COMMENTARY

Shall a Woman (Women) Lead Them?

Disclosures

January 15, 2019

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

Kudos and thanks to the 2018 editors of the JAMA family of journals,[1] to leaders of the American College of Physicians (ACP)[2] and a committee of the American College of Surgeons (ACS), many of them gun owners,[3] and to the Medscape and MedPage Today[4] editors for keeping the physicians' anti-gun violence flame alive.

In 1991, former Surgeon General C. Everett Koop and I issued a call for papers[5] about violence and especially gunshot wounding, announcing a coordinated theme issue across 11 American Medical Association (AMA) journals and American Medical News. On June 10, 1992, Dr Koop and I published an editorial[6] entitled "Violence in America: A Public Health Emergency," describing the results of that call for papers, detailing the severity of the problem, and issuing a call for action in the initial JAMA theme issue on violence.

We even published a 434-page compendium[7] of 113 articles by more than 240 authors, mostly physicians, from 11 individual AMA publications. The title was simply Violence. For many years, JAMA published annual theme issues dealing with various aspects of violence. The 1993-94 AMA President Robert E. McAfee, from Maine, took violence as his predominant presidential issue, emphasizing the prevention of domestic violence.

What happened then?

The CDC is now calling 2017 the deadliest year for American firearms fatalities in 40 years.

After topping out at 15.4 American gunshot wound deaths per 100,000 population in 1993, there was a gradual but substantial downward trend, to a low of 10.2/100,000 in 2011.[8,9] That's the good news.

The bad news is that the public health efforts at controlling gun violence galvanized conservative resistance. This led to the beefing up of a vastly more powerful arsenal in the hands of the citizenry, more gun purchases, often assault weapons with large magazines, enabling ever more mass- and school shootings.

Political power cut federal funding, and the Center for Disease Control and Prevention's (CDC's) hands were tied and not allowed to conduct research into the prevention of violence. The National Rifle Association (NRA) and its lobbying became ever more powerful.

Perhaps predictably, after bottoming out in 2011, deaths by firearms (homicide, suicide, accidental) began trending significantly upwards, to 11.8 in 2016 and 12.0 in 2017.[9,10] Because of population and death rate increases, the CDC is now calling 2017 the deadliest year for American firearms fatalities in 40 years.[10]

It is clearly past time for a new public health effort to reverse this upward slope. Physicians should lead by joining the active student movement against guns, created by kids whose classmates have been victims of mass murder too many times. A new constituency to join the movement might be country-western music fans, another recent mass-murder target.

If #MeToo can begin to fix one huge defect in our culture, maybe a physicians' movement led by women has a chance.

What with half of Americans owning guns or living in a household with guns, and the population's drive to commit suicide also rising, the task of gunshot fatality prevention seems more daunting than ever. But not to even attempt prevention is unacceptable to believers in the concept of public health. Times change; if #MeToo can begin to fix one huge defect in our culture, maybe a physicians' movement led by women has a chance.

So, go back to the beginning. Read the new (and old) collective articles and ideas from ACP, ACS, pediatricians, other physicians, and JAMA. Support the #MeToo, #ThisIsOurLane, and "It's My %@$#! Highway" initiatives and @DrJudyMelinek. Maybe, just maybe, the political climate is shifting so that the financial strings that have prevented the CDC from supporting serious research into how to prevent firearm injuries and deaths may be loosening a bit. The power and finances of the NRA may even be waning slightly.

Hope springs eternal, but action and results are what matter. It would be great, dear readers, if this discussion board could be filled with useful 2019 ideas. Please don't revert to the level of vitriol that, in recent years, has impelled the Medscape editors to not even permit moderated public discussion about gun violence. Please, let professional civility prevail.

That's my opinion. I'm Dr George Lundberg, and this is At Large at Medscape.

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