The President’s Podium: Physicians and Gun Violence

by James S. Gessner, M.D., President, Massachusetts Medical Society

Yet another mass shooting has stunned the nation, this time in Orlando, Gessner CropFlorida leaving 49 people dead and another 50 injured.  The home of Walt Disney World and the destination of thousands of tourists each year is now the site of the largest mass shooting in the history of America, joining such names as Columbine, Virginia Tech, and Sandy Hook, along with more than a hundred other places.

Such events are becoming all too common.  According to Everytown for Gun Safety, 133 mass shootings in 39 states occurred in the U.S. between January 2009 and July 2015 – almost two per month.  Yet as horrible and shocking as they are, mass shootings – defined by the FBI as any incident in which at least four people were murdered with a gun – account for a small share of firearm homicides.

The Centers for Disease Control estimates that more than 33,000 deaths from firearms – about 91 a day on average – occur each year.

The statistics make it abundantly clear: gun violence is a public health issue. And the physician’s voice – ever so critical on matters of public health – must become stronger.

The MMS stance on this issue has been firm and long-standing. Our medical society’s policy on firearms and gun violence is expansive and dates back to 1995. It is guided by “the principles of reducing the number of deaths, disabilities, and injuries attributable to guns; making gun ownership safer; promoting education relative to guns, ammunition, and violence prevention for physicians and other health professionals as well as for the public; and encouraging research to understand the risk factors related to gun violence and deaths.”

Our actions have matched our policy.  Our Committee on Violence Intervention and Prevention, also established in 1995, has provided a number of resources to help reduce violence in many forms, and gun violence has been prominent among the topics.

From testimony on proposed legislation on Beacon Hill, to education for patients, to resources for physicians on talking with patients, to our most recent Public Health Leadership Forum on Firearm Violence in April, to then-MMS President Dr. Richard Aghababian’s call to action following the school shootings in Newtown in 2012,  gun safety and gun violence have been key issues for our Society.

It is heartening to see more physician groups lend their strong support to the effort.  The American Medical Association, with longstanding policies on reducing violence from firearms, stated its position at this year’s annual meeting, adopting a policy calling gun violence in the U.S. “a public health crisis” that requires a comprehensive public health response and solution.  Perhaps most important, the AMA also resolved to lobby Congress to overturn legislation that for 20 years has banned the Centers for Disease Control and Prevention from conducting research on gun violence.

A second resolution by the AMA on firearm availability encourages legislation that would enforce a waiting period and background check for all firearm purchases and urges additional legislation to ban the manufacture, sale, or import of lethal and non-lethal guns of non-metallic materials that can not be identified by weapons detection devices.

In April of 2015, seven physician organizations, along with the American Public Health Association and American Bar Association, issued a call to action, declaring that “deaths and injuries related to firearms constitute a major public health problem in the United States.”

I am proud to say that more efforts at our medical society are underway. Our Leadership Forum will provide materials for six continuing medical education courses on gun violence to launch at the end of June.  Among the topics will be the role of the clinician, community-based prevention, and evaluating the risk for gun violence in patients.  Additionally, we are participating with Massachusetts Attorney General Healey in developing materials to enhance the provider-patient relationship regarding firearms.

The shock of Orlando may fade over time, but physician efforts to reduce gun violence should not.  Attorney General Healey, speaking at our Leadership Forum, highlighted the importance of physician participation in curbing gun violence, saying it will require a “partnership” with physicians.  Indeed it will.

The President’s Podium appears periodically on the MMS blog, offering Dr. Gessner’s commentary on a range of issues in health and medicine.

 

 

  1. I applaud the AMA, MMS and Dr. Gessner for raising their voices against the scourge of gun-related violence in this country. In addition to supporting a waiting period and background check for all firearm purchases–including sales at “gun shows”–it is important to focus on the most reliable predictor of violence: a previous history of violence. This includes domestic violence.

    According to Everytown for Gun Safety,

    “More than half of women murdered with guns in the U.S. in 2011 — at least 53 percent — were killed by intimate partners or family members…Over the past 25 years, more intimate partner homicides in the U.S. have been committed with guns than with all other weapons combined. And people with a history of committing domestic violence are five times more likely to subsequently murder an intimate partner when a firearm is in the house.” [1]

    And, while, in theory, federal laws prohibit gun sales to persons convicted of domestic abuse,

    “…in 35 states, state law does not prohibit all people convicted of misdemeanor domestic violence crimes and all people subject to restraining orders from buying or using guns. So while domestic abusers in those states cannot possess guns under federal law, local law enforcement and prosecutors do not have the tools they need to enforce those restrictions.”

    The AMA and the MMS are well-positioned to advocate for tighter regulation of gun sales to anyone convicted of misdemeanor domestic violence crimes, and to persons under an active restraining order related to domestic violence.

    Finally, I strongly urge all MMS members to read the superb op-ed by Gen. Stanley McChrystal, in the 6/17/16 NY Times [2], in which he states:

    “Here at home, many of us are alarmed by the carnage. We are alarmed by loopholes that let felons and domestic abusers get hold of guns without a background check. We are alarmed that a known or suspected terrorist can go to a federally licensed firearms dealer where background checks are conducted, pass that background check, legally purchase a firearm and walk out the door…Some opponents of closing these gaps in our laws will continue to argue that dangerous people will obtain guns in our country no matter what, and therefore that taking steps to make it harder for them is fruitless. That is both poor logic and poor leadership.
    Just as something as complex as a combat operation in a war zone meant that we could not eliminate every enemy combatant or prevent every American casualty, we cannot prevent every dangerous person from getting a gun, and we cannot prevent every gun tragedy. But wouldn’t preventing many of them be worth it? I believe it would.”

    As physicians, we can respect the “right to bear arms” under the 2nd Amendment, while advocating sensible and moderate regulation of firearms–as now occurs in most civilized nations with much lower rates of gun-related suicides and homicides than in our country.

    Respectfully,
    Ronald W. Pies MD
    Clinical Professor of Psychiatry
    Tufts USM

    1. https://everytownresearch.org/reports/guns-and-violence-against-women/
    2. http://www.nytimes.com/2016/06/17/opinion/home-should-not-be-a-war-zone.html?action=click&pgtype=Homepage&clickSource=story-heading&module=opinion-c-col-left-region&region=opinion-c-col-left-region&WT.nav=opinion-c-col-left-region&_r=1

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