Rare Joint Editorial Urges Clinicians to Act on Gun Violence

Nicola M. Parry, DVM

October 10, 2017

The recent mass shooting in Las Vegas was the largest in modern US history, with 59 people dead (58 gunshot victims and 1 shooter suicide) and more than 500 injured. This horrific event has once again highlighted gun violence as a public health crisis in the United States.

In a rare joint editorial, written by a group of editors and published in the Annals of Internal Medicine, JAMA, the New England Journal of Medicine, and PLOS Medicine, Darren B. Taichman, MD, PhD, executive deputy editor of the Annals of Internal Medicine and colleagues, share a list of ways in which healthcare professionals can use their skills and voices to address this public health threat. The editorial was published online October 10 in the Annals of Internal Medicine.

"[H]ere we are again with another editorial about the public health crisis of firearm-related injury and death following what used to be unthinkable," the editorialists write. "As health care professionals, we seem powerless. This public health crisis seems beyond the reach of our tools."

However, they state that healthcare professionals can do much to help address the problem.

Clinicians should not remain silent about the issue of gun violence, the authors say, but should continually work to reduce its burden.

In particular, clinicians should educate themselves about gun safety, and should discuss with their patients the evidence that shows guns at home increase the risk for homicide, suicide, and accidents. They need to ask patients about the presence of guns in the home, how they are stored, and whether children or other household members are at risk of harming themselves or others.

Dr Taichman and colleagues also recommend that clinicians read materials and proposals about sensible firearm legislation from healthcare professional organizations. Clinicians should also contact their local, state, and federal legislators to voice opinions about gun control, and should support candidates for public office with proposals that reduce gun-related injury.

The editorialists also advise clinicians not to allow potential political consequences to serve as a barrier to advocating for the well-being of patients and the public. Clinicians should meet with their institutions' leaders to discuss ways to influence governments, and should also tell the press and the local community about their institutions' opinions and actions.

"The only thing that will change the world for the better is a group of people who believe that they can change the world," Dr Taichman and colleagues conclude. "With regard to firearm-related injury and death, let's each be part of that group."

In a Viewpoint published online October 9 in JAMA, James M. Schultz, PhD, from the University of Miami Miller School of Medicine, Florida, and colleagues also summarize four key discussions needed beyond the focus on fatalities to help address the persistent public health challenges associated with gun violence.

These discussions need to consider the physically injured survivors of gun violence. Nonfatal firearm-related injuries are a substantial public health burden, they say, resulting in higher rates of rehospitalization and chronic disability than those associated with unintentional injuries, such as those in motor vehicle survivors.

The mental health consequences for survivors of mass shootings are also pervasive and long-lasting, and include conditions such as depression, anxiety, and posttraumatic stress disorder. These psychological consequences also extend to the victims' family members, as well as to first responders and hospital-based personnel.

The authors also discuss community responses and mental health interventions that can help make a difference in the aftermath of mass shootings. A "discussion regarding the design and funding for initiatives that reach gun violence–affected communities rapidly, and maintain psychological support and referral services long term, is a national imperative," they stress.

Last, they emphasize that any solution to this public health problem must consider the powerful influences of commercial interests whose incentive is to manufacture and sell more firearms.

Dr Schultz and colleagues conclude that any discussion about how to mitigate the public health challenge of gun violence will be enhanced by including these four issues, which are "as important, if not more so, than many aspects of the firearm epidemic that currently dominate public discussion and debate."

In an accompanying editorial published in JAMA, Howard Bauchner, MD, the journal's editor in chief, and colleagues note that, as with any epidemic, prevention is key.

They echo the need for healthcare professionals to do more to promote discussions with patients about the risks for firearm-related injury and death. And because suicide is the leading cause of gun deaths, they advise clinicians to also screen patients for suicide risk and deliver early clinical intervention as necessary.

"[T]he key to reducing firearm deaths in the United States is to understand and reduce exposure to the cause, just like in any epidemic, and in this case that is guns," Dr Bauchner and colleagues conclude.

Among the Annals of Internal Medicine's editorialists, one reports being a paid employee of the journal and the American College of Physicians (ACP); one reports being the journal's editor-in-chief, senior vice president of the ACP, and a full-time employee of the ACP; one reports being editor-in-chief of the New England Journal of Medicine and a full-time employee of the Massachusetts Medical Society (the owner and publisher of the New England Journal of Medicine); and one reports being chief editor of PLOS Medicine, an employee of the Public Library of Science, and working as a per diem physician at the University of California, San Francisco. The JAMA authors have disclosed no relevant financial relationships. One JAMA editorialist reports receiving research funding from the City of Seattle, Washington, and from the Arnold Foundation for firearm research. The remaining editorialists from both journals have disclosed no relevant financial relationships.

Ann Intern Med. Published online October 10, 2017. Full text

JAMA. Published online October 9, 2017. Article full text, Editorial full text

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