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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