Public Health and Physician Choices: Where Do You Stand on the Gun Control Debate?

Guest Commentary

Does every important contemporary issue in America evince a polarizing stance? It seems so. Whether it is “choice” versus “life” in the abortion arena, “blue” versus “red” in regard to politics, amnesty versus deportation for immigrants, the middle ground has become a “No Man’s Land.” Now, the gun control debate has been added to current consideration. It also seems to have divided people into 2 camps. Leave the situation as is consequent to Second Amendment rights or make changes (for example, banning assault weapons) that start a slippery slope to the loss of gun ownership.

What if the debate regarding gun ownership is reframed and discussed as a public health issue? Until now, it has been debated primarily as an individual constitutional right. A reframe would force primary care clinicians as medical professionals to possibly take different sides in the crisis. Would our opinions differ if we considered the implications of gun control as physicians and not as American citizens?

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Is Gun Safety A Public Health Issue?
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GUN CONTROL AS A PUBLIC HEALTH ISSUE

First, why is the gun debate a public health issue? Guns kill more than 30,000 Americans annually.¹ Guns kill more Americans each year than have been felled over a decade in Iraq and Afghanistan.¹ The US population is 13.7 times larger than Australia’s but has 134 times the number of total firearms deaths!² Physicians have been vocal in defense of life and safety in drunk driving laws and safety belt and anti-smoking campaigns. These public health dilemmas were front and center for medicine. Where should physicians explicitly stand on the gun control debate?

Second, it has been suggested that “fixes,” such as banning semiautomatic weapons, prohibition of Internet gun sales, and stricter registration/background requirements just will not work or are in conflict with the Second Amendment. Well that premise may not be accurate. After a “Sandy Hook”–like tragedy in Australia (on April 28, 1996, 35 people were killed in Port Arthur, Australia by a single assailant with an “assault” weapon), John Howard, Australia’s Prime Minister, with resounding public and political support, reformed gun control laws, with maneuvers similar to recent proposals by Mr Obama.² Australia’s rate of homicide has decreased 7.5% per year since then; suicide by firearm has declined from 3.4 to 1.3/100,000 person years; and there have been no further gun massacres in the country (there were 13 in the years preceding 1996).^2,3 Private gun owners still own guns in Australia. They have not lost their “right” to bear arms as a result of focused reform.

PHYSICIAN-DRIVEN REFORMS

A recent slate of papers in prestigious US journals have proposed reform driven by physicians.^1-7 Recommendations include: closing “background check” loopholes, banning assault weapons and high-capacity magazines, improving mental health services, and increasing research (presently it has been banned) on dynamics driving gun-related tragedies. One can add legal protections for physicians inquiring about patients’ gun ownership and safety. The physician-authors were chagrined that citizens, parents, and politicians have not been moved by Sandy Hook and by other similarly tragic events. My question to you is, “Should physicians, in their role as medical professionals, support gun control reform as a critical public health issue?” The mantra “guns do not kill people, people do” has been trivial and insufficient to the daunting task. Or, in the words of John Howard of Australia, will we continue “down the American path in regard to guns”?² It does not take a crystal ball to predict that a status quo will lead to more Sandy Hooks. ■

REFERENCES:

1.Mozaffarian D, Hemenway D, Ludwig DS. Curbing gun violence: lessons from public health successes. JAMA. 2013;309:551-552.

2.Chapman S, Alpers P. Gun-related deaths: how Australia stepped off “the American Path.” Ann Intern Med. 2013;158:770-771.

3.Mahar PD, Breen DT. Tragedy’s legacy. N Engl J Med. 2013;368:1846.

4.Kettl P. The NRA let me down. JAMA. 2013;309:1239-1240.

5.Ranney M, Sankoff J, Newman DH, et al. A call to action: firearms, public health, and emergency medicine. Ann Emerg Med. 2013;61:700-702.

6.Kellerman AL, Rivara FP. Silencing the science on gun research. JAMA. 2013;309:549-550.

7.Record KL, Gostin LO. A systematic plan for firearms law reform. JAMA. 2013;309:1231-1232.