Physician Groups Forge Action Plan Against Gun Violence

Marcia Frellick

August 08, 2019

Seven leading healthcare organizations on Wednesday published a call to action to reduce firearm injuries and deaths in the United States in the Annals of Internal Medicine.

The American College of Physicians (ACP), the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Surgeons, the American Medical Association, the American Psychiatric Association, and the American Public Health Association call for the following in a new policy paper:

  • Mandatory comprehensive criminal background checks for all firearm purchases, including sales by dealers, at gun shows, private sales, and transfers with limited exceptions

  • Research into the causes and consequences of firearm violence to help identify, test, and put in place strategies to reduce injuries and deaths

  • Closing the "boyfriend loophole." Currently, federal law prohibits domestic abusers from accessing firearms only if they are spouses and not dating partners.

"Offenders who have been found guilty of a crime of violence against a family member or intimate partner, including dating partners, cohabitants, stalkers, and those who victimize a family member other than a partner or child should be reported to the National Instant Criminal Background Check System and be prohibited from purchasing or possessing firearms," the authors write.

The groups also call for:

  • Instituting extreme risk protection order (ERPO) or "red flag" laws, which allow families and law enforcement to petition a judge to temporarily remove firearms from people at imminent risk of using them on themselves or others. Such laws should be enacted with due process in mind, the authors caution.

  • Allowing physicians to counsel at-risk patients about firearms safety in the home. The physicians oppose laws that forbid physicians from discussing a patient's firearm ownership. Physicians must also be able to document the conversations in the electronic health record just as they can and often are required to do with other discussions that can affect health, the authors add.

  • Scrutinizing and addressing the regulation of firearms with features designed to increase the speed and capacity of mass violence.

  • Supporting child access prevention laws that hold accountable firearm owners who negligently store firearms in a way that could allow minors access. "These laws are associated with a reduction of suicides and unintentional firearm injuries and fatalities among children," the authors write.

Safe storage also applies to homes with people with dementia, people with substance use disorders, "and the small subset of people with serious mental illnesses that are associated with greater risk of harming themselves and/or others," the authors write.

Regarding mental illness, the physicians emphasize that they support improved access to mental healthcare and they caution against including all individuals with a mental health or substance use disorder broadly in categories of people who should not be allowed to buy firearms.

They write, "The great majority of those with a mental illness or substance use disorder are not violent; however, screening, access and treatment for mental health disorders play a critical role in reducing self-harm and interpersonal violence."

The publication of the article comes after a weekend in which at least 31 people were killed in mass shootings in El Paso, Texas, and Dayton, Ohio, and dozens of others were injured. Chicago at the same time experienced its most violent weekend this year as at least seven people were killed and 48 wounded by gunfire.

"We are living in a world where gun violence is becoming increasingly common, and as physicians, we have a responsibility to address this public health crisis and to keep our patients safe and healthy," said Robert McLean, MD, FACP, president of the ACP.

"Follow the Money"

David Hemenway, PhD, professor of health policy at Harvard T.H. Chan School of Public Health in Boston, Massachusetts, director of the Harvard Injury Control Research Center, and author of "Private Guns, Public Health," has focused much of his career on researching firearms and gun violence and said that overall these measures are "very, very positive."

However, the biggest issue is to "follow the money," he told Medscape Medical News. "I'm an economist. So many of these organizations are giving money to support and promote and get elected politicians who fight against every one of these proposals."

He said he would also like to see policies go further than the proposals in the paper, for instance licensing of handguns.

Of the proposals the groups list in the article, Hemenway said expansive background checks would probably have the most impact, but he added that no one measure can change the trajectory.

"I would be pushing for licensing of handgun owners and registration of handguns, which happens in most developed countries. In Massachusetts we have licensing of handgun owners. We're one of the few states," he said.

He said taxes on firearms would be appropriate because "bringing a firearm into the community can have devastating effects on the community."

Attaching liability to gun ownership likewise would be appropriate, Hemenway said. "If you leave it around and it gets stolen and it's used in a crime someplace, you have some responsibility for that because you brought the gun into the community."

Approach Must Be Multifaceted

The physicians in their statement state that the multifaceted approach outlined in this paper is similar to approaches medicine has taken to stem tobacco use, motor vehicle accidents, and unintentional poisoning.

They acknowledge that what they are proposing will be met with controversy and argument within and outside the profession.

The National Rifle Association (NRA) said in a statement in response to the weekend violence, "Our deepest sympathies are with the families and victims of these tragedies, as well as the entire communities of El Paso and Dayton." They added "the NRA is committed to the safe and lawful use of firearms by those exercising their Second Amendment freedoms."

The authors of the paper write, "While we recognize the significant political and philosophical differences about firearm ownership and regulation in the United States, we are committed to reaching out to bridge these differences to improve the health and safety of our patients, their families, and communities, while respecting the U.S. Constitution."

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