Physician groups issue ‘call to action’ to reduce gun-related injuries and deaths

Calling gun-related injuries in the United States a “public health crisis,” seven medical specialty societies, the American Public Health Organization (APHA) and the American Bar Association (ABA) released a statement on Monday that calls for new policies to reduce such injuries — policies that won’t, the organizations insist, violate the Second Amendment.

The statement  — described by its authors as an urgent “call to action” — also stresses that the nine organizations intend to play an active role in getting such policies implemented.

“Our organizations support a public health approach to firearm-related violence and prevention of firearm injuries and deaths,” write the authors of the statement. “Similar approaches have produced major achievements in the reduction of tobacco use, motor vehicle deaths (seat belts), and unintentional poisoning and can serve as models going forward.”

The statement was published in the Annals of Internal Medicine. It was signed, in addition to the APHA and the ABA, by leaders from the American College of Physicians, the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Emergency Physicians, the American Congress of Obstetricians and Gynecologists, the American College of Surgeons and the American Psychiatric Association.

Sobering statistics

As background information in the statement notes, more than 32,000 people die each year in the United States from gun-related homicides, suicides and accidents — the highest rate of such deaths among all industrialized countries. In fact, guns are the second-leading cause of injury-related death (after motor vehicle crashes) for American adults and teens.

The U.S. also ranks first among 178 countries in terms of the number of guns in private ownership — about 300 million.

“Although some persons suggest that firearms provide protection, substantial evidence indicates that firearms increase the likelihood of homicide or, even more commonly, suicide,” the statement points out.

“This violence comes at a substantial price to our nation, with a total societal cost of $174 billion in 2010,” it adds.

Those costs “do not include the rippling physical and emotional burdens gun-related incidents leave on those who are non-fatally wounded and the communities who lose or support injured colleagues, friends and family,” writes Dr. Darren Taichman, executive deputy editor of the Annals of Internal Medicine, and editor-in-chief Dr. Christine Laine, in an editorial that accompanies the statement. “It does not matter whether we believe that guns kill people, or that people kill people with guns — the result is the same: a public health crisis.”

Recommendations

The statement offers several recommendations for reducing gun-related deaths and injuries:

• Support the requiring of criminal background checks for all firearm purchases, including sales by gun dealers, sales at gun shows, and private sales between individuals.

• Oppose state and federal mandates that interfere with physician free speech and the patient-physician relationship, including laws that forbid physicians to discuss a patient’s gun ownership.

• Support improved access to mental health care and caution against broadly including all persons with any mental or substance use disorder in a category of persons prohibited from purchasing firearms. … [A]lso support adequate resources to facilitate coordination among physicians and state, local, and community-based behavioral health systems so they can provide care to patients, raise awareness, and reduce social stigma.

• [Oppose] blanket reporting laws that compel physicians and other health professionals to report patients who are displaying signs that they might cause serious harm to themselves or others. [Such laws] can stigmatize persons with mental or substance use disorders, create a disincentive for them to seek treatment, and undermine the patient-physician relationship.

• [Support] restrictions for civilian use on the manufacture and sale of large-capacity magazines and firearms with features designed to increase their rapid and extended killing capacity.

• Advocate for robust research about the causes and consequences of firearm violence and unintentional injuries, and for strategies to reduce firearm-related injuries.

‘A disturbing silence’

Two years ago, as Taichman and Laine explain in their editorial, a similar appeal was made to U.S. physicians to join forces to focus on the country’s gun-related public health crisis.

“The profession’s relative silence was disturbing, but in part explicable by an inability to study the problem,” they recall. “Political forces had effectively banned the Centers for Disease Control [CDC] and other scientific agencies from funding research on gun-related injury and death. And the banned worked: a recent systematic review of studies evaluating access to guns and its association with suicide and homicide identified no relevant studies published since 2005.”

In January 2013, a month after the horrific mass murder of 20 children and six adults at the Sandy Hook Elementary School in Newton, Conn., President Obama issued an executive order that not only lifted the research ban, but specifically directed the CDC to conduct research on the causes and prevention of gun violence.

“Obviously, this directive alone will not end the suppression of science,” says Taichman, “for while research may now be ‘allowed,’ the CDC has been unable to direct new resources to this task as the President’s CDC budget requests to support a focus on gun-related violence were not funded. Compounding lack of research funding is the fear among some researchers that studying guns will make them politically unpopular and threaten their future funding even for unrelated topics.”

Still, add Taichman and Laine, “the profession is beginning to speak more loudly. At the CDC’s request, the Institute of Medicine developed a focused research agenda designed to have an impact on firearm-related violence in three to five years.”

One contribution to that new research agenda was published Tuesday in the Annals of Internal Medicine. Researchers report that people hospitalized in Washington State for gun-related injuries were significantly more likely to become repeat victims of gun violence — or to become perpetrators of gun violence — than the general population.

“Among hospitalized patients, prior criminality has a stronger association with subsequent violent crime perpetration than a prior diagnosis of mental illness,” the researchers conclude.

You’ll find links to the statement, editorial and study on the Annals of Internal Medicine website.