Doctor organization declares gun violence ‘public health threat’

Dr. Vivek Murthy, President Obama’s surgeon general nominee, has asserted  “guns are a health care issue,” based on treating gunshot victims. 

He’s not alone, which became even clearer on Thursday when the American College of Physicians (ACP), the country’s second-largest physician group, issued a new policy recommendations to reducing gun-related injuries and death.

“Firearm violence is not only a criminal justice issue but also a public health threat,” the group’s position paper states. “A comprehensive, multifaceted approach is necessary to reduce the burden of firearm-related injuries and deaths on individuals, families, communities, and society in general.”

And that burden is enormous, as the paper details. Each year, gun-related homicides, suicides and accidents kill more than 32,000 Americans. That’s about 88 deaths each day — the equivalent of “a good-sized airplane crash every three days,” as Dr. Molly Cooke, the president of the ACP, told Washington Post reporter Lenny Bernstein.

Another 73,000 people are injured every year from gunshot wounds. Many of those wounds lead to permanent and often devastating disabilities.

Number #1 in the world

The actual number of injuries is probably much higher, the ACP paper acknowledges. Research suggests that current reporting practices cause many gun-related injuries to be misclassified, particularly when children are the victims.

Furthermore, U.S. gun-related death rates still remain the highest in the industrialized world.

Though the rate of gun-related murders may have decreased by almost half since its 1993 peak, the number of gun-related deaths is down a smaller 20 percent (39,595 in 1993 versus 31,672 in 2010).

Some studies have reported that guns can serve a protective function, but the ACP notes that evidence suggests that guns are much more likely to end up killing or maiming someone for a reason that has nothing to do with self-defense.

One study involving data from three U.S. cities found, for example, that “for every time a gun was used in self-defense or for a legally justifiable reason, there were 4 accidental shootings, 7 criminal assaults or homicides, and 11 attempted or completed suicides.”

Witnesses to the devastation

Why should physicians care about firearm injury prevention?

“Whether it is a 75-year-old widower who commits suicide; a 17-year-old who accidentally shoots himself; a 20-year-old bystander killed on a city street; or a horrific mass shooting, such as the one that occurred in Newtown, Connecticut, physicians witness first-hand the devastating consequences of firearm violence for victims and their families,” the ACP explains in its position paper.

The group also notes that its own ethics manual states that “physicians should help the community and policy-makers recognize and address the social and environmental causes of disease, including human rights concerns, discrimination poverty, and violence.”

And, indeed, physicians may be uniquely positioned to make a difference in gun-related deaths and injury. Research has shown that even brief safety-related gun counseling from physicians can have a positive effect on how patients store their guns.  One study found, for example, that 64 percent of patients made safe changes in the storage of their guns after receiving gun-safety advice from their physicians compared to 33 percent who receive no such advice.

And 12 percent of the study’s participants who received gun-safety advice from their physicians reported removing the guns from their homes altogether.

Nine recommendations

Here are brief summaries of the nine recommendations in the ACP’s new policy paper:

• Gun safety needs to be approached as a public health issue, and policy decisions related to guns need to be based on scientific evidence.
• Doctors have a special responsibility to speak to patients and the general public about the prevention of gun-related injuries and deaths, and they should be protected from laws that interfere with their ability to talk with patients on this health issue.
• The purchase of legal firearms should be appropriately regulated, including the implementation of universal background checks.
• Guns should be subject to consumer-product regulations, including the required use of tracer elements or taggants on ammunition and weapons.
• Firearm owners should be encouraged to “adhere to best practices” in regard to gun safety. The ACP supports laws that would require gun owners to report the theft or loss of a gun within 72 hours of becoming aware of the loss so that law enforcement officials can attempt to track down the gun.
• Greater efforts should be undertaken to ensure that individuals with a mental illness who are at risk of hurting themselves or others receive care and treatment. The ACP cautions, however, “against broadly including those with mental illness in a category of dangerous individuals.”
• Effective legislation to ban the sale and manufacture of assault weapons needs to be enacted.
• Efforts should be undertaken to improve and modify firearms to make them as safe as possible, including the use of trigger locks and other built-in safety devices.
• Government agencies like the Centers for Disease Control and Prevention and the National Institutes of Health should provide more funding for more research on gun violence and on effective strategies for reducing injuries caused by guns. Furthermore, access to gun-related data should not be restricted

The policy paper was published Thursday in the ACP’s Annals of Internal Medicine, where it can be downloaded and read in full.