Last week, the Centers for Disease Control and Prevention released a report on changing trends in deaths from firearms in major U.S. metropolitan areas in it’s Morbidity and Mortality Weekly Report (MMWR):
Recently, firearm homicide rates in large metro areas and the nation overall began increasing, reaching levels comparable to those a decade ago. Firearm suicide rates have continued to increase in large metro areas and the nation overall.
Gun violence is a national public health problem which indisputably and significantly impacts our youth. Consider these statistics. In the United States during 2015-2016:
> There were 27,394 firearm homicides including 3,224 (12%) among persons aged 10–19 years.
> There were 44,955 firearm suicides including 2,118 (5%) aged 10–19 years.
> Homicide is the third leading cause of death in youth aged 10-19 years (16th for all ages).
> 87% of youth homicides are caused by firearms (74% of homicides for all ages are gun-related).
> Suicide is the second leading cause of death in youth aged 10-19 (10th for all ages).
> 42% of youth suicides are from firearms (50% for all ages).
Coinciding with the CDC’s report, the American College of Physicians (which represents internal medicine and adult specialty practitioners) issued a revised position statement entitled “Reducing Firearm Injuries and Deaths in the United States.” The ACP’s long-standing mission has been endorsed by many other provider organizations including the American Academy of Pediatrics:
For more than 20 years, the American College of Physicians (ACP) has advocated for the need to address firearm-related injuries and deaths in the United States. In 2014, the ACP published a comprehensive set of recommendations. In 2015, it joined the American College of Surgeons, American College of Obstetricians and Gynecologists, American Public Health Association, American Psychiatric Association, American Academy of Family Physicians, American Academy of Pediatrics, American College of Emergency Physicians, and American Bar Association in a call to action to address gun violence as a public health threat, which was subsequently endorsed by 52 organizations that included clinician organizations, consumer organizations, organizations representing families of gun violence victims, research organizations, public health organizations, and other health advocacy organizations. Yet, firearm violence remains a problem—firearm-related mortality rates in the United States are still the highest among high-income countries.
The National Rifle Association quickly responded publicly with an absurd and factually-vacuous rant on Twitter:
“Someone should tell self-important anti-gun doctors to stay in their lane. Half of the articles in Annals of Internal Medicine are pushing for gun control. Most upsetting, however, the medical community seems to have consulted NO ONE but themselves.”
Laurel Wamsley followed the inevitable Twitter-war:
“We are not anti-gun: we are anti-bullet holes in our patients,” Esther Choo, a doctor and professor of emergency medicine at Oregon Health & Science University, replied on Twitter. “Most upsetting, actually, is death and disability from gun violence that is unparalleled in the world.”
The response from others in the medical community was immediate and raw:
“I would like to graciously extend the invitation to the author of this tweet and anyone else from the NRA to join me at the hospital the next time I care for a child who has been hurt or killed by a gun that wasn’t safely stored or was an innocent bystander,” tweeted Jeannie Moorjani, a pediatric doctor in Orlando, Fla.
More physicians weighed in, often using the hashtag #ThisIsOurLane.
“Do you have any idea how many bullets I pull out of corpses weekly? This isn’t just my lane. It’s my f****** highway,” wrote forensic pathologist Judy Melinek, in a tweet that has gone viral.
A trauma surgeon in Utah tweeted a photo of his blue scrubs covered in blood. “Can’t post a patient photo,” he wrote, “so this is a selfie. This is what it looks like to #stayinmylane.”
Trauma surgeon Stephanie Bonne added this caption to go along with the photo of her unit’s “Quiet Room” at the top of this post:
“Hey @NRA ! Wanna see my lane? Here’s the chair I sit in when I tell parents their kids are dead. How dare you tell me I can’t research evidence based solutions.”
The ACP’s recommendations begin in the slow lane:
1. The American College of Physicians recommends a public health approach to firearms-related violence and the prevention of firearm injuries and deaths.
a. The College supports the development of coalitions that bring different perspectives together on the issues of firearm injury and death. These groups, comprising health professionals, injury prevention experts, parents, teachers, law enforcement professionals, and others, should build consensus for bringing about social and legislative change.
2. The medical profession has a special responsibility to speak out on prevention of firearm-related injuries and deaths, just as physicians have spoken out on other public health issues. Physicians should counsel patients on the risk of having firearms in the home, particularly when children, adolescents, people with dementia, people with mental illnesses, people with substance use disorders, or others who are at increased risk of harming themselves or others are present.
a. State and federal authorities should avoid enactment of mandates that interfere with physician free speech and the patient–physician relationship.
b. Physicians are encouraged to discuss with their patients the risks that may be associated with having a firearm in the home and recommend ways to mitigate such risks, including best practices to reduce injuries and deaths.
c. Physicians should become informed about firearms injury prevention. Medical schools, residency programs, and continuing medical education (CME) programs should incorporate firearm violence prevention into their curricula.
d. Physicians are encouraged, individually and through their professional societies, to advocate for national, state, and local efforts to enact legislation to implement evidence-based policies, including those recommended in this paper, to reduce the risk of preventable injuries and deaths from firearms, including but not limited to universal background checks.
The remainder of the ACP’s recommendations will sound sensible to the vast majority of Americans who, poll after poll informs us, are hoping for a meaningful, effective, AND Constitutional path forward to reduce the violence from guns that we feel in our lives, experience in our communities, and see in our daily media. You can read the rest of those recommendations here.