guns. And the last thing that medical professionals would ever want to be accused of doing is coming up with a response to a public health problem that didn’t align with 2nd-Amendment rights.

I have never understood how or why physicians need to be concerned about what the Constitution says or doesn’t say about guns when the evidence-based research that physicians are supposed to use to define all medical practice clearly proves that access to a gun is a significant health risk. Is the risk somehow lessened by locking the guns up or locking them away?  Sorry, but I have to gently break something else to my medical friends: There is not one, single study which has ever shown any connection whatsoever between ‘safe storage’ and the injuries caused by guns.

There are studies all over the place which find that when patients are counseled on safe behavior with guns, many of them later report that they have taken the doctor’s advice and are behaving with their guns in a safer way. But none of these studies are based on a before-and-after analysis of gun violence rates; it is simply assumed, with no evidence whatsoever, that behaving in a safe way with guns results in gun-violence rates going down.

When anyone puts their hand on a live gun (that’s a gun with ammunition ready to go) they have moved into a high-risk zone. And the only way to mitigate that risk is to make it impossible for anyone to put their hands on that gun. Now there happen to be many people (one of them me) who have decided for all sorts of reasons that they have no problem accepting that risk. There are also a lot of people who still like to ‘light up a Lucky’ or walk around with 40 extra pounds on their frame. And by the way, the Constitution gives every American the ‘right’ to do both.

Would any physician ever claim, in the interests of  ‘non-partisanship,’ that these patients should be advised to find a safer way to eat or smoke? Of course not. And that being the case, the physicians who think they can find some kind of neutral pathway to reducing gun violence are simply showing their ignorance about guns.

Want to get rid of gun violence? Get rid of the guns designed to cause gun violence. An approach which, by the way, doesn’t run counter to the 2nd Amendment at all.

Guess What? Gun Violence Has Become an Investment Opportunity.

November 14, 2019

mikethegunguy Blogs , , 4 Comments

              Sooner or later I knew it would happen. Gun violence has become an investment opportunity. Or I should say, talking about gun violence has now become a way to bring investors together who can try to make a buck by putting dough into various new ventures and other schemes.

              Want to get in on the ground floor?  There’s a conference being held in New York City  on December 12 whose chief sponsor is an outfit called Northwell Health, which owns and operates more than 20 hospitals in New York State. Chief among these hospitals are Long Island Jewish Hospital and North Shore Hospital which, along with more than 700 outpatient clinics and other facilities, employs more than 68,000 and runs more than 50 of those cutsie, little ‘urgent care’ centers which keep popping up all over the place.

              I think it’s really interesting that a medical conglomerate which doesn’t operate a single health facility in any inner-city neighborhood would get interested in health issues related to guns. If I were to take the time to analyze gun-violence rates in the areas served by Northwell’s hospitals, outpatient clinics, rehab and dialysis centers, pharmacies, imaging and everything else, the baseline number for gun-violence injuries would be somewhere around zilch.  So how come a medical system which treats the patient population least likely to suffer gun injuries is all of a sudden so concerned about what their CEO refers to as ‘this public health crisis?’

              Maybe it’s because Northwell has teamed up for this big deal with a private investment firm, Landmark Ventures, which holds what they refer to as ‘carefully curated’ events connecting ‘thought leaders, C-level executives, innovators and entrepreneurs.’ The purpose is to ‘build strategic relationships and partnerships with top industry dealmakers.’ In other words, Davos Lite.

              So there you have it. Gun violence has now become a vehicle for talking about the latest and greatest investment opportunities that might just be relevant to the medical field. After all, the medical industry now cranks out more than $3.65 trillion every year. That’s not chopped liver even in my book.

              Coming up with new medical products happens as well to be a particular end-game for Northwell Health, which runs a medical-products lab that has gone heavily into a new medical technology, ‘bioelectronic medicine’ which promises to replace pain-killing drugs with electronic impulses that will control the nerves which create pain. These products, none of which are yet on the market, also are being developed to control bleeds. Is that the connection with injuries caused by guns? Maybe they are working on some kind of electronic impulse that will inhibit all those street thugs from taking out their Glocks because ‘he dissed me.’

              In any case, you may recall that back in February, the American College of Surgeons hosted a national, gun-violence ‘summit’ where representatives of more than 40 medical organizations showed up, spent a day blabbing back and forth and issued the usual laundry-list of recommendations for reducing gun violence through the application of various ‘sensible’ gun laws. Then everyone went home and that was the end of that.

              Funny, but the invitation sent out by Landmark Ventures for the ‘carefully curated’ New York event went to the same groups who showed up at Chicago, along with companies like Wal Mart and Dick’s Sporting Goods, who have stopped selling black guns. Oh well, you never know what will happen when you get a bunch of sporting-goods salesmen in a room with a high-level assortment of innovators and entrepreneurs.

              If you catch a slight bit of sarcasm in my text, it’s not by accident but by design. Five or six years ago, you could go to any number of conferences which bring ‘thought leaders’ together but you wouldn’t hear any discussions about guns. Now such conclaves seem to be breaking out all over the place.

              There’s only one little problem. Basically, these confabs don’t accomplish a friggin’ thing. Unless what you’re just trying to accomplish has really nothing to do with the violence caused by guns.

Older Entries

%d