Physicians Continue #ThisIsOurLane Pushback Against NRA

Alicia Ault

November 20, 2018

As the #ThisIsOurLane campaign on Twitter continues to gain momentum, the editors of the Annals of Internal Medicine and the American College of Physicians (ACP) have issued a formal response to the National Rifle Association (NRA): Physicians are clearly and solidly in their lane in their efforts to reduce gun violence.

The ACP's response came in the form of an editorial published online in the Annals on November 19. "Those who seek to silence progress toward finding solutions to the crisis of firearm-related injury are traveling a lane that leads, literally, to a dead end," write Darren Taichman, MD, PhD, executive editor, Christine Laine, MD, MPH, editor-in-chief, and Sue S. Bornstein, MD, chair of the ACP's health and public policy committee and coauthor of the October 30 position paper on gun violence that rankled the NRA. "We're going to stay in our lane and keep moving forward."

The American College of Surgeons (ACS) has published a report on reducing gun violence from a task force made up of 22 surgeons — 18 of whom are firearm owners — along with four surgeon leaders from the ACS Committee on Trauma and the ACS Board of Regents. The group makes recommendations on how healthcare professionals and gun owners can work together to address the ongoing public health crisis of gun-related violence in America.

"We think it's very useful to find common ground," David Hemenway, PhD, professor of health policy and director of the Harvard Injury Control Research Center at the Harvard T. H. Chan School of Public Health, told Medscape Medical News. Hemenway, who was not part of the task force, applauded the report, noting that it cites the work of his colleague Catherine Barber, MPA, who has engaged firearm owners to help with suicide prevention.

"It's nice to see physicians' organizations standing up and playing a strong role in trying to reduce this uniquely American problem," said Hemenway, who has extensively studied injury prevention, including the prevention of injuries involving firearms.

Georges C. Benjamin, MD, executive director of the American Public Health Association, said he's also pleased with all of the activity from physicians' groups. "The medical community is finally in many ways stepping up to the plate, broadly to address this," Benjamin told Medscape Medical News. "Clearly, we've had enough."

He applauded the ACS's recommendations, saying they are aligned with a public health approach to preventing and treating gun violence. For it's part, the ACP has been on the forefront of addressing gun violence, Benjamin said, adding that its most recent article, along with the editorial, are "saying, 'look, doctors, this is ours; we have a role here and it's an appropriate role.'"

We Are in Our Lane

After the NRA's November 7 tweet telling "self-important doctors" to "stay in their lane," physicians unleashed a tweetstorm in response. Popular media has picked up on the tweet campaign, and newspapers and magazines have published editorials from physicians explaining why gun violence is a public health issue and why physicians are eminently equipped to respond to the crisis.

The ACP's editorial picks up on that theme. It lists a host of facts: for instance, that people who accidentally incur gun-related injuries nearly always require acute medical care and that 40% of those who die by suicide have seen a primary care physician within the preceding month. "Thus, talking with patients at risk for suicide about their access to firearms is clearly 'in our lane,' " the authors write. Clinicians regularly screen for alcohol use disorder and intimate partner violence — both of which increase risk for firearm-related violence.

"What about applying pressure to bleeding bullet wounds? Emergency surgery to repair shattered bodies? Weeks of intensive care to support organ failure in gunshot victims? Telling distraught family members that their loved one is dead? The management of chronic pain, functional limitations, and psychological trauma for patients who survive firearm injury but never regain their preinjury health?" These, too, are in a clinician's lane, they write.

At press time, the NRA had not responded to Medscape's request for comment on the ACP editorial.

Surgeons Looking for Bipartisanship

The ACS believes that physicians should be part of the solution — and that gun owners should be as well, said Eileen M. Bulger, MD, FACS, chair of the ACS Committee on Trauma.

The trauma committee's Firearm Strategy Team (FAST) Workgroup's recommendations focus on the use of public health prevention techniques and spell out that gun owners have individual responsibility for the purchase, transfer, storage, and use of their firearms. "Everything we do that gives us freedom comes with responsibility," Bulger told Medscape Medical News. To be able to drive a car, for instance, requires training, licensure and insurance. "If you don't drive a car responsibly, you face liability," she said.

Gun owners should have both responsibility and liability, according to the group's recommendations. But the government also must take some new steps — and that won't happen without bipartisan agreement, Bulger said.

The FAST group spent about 9 months compiling recommendations that would take politics out of the equation, Bulger said. "We have to make it a bipartisan issue," she said, adding that polarization regarding gun ownership has deflected attention from the real problem — gun violence.

The NRA has attempted to portray anyone concerned about gun violence as being anti guns. But that doesn't wash with the surgeons on the work group, 18 of whom are avid gun owners. As some physicians have noted on Twitter in the #ThisIsOurLane campaign, they are not anti-gun, but anti–bullet holes in their patients.

The FAST workgroup made the following recommendations, which were agreed upon by all 22 of the participants:

  • Robust background checks are needed for all gun purchasers —including persons who engage in private transfers and sales — as a way to prevent those who are a danger to themselves and others from accessing guns. The ACS suggested including prohibitions on purchases by those who have a record of intimate partner domestic violence offenses and misdemeanor offenses involving stalking.

  • Registration should be require for all firearms, and an electronic database for all registered firearms should be established.

  • Tighter restrictions should be placed on "high capacity, magazine-fed, semi-automatic, high velocity firearms."

  • Formal gun safety training should be required for all new gun owners.

  • Owners who do not provide reasonable, safe storage of firearms should be held responsible for adverse events related to the discharge of those weapons. This should extend to owners whose firearms have been stolen.

  • Efforts to keep weapons out of the hands of people who are a threat to themselves or others should be expanded. The mandatory reporting by law enforcement and medical personnel should be a standard practice.

  • Encouragement should be given to the development of technology to make guns safer, including technology to prevent unintentional discharge and unintended use by someone other than the registered owner.

  • The news coverage of mass shootings should be more muted; in particular, the notoriety of the shooter should be eliminated.

  • Teachers, counselors, peers, and parents should be encouraged to recognize mental health warning signs and social isolation. When signs are identified, immediate referral to mental health professionals should follow.

The workgroup also urged a lifting of restrictions on federal funding on research into firearm injury and firearm injury prevention, including the root causes of violence.

Private Groups Step Up to Fund Research

The ACP editorialists agree that better research is needed to help understand what drives gun violence, what are some of the possible solutions, and how to implement those solutions.

"To date, the ability to study important questions that might help reduce firearm-related injury has been hampered by a lack of funding and a worry among researchers that studying anything related to guns could put their research careers at risk," the authors write.

The editorial announced that Annals and the ACP are collaborating with the American Foundation for Firearm Injury Reduction in Medicine (AFFIRM) to provide funding for research.

Other private organizations and states have been stepping up to fill the federal gap. The National Collaborative on Gun Violence Research — founded by the Laura and John Arnold Foundation and administered by the RAND Corporation under direction of the collaborative's research advisory committee — is aiming to award $20 million to $50 million over the next 5 years to "support development of fair and effective policies that recognize individuals' rights to own guns." The group recently said it will seek its first awardees in January, awarding up to $10 million in this go-round.

In April, Kaiser Permanente committed $2 million to the study of gun violence, and the states of New Jersey and California have begun funding some research, Hemenway said.

"We are beginning to see more and more funders step up to the plate," Benjamin added. But, he said, the barriers to conducting federal research and federal enforcement need to be removed so that agencies such as the Consumer Product Safety Commission can regulate guns as consumer products, and the Bureau of Alcohol, Tobacco and Firearms can "properly regulate the gun dealers," he said.

The authors, Dr Hemenway, Dr Benjamin, and Dr Bulger have disclosed no relevant financial relationships.

Ann Intern Med. Published online November 19, 2018. Full text

J Am Coll Surg. Published online November 14, 2018. Full text

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