Physician PACs Donate More to Opponents of Firearm Safety Laws

Troy Brown, RN

February 22, 2019

Physician organization-affiliated political action committees (PACs) donated more than $7 million to United States Senate and House of Representatives candidates who opposed firearm safety policies during the 2016 election cycle, a study has found. That is twice as much as they donated to candidates who supported firearm safety policies, and in stark contrast to many physician organizations' published views on firearm safety.

"National physician professional organizations are well positioned to lead in advocating for public policies that reduce firearm-related morbidity and mortality, and many have taken public positions in favor of such policies. However, our findings suggest that these organizations' associated PACs contribute more often and give more money to candidates who oppose evidence-based firearm regulation than to those who support it. This donation pattern appears to be inconsistent with and a barrier to effective public health advocacy for firearm safety," the researchers write.

Jeremiah D. Schuur, MD, Department of Emergency Medicine, Rhode Island Hospital; and Department of Emergency Medicine, Brown University, both in Providence, Rhode Island, and colleagues published their findings today in JAMA Network Open.

They conducted a cross-sectional study comparing financial contributions from the 25 physician organization-affiliated PACs that made the largest contributions to US House and US Senate candidates who did and did not support firearm safety policies. Physician organizations were deemed to endorse firearm safety policies if they had endorsed the 2015 Firearm-Related Injury and Death in the United States: A Call to Action From 8 Health Professional Organizations and the American Bar Association, published in April 2015 in Annals of Internal Medicine. Forty additional organizations endorsed the Call to Action.

Recommendations in the Call to Action included universal background checks for those seeking to purchase firearms, removing laws that ban physicians from talking about firearm safety with patients, promotion of research related to firearms, and restricting military-style assault weapons.

In the current study, Schuur and colleagues used three criteria to measure candidates' support for firearm safety legislation: (1) the candidate's voting history on US Senate Amendment (SA) 4750, which proposed expansion of background checks; (2) cosponsorship of US House Resolution (HR) 1217, which proposed expanding background checks and strengthening the national criminal background check system; and (3) the candidate rating ("not A" vs "A") by the National Rifle Association Political Victory Fund (NRA-PVF), which is an overall measure of a candidate's support for firearm regulation. The researchers used cosponsorship of HR 1217 because no legislation on background checks was voted on during the 114th US Congress.

All healthcare professional-related PACs gave a total of $23.7 million to candidates during the 2016 election cycle; the 25 largest organizations gave 57% of that amount ($13.6 million).

US Senate Candidates Rewarded for Failing to Expand Background Checks?

SA 4750, which would have expanded background checks, failed to pass in June 2016 (44 for, 56 against). Overall, the physician organization-affiliated PACs contributed to the campaigns of 29 Senate incumbents running for re-election, giving $500,000 more to those who had voted against SA 4750 than to those who voted in support of it ($1,025,500 vs $525,500). When examined individually, the researchers found that 20 of the 25 PACs (80%) gave more to Senate candidates who had voted against the bill than to those who voted for it.

The American Association of Orthopaedic Surgeons and the American Medical Association each gave more than $100,000 to candidates who voted against the bill ($111,000 and $109,000, respectively), compared with candidates who supported the bill ($27,000 and $58,000, respectively).

US House of Representatives Donations Also Uneven

Fewer than half of US House candidates had cosponsored HR 1217, which would have expanded background checks (189 cosponsored; 246 did not cosponsor). The physician organization-affiliated PACs contributed to the campaigns of 329 candidates — 133 of whom cosponsored the bill and 196 who did not support the bill.

Overall, the PACs gave $2.8 million more to candidates who did not cosponsor HR 1217 than they gave to cosponsors ($6,130,775 vs $3,252,100). Individually, all but one of the 25 PACs gave more to House candidates that declined to cosponsor the bill than to those who did cosponsor it.

The top four donors to candidates who did and did not sponsor HR 1217 were the PACs affiliated with the American Association of Orthopaedic Surgeons ($374,550 vs $699,525), the American Medical Association ($348,500 vs $664,000), the American Society of Anesthesiologists ($315,400 vs $663,700), and the American College of Emergency Physicians ($227,955 vs $625,385).

The PAC affiliated with the American Academy of Family Physicians was the only group to spend more on candidates who supported HR 1217 than on those who did not ($209,200 vs $206,500).

National Rifle Association Ratings

The NRA-PVF gave A ratings to 379 House and Senate candidates, B ratings to 13 candidates, C ratings to eight candidates, D ratings to 35 candidates, and F ratings to 474 candidates.

Overall, the physician organization-affiliated PACs that were studied contributed $5.6 million to "A-rated" candidates and 4.1 million to candidates not given an A rating (difference, $1.5 million). Twenty-one of 25 PACs (84%) gave more in total to A-rated candidates than non–A-rated candidates and eight of 25 (32%) gave more per candidate to A-rated candidates than to those who were not A-rated.

All but one of the 25 PACs (96%) donated to a larger proportion of the A-rated candidates than to those who did not have an A rating.

"[T]hese physician PACs were more than twice as likely to contribute to and gave almost $1.5 million dollars more to candidates rated A by the NRA-PVF, a group that publicly opposes most of the evidence-based firearm policies endorsed by health care professional organizations," the researchers write.

Evidence supports measures such as expanded background checks, permit-to-purchase, and minimum purchasing age of 21 years. "Other policies, including those that seek to curb firearm trafficking, restrict firearms in public places, and ban military-style assault weapons, lack strong evidence of efficacy. However, most of these interventions have not been rigorously studied because of limitations on federally funded research, a restriction supported by the NRA-PVF," the researchers continue.

The study "highlights the disconnect that currently exists between physician organization political action committee (PAC) priorities and the positions of their membership when it comes to firearm injury prevention," Rebecca M. Cunningham, MD, from the University of Michigan School of Public Health and School of Medicine, Ann Arbor, and and colleagues write in an invited commentary.

"As the authors note, this is not a new issue in medicine. For many years, we saw a similar discrepancy between the American Medical Association's public calls to regulate the tobacco industry and their financial support of politicians who actively voted against such regulations," Cunningham and colleagues explain.

Schuur and colleagues urge physician organizations to take a closer look at their PACs' financial contributions to political candidates. "[W]e believe that physician leadership — in the form of public statements and financial support — is important in shaping policy on public health issues. Such advocacy is more likely to be effective when political contributions are aligned with organizations' policy statements," they write.

The authors and editorialists have disclosed no relevant financial relationships.

JAMA Network Open. Published online February 22, 2019. Abstract, Editorial

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