Med Students Seek More Gun Violence Prevention Research

Kerry Dooley Young

September 19, 2018

Medical students held meetings across the United States on Monday to call for increased attention to gun violence prevention, including the elimination of a long-standing barrier to federal research in this field.

A team of Stanford University physicians and medical students spearheaded the creation of SAFE (Scrubs Addressing the Firearms Epidemic). The group expected simultaneous rallies at more than 40 locations. Medical students across the nation took part in the rallies, with tweets posted about events at Yale, the University of Miami, New York University, Emory University, and the University of Southern California.

 

Students from medical schools in several states, including Maryland, Massachusetts, New York, and Ohio, posted photos on social media of their participation in SAFE's teach-ins.

The group, which is allied with the Silicon Valley Community Foundation, said it's seeking to foster use of evidence-based policies to make gun ownership safer.

"This is not a statement on the rights of individuals to own guns or how many guns they can own," Sarabeth Spitzer, co-chair of the SAFE Board and a Stanford medical student, told Medscape Medical News in an interview.

Instead, it's a call for help "from physicians to be able to do our job, which is discovering what makes people safer," Spitzer said. "Right now, our hands are tied because there is so little funding in this area for research."

A total of 38,658 firearm-related deaths occurred in the United States in 2016. Of those, almost 23,000 were due to suicide, and nearly 15,000 were due to homicide, the group said, citing the Centers for Disease Control and Prevention (CDC) as its source. In addition, there were more than 116,000 nonfatal firearm injuries.

In recent years, federal lawmakers have sought to increase physicians' resources to address other public health issues, including bills aimed at the current opioid epidemic.

However, politics around gun ownership have limited the scope of work that can be done on gun violence, SAFE says.

The Senate passed a spending bill yesterday for fiscal 2019, but it will continue a restriction on federal medical research that dates to the mid-1990s.

"None of the funds made available in this title may be used, in whole or in part, to advocate or promote gun control," says the text of the bill meant to fund the Department of Health and Human Services (HHS) in fiscal 2019, which starts October 1.

According to SAFE, that clause has created an imbalance that results in too few dollars directed at a major public health threat and thus too little information on how to mitigate the problem. For example, the group's website contrasts the progress made in lowering deaths from motor vehicle accidents in the past decade with the lack of similar progress seen for firearms.

The age-adjusted mortality rate per 100,000 people from motor vehicle accidents dropped from 14.8 in 2001 to 11.6 in 2016, according to SAFE calculations, drawn from CDC research. During the same period, the rate for deaths from firearms rose from 10.3 to 11.7, SAFE said.

Physicians-in-training want to see the same public health tools that have been used to address auto-related deaths and other public health issues applied to gun violence.

Charles Hartley, one of SAFE's coordinators at George Washington University's School of Medicine and Health Sciences, said it's "insane" that there's so little research to help guide physicians-in-training to improve the safety of firearms.

"It's important for us to understand just so that we can deal with it practically," he told Medscape Medical News after a SAFE teach-in event at George Washington University in Washington, DC, on Monday.

While there's been debate about the appropriations restriction's breadth, it's clearly been an impediment to efforts to look more closely at the risks of guns in society.

The provision was first added to the annual spending bill funding HHS in response to concerns from advocates for gun ownership. In 1993, the New England Journal of Medicine published the results of a CDC-funded study that cited gun ownership as a risk factor for homicide in the home.

The National Rifle Association (NRA) criticized the study, and Rep. Jay Dickey (R-AR) introduced the clause into a spending bill to block the CDC from further research in this area. (The NRA did not respond to a request for comment on SAFE's activities.)

Dickey would come to regret his decision. In 2012, he wrote an op-ed in the Washington Post with a former top CDC official, calling for the kind of research into firearm violence that's routinely done for traffic safety.

"We were on opposite sides of the heated battle 16 years ago, but we are in strong agreement now that scientific research should be conducted into preventing firearm injuries and that ways to prevent firearm deaths can be found without encroaching on the rights of legitimate gun owners," wrote Dickey and Mark Rosenberg, MD, who had been director of the CDC's National Center for Injury Prevention and Control from 1994 to 1999.

Yet, critics have continued to cite the Dickey amendment as a reason to block funding for efforts to curb gun violence research. House appropriators did so in 2015 when rebuffing a bid by the Obama administration to secure $10 million for new studies.

In a report, the majority of the House Appropriations Committee reminded the CDC that "the long-standing general provision's intent is to protect rights granted by the Second Amendment."

"The restriction is to prevent activity that would undertake activities (to include data collection) for current or future research, including under the title 'gun violence prevention', that could be used in any manner to result in a future policy, guidelines, or recommendations to limit access to guns, ammunition, or to create a list of gun owners," the appropriations' majority said in the report.

Blurred Political Lines

This is an issue around which expected party lines can blur.

Two Democrats, Reps. Henry Cuellar of Texas and Sanford D. Bishop of Georgia, for example, joined GOP House appropriators in defeating a July 2018 bid by Rep. Nita M. Lowey (D-NY) to provide funding for firearm prevention research. Her proposed amendment to a fiscal 2019 spending bill failed 20-32.

And one of SAFE's founders is a retired Air Force colonel, who says his criticism of the wide availability of certain firearms scuppered his chances for a top health post in the Trump administration. Now a Stanford University professor of medicine, Dean Winslow, MD, recounted in a statement about Monday's SAFE activities, having seen firsthand "the devastating effects that assault weapons have on human bodies" during his deployments as a flight surgeon in Iraq and Afghanistan.

"Easy access to these same types of weapons in the US has resulted in dozens of horrific mass shootings — and handguns cause the deaths of at least 20 veterans each day by suicide," Winslow said.

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