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Should Doctors Stop Talking About Gun Violence Because Medical Errors Cause More Deaths? No.

May 7, 2016

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Gun Nation is abuzz with the publication of an article in the British Medical Journal which finds an alarmingly high rate of U.S. hospital deaths due to medical errors.  Now why would the pro-gun noise machine care one way or the other about an article in a medical journal?  Because it’s been an article of faith amongst the gun faithful that physicians should stop wasting their time talking about gun violence when the number of people killed each year by firearms is just a fraction of the number who die due to medical mistakes.  And since the BMJ article states that medical errors account for anywhere between 200,000 and 400,000 avoidable deaths each year, and annual gun homicides only count around 11,000, why can’t doctors take care of really ill patients properly before they start making so much fuss about guns?

docs versus glocks           Marion Hammer, former NRA President who spearheaded Docs versus Glocks in Florida, says that docs should “do no harm” and keep their political opinions out of the examining room.  And in pushing for the gag law, Hammer distributed a document that listed ‘medical misadventures’ as three times more likely to result in deaths than accidental shootings.  Other sources, like media that promote natural healing, paint an even grimmer picture, with one expose claiming that guns kill 31,940 Americans each year (homicide/suicide/accidents) but the medical system accounts for783,936 deaths! By the way, this particular website also published a story that said the San Bernardino shooting had all the “signs” of a staged government operation, and this story rolled out more than 31,000 times.  Hmmmmm.

The problem is that the British Medical Journal isn’t an adjunct of the Area 51 gang, so when they publish something about morbidity from medical errors, it needs to be taken seriously, particularly if what they say ends up being injected one way or another into the gun violence debate.  Now let me make it clear that I’m not a physician and I have no medical training of any kind.  But I know how to read the King’s English and I can figure out whether data in a peer-reviewed journal aligns with the facts and conclusions on which the article is based.  In the case of the BMJ, I not only read the article detailing mortality rates from medical errors in U.S. hospitals, I also closely read the articles on which the BMJ article was based. Let’s start first with the BMJ.

In 2013, 611,000 Americans died from heart disease, 585,000 died from cancer and 251,000 died from medical error, this last being the third most common cause of death.  Since the medical profession doesn’t actually have specific medical errors as coded events in the ICD-10 coding system used almost universally as the primary indicator of health, the figure noted above is a best-guess estimate based on specific studies of in-patient outcomes throughout the U.S. The most comprehensive study from Medicare records, gave the total mortality for doctor errors as slightly more than 195,000 per year from 2000 through 2002, of which 75% of all deaths were attributed to something known as ‘failure to rescue,’ which means a diagnostic error leading to improper (or no) treatment, leading to the patient’s death.

But failure to rescue in a clinical context may have little, if anything to do with decisions made by physicians themselves. Many such deaths are attributable to mistakes in managing patient information, particularly for elderly patients who tend to suffer from multiple conditions requiring intensive and complicated care. A necessary treatment is omitted or delayed, vital signs begin to decompose, the patient is dying but his physician may be far removed from the scene.

To compare the ‘responsibility’ of physicians for patient deaths to the ‘responsibility’ of a gun owner who lets his gun get into the wrong hands, is to make a comparison with no basis in fact. But since when did Gun Nation respond to the issue of gun violence with any facts at all?

 

What Do Doctors Need To Tell Patients About Guns? That Guns Are Lethal No Matter How Safe You Are.

August 6, 2015

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This week the online version of JAMA contained an important editorial by two noted gun violence researchers.  Their editorial followed from a February “call to action” issued by the eight leading professional medical organizations promoting the idea of greater physician engagement in dealing with gun violence, notwithstanding the attempts by the NRA to legally de-legitimize the ability of doctors to talk to patients about guns.

The authors of the editorial, Drs. Marion Betz and Garen Wintemute, believe that physicians need to develop what they refer to as better ‘cultural competencies’ in order to overcome the alleged suspicions that gun owners harbor about medical professionals who try to talk about their ownership and/or use of guns.  I say ‘alleged’ because I have yet to see a single, bone-fide survey that actually quantifies the anti-physician attitudes the NRA has worked so hard to stir up. The fact that a group of red-meat Florida legislators say “yip’ every time that the NRA lobbyist Granny Hammer says ‘yap,’ doesn’t prove anything at all about how the average gun owner would feel if his doctor initiated a conversation about guns.

jama                Betz&Wintemute present no data on the attitudes of gun-owning patients but there are surveys of physicians which indicate that the majority of medical professionals don’t know enough about guns to feel comfortable raising the issue of gun violence within the context of clinical care.  And the authors are certainly correct in calling for the medical community to find ways to remedy their lack of communication skills. But with all due respect to the very important research conducted by Betz&Wintemute over the years, I am still not convinced that a growth of cultural competence in the area of gun violence should primarily focus, as they suggest, on counseling about the safe use and storage of guns.

In 2013, as the authors note, 117,894 men and women were killed or wounded with guns. But less than 15% of these injuries were considered accidents, or what the CDC calls unintentional events. Now don’t get me wrong: 17,369 accidental shootings is a serious health issue in and of itself.  And anything that can be done to lessen the impact of these events on the victims, their families and the medical system which has to respond to the problem should certainly be put into effect.  But what makes gun violence such a disturbing social and medical phenomenon is the fact that each year at least 100,000 among us make the conscious, often impulsive decision to pick up a gun and use it to shoot ourselves or someone else.  Last year the CDC called 24,000 Ebola cases in Central Africa an “epidemic.”  What do you call 100,000 cases of gun violence in the U.S. every year?  A day at the beach?

If the medical community is going to take a more dynamic approach to gun violence, I think that increasing communication skills regarding safe storage and gun safety is putting the cart before the horse.  Betz&Wintemute are correct in suggesting that effective counseling has to reflect the individualized nature of every clinical interaction, but the real problem that physicians face is not learning how to tell a gun-owning patient to lock up or lock away the guns; it’s learning how to identify patients who are prone to engage in gun violence, regardless of how they store their guns.

Adam Lanza’s mother dragged him from one shrink to another.  At no time did a medical professional ask why her home was virtually littered with guns.  Elliott Rodger, who shot 17 people in Isla Vista, California, had been seeing therapists since he was eight years old.  Not a single medical society has yet to adopt clinical guidelines to help physicians identify at-risk patients before they pull out a gun. Doctors are hardly the only group who can give advice on safe storage of guns.  But what only they can do is identify and treat risks to health.  And anyone who believes that a gun doesn’t represent a health risk doesn’t know much about either one.

Everytown Starts Their Own ‘March Madness’ Campaign And May All The Teams Lose.

March 26, 2015

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Leave it to Shannon and the chicks (as in women, not in birds) to come up with a new twist on America’s national bash known as ‘March Madness’ by starting their own campaign to prevent colleges from becoming the latest venue where anyone and everyone can carry a gun.  The Everytown group has just posted a new graphic identifying the states where bills have been introduced that would allow guns on campus, of which four such attempts have gone down the tubes but twelve more remain to be finished up.  The campaign has gotten a boost from Bryant Gumbel, whose commitment to reducing gun violence is so pronounced that he’s been attacked by Ted Nugent, who might do himself a favor and stick to strumming his guitar.

Most of the folks who honestly believe that guns would make campuses safer are reacting to a recent spate of news stories regarding campus rape.  And while nobody wants to walk around a college campus in fear of being attacked, the question which needs to be addressed is whether carrying a gun would really make anyone on campus more safe.  The truth is that college campuses, particularly the larger schools with residential populations, happen to be places where certain types of behaviors are unfortunately all too common, and such behaviors are guaranteed to make students much less safe when combined with access to guns.

march                I am referring to two issues that are generic to campus life: alcohol and suicide.  According to the NIH, four out of five college students consume alcohol and half of those student drinkers admit to binge drinking as well.  More than 1,800 college students die from alcohol-related injuries, and nearly 700,000 students report being assaulted by another student who had been drinking prior to the attack.  Nearly 600,000 students each year end up in the campus health station because they injured themselves while under the influence of alcohol, and nearly 100,000 reported that they were sexually abused by someone who was under the influence during the attack.

Proponents of campus guns will tell you that these statistics prove the necessity of getting rid of gun-free college zones, but what they don’t want to do is look at the possible use of guns by the students who drink and then assault someone else.  Even the average gun nut (myself included) will admit that guns and alcohol don’t mix, and it’s to Everytown’s credit that the announcement of their March Madness campaign focused specifically on the degree to which alcohol impairs judgement, particularly the mental stability required to behave safely around guns. As for suicide, it happens to be the second leading cause of death for college students, and if anyone tells you that a suicidal person is less prone to end their life because they have access to a gun, you’re not talking to someone who possesses even a shred of intelligence, never mind common sense.

Last week the debate on campus guns got particularly loud in Florida, due largely to the energy and effort of the gun-totin’ Grandma, a.k.a. Marion Hammer, the Gunshine State’s lobbyist for the NRA.  She sent out a call to all the gunnies in Florida, telling them that their constitutional “rights” were being violated if they couldn’t bring their guns into classrooms and dorms. This is a rather odd view of the 2nd Amendment, given the fact that the Supreme Court in the landmark Heller decision, specifically noted that Constitutional protections of gun ownership did not preclude the government from banning guns in “sensitive” places such as schools.  But leave it to the NRA and Grandma Hammer to explain the Constitution whichever way they can.

Most proponents of colleges as gun-free zones cite the degree to which campuses are also usually crime-free zones.  What I like about the Everytown campaign is that it brings us squarely back to the real issue, namely, that someone walking around with a gun is a greater risk to himself and others than when the gun was left at home.  Let’s see how Everytown’s tournament plays itself out.

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The Violence Policy Center Has Something Important To Tell Us About Guns.

March 24, 2015

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When the Violence Policy Center began tracking shooting homicides committed by persons with concealed-carry permits, they were attacking the most cherished totem of the pro-gun community, namely, the idea that armed citizens play a positive role in protecting themselves and others from crime.  The fact that there is no credible research to back up this bromide is beside the point; it’s the stock-in-trade of every statement made to justify the concealed-carry of guns.  You can hear it from the NRA’s chief Florida lobbyist, Marion Hammer, arguing for concealed guns to be permitted on college campuses, you can hear it from national legislators on Capitol Hill as they debate a national, concealed-carry reciprocity law.

To the Violence Policy Center’s credit, they have not only maintained their stance regarding CCW-holders who use guns to shoot themselves and others, they have now augmented their effort with an updated website which lets viewers  examine specific information about CCW shootings on a state-by-state basis. One thing I should say right from the gitgo; the data is not meant in any way to be comprehensive, nor could it reflect the true degree of violence caused by individuals who are licensed to walk around with guns.  Nobody collects such data, which forces the VPC to fall back on media reports that are, by definition, very incomplete, vague and therefore capture only the tip of the iceberg at best.  But anyone who attempts to discredit this effort by getting into a spat over whether the numbers show this or the numbers show that is missing the point.

conference program pic                What the new presentation allows you to do is look at the details of these CCW shootings, compare what you read from one state to another, and draw some conclusions not about the connection between concealed-carry and gun violence, but the much greater issue of access to guns and gun violence per se.  After all, pro-gun proponents will tell you that virtually all gun violence is caused by guns getting into the ‘wrong’ hands, which means that if we take guns away from criminals and the mentally unstable, there won’t be any gun violence at all. But the content on the VPC website belies such nonsense, and what it says deserves to read in full.

Here’s a couple of quick examples drawn from the first entry of various states picked at random for purposes of review.  Mississippi:  Three drunks get into a bar argument and two end up shot dead.  Arizona: Husband shoots wife to death.  Oregon: Shooter kills father, kills another guy and then kills himself.  Ohio: Two guys are drinking at a party, one disses the other, bang.  Maine: They leave a bar, they are both boozed up, an argument starts, and that’s that.

Notice a pattern?  Five shootings, eight people dead, seven knew each other well before the fatal incident occurred. Not one of the shooters was a ‘criminal.’  Not one of these shootings involved the commission of any crime.  In fact, the shooters in every single case were law-abiding citizens or otherwise they wouldn’t have been able to carry a gun.  Despite what the NRA and the other pro-gun propagandists say, these reports picked at random from the VPC website are exactly what true gun violence is all about.

According to the FBI, less than one out of five fatal shootings in the United States takes place during the commission of a serious crime.  Homicide is impulsive, it usually grows out of disputes between relatives or friends, and if a gun is present the argument gets very violent, very fast.  And this is particularly true when the homicide victim is a woman; virtually every woman killed with a gun or any other weapon lost her life during a domestic dispute.

The pro-gun community can talk from today to next year about how we much safer we are because more people are walking around with guns.  I don’t think this argument should turn on numbers; I think it should turn on the lethality of guns.  The VPC website hits that one right between the eyes.

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