An Old Problem Grows Worse
I got my first lesson in America's gun problem one day during my residency,
when a patient walked into the emergency department at Johns Hopkins Hospital,
bleeding from a chest wound and waving a .44 magnum revolver. "I
want help," he said, and squeezed off a round.
A nurse and I dove under a metal desk. As slugs smashed into the desk and
the wall behind it, I asked myself why this was happening. I'm still
searching for an answer.
As physicians, we will always have to try to patch up the people who survive
gun violence. But as professionals dedicated to preserving life, I believe
that we also must speak out for gun control.
In just over 5 months, 101 individuals have died in massacres perpetrated
by people with overwhelming firepower in their hands.
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On October 1, 2017, a gunman armed with multiple guns including ten AR-15
rifles shot some 1100 rounds into the crowd at a Las Vegas concert,
killing 58 people.
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On November 5, 2017, a gunman used his Ruger AR-556 to
murder 26 people at the First Baptist Church in Sutherland Springs, Texas.
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On February 14, 2018, a gunman armed with an AR-15 and multiple magazines
killed 17 people at Marjory Stoneman Douglas High School in Parkland, Florida.
These are only the most recent mass shootings to take place in the United
States; they are occurring now with horrifying regularity. They will continue
until we take action. And they are only a small part of the problem with
gun violence in this country. Thirty-five thousand of us die by guns every year,[1] mostly by smaller-scale murders, suicides, and accidents involving handguns.[2] It is not normal. We shoot each other at roughly 20 times the rate found
in other high-income countries.[3]
As a physician, I like to look at a social problem as I would examine any
malady—by making a diagnosis, analyzing the pathogenesis, and recommending
an intervention. In this case, the diagnosis is clear. We have created
a public health hazard by allowing virtually everyone access to military-grade
weapons. These weapons are being used to kill innocent people, including
our children.
The Second Amendment, Clarified
What's the pathogenesis of this public health hazard? It started in
1791 when the Second Amendment to the US Constitution was ratified. It
says: "A well-regulated Militia, being necessary to the security
of a free State, the right of the people to keep and bear Arms, shall
not be infringed."
At that time, the fledgling nation had no standing army. The founders believed
that local militias should respond to crises such as a sudden invasion
by a foreign power. These militias would be composed of ordinary citizens,
most them living in rural places, who would arm themselves with the weapons
they kept at home for hunting. No records from the time suggest that the
framers wished to protect an individual's right to weapons.[4]
In the centuries since then, the state militias were essentially incorporated
into the federal standing army. Military weapons have evolved into a lethal
firepower the framers of the constitution never imagined. And with most
people in cities and suburbs, population density makes the misuse of these
weapons even more dangerous.
Some still argue that individuals need guns to protect against encroachments
of civil liberties by the federal government. But it is no longer reasonable
to imagine that rifles and handguns are any match for the tanks, bombers,
and missiles of the US military, and no person in their right mind would
allow individuals access to that kind of armament.
At the same time, we are grappling with a huge problem of untreated mental
illness. For example, in California state prisons, 29% of the population
is mentally ill.[5] We are simply not keeping up with the vast need for diagnosis and treatment
of psychosis, depression, anxiety, and other disturbances that can lead
a person to an impulsive act of violence.
Recognizing such changes, local, state, and federal governments have been
writing laws about firearms for 2 centuries. And the US Supreme Court
has held that the Second Amendment does not confer a "right to keep
and carry any weapon whatsoever in any manner whatsoever and for whatever
purpose."[6]
Physicians Must Actively Pursue Solutions
Our laws have not kept up with the rapid changes in the circumstances of
gun use. Guns have always played an important part in our popular culture,
and many people revere them as the ultimate symbol of individual rights.
Thus, even the most modest proposals to restrict the use of guns face
fierce opposition. We can and should uphold the right to responsible use
of guns while restricting the irresponsible use of them, just as we uphold
the right to drive automobiles but also restrict their use to trained
adults who do not drive while inebriated.
What role can physicians play in this intervention? That day in the emergency
department, when bullets rained onto the wall behind me, I got a full
taste of the risk physicians face when working with desperate people.
But our obligation goes beyond defending our personal safety. Our children
are our most sacred resource. We must protect them from physical and emotional
harm at all costs. If we do not actively pursue solutions to this societal
malady, we will seem to condone it.
As public health leaders in our communities, we must speak up for intelligent
restrictions on gun use, just as we speak up about vaccination, fluoridation,
and sanitation, wherever we can gain access to a public forum—in
newspaper op-eds, at town halls, in blogs, and in community newsletters.
I support the 2015 call to action from the American Academy of Family Physicians,
American Academy of Pediatrics, American College of Emergency Physicians,
American Congress of Obstetricians and Gynecologists, American College
of Physicians, American College of Surgeons, American Psychiatric Association,
American Public Health Association, and American Bar Association.[7] This document lays out common-sense policies that I believe could save
thousands of lives every year:
- Physicians should be able to discuss firearms with their patients. At times,
the primary care physician is the only person in a position to recognize
an individual's risk for suicide or murder. Just as we must be aware
of our patients' risk for addiction before we prescribe opioids, so
must we take into consideration their risk of harming themselves and others.
When patients express a desire to hurt someone, we should be able to follow
up by asking about their access to firearms and, if the danger seems imminent,
contact family members or law enforcement. Laws that limit these discussions
are detrimental to the public health. By the same token, no law should
force a physician to report information a patient has made in confidence.
- More extensive resources should be devoted to awareness, diagnosis, and
treatment of mental illness.
- People who want to buy firearms should undergo criminal background checks,
including for sales by gun dealers, sales at gun shows, and private sales
between individuals.
- Civilians should not be able to buy weapons designed to kill large numbers
of people in a very short amount of time.
- Congress should provide more funding and not restrict research into firearm
violence by the Centers for Disease Control and Prevention, the National
Institutes of Health, and other government agencies.
Those measures could have prevented me from facing the longest half minute
of my life, under that desk in the emergency department. As we cowered
there, our assailant alternately called for help and fired his gun while
we shouted to him that we would like to help him if he would put down
the weapon. Finally, he dropped the revolver and followed us into the
trauma room, where he went into cardiac arrest. We opened his chest, fished
out the bullet, and resuscitated him.
Decades later, I am still fishing bullets out of bodies. But now I have
decided to speak out.
References
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Bower E. American deaths in terrorism vs. gun violence in one graph. CNN.com.
October 3, 2016.
ArticleAccessed March 28, 2018.
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Woolfolk J. Guns and deaths in America: The numbers. The Mercury News.
February 28, 2018.
ArticleAccessed March 28, 2018.
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Richardson EG, Hemenway D. Homicide, suicide, and unintentional firearm
fatality: comparing the United States with other high-income countries,
2003. J Trauma. 2011;70:238-243.
Abstract
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Waldman M. How the NRA rewrote the second amendment. Politico. May 19, 2014.
Article Accessed March 28, 2014.
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Sewell A. Mentally ill inmates are swamping the state's prisons and
jails. Here's one man's story. Los Angeles Times. June 19, 2016.
Article Accessed March 28, 2018.
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Supreme Court of the United States. District of Columbia, et al. v Heller.
Decided June 26, 2008.
ArticleAccessed March 28, 2018.
-
Weinberger SE, Hoyt DB, Lawrence HC 3rd, et al. Firearm-related injury
and death in the United States: a call to action from 8 health professional
organizations and the American Bar Association. Ann Intern Med. 2015;162:513-516.
Abstract
Medscape Orthopedics © 2018 WebMD, LLC
Any views expressed above are the author's own and do not necessarily
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