Physicians, Money and Gun Violence

Sometimes in this column I just have to stick my foot in it. There are aspects of the emotional debate on gun violence that have not gotten much attention and are pertinent to doctors, our work and our pocketbooks. So let's go.

First, a disclaimer: I have been a gun owner all of my life. But I have been dismayed at how a minority — a very loud minority — has been allowed to hijack and reframe the whole subject of gun ownership for too many years.

Now, after the tragedy at Sandy Hook, all surveys show that a majority of Americans finally want to do something reasonable about managing gun violence: both in controlling how we get them and in who gets them. Freedom has its costs, and freedom from the burden, socially and economically, of firearm violence on the streets and in our homes is through thoughtful regulation of guns and more attention to long-neglected mental health policy in the U.S.

A few pertinent facts will help shape our approach. First, every year about 30,000 Americans are killed by guns, according to the U.S. Centers for Disease Control and Prevention (CDC). That's almost as many as are killed on our highways, many more than a number of diseases that we fret so much over and 10 times as many as died on 9/11. And that number is every year. Someone even figured that this useless toll of lives took 92.5 million pounds of earth to bury last year alone.

What passes under the radar of the scope of firearm carnage is the number of people who are wounded by guns and survive. The CDC estimates that two people are wounded by gunshots for every person killed. In 2010, the CDC reported that 73,505 Americans were treated in hospital emergency rooms by our trauma colleagues who labor so hard to save the wounded — many of these injuries are preventable by more sensible policies than we have now.

This endemic plague of gun violence is clearly an unresolved public health issue of major proportions. We in medicine, personally and collectively, have largely rationalized our non-involvement, being pre-occupied with too many competing public health demands or have bought into the peculiar way in recent years that the one-issue, narrow-minded have controlled the subject of the role of guns in our culture and/or we just wanted to stay away from the aroma of the whole mess.

Another point, one that goes directly to our pocketbooks is that firearm-related deaths and injuries result in an estimated $2.3 billion each year, according to a JAMA study. Half of that cost is borne by U.S. taxpayers.

The focus on firearms in our country in recent years has been only on the question of the degree and circumstances of regulating acquisition and ownership. In an effort to get around the emotional logjam created by the National Rifle Association and its fellow travelers, people are now looking at things like fast, accurate background checks, requiring training, licensing and taxation. We regulate automobiles and many other aspects of common life and it is finally making increasingly reasonable sense to most level-headed Americans to do the same with guns.

The other half of the equation is of even more direct professional concern to doctors. That is the appalling lack of attention and coordinated effort for mental health that now prevails in the U.S. We need more attention, more directed policy and certainly more funding for the mental health problems that currently go unaddressed, piecemealed out or dealt with as an afterthought. And not just including the kinds of diagnoses that seem to be associated with violence. Mental health too often has been the caboose of health care concerns and you could make a strong case that it ought to be at the forefront of the train.

And aren't we all dismayed by having to read about even one more "strange loner," or "disgruntled employee" or "extremist?" I know that we have to be careful with freedom of expression, privacy, due process and other concerns, but not doing something to advance a knowledge-based, collective understanding and management of our violence-liable outliers is no longer acceptable.

And we cannot accept the lame, and provably false, counter argument that even if guns were more sensibly managed that people would still find a way to suicide or kill each other. It's just too easy to wreck disproportionate havoc when a powerful gun comes easily to hand.

Nor can we accept the idea any longer that America is doing an acceptable job managing it's mentally ill in its fragmented, disorganized and wholly inadequate way. It is also not okay to simply continue allowing the dangerous fringe to self-medicate its paranoia just by buying more and more guns. Too often, these situations have, and will, end badly.

The subjects of gun ownership and mental health apathy, too often, are interrelated. We must gradually begin to realign our cultural attitudes with reality, our knowledge and our core values, just as we have been doing with civil rights, smoking, gay rights and a host of other hot-button issues.

On a lighter note, maybe we should just follow Chris Rock's suggestion that the simple solution to the firearm debate is to open the market for any kind of gun ownership, but charge $5,000 for a bullet.