The yin and yang of gun policy

yinJust like the current political situation has left many of us, and I would suggest, the entire country reeling in confusion and chaos, so, too, gun policy has done the same. The gun  lobby is set to overturn just about anything that makes common sense when it comes to gun policy. A bill which passed through both houses of Congress and set to be signed by our current President, undid something our last President did to try to stem the tide of gun violence. President Obama’s executive order was meant to keep people with very serious mental health disabilities from being able to legally purchase guns by placing their names on the list of prohibited purchasers in the National Instant Check System. It was not meant as an evil attempt to confiscate guns or take away anyone’s rights to own guns who should be responsible with guns.

But, as these things go, it got caught up in the politics of gun policy. I found this article by Josh Horwitz of the Coalition to Stop Gun Violence to be a very good summary of the provision and where we are now. Let me quote from what he wrote for Huffington Post:

I have felt this discomfort listening to the recent public debate about the Social Security Administration (SSA) rule that prohibited those with a mental health disability and an appointed representative payee from purchasing or possessing firearms. The policy, which Congress recently voted to repeal, was the Obama administration’s effort to keep guns out of the hands of dangerous people. President Obama deserves a lot of credit for doing everything in his power to reduce America’s gun violence epidemic. Unfortunately, by focusing the prohibition directly on a mental health disability, the rule furthered the mistaken belief that mental illness is a major cause of violence. (…)  I have felt this discomfort listening to the recent public debate about the Social Security Administration (SSA) rule that prohibited those with a mental health disability and an appointed representative payee from purchasing or possessing firearms. The policy, which Congress recently voted to repeal, was the Obama administration’s effort to keep guns out of the hands of dangerous people. President Obama deserves a lot of credit for doing everything in his power to reduce America’s gun violence epidemic. Unfortunately, by focusing the prohibition directly on a mental health disability, the rule furthered the mistaken belief that mental illness is a major cause of violence.

Certainly the efforts of the gun lobby to overturn a provision meant to be life saving are fraught with the past history and statements of those in the lobby who have claimed that we ought to just center our efforts to prevent gun violence on mental illness:

Senator Charles Grassley, Republican of Iowa, envisioned people with “an eating disorder” being barred from buying a gun. To the contrary, the rule was focused narrowly on disabled individuals who require a trustee for personal management. They would have had the right to appeal. Senator Grassley himself noted last year the flaws in the background check database when he proposed greater cooperation among federal agencies with relevant information.

“The Republicans are so hypocritical on this issue,” said Senator Christopher Murphy, Democrat of Connecticut. He has fought for both stronger gun controls and better mental health care in the aftermath of the 2012 school massacre in Newtown, Conn. A mentally troubled individual used a legally purchased assault weapon and shot to death 20 children and six school workers. The disability rule was a response to that tragedy after Congress refused to tighten gun safety laws.

Ah- the hypocrisy.

Sigh.

And so, this provision, though not perfect, was centered on the concerns that some people are, indeed, potentially dangerous to themselves or others. There are ways to deal with this conundrum and public health and safety concern without throwing the proverbial baby out with the bath water. Horwitz suggests Gun Violence Restraining Orders or, in Minnesota, a proposed Gun Violence Protection Order bill, to deal with concerns that family members have about a loved one who could become dangerous if they have access to a firearm.

The article ends like this:

Prohibitions on gun ownership are critically important. The United States’ gun laws include far too many loopholes that allow dangerous people to do harm. But the laws we support should be based on research and focused on dangerous behavior – not genetics, not diagnoses. If we want our movement to succeed, a data-driven strategy is the only way forward.

Yes. We have work to do. It does not have be either/or. It should be a rational discussion about how we can save lives and protect families and communities from insidious gun violence that takes the lives of 33,000 of us- most due to suicide.

All of this is the opening salvo in what will surely be attempts by the corporate gun lobby to weaken gun laws in the states and through federal legislation. We will not be safer as a result.

And that is why we need to recognize the risk of guns in the home and guns in the hands of people who could become dangerous to themselves or others. So the other side of this week’s gun policy was a Florida court decision that overturned a previous Florida court decision that allowed the bill, nicknamed “Docs vs. Glocks”, to stop physicians and healthcare providers from talking to patients about the risks of guns to their families. Just as physicians, physician assistants, nurses ask questions about whether we feel safe in our homes when going for our annual physicals, they should be able to ask about guns. They ask about smoking, alcohol use, bike helmets, stored poisons, seat belts, child car seats, and many other things that could cause harm to our health or well being.

From the above-linked article:

Stop for a moment and consider that the Second Amendment injury here lies not in the possibility that a physician can do anything to take away anyone’s gun, but in the outside chance that she will use her knowledge of actual medical evidence to suggest that guns can kill people and her patient might listen to her. This is literally an argument for a constitutional right not to learn stuff from people who know stuff because you might then feel bad about the stuff you own.

It is a fact that firearms injuries take the lives of almost as many, if not more of us than auto accidents. Domestic shootings take the lives of far too many (mostly) women. Gun suicides are a very real risk to families.

So the recent ruling was a victory for common sense and first amendment rights of those who provide healthcare to practice their profession as they were taught and as they are charged to do by their Hippocratic Oath.

Lawyers for the Brady Center were involved in this case and did a great job of defending the rights of professionals to do their jobs and to keep us safe from devastating gun violence. More toddlers have shot Americans than terrorists. Isn’t this a national public health and safety epidemic? Is there any rational reason to keep this from happening however we can?

Below is from the Brady Center’s statement, in its’ entirety,  about the ruling:

Today, in a landmark decision with national repercussions, a federal appeals court struck down an NRA-backed Florida law that restricted doctors from talking to their patients about the risks of guns. The decision by the full panel of the United States Court of Appeals for the 11th Circuit in Atlanta is a victory for the Brady Center to Prevent Gun Violence and Ropes & Gray, who brought the lawsuit on behalf of doctors who believed the law violated their First Amendment rights.

Wollschlaeger v. Scott was filed on June 6, 2011, challenging the Florida law, under which doctors can be censored, fined, and have their licenses to practice medicine revoked if the Florida Board of Medicine found they violated the law.

Dan Gross, President of the Brady Center to Prevent Gun Violence, said, “The gun lobby and its lap dogs don’t want Americans to know the truth about the danger of guns in the home because it will hurt their bottom line. The fact is, guns are far more likely to kill a child or family member than protect them. We are pleased the Court recognized Americans have a constitutional right to hear the truth about guns, and the gun lobby has no right to silence doctors or keep patients in the dark. We will continue to work with the medical community to get the truth out, to protect American children and families from the scourge of gun violence.”

Jonathan Lowy, co-counsel in the case and Director of the Brady Center to Prevent Gun Violence’s Legal Action Project, said: “Today’s ruling is an important victory for public safety and free speech rights, and a crushing defeat for the corporate gun lobby and the politicians who do its bidding. Politicians and special interest lobbies have no business standing between doctors and their patients, or keeping doctors from telling people the truth about the risks of guns or other products. Doctors have the right to decide how best to advice patients about risks that may endanger their families, and parents have a right to full information so they can make smart, informed decisions about how to keep their families safe.”

Ropes & Gray partner Doug Hallward-Driemeier said, “This decision is critical to the health and safety of Florida families. It makes clear that the First Amendment does not allow the government, on the basis of politics, to interfere with a doctor providing her best medical advice to her patient.”

Nancy Evans, Brady Campaign Sarasota Chapter president, said, “This is an incredible victory not only for Florida doctors but for our entire nation. I joined the fight a year ago because I believe our doctors should be able to have any conversations necessary to keep their patients healthy and safe. I am so thankful the court struck down this terrible law.”

The lawsuit was brought by the Brady Center to Prevent Gun Violence, the firms law Ropes & Gray LLP and Astigarraga Davis, on behalf of individual Florida doctors, as well as organizations representing 11,000 Florida health care providers, including the Florida Pediatric Society/Florida Chapter of the American Academy of Pediatrics, the American Academy of Family Physicians, Florida Chapter, and the American College of Physicians, Florida Chapter. Douglas Hallward-Driemeier of Ropes and Gray argued the case as lead counsel for the Plaintiffs.

In 2012, a trial judge in the Southern District of Florida held that the law was unconstitutional and granted a preliminary injunction. In 2014 a divided three judge panel of the 11th Circuit reversed. The full 11th Circuit heard the case en banc in 2016.

Numerous studies have proven that a gun in the home actually makes its residents less safe — 89% of unintentional shooting deaths of children occur in the home. The reality is that a gun in the home is more likely to be used in a homicide, suicide, or accidental shooting, than in self-defense. Recent research has shown that one third of all households with children under the age of 18 have a firearm, and more than 40% of these households store their guns unlocked.

So there we have it. The yin and yang of gun policy in America. I believe these opposing views of our world affect almost all of us. Who among us does not have a family member or a close friend who we feel could be, perhaps temporarily, potentially dangerous if they have access to a firearm? Who among us does not trust their physicians or healthcare providers to do what they were trained to do professionally to keep us healthy and safe?

If you want to understand the wide ranging ripple effect of gun violence and the financial, emotional and physical toll it takes on individuals, families, communities and our health care system ( which costs us all financially) take a look at this amazing story of a man who received a face transplant at the Mayo Clinic in Rochester, Minnesota after attempting a gun suicide. Ironically his new face came from another young man who died from gunshot injuries in a gun suicide.

This is an emotional story at the least…. the ripple effect of gun violence.

There are no evil motives here. There are only sincere and fact-based attempts to prevent gun violence and the effects it has on our families and communities.

But we have a world where it’s us vs. them with no common sense conversation or policy in the middle. We are talking about our families and our children and grandchildren. Let’s look at what the true interests are on both sides of this issue and come down on the side of public health and safety, not profits or power.

 

 

Under the gun- getting our heads out of the sand

head_sand_110731When Congress and the gun lobby can decide for the nation that an agency that studies and makes recommendations about public health issues should not study gun violence, we have a serious problem. One wonders why it has taken so long for this national disgrace to get the attention it deserves? Why have we let this happen? Because this stuff flies under the radar and the public does not know or understand the extent to which the gun lobby has gone to get its’ way.

After the Sandy Hook shooting in December of 2012, something changed in this country. The gun lobby has been under more well deserved scrutiny than ever before and that scrutiny is not complementary. I’m talking about the fear of retribution about even mentioning the idea that we should study the causes and effects of gun violence, of course.

An article from The Trace examined what is going on at the CDC ( Centers for Disease Control) and found some known and unknown facts that should concern us very much if we care about saving lives and preventing the devastation of gun violence. From the article:

“It was the leadership of CDC who stopped the agency from doing gun violence research,” Mark Rosenberg, a founder of the CDC’s National Center for Injury Prevention and Control, the division of the agency responsible for its work on the subject, tells The Trace. “Right now, there is nothing stopping them from addressing this life-and-death national problem.”

How much latitude the CDC has to pursue gun violence research is hardly an academic argument. The CDC is the nation’s leading public health agency, with a yearly budget of more than $11 billion. The failure of the CDC to invest in studies of gun violence has greatly inhibited the ability of social scientists, law enforcement agencies, and policymakers to understand the scope and causes of shootings — while also limiting understanding of interventions that might save lives.

How could this happen in a country that values research and being on the leading edge of solving public health problems?

The CDC was one of the first agencies to study gun violence as a public health issue. In 1992, Rosenberg and five colleagues launched the Division of Violence Prevention at the Injury Center, operating out of a converted men’s room with a yearly budget of around $260,000. Without any political impediments, they began to focus on identifying the root causes of firearm deaths and the best methods to prevent them.

One of the first studies that the division funded was “Gun Ownership as a Risk Factor for Homicide in the Home.” Published in the New England Journal of Medicine in 1993, the research found that the mere presence of a gun in a home increased the risk of a firearm-related death by 2.7 percent, and suicide fivefold — a “huge” increase, according to Rosenberg.

The NRA was furious about the findings, which it viewed as biased. The gun organization launched a campaign to shut down the Injury Center, an effort soon joined by two conservative groups led by pro-gun medical professionals,Doctors for Responsible Gun Ownership and Doctors for Integrity and Policy Research. The latter famously called CDC investigators “liars masquerading in lab coats.” The NRA and the conservative doctors’ groups began pressuring members of Congress to stop the CDC’s gun violence research. By 1995, eight senators had signed on to the cause. The next year, 1996, Republican Representative Jay Dickey of Arkansas introduced the amendment bearing his name as a rider to an appropriations bill.

Notably, the Dickey Amendment did not immediately lead to a total stoppage of gun violence research by the CDC, as Satcher kept a few existing initiatives alive. But when Satcher left the CDC in 1998, Rosenberg says, his departure marked the end of substantive gun research at the agency. The new director, Jeffrey Koplan, had little interest in continuing the agency’s work on gun violence prevention, Rosenberg says.

 Ah. Now it makes sense. Or not. More…

In his 2017 budget request, President Obama requested $10 million specifically for gun violence research at the CDC — which works out to roughly 0.1 percent of the agency’s total funding allotment. Rosenberg believes that rather than waiting for a Republican-controlled Congress to grant Obama’s request, the CDC could immediately divert that sum from other programs to jumpstart new studies.

“They could do that in the blink of an eye,” he says.

Satcher, the CDC director who sought to shield gun research from cuts, says he understands Rosenberg’s viewpoint — but also knows firsthand how political realities can shape agency policy.

“I think it could be feasible, but the question is, how would it affect their budget?” he asks. “How would Congress punish the CDC for that? It would be easy for me to criticize the CDC, and I’m tempted to do that. But I also know the kind of risks they’re facing.”

Ok. Now we are getting at the truth of the matter. The CDC would be punished by Congress for using money in its’ budget for research into the causes and effects of gun violence.

Sigh.

So it’s a risk to study gun violence? And if the research shows that it’s a risk to have loaded guns lying around at home, what does that mean for the public health and safety? What does that mean for the corporate gun lobby and gun manufacturers? What does that mean for the American gun culture? And most important of all, what does that mean for saving lives? Hmmm.

Where is common sense? Why would one lobby group get to decide on vital national research into the causes of one of our nation’s most serious national public health epidemics. For what other cause takes the lives of 30,000 Americans and doesn’t get the attention and the concern it should have? And why is a lobby group so afraid of what the research would divulge if given a chance? What would be the result? Would Americans begin to take their heads out of the sand and see that guns in homes are an actual risk to their families and communities? How awful would that be? Perhaps only 20,000 Americans would lose their lives to bullets or suffer from fewer injuries that cost us all billions every year. Would that be so bad?

We already know that the gun lobby does not like Physicians talking to their patients about the risks of guns in the home. They have done in Florida what they would like to do everywhere- punish Physicians for doing their jobs. From the article:

When a Florida pediatrician asked the same question — “Do you have guns in the home?” — during a checkup in 2010, the reply from a mother of three was sharp: None of your business. She objected to the query as “very invasive,”complaining to her local newspaper, “Whether I have a gun has nothing to do with the health of my child.”

And so began what’s come to be known as the Docs vs. Glocks dispute. In 2011, after a lobbying push by the National Rifle Association, Florida passed the Firearm Owners’ Privacy Act, restricting physicians from asking about gun ownership and from counseling about gun safety in routine appointments. Potential penalties include fines, suspension and loss of a medical license. A federal judge blocked the law as an unconstitutional restriction of doctors’ speech. Then an appeals court panel overturned the ruling, emphasizing patients’ rights to own guns and to privacy.

This Florida case is just the latest example of how the politics of guns have affected physicians’ ability to bring science to bear on what experts can see plainly: That gun violence is a public health issue. The full U.S. Court of Appeals for the 11th Circuit is now preparing to hear the case, and legislators in at least 12 states have expressed interest in similar bills. So it’s worth correcting what lawmakers and the court panel misunderstand about the doctor-patient relationship and about the relevance of firearms to pediatric care — in a country where more than 2 million children live in homes with unsecured guns.

There are reasons for health care providers to discuss common safety and risk factors with their patients and patients’ families. More from the article ( written by a Pediatrician for the Washington Post):

But beyond responding to immediate warning signs, responsible doctors need to be able to counsel patients on matters that pose the greatest statistical risks to their health and well-being. Heart disease is the leading cause of death in Americans 65 years and older, so doctors talk to their elderly patients about healthy eating habits, regular exercise and smoking cessation. For children between the ages of 1 and 14, the leading cause of death is unintentional injury, a category that includes car accidents, suffocation, burns, drowning and gunshot wounds.

As pediatricians, we counsel parents about all of these issues. We explain how to properly install car seats. We caution against children playing with plastic bags. We teach about safe water temperature. We discuss safety around pools.

Gun safety is no different from any of these topics. Comprehensive numbers on gun accidents are hard to come by, in part because National Rifle Association lobbying and limited funding has deterred the Centers for Disease Control and Prevention from conducting firearm research. But outside research found that in 2015, children accidentally shot themselves or someone else at least 278 times, averaging more than five times a week. By some estimates, keeping guns locked up and unloaded could prevent 70 percent of unintentional shooting deaths among children.

Sometimes parents aren’t aware that their gun storage practices are unsafe. During one recent appointment at our clinic, a mother said she wasn’t sure if there were any guns in her home. Her father is a police officer, she said, and there might have been one or two in a closet. In a 2006 study published in the Archives of Pediatrics and Adolescent Medicine, nearly a quarter of parents who reported that their children had not handled a household gun were contradicted by their children.

Would it be so bad to recognize that suicide by gun takes more lives than homicide by gun? Would it be so bad to admit that too many self proclaimed “law abiding” gun owners are leaving guns out for children and teens to access, causing avoidable and totally senseless loss of life? Would that be so bad?

Until we make this one of our most important issues and the focus of attention and research, the devastation of gun violence will continue unabated. Until the corporate gun lobby comes forward to help do something about this public health and safety epidemic, they can’t be taken seriously when they claim that they teach safety with guns.

In case you haven’t noticed, it isn’t working. Kids are still getting their hands on guns and killing or injuring themselves and others. Domestic abusers are still gaining access to guns and shooting intimate partners on a regular basis. Teens and older males are still shooting themselves in suicides that don’t have to be but continue because of easy access to guns- the method most often used and most effective for the taking of one’s own life. Our military members will still be shooting themselves because of lack of services, PTSD, depression and battle wounds. In this article about the Minnesota National Guard and the high number of suicides, this quote says what we know but don’t talk about often enough:

Most have been men. The average age of victims was 26 — much younger than the middle-aged males in the general population who kill themselves. The most common cause of death — a self-inflicted gunshot.

Can we talk about this openly without fear of being attacked by the gun lobby? Lives depend on the answer.

Meanwhile, gangs will continue shooting at each other and often taking innocent lives in the process. Law enforcement will still shoot innocent people when it’s not necessary. Armed citizens will roam our streets with guns so law enforcement officers feel the need to protect themselves. People will still come up with ways to manufacture ever smaller, more concealable pistols for public use. The gun lobby will still convince elected leaders with their heads planted firmly in the sand and in the campaign money trough that guns should be carried everywhere we go. Researchers will still be fearful that if they dare consider the idea that we should have a better understanding of what causes most of our gun deaths and how we can prevent them, they will lose their funding or suffer from the offensive and vile vendettas against them from gun extremists.

And those of us who are publicly writing, speaking and taking actions against the gun violence that is so obviously a public health epidemic will still be called names and suffer from the hateful comments from the gun extremists.

But the majority of Americans are now on the side of common sense. That is little solace when their leaders refuse to act on behalf of victims and survivors and do the right thing. Elections are coming soon. Vote for #gunsense and make sure you know how your candidates stand on saving lives and supporting the public health and safety of their constituents. We can’t let the gun extremists win any longer. Threats of violence, fear of a minority of gun owners, attacking candidates who stand with the majority- not acceptable any more.

Take your heads out of the sand. Lives depend on it. We have had #Enough of this nonsense in the name of profit and power. Let’s get to work and demand the change our country deserves.