Monday, December 17, 2012

Is the medical profession doing enough about gun violence?

Are any of us?  This is the question that we all must ask ourselves, in the wake of the incalculably sad massacre of little school children in Newtown, Connecticut.

I have struggled for days now to find the right words—how can I, or anyone else for that matter, find the words to describe the indescribable shared grief we have about the indescribable horror of that day and its aftermath?  But I have to say something, we have to say something.  Something about what this says about our country, and its repeated inability to rise to the occasion to address the causes and consequences of gun violence.  Silent reflection in the face of tragedy is a necessity for most of us. But silence in the public policy arena means acquiescence to the cynical and powerless view that there is nothing that can be done to prevent the next Sandy Hook, or Virginia Tech, or Aurora, or Columbine.

Yesterday, President Obama found a way to speak truth to the people of Newtown, and to the country.  He said that “This is our first task — caring for our children.  It’s our first job.  If we don’t get that right, we don’t get anything right.  That’s how, as a society, we will be judged. And by that measure, can we truly say, as a nation, that we are meeting our obligations?  Can we honestly say that we’re doing enough to keep our children — all of them — safe from harm?  Can we claim, as a nation, that we’re all together there, letting them know that they are loved, and teaching them to love in return?  Can we say that we’re truly doing enough to give all the children of this country the chance they deserve to live out their lives in happiness and with purpose?  I’ve been reflecting on this the last few days, and if we’re honest with ourselves, the answer is no.  We’re not doing enough.  And we will have to change.”

We are not doing enough.  We will have to change.

So, those of us who work for, or are members of health professional societies that are dedicated to improving health and well-being of the American people, must ask ourselves, are we doing enough?  Is the medical profession, the healing profession, doing enough?  How will we be judged?

My employer, the American College of Physicians, has been on record since 1996 (policy reaffirmed in 2006) calling for policies to prevent firearm injuries, including a ban on assault weapons, like the one used in Sandy Hook.  Banning assault weapons and high capacity ammunition may not prevent tragedies like Sandy Hook, but simple logic tells us that there would be fewer casualties resulting from them.   Most recently, ACP has called for “best practices” to reduce injuries and deaths from firearms, as well as the right of physicians to ask patients about firearms in the home.

Some members of Congress, who previously had the highest ratings from the National Rifle Association, agree that the time has come for “rational gun control” and “meaningful action” on guns including even a ban on assault weapons.  But many others remain opposed to any new restrictions on gun ownership.

We also have to acknowledge that even if future sales of assault weapons were banned tomorrow, there are millions of them that would legally remain in persons’ hands, because they were acquired before the ban. Some will end up in the hands of people who want to inflict the maximum harm to others, but most won’t.  We have to acknowledge that most gun owners, including owners of assault weapons who use them only for recreational target-practicing, would never harm anyone or wish harm on anyone. They too care about their children and they care about ours.

An evidence-based analysis would have to acknowledge that the deaths from homicides reached a 50 year low in 2010, even as restrictions on gun ownership have been loosened across the country and even without a ban on assault weapons.  An evidence-based analysis would also acknowledge that a good part of that decline may be due to better emergency care for trauma—large numbers of people are still getting shot, but not as many of them are dying from it.  An evidence-based analysis would acknowledge that it isn’t just the massacres we need to care about, it is the men, women and children who are murdered or injured everyday on city streets and buses and workplaces and in their own homes.

An evidence-based analysis would also acknowledge that many disturbed and potentially dangerous people don’t have access to mental health services in the United States. It would acknowledge that the vast majority of those with mental illness pose no threat to others.   An evidence-based analysis would acknowledge that people with mental illness benefit from having the loving support of their families.  But it would also acknowledge that being in a loving family, and having access to mental health services, does not guarantee that very distributed persons will be able to control their violent impulses.  Just read this heartbreaking account from a loving Mom about her challenges in controlling her sometimes violent son, despite having access to mental health services.

To be clear, I believe, and ACP believes, that limiting access to assault weapons and high capacity ammunition can help reduce the death toll.   But it is just one piece of the puzzle.  We will need to carefully examine all of the evidence that we can find on the most effective strategies to minimize deaths and injuries from firearms, and strive to seek a national consensus to implement them.

But the complexity of the problem and possible solutions should not be used as an excuse to delay action or to accept the status quo.  “No single law — no set of laws can eliminate evil from the world, or prevent every senseless act of violence in our society, “observed President Obama yesterday. “ But that can’t be an excuse for inaction.  Surely, we can do better than this.  If there is even one step we can take to save another child, or another parent, or another town, from the grief that has visited Tucson, and Aurora, and Oak Creek, and Newtown, and communities from Columbine to Blacksburg before that — then surely we have an obligation to try.”

We have an obligation to try, including asking whether the healing professions are doing enough about to curb gun violence in the United States.

Today’s questions:  Is the medical profession doing enough to advocate for policies to reduce injuries and deaths from firearms?  Are any of us?


Susan Hingle said...

Lack of access to good mental health services is an enormous part of the equation that unfortunately doesn't get talked about enough. I hope that people will be realistic and include this key part ion the discussions that will ensue in the wake of this tragedy.

Steve Lucas said...

In 1998 my brother was shot and killed trying to disarm an employee at work. This person had a long history of alcohol, drug abuse and domestic violence, and as a convicted felon was not allowed to own or possess a gun. The shooters intent was to kill all of management and the employees, feeling gratitude, would elect him manager of the factory. My brother was killed with a 22.

After sorting through a large number of emotions we came to the conclusion that my brother was killed by a man, not a gun. The gun was only a tool for a person who through a drug fueled fog saw himself as something other than the person he was, one of many.

Since that time I have seen one central theme in all of the atrocities committed in this country and around the world: They have been committed by a person with mental issues.

I in no way wish to return to the bad old days of warehousing the mentally ill. Today we often see medications aggravating mental problems and creating violence while a person seeks solutions to their problems. Moving to my wife’s hometown many years ago patients were given the “right” not to take their medication and along with this “right” the local mental hospital was closed, with no life skills the result was an influx of people living on the street. The result was one of these people, feeling somehow insulted, set fire to our church, nearly burning it to the ground.

The cops and robbers I played at 5 or 6 has become the violent computer game now played by 20 some things, often to the exclusion of social contact. TV and movie violence have reached epic proportions.

There is the claim that all we have to do is love more, medicate more, and be more involved in a person’s life. My youngest brother died nearly four years ago an alcoholic. He pushed all those aside who were not enablers, or who did not in some way serve his needs.

This is a complex issue with no simple answer. Simply taking away guns will result in the use of other weapons, as we have seen around the world. Warehousing the mentally ill will only result in the atrocities of old. Limiting TV and video violence infringes on other “rights.”

While we must take multiple steps to prevent these types of atrocities we must understand that with a growing population, the ability of people to become increasingly isolated, this type of evil does exist.

Taking away guns may make us feel better, but my reality is we live in a violent society where many people have been marginalized, and in an effort to preserve their “rights” we have allowed them to commit unspeakable evil.

Steve Lucas

BDoherty said...
This comment has been removed by the author.
BDoherty said...

I want to thank Steve Lucas for sharing his thoughtful and heartfelt insights on having to grieve for a brother who was killed by a severely disturbed person and for another brother who died from alcoholism and rejected help from a loving family. And I agree with him that the solutions are complex--mental health, culture, addiction, violent video games, all play a role, but I also believe that access to assault-style weapons and high capacity magazines increases the ability of a disturbed or just evil person to inflict the maximum number of casualties in the shortest period of time. But it is also true that no set of policies can completely prevent violent persons from inflicting harm on others. We can only strive to reduce (substantially, one hopes)the number of such violent incidents and the death toll when they do occur through a combination of evidence-based policies that identify approaches that work. I hope we can all agree that we owe it to the victims, and ourselves, to try.

Steve Lucas said...


I want to thank you for your kind words. My fear is that there will be a focus on a style of weapon and once a ban is in place this issue will fall to the wayside. We had an assault weapons and clip size ban in this country and this did not produce the desired decline in weapons related crime.

The news in my community is a robbery that was posted to YouTube as a rap video that netted the robbers $14 and a pizza. The immediate response was we need increased spending to help these poor boys who held a gun to a clerk’s head while they lay face down on the floor.

Gun ownership and gun crime continue to decline, what we need is a way to better regulate those who may become violent. That is an issue for which I do not have an answer.

What is good is that we are having this discussion. Parents of children with mental issues are beginning to express their concern with violent episodes. Medications are being exposed that drive destructive behaviors.

We should not fear those with mental issues and we should not live in fear in any social setting of an unprovoked physical attack.

The most troubling aspect of this, and other episodes around the world, is that they are perpetuated on that which we hold dearest, our children.

Steve Lucas

Harrison said...

Our EHR has some interesting questions that we can choose to ask, or not, when doing a physical exam. One of them is about guns in the home, and about trigger locks.
I have asked it.
But I live in a very 'red' part of California. And most of my patients are quite vocal in opposition to Obamacare and they are quite sure that the country is going to be in the worst shape it has ever been in because he is President.
And they will spontaneously make statements about how the President has a secret agenda to confiscate all of their guns, and they truly resent it.
So when I ask that question -- and I do carefully pick and choose how I ask that question -- I am always a bit anxious about the potential reaction.
And I have had a few.
A couple have clearly asked where I was getting that question from and how they are sure that the government planted that question in the EHR so that they could find out about their guns.
And they asked me specifically not to write anything about their guns in the record.

I don't know how ready some people are for reasoned discussions about this issue.
Statistics won't help, because...well, you know,...who controls the statistics.
Why aren't they telling you about all of those times where gun carrying people saved the day???

Progress on this issue in our society is going to be slow.
Guns that can shoot 30 rounds in 5 seconds will be available to unstable people for a very long time.
We shouldn't live in fear, but we also shouldn't be surprised when this happens again.
Because, well, ... it just will.


Unknown said...

Since Cain and Able, is has become apparent that humans have a tendency to kill other humans, as is war a part of the human genome. A serious person hopes that the coming discussion focuses upon that dark corner of the human soul which engenders this behavior, rather than upon the rock, the arrow, the trebuchet, the gun, or the future weapon-du-jour that is merely an instrument, and not the source of evil in the world.

Australia banned legal guns several years ago, and now suffers a 10% increase in homicides, and 44% increase in armed robbery and other violent crimes, as citizens now have no legal means of protection.

Humans have not the wisdom to legislate wisely, and in a land which has literally lost its soul to dialectical materialism, one despairs at the nature of the upcoming national discussion concerning gun violence.

The fact is that a certain number of people--which number is known only to God--are going to die of violence this coming year. By putting defensive weapons into the hands of responsible citizens, thus do we have the means of deciding whether the insane, the criminal will have total control in deciding who among us dies, or whether the armed citizen can at least protect the innocent and the children. My "black bag" has never been without a 9mm automatic pistol. Dominus vobiscum.