Should Physicians "Get So Political" About Gun Violence?

A few years ago, my wife and I took a long cross-country road trip that led us to Chicago as its penultimate destination. There we met our longtime friend — a third-year resident trauma surgeon at a hospital in the city’s infamous south side – at the end of one of his grueling 24-hour shifts.

He’d changed out of his scrubs and at first looked immaculate. But after I shook his hand and pulled him in for a hug, I noticed that he hadn’t changed his sneakers. They were spattered with bloodstains. I imagined all the things he’d seen and done in the last 24 hours.

Later that evening, we met for dinner. My wife and I asked him questions about his life as a New Jersey expat working long, high-stress shifts in the emergency department. He said he loved it and that there was nothing else like it in the world. He’d just saved a young woman who’d been shot twice in the abdomen a few hours before we met. It was his third gunshot victim of the shift, he added.

“How are you still awake?” I said. “You must be completely spent.”

He stopped eating for a moment and looked at me intently. “No more than any other day,” he said.

A Doctor’s Place

I came to learn later that night that in his 3 years of residency, he hadn’t worked a single shift without having to treat a gunshot victim.In the early hours of Tuesday, May 29, 2018, Fox & Friends issued a poll on Twitter that asked the page’s 1.21 million followers whether the American Medical Association (AMA) should “get so political” about gun control. It quickly garnered more than 33,000 votes, 1800 replies, 1400 retweets and 700 likes. The poll appeared to be a resounding success for the media company, especially in this brave, new data-driven world that moves in response to ratings, pageviews, listens, likes and shares — whatever the metric du jour may be.

American Medical Association to consider pro-gun control agenda. Should this group get so political?

— FOX & friends (@foxandfriends) May 29, 2018

Doctors and Gun Violence

In the big picture, I think the poll was a success, but not in the sense that Fox News — America’s most dominant, and perhaps most influential, cable news channel — would have wanted:More than 30,000 people (roughly the same number of people who voted in the poll) are purposely shot to death each year in the US. It was only 8 months ago that we experienced the worst mass shooting in US history. As similar incidents vault onto headlines at what feels like shorter and shorter intervals, evidence mounts that we are living in the middle of a firearms-related public health crisis. Many physicians have come to know deaths from firearms in the US as contributing to an ongoing epidemic — one that’s spreading in speed and intensity and in some ways resembles the now-ubiquitous opioid epidemic.

But when it comes to firearms and opioids, our government seems to be reacting in vastly different ways. As an avid follower of the movements of the US Food and Drug Administration (FDA), I’ve seen firsthand the measures the agency has taken to try to curb the opioid epidemic, from establishing an FDA Opioid Policy Steering Committee, holding public workshop meetings, evaluating indication specific doses, exploring alternatives, and even removing harmful opioids from the market. Agency Chairman Scott Gottlieb, MD, last year said the epidemic is “our greatest immediate challenge,” and “a public health crisis of staggering human and economic proportion.”

Moreover, a quick PubMed search for “opioid” returns nearly 150,000 published studies. Millions of hours of research, workshops, CME events, conference sessions, and a mounting cache of evidence from published studies all suggest that that the medical community and the government are similarly interested in exploring new ways to curb opioid abuse. It’s unclear whether all this information is what’s spurring the government to act, but it seems obvious that the plethora of data medicine has produced is extremely valuable and can help us make informed decisions.

On the other hand, a search for studies that contain the term “firearm” returns a derisory 7000 studies. When it comes to guns, there has even been a study on the lack of studies, which, perhaps predictably, arrived at a disconcerting finding: Gun violence research is “substantially underfunded and understudied relative to other leading causes of death, based on mortality rates for each cause.”

It shouldn’t be a surprise, then, that despite evidence suggesting that “a higher number of firearm laws in a state are associated with a lower rate of firearm fatalities, overall and for suicides and homicides individually,” no new federal gun laws have been passed since 2008, and hundreds have been rejected. A lack of research is by no means the sole cause of federal inaction, but it could not have helped. This is a data-driven world, after all. Perhaps there simply aren’t enough data.

One doesn’t have to feel one way or another about gun violence to see that we need to improve our understanding of how and why we continue to allow so many people to be shot to death every year in the US. If we can agree on that, then it becomes obvious that any meaningful pathway toward curbing gun violence must include the steadfast commitment, everyday involvement and expert consultation of physicians.

There’s no surer way to defeat an illness than to understand it. To understand it, we must study it. Physicians and other health care providers are the most reliable viewpoint through which we can measure the harmful effects that firearm violence has on our collective health. They are on the front lines of nearly every battle in the war against gun violence — hospitalists and surgeons treat victims, psychiatrists prescribe therapies that might prevent incidents before they occur, epidemiologists and public health experts monitor the spread of violence and engage communities to steer them toward lives where it doesn’t seem necessary.

Gun violence IS a health and mental health problem. Expecting doctors to stand on the sidelines, so as not to appear “political”, is just wrong. TY @hshermd @peter_masiakos and all professionals for speaking out and for making a difference. https://t.co/gLL5LHYgg8

— SharonParkinson PsyD (@DrSharonPsyD) June 5, 2018

You were suffering from depression. I could see the signs and tried to get you to see your doctor about it but you were ashamed to go. You knew things were getting bad and you gave away your handguns but not the shotgun. Miss you, Dad.#ShareAGunViolenceStory

— Mark Reid, MD (@medicalaxioms) June 2, 2018

I’ve worked in ED since 1993.

I’ve never seen a victim of gun violence.

But then again, I work in the U.K. #ShareAGunViolenceStory

— Chris Biggin (@chrisbiggin) June 3, 2018

You were a chief resident in surgery when I was a medical student. You were walking to hospital when you were shot. Your co-residents did your ED thoractomy. You died. #shareagunviolencestory

— Jo Buyske (@BuyskeJ) June 3, 2018

#ShareAGunViolenceStory

You were shot riding a bike with AK47 by rival gang.

Massive destruction! Multiple laparotmies. Extensive soft tissue debrid. Open abdomen. Organ failure. Long ICU stay and rehab.

You survived! Married, turned life 180, and gave 1st child my name.

— Michaela West (@MichaelaWst) June 4, 2018

I heard your baby dying inside of you and cut you open, right there in the ED. You had no chance after multiple shots to the chest, all by a man you knew. But I had to try for your son. You were 20, he was 28 weeks.

I’m sorry I couldn’t save him.#ShareAGunViolenceStory

— Chitra Akileswaran (@chitra_mdmba) June 3, 2018

20+ years in Australian emergency medicine. City of 4 million. I have not had a #ShareAGunViolenceStory since 2002. The political system had the courage to make that happen back in 1996

— Ian Summers (@IanMeducator) June 3, 2018

While the number of deaths from #GunViolence are mind blowing 38,658 (2016). Let’s not forget that these are not just abstract numbers.

Here are the Faces of Gun Violence! @JosephSakran @shannonrwatts #ShareAGunViolenceStory pic.twitter.com/wfTiKo2MHI

— Docs Demand Action (@DocsDemand) June 3, 2018

Medical professionals study and treat the causes and effects of gun violence every day. Who better than physicians to “get so political” about it?

Editor’s note: This is a column written by Tom Castles, associate director of editorial. His analysis reflects his views, not necessarily those of the magazine.