Physicians urged to join discussion on gun policies

With the nation grasping for ways to cope with the December massacre at a Connecticut elementary school, physicians are taking note and urging their colleagues to make their voices heard in the debates on gun control-even in the face on new legislation that aims to silence them.

Doctors have a powerful voice in shaping policies around public health issues and should use that voice to influence discussions on domestic gun policies in the wake of the last school shooting, says Christine Laine, MD, MPH, writing in the Annals of Internal Medicine and mirroring comments in an editorial to appear in the January 10 issue of Medical Economics.

“We are long overdue in directing our expertise, commitment, and passion to mitigating gun violence,” says the practicing physician and editor-in-chief of the Annals journal. “Just as physicians worked to safeguard public health by promoting smoking bans in public places, we should draw on like motivations and similar strategies to promote sensible, evidence-based laws to decrease the harms associated with gun violence.”

The U.S. had the highest rate of homicides and suicides involving firearms out of any other high-income country in the world, according to Laine. With the difficulty surrounding the diagnosis and identification of individuals who can carry out violent acts such as school shootings, she urges doctors to make their mark on this issue by working to end gun violence.

Leading medical organizations have long identified gun violence as an important public health issue worthy of physician intervention. The American College of Physicians (ACP) last issued a position paper on firearm injury prevention in 1998. The paper favored strong legislation to ban automatic and semi-automatic assault weapons, supported law enforcement measures to help identify weapons used in crimes, and called for restrictions on the sale and possession of handguns. The ACP recently announced plans to revisit its position paper on gun control, but politics has played a role in preventing additional commentary and research on the topic of gun control from being developed, say Annals editors.

“We have had experts decline opportunities to write about guns even after mass shootings because they fear funding for their research programs unrelated to guns might dry up if they advocated for stricter gun control,” Laine says. “In the wake of the horrific deaths of 20 children, physicians should resolve as we begin 2013 to raise our voices on the matter of guns.”

Some states already are working to stifle doctor voices when it comes to the debate on gun control, however.

More than 128,000 children in Florida alone live in homes with at least one loaded, unlocked firearm, according to a report published recently in the Archives of Pediatric and Adolescent Medicine. Additionally, the report notes, Almost 20% of pediatric deaths and one-fourth of adolescent deaths in 2007 were firearm-related. The American Academy of Pediatrics urges pediatricians to assess for child access to firearms and counsel families about firearm risks and safety. Family physicians and other doctors, of course, could perform similar roles.

Despite the Florida statistics, in early 2011, that state's legislature introduced a bill that would result in disciplinary action for any physician who, in a patient's view, "harasses" a patient by posing questions to him or her about gun ownership.

“If the bill became law, it would restrict physician practice in an unprecedented fashion and put pediatricians in conflict with evidence-based, national recommended prevention standards set to save children’s lives,” the Archives report states.

The bill did become law, and appeals have been filed, but for now, enforcement of the Physician Gag Law is blocked. Its passage signals new threats to practicing doctors, however, and the Archivesreport notes that similar legislation already has been proposed in Alabama, Minnesota, North Carolina, Oklahoma, and Tennessee.

Not all physicians are planning to let such legislation, if enacted, quiet their efforts, however. Two new commentaries in leading medical journals chastise the increase in gun violence and urge a return to research on firearm-related injuries and deaths.

In a commentary published in the Archives of Internal Medicine, Jerome P. Kassirer, MD, writes that perhaps the best way to reverse the trend of increased use of weapons and mass destruction is to restore funding for gun-related injury research.

“Given the large and increasing number of deadly mass shootings and the enormous number of military-style assault weapons available, it stands to reason that we must find ways of reversing the trend, and as physicians, this task should be part of our professional responsibility,” he writes. “We can advocate for restoring the ability of the National Center for Injury Prevention and Control at the Centers for Disease Control and Prevention to study gun-related injuries and fund these efforts generously. Only then can we get answers to some of the unresolved questions about the relationships between private firearms and injuries and deaths.”

Kassirer, a former ACP governor and regent, past chairman of the American Board of Internal Medicine, and former editor of the New England Journal of Medicine, also advocates for greater action at top levels of government to regulate private gun ownership, as well as for adding more safeguards to weapons such as trigger locks that require a code to operate the weapon.

Another commentary, by Frederick P. Rivara, MD, MPH, published in the Journal of the American Medical Association, reiterates the need for the restoration of funding to firearm-related injury research. Rivara, who is chief of the division of general pediatrics, vice chairman for academic affairs in the Department of Pediatrics, director of the general pediatrics fellowship/NRSA Primary Care Research Fellowship, and professor of pediatrics at the University of Washington, Seattle, stresses that reductions were made in injuries from automobiles, swimming pools, and in fires-not through bans on things like cars and matches-but by translating research findings into effective interventions.