Physicians must face public health crisis of gun violence, MDs say

When physicians face a public health crisis, they fight it head on. So why would “the public health crisis of firearm-related injury and death” be any different from that of, say, a deadly infectious disease epidemic, asked a recent Annals of Internal Medicineeditorial.

“[H]ealth care professionals would sound the alarm. We would demand funding. We would go to conferences to learn what is known and what we should do. We would form committees at our institutions to plan local responses to protect our communities,” wrote the editors, who included Darren B. Taichman, MD, PhD, executive deputy editor of Annals of Internal Medicine, Howard Bauchner, MD, editor-in-chief of JAMA, Jeffrey M. Drazen, MD, editor-in-chief of New England Journal of Medicine, Christine Laine, MD, MPH, editor-in-chief of Annals of Internal Medicine, and Larry Peiperl, MD, chief editor of PLOS Medicine.

The editors wrote in response to the deadliest mass shooting in United States history, in which a lone gunman killed 59 people and wounded more than 500 in Las Vegas, NV.

“More silence is not the answer,” they wrote, calling for physicians to respond as they would to any other public health crisis.

“Have we demanded funding to adequately study the problem and test solutions?” they asked. “Have we mobilized forces at our institutions to plan strategies to lower the risks in our communities? Have we talked to our patients about gun safety and effectively challenged policies that would enforce our silence on this matter? Some of our colleagues have. We should be proud of them, but they need all of our help. And so do our patients.”

Physicians can do more

“The solution lies in not just focusing on Las Vegas and the hundreds of other mass shootings that have occurred in the United States in the last 14 months, but rather to underscore that on average almost 100 people die each day in the United States from gun violence,” wrote Dr. Bauchner in his own editorial in JAMA.

More Americans were killed in 2015 by firearms (36,252) than in motor vehicle crashes (36,161), Dr. Bauchner pointed out.

“Physicians and other health care professionals can do more,” he wrote. Physicians should ask and advise patients (especially high-risk patients) about guns—a discussion that’s protected by the First Amendment. “Physicians can conduct appropriate screening and early intervention for suicide, the most common cause of gun deaths,” he added.

As with any epidemic, more research must be done to stop it. But in the past two decades, Congress has limited such studies from being conducted, Dr. Bauchner asserted. “This attempt to suppress research into gun violence resulted in a 64% decline in the number of firearm studies per million citations in SCOPUS between 1998 and 2012.”

The day after the mass shooting in Las Vegas, the Journal of Urban Health published a study on the criminal use of assault weapons and high-capacity semiautomatic firearms. “Assault weapons and other high-capacity semiautomatics appear to be used in a higher share of firearm mass murders (up to 57% in total), though data on this issue are very limited,” wrote authors from the Center for Evidence-Based Crime Policy at George Mason University, Fairfax, VA.

Since 2004, when a federal ban on high-capacity semiautomatics expired, the share of these weapons among all guns used for crime grew from 33% to 112%—“a trend that has coincided with recent growth in shootings nationwide,” the study authors found.

‘Guns kill people’

“Guns kill people,” wrote Dr. Bauchner in his JAMA editorial. “More background checks; more hotel, school, and venue security; more restrictions on the number and types of guns that individuals can own; and development of ‘smart guns’ may help decrease firearm violence.”

“But the key to reducing firearm deaths in the United States is to understand and reduce exposure to the cause, just like in any epidemic,” he concluded.

“In this case, that is guns.”