Bar Association Joins Medical Groups to Curb Gun Violence

Neil Osterweil

May 02, 2015

BOSTON — The issue of gun-related injury and death evokes fervent, near-violent passions from all points along the political spectrum. But in the medical community, consensus is growing that there is an urgent need for policies to reduce rates of gun violence in the United States.

"Imagine what would happen in the healthcare system if all those who came in to be evaluated for suicide attempts were sent home with just a patching up — reversing their overdose or whatever — and no mental health evaluation or treatment. Everyone would think that was malpractice," said JudyAnn Bigby, MD, former secretary of health and human services for Massachusetts.

"Yet we still send mostly men home after an assault with a firearm without any evaluation," she explained during a news conference here at the American College of Physicians (ACP) Internal Medicine 2015.

"Gun violence is a public health threat," Suffolk County District Attorney Daniel Conley, who is chief law enforcement officer in Boston, told reporters.

Currently, 28 medical groups and lobbying organizations have joined the ACP in a call for national policies that reduce firearm injuries and deaths but adhere to the Second Amendment to the Constitution of the United States, which enshrines the right of the people to keep and bear arms.

Seven other professional medical and health organizations have also joined, along with the American Bar Association.

We still send mostly men home after an assault with a firearm without any evaluation.

The call to action, published in the April 7 issue of the Annals of Internal Medicine (2015;162:513-516), supports universal background checks for all firearm purchases, the repeal of gag laws that prevent physicians from asking patients about the presence of guns in their lives, the enhanced early identification and treatment of mental health disorders that can lead to acts of gun-related violence, the regulation of military-style assault weapons and high-capacity bullet magazines, and research into the causes and consequences of firearm violence and unintentional injuries.

Changes Within the Second Amendment

In a legal justification of the suggestions in the call to action, Steven Weinberger, MD, executive vice-president and chief executive officer of the ACP, pointed out that "the American Bar Association stated that all of our recommendations are within the bounds of the Second Amendment, and that none of them go against any Supreme Court decisions."

When he was asked whether the National Rifle Association had been invited to join the call to action, Dr Weinberger acknowledged that the organization had not been contacted.

"Unfortunately," he said, "it's very difficult to engage the National Rifle Association with, I would say, a professional discussion, or a discussion that remains anything other than absolute, total rejection of anything that they view as changing their position about guns."

"It's not just the National Rifle Association," he added. "A lot of the funding from the National Rifle Association is from gun manufacturers, and their lobby has been absolutely unrelenting, their lobby has been absolutely uncompromising. We would be willing to have that discussion, but I honestly doubt that discussion will occur because of their unwillingness to participate."

"The preventable harm caused by gun violence, and particularly handgun violence, is a public safety issue, a public health issue, and, from my perspective, a civil rights issue," Conley explained.

"In Boston and in most major cities, more homicides are committed with firearms than with all other weapons combined. Tragically, no weapon makes a murder easier to commit and harder to solve than a handgun," he said.

The results of that violence have been seen first hand by Ali Raja, MD, a trauma surgeon at Massachusetts General Hospital in Boston.

He told Medscape Medical News about an emergency thoracotomy he performed on a young man who had sustained a gunshot wound from a bullet that pierced the pericardium and was lodged in the heart. The patient died in the emergency department. When Dr Raja then examined the body, he was able to see scars characteristic of an earlier gunshot wound and previous thoracotomy.

"Had something been done when he was first treated for a gunshot, he might not have died," he said.

"The concept of prevention is something we do every day. For example, we tells kids to wear helmets because we know they'll fall off bikes. So when we see a patient who is in a violent situation or who is predisposed to becoming a victim of gun violence, we have to do something about that; it's incumbent on us to do something. I don't have a clear idea what that is, but this call to action is a good start," Dr Raja explained.

The gag laws decried in the call to action put clinicians at risk just for doing their jobs, said Steven Albert, PhD, from Pitt Public Health at the University of Pittsburgh.

"The gun lobbies don't want physicians to routinely ask about gun ownership, except if the physician in good faith believes that this information is relevant to the patients' medical care or safety, or the safety of others," Dr Albert told Medscape Medical News. "In other words, they don't want it to be a routine inquiry. Physicians should have a high index of suspicion that there's some danger to somebody, But 'in good faith' is way too vague. Any physician could be reported to a state medical board. That puts quite a chill on physician counseling for gun safety," he pointed out.

Clinicians and public health experts have both the right and the duty to advocate for gun safety, just as they advocate for safer cars, the prevention of domestic abuse, and playground safety for children, said David Hemenway, PhD, from the Harvard T.H. Chan School of Public Health in Boston.

"Pediatricians talk about all of these issues with their patients all the time, but this is the one issue they're getting huge pushback on," he reported.

The United States lags far behind other developed countries in controlling gun-related injuries in deaths in children and adults, Dr Hemenway added.

"I teach public health to international students," he said. "They all say, 'What are you doing? How can you let this happen?'."

American College of Physicians (ACP) Internal Medicine 2015. Presented May 1, 2015.


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