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Hello and welcome. I am Dr George Lundberg, and this is At Large at Medscape.

I have been trying to figure out why American physicians and other healthcare professionals get so riled up about guns. I thought that my recent suggestion that physicians who are at particular risk for suicide had best not have guns readily available was benign and made pretty good sense. There are substantial data to support that approach to suicide prevention.

That statement prompted more than 300 comments, including those considered by editors to be too uncivil and noncontributing to be permitted publication by Medscape. Some responders agreed with my position, but very many not only disagreed but did so in a defensive, aggressive, and even offensive way; not the stuff of usual discourse about public health and preventive medicine.

Editors understand that readers who disagree with an article are more likely to be motivated to comment than those who agree, so the letters or comment sections of publications do suffer from selection bias. Nonetheless, what kind of topic in 2015, other than money or Obamacare, could cause otherwise cool and calm healthcare professionals to turn so hostile?

Some readers likened gun possession to an addiction.

I was not around for the American discussions about alcohol that must have coincided with the enactment and subsequent repeal of the Volstead Act that established prohibition. But I do recall the political debates in Alabama surrounding "local option," meaning prohibition by county, as being pretty vituperative. And, of course, "reefer madness" and similar hyperbole have long been applied to other psychoactive drugs.

Let's examine this. Psychoactive drug addiction, such as with alcohol, nicotine, or opium, is characterized by:

  • Availability of the agent for experimentation;

  • Initial use producing pleasure followed by subsequent pleasant episodes of use and positive secondary reinforcement;

  • Psychological dependence or habituation;

  • Tolerance, with need to use more to get the same effect;

  • Chemical physical dependence;

  • Withdrawal symptoms when the agent is taken away;

  • Drug-seeking behavior;

  • Continued use even when obvious harm has been experienced; and

  • Rationalization and denial.

Gun possession and use, similar to sex and gambling, are not chemicals placed into an organism, so they cannot produce the fifth factor, chemical physical dependence. But give some thought to the other eight characteristics of addiction. Many do seem to apply—remarkably closely—to gun possession and use in the American culture.

  • Availability? Check;

  • Positive reinforcement? Check;

  • Habituation? Check;

  • Tolerance? Big check. Once someone becomes a gun owner, adding guns is usual; one is not enough. The average American gun-owning household includes 8.1 firearms, up from 4.1 in 1994. The NRA goes bonkers about any suggestion of limits;

  • Chemical dependence? No;

  • Withdrawal? I have not personally seen a convulsion in a gun-owning doctor when confronted with the possibility of losing his or her guns, but pretty damn close. I mean....;

  • Weapon-seeking behavior? Check;

  • Continued use despite harmful results? Check; and

  • Rationalization and denial? Check.

The Bard was right again. Methinks they do protest, much too much.

That is my opinion. I am Dr George Lundberg, At Large at Medscape.


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