Noth Carolina Joins The List Of Dumb States In Trying to Keep Doctors From Talking To Patients About Guns.

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Here we go again.  Another state legislature, in this case North Carolina, may be joining 3 other dumb states in enacting a law that will prevent physicians from talking to patients about guns.  The bill would prohibit physicians from mentioning guns on intake questionnaires and worse, prohibits physicians from telling authorities about concerns that arise from interviewing a patient about gun ownership.  This stupidity first began in Florida which passed such a law inaugurating a legal battle known as Docs Versus Glocks which eventually resulted in the law being upheld by the 11th Circuit in 2014.

The North Carolina law, however, goes further into the realm of stupidity because it not only enjoins physicians from asking patients about gun ownership unless the patient has expressed a desire to harm himself or others, but it also prohibits disclosing information about gun ownership to any authorities except in instances where the aforesaid patient – ready for this? – has been “adjudicated incompetent due to mental illness.”  Does this law actually forbid a physician from informing law enforcement about a potential act of gun violence because the patient in question hasn’t yet gone before a judge who decided that the guy happens to be crazy as hell?  That’s right.  That’s exactly what the bill which may be taken up by the House Appropriations Committee actually says.

docs versus glocks                This new law creates a rather interesting predicament for doctors even if they don’t feel compelled to ask their patients about guns.  Because let’s say that a patient tells a physician, for example, that he’s suffering from extreme depression and is thinking of taking his own life.  He then further tells the physician that he owns guns and he is planning to use one of the guns on himself because he knows that it’s the quickest and easiest way to get the job done.  Under this law, the physician can’t actually do or say anything at all.  The guy is depressed but he’s lucid and hardly mentally incompetent.  The doctor can ask the guy about what kind of gun he’s planning on using to blow a hole through his head, but all he can do is perhaps suggest that the patient rethink the whole idea.  He can’t even tell the patient to get rid of the gun because the law also says that an individual’s right to own a gun is a “private matter” over which the doctor has no authority or input at all.

I’m not totally surprised that such a law would be enacted when I consider the original source, namely a loony Republican State Representative named George Cleveland, who once stated that nobody in North Carolina suffered from ‘extreme poverty’ when, in fact, roughly 8% of the state’s residents have incomes that fall below the extreme poverty line, and overall North Carolina ranks as the 13th poorest state. This rock-red Republican, by the way, just happens to be a gun nut and you can get a sense of this from his home page on Pinterest which is covered with guns. Don’t get me wrong.  I don’t think that Representative Cleveland is a bad guy because he likes guns.  I think he’s a bad guy because this is a bad law.

Cleveland’s bill stands the Hippocratic Oath on its head. The law basically says that a physician cannot do or say anything to reduce the possible harm caused by someone who admits wanting to use a gun to hurt themselves or someone else.  Of course this same physician would be free to pick up the telephone and call the cops if someone walked into his clinic and said he was going to stab someone else with a knife.  If anyone other than the NRA really thinks this law is an important step forward in protecting our 2nd Amendment rights, then I just hope you’re not the guy or gal in North Carolina whose spouse just told a physician that they are going to grab you, grab their gun and put a bullet through your ear.

Physicians And Guns: Another NRA Sycophant Ignores The Truth.

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As physicians slowly but surely push their way back into the debate about gun violence, you can be sure that the NRA and its legion of willing sycophantic journalists will be right behind them attempting to explain why doctors should avoid any discussion with their patients about guns.  The latest such effort comes from a right-wing blogger, Vic Khanna, who identifies himself as a health-care consultant and gun owner in an opinion-piece found on the Federalist blog.

The piece begins with the usual nonsense about how Obamacare is a threat to everything and that it threatens everyone’s individual liberties, most of all the liberty to own a gun.  This is the standard crap that has been promoted about every liberal program or policy since the Republicans realized that protecting the 2nd Amendment was a good wedge issue for them to use at the polls.  But Khanna then goes into detail criticizing the efforts by Adam Goldstein and other physicians to create standards for judging CCW fitness among patients, an issue for which Goldstein has published several important peer-reviewed articles over the last several years.

docs versus glocks                Of course Khanna neglects to mention the fact that Goldstein, who happens to be Professor of Family Medicine at UNC-Chapel Hill, got into the CCW-competency business after receiving requests from sheriff’s departments in North Carolina who are required under law to consult a physician if a person’s mental or physical condition might make granting of CCW a risk.  Now isn’t that amazing? North Carolina actually had the good sense to codify a requirement that recognized the unique competencies of physicians in diagnosing mental or physical impediments to carrying around a gun.  What?  Let those gun-grabbing, elitist doctors decide whether you or I can walk around with a gun?

But Khanna isn’t about to tell the truth and enlighten his readers to the fact that law enforcement is in kahoots with the medical establishment to keep North Carolina residents from carrying their guns.  He’s also unwilling to honestly summarize the gist of Adam Goldstein’s publications on this issue, namely, the lack of clinical guidelines that physicians need to use when they diagnose all sorts of physical and mental conditions which might otherwise keep Americans from doing such non-essential activities as driving a vehicle or going to school.  Perhaps in his role as a health care consultant Khanna tries to figure out ways to help parents avoid taking their children for the mandated health exam that most jurisdictions require before a kid can enroll in school.

Last year Adam Goldstein and other researchers sent out a questionnaire to 600 North Carolina physicians asking whether the recipients believed that they possessed sufficient medical knowledge to make a determination about the CCW fitness of individual patients.  Of the 40% who returned the questionnaire, “a majority felt that they could not assess their patients’ physical capability to carry concealed weapons,” and nearly all the respondents felt that they needed special training before making medical assessments for CCW that might be required under North Carolina law.

Did Goldstein and his colleagues use these findings to promote the idea that issuance of CCW should be curbed or discontinued?  No.  Did they use these findings to challenge the rights of North Carolina resident to own guns? No. They did what the Hippocratic Oath requires them to do, namely, to raise concerns about their own ability to identify and reduce harm, in this case the harm that might occur if someone who was mentally or physically disabled could go around with a gun.

The NRA and its sycophant journalist crew like Vic Khanna have been playing fast and loose with the facts about physicians, patient care and gun ownership for the past twenty years.  They’ve gotten away with it quite simply because most people visit doctors for medical conditions that don’t involve guns.  But the tide is beginning to turn, and when the American College of Physicians urges their members to ‘educate’ patients about guns, physicians like Adam Goldstein  won’t be turning to the likes of Vic Khanna in order to figure out how to respond.


Who’s To Say Whether I Should Carry A Gun?

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The NRA decided years ago that there’s no seat at the table for physicians when the committee hearing or the funding agency gets together to talk about guns.  They don’t even want physicians talking to their own patients about guns and they certainly don’t want the Surgeon General  ever to say anything about guns. But while such aggrieved nonsense may play well with the NRA faithful, particularly repeated by a putative Presidential candidate, those who live in the real world know that we all need a physician when it comes time to make critical decisions about our health.

One of the critical health decisions for which people might need medical counsel is whether or not to carry a gun. Now I know that the pistoleros who spend every vacation sharpening their skills at shoot-em-up amusement parks like Gunsite or Thunder Ranch don’t need help deciding whether their eye-hand coordination will let them emerge victorious from the fray, but there must be plenty of people among the eight million Americans now holding CCW privileges who don’t have the physical or mental dexterity that handling a lethal weapon requires.

paul                Even though a majority of now states issue CCW on a “shall” (required) rather than a “may” (discretionary) basis, there are hardly any states that do not grant the official issuing CCW the authority to deny a permit if the applicant, regardless of legal background, might use a weapon to endanger himself or someone else.  The NRA would probably say that one of their local members should be consulted in cases like this, but you and I know that the licensing authorities will turn to a physician because a doctor is the only professional they can really trust.

But this brings up a little problem.  Because it turns out that many physicians don’t trust themselves to make competency decisions about whether people should own or carry guns.  The American College of Physicians conducted a poll which revealed that two-thirds of its members didn’t counsel their patients on firearms because they didn’t know enough about how to treat patients at risk for misusing their guns.  A similar poll conducted by the American College of Emergency Physicians in 2013 said the same thing.

We now have a new poll that asked physicians in North Carolina whether they felt comfortable responding to requests from county sheriffs who needed to verify the physical or mental competency of someone wanting to carry a gun. This poll, of whom one-third of the respondents indicated they owned guns, found that 60% of the physicians did not feel they could “adequately assess” whether their patient was physically capable of carrying and using a concealed gun, and nearly 50% felt they could not determine CCW competency on mental grounds.  As for those who think that the medical profession has been cowed into submission by the lunacies of a self-certified Kentucky opthamologist and a small, pro-gun fringe, a majority of the respondents did not believe that the doctor-patient relationship would suffer if they didn’t certify the patient as being fit to carry a gun.

The real knowledge deficit created by defunding CDC gun research is not whether guns are a medical risk.  The bigger issue is the fact that, when confronted with a patient possibly at risk to commit (or be the victim of) gun violence, many physicians don’t know what to say or do. Now that the American Medical Association has just endorsed the idea of medically-accredited gun violence education, perhaps the gap will begin to close.  And if anyone out there thinks their physician is now their enemy because he wants to talk about guns, perhaps you should make an appointment for your next checkup with Doctor Rand Paul.

Bloomberg Goes After Gun Traffickers: Does He Know Who He’s Looking For/

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bloomMike Bloomberg, soon-to-be former Mayor of New York City, has blanketed the airwaves and the internet since Sandy Hook with his campaign to stop gun trafficking.  Although I can’t find a strict explanation for what constitutes gun trafficking, I guess we can use the one found in H.R. 2554, the bill to prohibit firearms trafficking that was introduced by Rep. Carolyn Maloney (D-NY) that never got out of committee.  The text of the bill says that trafficking is the transfer of a firearm to an individual:

whose possession or receipt of the firearm would be unlawful; or who intends to or will use, carry, possess, or dispose of the firearm unlawfully.

If you want to know what this means or doesn’t mean, which is a polite way of asking whether Bloomberg, Maloney, et. al.,  knows what they’re talking about, just read on.

Bloomberg’s gun trafficking “evidence” is presented in two ways: there’s a detailed report and an interactive website.  The website allows the viewer to choose any state and see where guns initially sold in that state were later picked up by the cops, or you can turn it around, choose a state and see where guns picked up in that state were first sold.

Not surprisingly, the states that exported the most guns to other states are also states where there are few, if any legal restrictions on gun sales.  The website lists 10 state gun regulations that help deter illegal gun activity (licensing, straw sales, etc.) and only two of the top-10 exporting states, Virginia and North Carolina, had 4 of these regulations on the books, and nearly all the other high-exporting states had one or none.

It has long been an article of faith held by Bloomberg and other gun control advocates that more gun laws equals less gun crime.  But the evidence isn’t so much causal as coincidental because states that have stricter gun laws also tend to be states with less gun ownership.  And the bigger problem is that it’s simply impossible to take a phenomenon as complicated as crime and try to find a single factor that explains why and when it occurs.

But the real problem with Bloomberg’s search for gun traffickers lies in the fact that if we use the transfer of a firearm to test the definition of gun trafficking, and restrict our data to interstate seizure of crime guns, the data used to rank the exporting states starts to get less than precise.  For example, Georgia ranked 10th in total exports and yet 35% of all their exported guns were found in contiguous states.  Virginia was the 7th-highest export state but 40% of its gun exports were found in DC, Maryland and North Carolina.

I’m not surprised that a majority of the crime guns recovered in New York come from non-contiguous states when you consider that both Massachusetts and Connecticut not only have strict laws but have a per capita gun ownership rate far below the national average.

I could write ten more diaries on the analytical problems involved with understanding gun trafficking but my point is simply this:  If anyone thinks there’s a silver bullet out there that will solve the issue of gun violence, think again. The problem is very complex, it’s simply not amenable to any sort of “quick fix,” and before we change the laws, we better make sure that we really know what’s broken and whether we can fix it.


Is The 2nd Amendment Really Under Attack?


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 I have spent the better part of the last five months sitting in my gun shop, selling as many guns as I can get my hands on to well-intentioned guys and even a few gals who really believe their 2nd Amendment “rights” are under attack.  And every day I get an email from Chris Cox or Wayne LaPierre telling me that they’re doing their level best to keep my guns from being taken away.  Chris and Wayne are going to stand and fight and if I don’t stand with them, those hard-fought freedoms will slowly but surely be taken away!

Except the truth is that there’s never been a time when American gun rights were more secure.  Know why?  Because in most parts of the country there aren’t any laws covering the way people use guns at all.  Let me give you just a few examples.

Everyone agrees that guns should be kept locked up.  The NRA says so, the American Academy of Pediatrics says so, everyone says so.  There are currently 39 states that have no laws requiring gun locks of any kind, and only one state, Massachusetts, requires locks on all guns.  Is it any wonder that two children under five years of age were accidentally shot in Kentucky in the last several weeks?

The good news is that if you live in one of those 39 states and happen to leave a loaded gun around which someone picks up and uses to shoot someone else, it will be ruled an “accident” and the gun will then be returned to you.  After all, why should you be charged with aiding a homicide when it wasn’t your finger that pulled the trigger of your gun?

Or take the issue of alcohol and guns.  NRA-certified trainers like myself are told to make it clear that we will not tolerate alcoholic beverages in or near our training sessions, nor will we allow anyone to touch a gun who appears to be under the influence.  There are currently 39 states that allow people to bring guns into establishments that serve liquor.  Oops!  The North Carolina House just voted to permit bars and restaurants to serve alcohol to gun-toting customers, the bill’s sponsors saying that they felt that the measure was a proper “expansion” of Second Amendment “rights.”

The North Carolina bill also removes sporting arenas from the list of places where it used to be prohibited to bring a gun.  This makes North Carolina the 42nd state to allow fans at baseball, football and basketball games to stick their Glock or Ruger pistols into their waistbands before ending the tailgate party and heading into the stadium.  Of course thanks to the defense of their 2nd Amendment “rights” those pistol-packin’ fans in North Carolina can now also sit there and guzzle down a few beers while cheering the Tar Heels home.

Remember all the old Western movies where the cowboys had to check their guns before they came into town?  I didn’t notice Gary Cooper or John Wayne worrying much about the 2nd Amendment when they strode into the saloon and told Jack Palance to “nice and easy” take off his guns.  I’d like to believe that we are all responsible enough to know where and when we should carry a gun.  And my organization, Evolve, has no issue with anyone, gun owner or not, who believes as we do that gun responsibility should be shared by all.  But let’s not kid ourselves.  Every day we hear about some kid getting shot or wounded because someone else didn’t behave responsibly with a gun.  That’s got nothing to do with attacking the 2nd Amendment. It has everything to do with demanding sensible laws that embody common sense.