Suzanne Koven, M.D. asks some valid questions:
Suppose 20 children and 6 adults died at a school in a very short time period. And suppose there were clusters of similar deaths, many of young healthy people, around the country: at a movie theater, a shopping mall, a high school, a house of worship. Would you expect the Center for Disease Control to get involved in trying to figure out why these people died and how to prevent similar deaths? Would you want your own doctor to do all he or she could do to prevent similar “outbreaks” from occurring in your community? Even if the cause of the deaths turned out to be complex, multi-factorial, and overlapped non-medical arenas, such as the law?
I believe most pediatricians would answer yes, yes, and yes. There are numerous examples of attention given to guns and gun violence in the pediatric literature. There are policy statements from the American Academy of Pediatrics:
Physician counseling of parents about firearm safety appears to be effective, but firearm safety education programs directed at children are ineffective. The American Academy of Pediatrics continues to support a number of specific measures to reduce the destructive effects of guns in the lives of children and adolescents, including the regulation of the manufacture, sale, purchase, ownership, and use of firearms; a ban on semiautomatic assault weapons; and the strongest possible regulations of handguns for civilian use.
Dr. Koven continues by asking:
Did any doctor ask Nancy Lanza: Do you have guns at home? Are they kept locked separately from ammunition? Are they accessible to anyone else, especially children and the mentally ill? Would it have helped? Or, at least, how would it have hurt?
These are questions pediatricians should be asking at well-child visits. I must admit that I don’t ask as much as I used to. I’ve had my share of parents get very defensive and, perhaps, offended by me asking these three non-threatening questions:
- Do you have guns in the home?
- Do you keep your guns safely locked away?
- Do you employ safety measures such as storing ammunition separately and using trigger locks?
Anyway, they seem to be non-threatening to me. I think that James C. Salwitz, M.D. would agree:
I feel guilty about the killings in Colorado. As a doctor, those horrid events are a personal failure. I have spent a career fighting illness, often investing hundreds of hours in a single cancer case, yet in minutes, a dozen people vanish and 58 are grievously wounded. Another 32,000 will die this year from gunshots, over 76,000 will be crippled and I cannot keep up with this slaughter. Why is this my fault? Because, I am a physician and guns are a disease.
Edwin Leap, M.D. disagrees:
So which thing do we need to limit? Which part of the process do we need to tighten? If you want to expand psychiatric background checks, I can get on board with that. Depends, of course, on how you define mental illness. If the desire for a gun is a sign of mental illness, we’ve made no progress. But if you mean a history of suicidal or homicidal behavior or commitment for such, fair enough.
So let me be clear. I have a concealed weapons permit. It took a background check, fingerprinting, a class and a test. I have a gun safe. I have taken extra training in the effective use of my weapon.
What would you like me to do differently? What would you like to take from me? If I threw open the safe and said, “come take what you want to make society safer,” what would you take? Would the world be better?
The thing is, I’m representative of the vast majority of America’s gun owners. Like it or not, we’re a boring, law-abiding bunch.
Americans are going to have an overdue and spirited debate about gun violence in 2013. Hopefully it will be a civil and sensible discussion on three key topics: guns, mental health, and violence in our culture. Pediatricians should be part of this conversation. I agree with President Obama that we cannot tolerate these senseless tragedies any longer. We’ve got to change.
Read articles by Drs. Koven, Salwitz, and Leap at KevinMD.com.