• Rosalind Kaplan, MD

Not Again

By Rosalind Kaplan, MD

Well, last week, after the hate crime shooting in Buffalo, I planned on writing a post about the medical world's take on gun violence and gun control. But I wasn't expecting to write it in the wake of yet another mass shooting, this time in an elementary school in Uvalde, Texas, in which 19 children and 2 adults were killed and many more injured.

In 2018, the American College of Physicians, the larges medical specialty association in the US, released a policy paper entitled Reducing Firearm-Related Injuries and Deaths in the United States. It outlined evidence-based strategies to keep guns out of the hands of those at high risk of harming themselves or others through suicide, domestic violence, accidents, and homicide.

The NRA responded to the release of that paper by telling physicians to 'STAY IN YOUR LANE.' The viral response to this from physicians was # IT IS MY LANE.

Other medical associations, including the AMA and many others, have also signed on to the battle against needless loss of life, injury, disability, and mental health consequences of gun violence. There is dissent among some physicians about how much medicine ought to be involved in what some call a 'political' issue, but the vast majority of doctors I talk to are clear that it is, in fact, our 'LANE.'

It's hard for me to understand how anyone can believe that healthcare and politics are not intricately intertwined. Right or wrong, healthcare is a political issue in the US. Politics dictate health insurance coverage. It dictates economic policies that have led to health disparities, and those that can alleviate or worsen those disparities. Politics have become deeply imbedded in the response to the pandemic. Politics are driving reproductive care, or the lack of it. How can we then say that medical professionals should stay out of the political discourse??

When it comes to guns, I get that the second amendment is 'the right to bear arms,' and I am not invested in abolishing the second amendment. But no 'right' is an absolute right, and when a 'right' becomes a public health threat, and affects the mental and physical health of both gun owners and everyone else, the healthcare sector, medical professionals, including medical societies, and healthcare systems, are already involved.

It is medical professionals who are entrusted to prevent suicide, which is still the leading cause of gun-related deaths. It is health professionals and the healthcare system who care for those injured by gunfire- in OR's and trauma units- , and health professionals who must inform families when patients lose their lives or their limbs to gun violence. Medical professionals take care of those with longterm damage- paralysis, colostomies, infections, amputations- from gun violence. And it is partly medical professionals who are tasked with the mental health of survivors and witnesses of shootings, and the declining health that those with post-traumatic stress disorder and depression and anxiety and grief experience after these events. IT IS OUR LANE.

The recommendations of medical societies include the most obvious of measures: background checks and other measures to keep guns out of the hands of those who have a history of violence, such as domestic abusers. Support for safe gun storage to reduce accidental deaths, especially those of young children. Training in gun safety as a prerequisite of gun ownership. The ability to have temporary removal of firearms from those who may be a risk to themselves or others, while evaluation is pursued. These laws would protect the vulnerable, and it seems almost absurd to want to prevent their passage.

The ACP also called for a ban on assault-style weapons and large-capacity ammunition magazines. If the American 'right to bear arms' is for protection and for sport, then why would anyone outside of the military need an assault weapon?

In the wake of both the Buffalo shooting at Tops Supermarket and the Uvalde Robb Elementary school shooting, the question of whether, like access to alcohol, access to firearms should be limited to those 21 years of age and up, instead of 18 years of age and up, has also been raised repeatedly. We know that the adolescent brain is not yet fully developed, particularly in males (males are, in fact, overwhelmingly responsible for mass shootings). We should be asking this question and exploring the reasons why it is easier for adolescents to access guns than alcohol. In fact, it is easier, in general, to access firearms than many other things, and we ought to wonder about this- licenses and intensive background checks are required for so many activities, but not for gun ownership.

You may notice that I haven't said much about the need for more mental health access and other possible societal changes. There is no doubt that improving access to mental health services and more opportunities for screening for mental illness would prevent some gun injuries and deaths, and is crucial for the overall well-being of our society. But I seriously doubt that it, as a single intervention, would solve the problem of gun violence. Someone like Salvador Ramos, who had a troubled background but had never been in trouble with the law before Uvalde, may never have come to the attention of mental health workers. Even with improved access to care, one would have to seek that care, unless screening was mandated as a prerequisite to gun ownership. I'm not saying that's the answer, but none of these interventions alone will solve a problem that has such a multi-faceted origin.

Apparently I'm naive, since somehow, interventions that seem no-brainers to me, has been repeatedly rejected and ignored by the politicians. Of course, the NRA also says that I'm out of my lane, and seems to be more powerful than the ACP and all the other medical societies combined.

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