Ricochet is the best place on the internet to discuss the issues of the day, either through commenting on posts or writing your own for our active and dynamic community in a fully moderated environment. In addition, the Ricochet Audio Network offers over 50 original podcasts with new episodes released every day.
Doctors, Guns, And Staying In Your Lane
The National Rifle Association (NRA) is never one to back down from a fight, even during emotional times following mass shootings. Last week, however, they clearly stumbled, in response to a recently published paper recommending numerous gun regulations.
The article, published in the Annals of Internal Medicine, was ostensibly a position paper for the American College of Physicians (ACP). The authors certainly do make numerous recommendations…some scientific and evidence based, while others were not. Among the various recommendations they make is banning all semiautomatic weapons, waiting periods for gun purchases, banning of bump stocks, and other restrictions.
The NRA responded in their online blog, with a piece titled “Surprise: Physician Group Rehashes Same Tired Gun Control Policies”. They continue:
Everyone has hobbies. Some doctors’ collective hobby is opining on firearms policy. Half of the articles in the “Latest from Annals” email from the Annals of Internal Medicine journal are related to firearms.
The most prominent of these articles is a position paper written by the American College of Physicians (ACP) that expands upon their 2014 paper and reflects every anti-gunner’s public policy wish list, save for the outsized role given to doctors. The ACP’s policy recommendations include a ban on semiautomatic firearms and “high” (read: standard) capacity magazines, licensing and permitting requirements, improved reporting to NICS, restrictions on concealed carry, and so on. None of the ACP’s policy recommendations focus on law enforcement or the importance of identifying, prosecuting, and incarcerating criminals. As Philip J. Cook notes in his commentary, “It is unfortunate that the public health community has not recognized the importance of policing gun violence as a key aspect of prevention.”
As a public relations problem, the NRA statement was a misstep and overly broad. The NRA was trying to make the point that there are many aspects to the gun violence debate, and physicians alone aren’t the only experts whose opinions were valid. However, their above message and their later tweets telling doctors to ‘stay in their lane’ was clearly arrogant, dismissive, and provided their opponents with an easy target for their social media response.
Calling their above statement a poor choice of words is an understatement. Physicians certainly have a right to voice their concerns regarding gun violence. With over 14,000 gun homicides, as well as almost 23,000 gun suicides (as of 2016), this is an issue which certainly impacts the medical profession in many ways, and they have as much right as anyone to voice their positions. The NRA would be well served to voice that stipulation in the future. I and many others, even those that are sympathetic to gun owners’ rights, were heavily critical of the NRA’s messaging in this regard.
Where the NRA and the ACP both miss the boat is on focusing on evidence-based decisions, instead of partisan bickering. In response to the ill-conceived NRA response, thousands of doctors have joined social media using the hashtag #ThisIsOurLane. Numerous articles in papers and online sites including the Washington Post and Vox have been written over the issue. It has been an effective campaign in messaging and rhetoric and definitely has had an emotional impact for gun control advocates.
The problem, however, is that both sides are largely missing the larger debate on guns. As usual, we revert to our respective partisan bases, and we ignore the evidence-based arguments we should be having, instead of reciting the same old tired responses that never progress anywhere.
For example, many of the recommendations made in the ACP article are already law. Even worse, literally no one opposes some of these recommendations, even including the NRA. For example, reporting of criminals to the database:
Sales of firearms should be subject to satisfactory completion of a criminal background check and proof of satisfactory completion of an appropriate educational program on firearms safety. The American College of Physicians supports a universal background check system to keep guns out of the hands of felons, persons with mental illnesses that put them at a greater risk of inflicting harm to themselves or others, persons with substance use disorders, domestic violence offenders, and others who already are prohibited from owning guns.
… ACP supports strengthening and enforcing state and federal laws to prohibit convicted domestic violence offenders from purchasing or possessing firearms.
Much of this is already in fact the law of the land. This has been true for some time, and even more important, these are issues on which there is virtually no dispute, even from most gun rights advocacy groups.
One area where I feel the ACP and other physician groups have let the country down is on the issue of how mental illness relates to gun rights. If physicians are an expert on any part of the gun regulation debate, it should be their knowledge of how mental illness is involved with this epidemic. This is clearly a sensitive topic, however. How does one determine if an American, who has not committed a crime as of yet, lose their constitutionally granted individual rights? What process do we, as a country that believes in due process, use for such a practice? And how can we possibly restrict these constitutional rights, while still allowing mentally ill patients to feel comfortable with coming forward with their problems, so their illnesses can be treated?
The ACP appears to come close to recommending harsher restrictions on people with mental illness, but then provides a caveat that undermines the entire discussion:
The College cautions against broadly including those with mental illness in a category of dangerous individuals…
This is problematic, in my humble opinion. There is actually more evidence that strict guidelines on restricting rights for the mentally ill would decrease homicides than most of the other ACP recommendations. So why draw the line here? Of course, as I have stated above, I fully understand there are issues with protecting individuals with mental illness. Any restriction of rights for the mentally ill is fraught with legal and moral dilemmas.
But the ACP is perfectly willing to use recommendations with far weaker data and evidence (for example, with restricting the spread of concealed carry laws, which the authors themselves admit in their piece that they lack strong evidence for) and then are willing to use that weaker evidence to restrict the rights of a far greater number of law-abiding citizens. So why not restrict the rights of law-abiding citizens with mental illness? The ACP clearly isn’t basing all their recommendations purely on evidence; and that is where their expertise crosses the line into pure partisanship.
Here is maybe my biggest problem with the entire ACP piece, and the most salient example of where their expertise fails them entirely:
The College favors enactment of legislation to ban the manufacture, sale, transfer, and subsequent ownership for civilian use of semiautomatic firearms that are designed to increase their rapid killing capacity (often called “assault weapons”) and large-capacity magazines, and retaining the current ban on automatic weapons for civilian use.
Let us note, this statement largely implies that the authors of this article really don’t have an understanding of guns at all. Do they realize the vast majority of handguns sold in the US today…are semiautomatic?
In short, the authors are suggesting banning the most commonly purchased type of weapon for self-defense in the country. Furthermore, this is an area on which the Supreme Court has already spoken. Both District of Columbia v. Heller, and later affirmed in McDonald v. Chicago, that individuals have a right to a handgun as a protected individual right under the Second Amendment. Are the authors suggesting the ACP now opposes the Second Amendment? If you take them verbatim, that is exactly what they are proposing, for all practical purposes.
The ACP does try to provide a caveat to this:
“The College acknowledges that any such regulations must be consistent with the Supreme Court ruling establishing that individual ownership of firearms is a constitutional right under the Second Amendment of the Bill of Rights,” the paper said.
However, their other recommendations make it clear they haven’t really taken the time to consider these legal precedents when making many of their recommendations. Thus, the authors should readily admit that their own expertise in these matters is limited. And there is nothing wrong with that. A humble approach to this contentious debate is likely to make others more receptive to their arguments, instead of the arrogance displayed by both sides here.
As a physician myself, I can say I have gone through this evolution personally. It takes years of reading, talking to gun owners, and talking to policy experts to really understand how complicated and difficult the gun issue is in America. I have never owned a gun and only fired one once, while hunting. However, a decade ago, as the gun control issue became a health policy issue, I forced myself to learn far more about guns than I ever wanted to. After the Sandy Hook massacre, I tried to take it upon myself to find approaches of how real life proposals, following the Constitution, could be enacted to actually decrease the chances of such tragedies from recurring. And since that time, although the debate has become more heated, the solutions have become more scarce.
In an emotional piece, Dr. Judy Melinek in Vox pleas for her case:
As scientists and caregivers, we doctors are in a unique position to understand the scale of human suffering caused by guns. We are driven both by data and by an intense feeling of personal responsibility toward those in our care. Gun deaths get the most media attention following a mass-fatality incident, such as in Parkland, Las Vegas, Pittsburgh, or Thousand Oaks. The daily carnage we witness in hospitals and morgues is often overlooked, but it happens everywhere, to every group of Americans, and leaves our patients and their families with an accumulation of broken bodies, coffins, and grief.
I respect Dr. Melinek’s opinion and many thousands of other physicians that feel the same. And I fully admit that we need to think long and hard about gun policy in this country. But I also believe that many of these physicians are not experts in all fields related to this issue, and are certainly are no more gun experts nor experts on Constitutional law than I am. And just as we, as physicians, should be respected for our medical expertise, we physicians should be humble and admit we must sometimes defer to others in these other fields in which we may be well read, but are not truly are experts.
I think many doctors do understand that only with an honest, fruitful debate with legal experts and gun advocates can we really make progress on this issue. Dr. Heather Sher, a fellow radiologist who treated victims of the Parkland, Fl shooting earlier this year, wrote a public letter in which she pleaded with the NRA to come together with physician groups in order to have a more productive discussion on how we can reduce gun violence, while still protecting individual rights on guns. The letter has gained tens of thousands of signatories in the interim. Others, like Dr. Richard Sidwell, a trauma surgeon in Des Moines, IA, tried to explain to critics how his roles as NRA member and trauma surgeon “are NOT mutually exclusive.” This did not go over well in the era of the Twitter social media mob, however. But again, both of these physicians, in different ways, were trying to bring people of all facets of medicine and the gun debate together in hopes of reaching some common ground. To me, this was a far more intellectual way to proceed on this than writing dismissive blog posts and snarky tweets that help literally no one.
So doctors are a valuable voice, and their expertise matters. Their expertise on how gun violence is harming the American public is incontrovertible, and their interest in finding ways to reduce such violence is an essential component of the debate. However, just like any experts, their expertise goes only so far and is limited in scope, knowledge, and experience. They cannot be relied upon for detailed debates on which guns are legal, illegal, dangerous or not. That is not their bailiwick. And just as the NRA would be well served to defer on medical issues to physicians, physicians would be well served to defer on the specifics of guns to gun experts, unless they are willing to become experts in all of those fields as well.
Published in Guns
If a business or venue or institution can not or will not provide the protection necessary to keep those within their jurisdiction safe, then they have no business disarming those who care most about their own live.
This is a thoughtful post, but it misses the point completely. There is no such thing as “gun violence.” There are violent people, and restricting their access to guns will simply make them look for other tools. Observe the “knife control” campaigns in the UK.
I am suspicious of having doctors involved in a gun control debate because having an opposing viewpoint declared to be mental illness is a classic tactic of the left. Paging Dr. Lysenko…
I agree. They should keep their professional identification out of the discussion. It is important to know who these people are, though, so we can keep an eye on them.
Well, yes violent people will express their violence, but the scope and impact of that violence can be greatly altered by limiting their access to tools that multiply their effectiveness. It isn’t that one can not beat a person to death with their bare hands, it is that if all you have is that it will be a lot harder and take a lot longer. After all given a choice I think most people would rather be punched than shot, no?
Of course the whole force multiplier of a gun is one of their attractive features as a tool of self defense. A 100lb woman can stop a 300lb man very easily with a gun, but if she were to try to so so with a knife, it would be far less effective.
I guess the question one can from a utilitarian stand point ask is how many criminal acts of violence are stopped by a would be victim because they had a gun vs. how many people are criminally injured with a gun? Do we know that?
It’s a problem, though, to decide which people need to have that access limited.
Very good article, thanks. You argued your position very well.
I do strongly disagree with it. You are implicitly arguing that the citizens of the American republic should tolerate Congress passing laws that regulate private firearms, absent any constitutional authority to do so, as long as expert opinion finds them useful.
What conceivable argument could be made against this: your position implies unlimited government, and nullifies the Constitution?
“Partly unlimited government” is an oxymoron. If the Constitution’s limits on Federal power are honored only when it suits Congress, then none of those limits are law.
In saying what the people should not tolerate, I am not being in the slightest bit naive. I realize that the people no longer support republican government, no longer believe in limited government, no longer support the Constitution except when it suits them. I am simply saying that we are unwise to abandon the republic, and would be wise to restore it.
Well that I think argues for a general limitation doesn’t it. Rather than picking who is or isn’t competent, you declare all people equally incompetent. In a way that is supremely fair.
I think speaking as an agnostic on gun ownership (I don’t own one nor do I feel a need to) I would actually appreciate more honesty from the Left about their intentions. I personally don’t think there is an inherit human right to owning a gun specifically or really any weapon for that matter. I think it is derived right from two actual natural rights; the right to self defense and the right to property. So I think there can be quite a bit of lee way in determining just what restrictions on weapons can be implemented without infringing on self defense and property rights.
Except you don’t. You generally pick the government as more important than the people. Or more specifically, the people who manage the government and who have a vested interest in their own social position as managers.
I look forward to the ACP’s position paper on abortion. Doctors know when life begins.But I bet they’ll sanction terminating it.
All the more reason they should stay out of the gun issue.
crimeresearch.org knows a fair amount, here are some links:
https://crimeresearch.org/cprc-research/
Murder and homicide rates before and after gun bans
Comparing murder rates and gun ownership across countries
The doctors are invoking their priestly authority and, once again, speaking in the name of science but without thinking scientifically.
Take them at their word. There is an epidemic of gun violence, but it is not nationwide. It is located in specific places. If they were attempting to control a contagious disease of bacterial, viral, or parasitic origin, they would employ different approaches if the disease
• had isolated, sporadic outbreaks or was geographically isolated
• was endemic in a population
• was epidemic in a population
and so on.
The following are probably not terribly relevant to homicides, though cats and toxoplasmosis make you wonder if there are germane unknown infections:
zoonoses endemic or epidemic in a host or vector animal population
Murders in US very concentrated: 54% of US counties had no murders in 2014; 2% of counties have 51% of murders [and within many of those counties, most neighborhoods have few to none while some have most. For example, Chicago.]
The NRA exists only to suck up money through lobbying. I quit their quisling organization a long time ago.
I recommend Gun Owners of America instead. They don’t lobby for bump stock bans.
Actually, I don’t think that doctors have any more a “valuable voice” in this debate than your Aunt Minnie has. There is nothing whatever unique about a doctor’s perspective in this area far out of their lane of alleged expertise. Knowing how strong a dose of prednisone will help open up a throat swelled shut by strep gives not expertise whatever regarding AR-15 magazine sizes or school metal detectors.
Right now, doctors should be focused on one thing only- figuring out how to reduce the cost of health care. They don’t because the large majority of the group wants to preserve their referent authority and income levels through guild scope-of-practice limitations protected by the captive regulators in the states.
This will all go away as soon as the US government stops blowing taxpayer money and puts an alternate federal medical care licensing regimen in place- using much lower level employees assisted by smart computer data systems and sensors- for any health care paid for with federal cash. This will overcome the medical primary care cartel so that the family practice docs can sit at home, uncompensated, and prattle off all their opinions about gun violence to a yawning world and at the same time solve much of the Medicare cost issue.
What is wrong with a bump stock ban? Not particularly effective in preventing nuts from shooting, but there is also no legit need for a bump stock.
There is no legit need for many freedoms enjoyed by free people. Unleashing armed men from the state to eradicate them is a very slippery slope. Just like the docs in the article above are sanctioning government violence on vast swaths of law abiding Americans.
As an aside, a bump stock is only a plastic doohickey that facilitates a technique that can be accomplished fairly well with any semi auto rifle. Those in favor of their ban are effectively kicking out a leg of the stool on the legality of most firearms in this country (unconstitutionally).
The bump stock is stupid. It’s a dumb toy and shooting with a bumpstock is only done by idiots who aren’t interested in hitting their target with any accuracy.
But if you allow them to ban bump stocks, then they will ban pistol grips. Then they will ban floating barrels. Then they will ban rifling. Then they will ban calibers over .22. Then they will recoil in horror that the 5.56mm is really a .22, so they will ban high power bullets and only allow .22lr. Do you see where it goes?
This is why our country is descending into socialism. Republicans again and again grant the premise of the socialist arguments. Giving free money to the poor is good (no it’s not) say the socialists, and republicans will argue “sure it’s good, but let’s not give so much. They cede the premise of the argument, and debate shifts from whether it’s a good idea to how much should we give, and that always creeps up. If a little is good, a lot has to be better.
If a little gun control is good, then we have lost the argument and the encroachments will continue. The only way to stop the encroachments is to argue that freedom is good, and choice is good, and the second amendment includes the freedom to own machine guns, howitzers, and battleships. Once we advance that argument, then the debate switches to how to we store our howitzers to keep our neighbors safe from inadvertent mishaps. For example, the law should only say that howitzers can only be fired on ranges that are well designed to keep innocent people from being harmed, (or during insurrections). We need to restore the premise of the second amendment where the people are better armed, or have the ability to be better armed than the federal government.
The NRA doesn’t even come close to that because it would undermine their lobbying. They exist to lobby, not to promote freedom. They throw a carrot to the cause of freedom occasionally, but only for the purpose of ensuring their lobbying continues.
Well yes, we have data on that. According to Wikipedia there were 74,000 nonfatal firearm injuries and 34,000 firearm deaths in 2013. Additionally the CDC conducted a study that concluded that the defensive gun use by victims in 2013 is in the range of 500,000 to 3 million. So there are alt least 5 times as many defensive uses of firearms as deaths or injuries from them. Note, the injuries and death data is not just criminally injured, which was asked in your question, but all firearm injuries and deaths.
Yes, the NRA spends a lot lobbying. The NRA lobbies for freedom so we don’t have to use our guns to fight for it.
No. They lobby for bump stock bans. They lobby for background checks. They don’t lobby for overturning the NFA and the GCA.
I enjoyed this article quite a lot, but its conclusion left me confused:
I agree with this in theory, on the grounds that doctors have direct experience with treating gunshot wounds that most of us (thankfully) lack.
In practice, I’m not sure what this this experience would actually offer. That gunshot wounds are grievous and often lethal is axiomatic. Moreover, the overwhelming majority (98%+) of firearm fatalities are intentional, rather than accidental*. Aside from the overlap with mental illness, I have trouble imaging what information or expertise doctors could offer in this that would actually be useful.
Am I missing something.
* Numbers I pulled from the CDC for 2016. In comparison, 99% of MV fatalities are accidental.
Right now, when I go to the doctor I want her to be focused on one thing only — figuring out how to provide me with the best health care.
It may be helpful to point out that most gun-related deaths are suicides.
https://www.nytimes.com/2015/10/09/upshot/gun-deaths-are-mostly-suicides.html
https://www.npr.org/2017/09/30/554789675/report-finds-suicides-are-even-more-common-than-gun-homicides
http://www.pewresearch.org/fact-tank/2013/05/24/suicides-account-for-most-gun-deaths/
While bump stocks are mostly a stupid toy, the fever to ban them represents a profound ignorance of American history, or a denial of our heritage. We are a nation founded by means of armed revolution, and on the principle that the people have a right to overthrow their government, by violence if necessary. Given that truth, we should be deregulating actual machine guns and assault rifles, not banning the ersatz version thereof.
The NRA’s position on bump stocks has been to ban them, since Las Vegas. They lobbied for instant background checks, while lobbying against registration and waiting periods. They have lobbied to overturn parts of the NFA (suppressors).
There are an estimated 440,000 deaths each year from medical malpractice.
One can see how the ACP might prefer to weigh in on gun legality.
Doctors kill 250,000+ people a year through their own errors, yet presume to lecture we the people on what devices we should own.
Physician heal thyself (or at least thy profession).
It’s a good point, and one that is very rarely mentioned. If a (or “the”) purpose of the positive right to bear arms in the Second Amendment is to allow the people to deter or defeat a well-regulated, well-armed government force, then it requires them to have weapons as deadly as the machine guns and other arms carried by that force. Not pistols, shotguns, and AR15s.
If your point were discussed more, it would stimulate discussion of another question which is too often ignored.
The ability of the people to defeat well-regulated armed forces depends not only on possession of arms.
It requires also what in the Founding Fathers’ day was called a “well-regulated” combat force. “Regulated” had a different meaning. Back then, it meant well-organized, well-disciplined, well-trained, experienced. It did not refer to the number of pages spewed out in the Federal Register.
A credible threat to tyrants would require not just a large number of homes with powerful weapons sitting in them, even if each of the individual homeowners is able to hit targets with them on Sunday afternoons down at the range.
The states have already got militias (the Guard) which are well-regulated, combat-hardened, and well-armed enough to put up a nasty fight against the US Government’s troops. We wouldn’t win a fight if it came to that, but the friends and families of our dead and injured would represent a lot of the votes which keep the two parties’ pols in power. And regular troops wouldn’t fire on their high school chums in the first place. There’d never be a fight because they’d back down, I think. Even Trump would.
That’s if the people were to succeed in taking control of their militias away from the national government. That’s a political challenge, not a military one. A young generation that is unwilling to vote for freedom won’t be willing to die for it.
Finally, except as individual elected officials, we want doctors’ hands as far away from the levers of power as possible.
Read em’ and weep, courtesy of Kim at Splendid Isolation:
And:
Tools that multiply their effectiveness, like cars?
The problem with any solution developed by people who hate guns is they inevitably limit access to people who are not violent, mentally ill, or excons.
Edited to add: Also…
Even if a “well-regulated militia” was referring to government rules, it’s the militia that is to be “regulated,” not the arms. The implication, of course, is that you won’t have a well-regulated militia, if you infringe on the right to own and carry weapons. Sadly, too many flip the meaning around, and claim the amendment calls for the arms to be regulated, in the current sense of that word.
From The Heritage Foundation (emphasis added):