I, like most people in this country, no matter what your racial or sexual biases, were horrified by the killings in Orlando. But the rhetoric from Hillary, Trump and the politicians all make me truly ill.
The question has extreme importance in medicine and healthcare, especially since there is a push in the powers that be in the government to make physicians responsible for questioning our patients as to whether they had guns and to use this as part of the physician interaction and quality measures in our practice. As if we physicians need another job besides managing their diseases, etc. !!
US News staff writer Kimberly Leonard commented that physicians often don’t ask patients whether they have a gun at home, but a group of doctors say it’s time to start.Dr. Garen Wintemute, director of the violence prevention research program at the University of California—Davis wrote recommendations for discussing gun ownership with patients in an article published Monday in the Annals of Internal Medicine. They recommended that doctors first ask during routine screening whether a patient keeps a gun in the house. If the answer is yes, they directed a doctor to ask whether the gun belongs specifically to that patient and then ask whether the gun is loaded or locked up.
This type of screening is consistent with the position of various medical associations, including the American Medical Association, which has called for gun violence to be treated like a public health issue. The group has likened the gun issue to safety discussions about swimming pools or lead paint. Gun rights groups say the approach is a way to restrict Second Amendment rights and have said doctors are not experts on gun safety.
Authors in Monday’s article acknowledged that physicians needed to be trained on the subject, given that one of the main reasons doctors don’t ask about firearms is that they don’t know how to talk about safe gun storage. Further, the authors also admit that few studies have been conducted to show whether this kind of screening is effective in reducing violence. Also, more important, we are involved in caring for the patients that are being shot.
In addition to lack of training or fear of offending patients, doctors hesitate to ask patients about gun ownership because they think it is against the law. The authors note in their article, however, that no federal or state law bars doctors from asking patients about gun ownership when it is relevant to their health or to the health of others. Laws also do not prevent doctors from sharing that information with police or family members when someone might be in danger.
Still, some state and federal laws do address gun ownership questions. Doctors in Montana may not refuse health care for patients who will not answer questions about guns. In Missouri, doctors cannot record information about patient gun ownership unless a doctor believes the information is medically relevant. Minnesota prohibits its exchange, on which private health insurance is sold, from collecting information about gun ownership.
Even President Barack Obama’s health care law, the Affordable Care Act, prohibit wellness programs from requiring that doctors collect information about gun ownership. A law passed in Florida in 2011, which some have called a “gag law,” says doctors should refrain from asking about guns and may not intentionally enter information about gun ownership into a medical record. The law is being contested, but its language also allows doctors to ask about guns when they believe they pose a risk to the health and safety of the patient or of others.
Authors of the article recommended doctors start asking about gun ownership, if not routinely then particularly among patients who have a history of violence, including expressing a desire for suicide, or for those who show risk factors for violence, such as drug or alcohol abuse.They also recommended doctors consider the demographics of patients in determining whether to ask about gun ownership. Most gun deaths are suicides, which occur primarily among white men. The most frequent victims of gun homicides are young black men. In 2014, 33,599 Americans died from gunshot wounds.
Dr. Manny Alvarex of Fox News wrote, “In a tearful address to the nation on Tuesday, President Obama sought to deliver on a promise he made to the American people in the wake of the horrific Newtown, Conn., shooting in 2012 by taking executive action for stronger gun control laws. Part of the plan for what the Obama administration calls “common-sense gun safety reform” involves enabling health care providers and certain state agencies to report the identities of patients suspected to have mental health issues to the National Instant Criminal Background Check System (NICS) without violating the Health Insurance Portability and Accountability Act, or HIPPA, which has been the law of the land in medicine for quite some time.
So any doctor who accepts Medicare or Medicaid payments will now be allowed to report certain demographic information identifying patients they believe to be subject to a federal “mental health prohibitor,” thus preventing them from possessing a firearm.
Personally, I’m sick and tired of physicians being placed in the middle of government politics and using us for political agendas that have nothing to do with being a doctor. This latest law allowing doctors to report on individuals suspected of suffering from mental illness is inefficient at best.
Gun control is a legal and political problem that should be fixed by Congress and federal rulings— not a problem to put on the shoulders of health care professionals. There are laws in the books that we as physicians have grown up with that do not allow us to share personal and clinical information about a patient with anybody else without written consent. In other words, I cannot even talk to another medical colleague about a patient’s condition without that patient’s consent. But somehow, the president seems to be suggesting that if we even think a patient is suffering from mental illness, we should report them.
Since 2013, Medicare and Medicaid have suggested patients be asked about gun ownership at their doctor’s visits. Even when that recommendation came out, I couldn’t figure out why. But this latest superficial suggestion is not only dangerous but also inappropriate.
First, not all physicians are qualified to diagnose mental health. To diagnose mental health, credentialed doctors must perform specific tests. I hardly think that a kidney specialist is qualified to make a diagnosis of schizophrenia. Now, I have nothing against kidney specialists, but we all go into different fields to focus on certain parts of the body! I believe we could be getting into murky waters with the proposed legislation as it could potentially compromise the credibility of otherwise innocent citizens.
Thanks to the emergence of the black market, gun violence is overwhelmingly committed with firearms that are obtained illegally. Everybody knows that. As it has been suggested by many of my colleagues here at Fox News who are better qualified than I am to discuss this issue, stricter federal court rulings to punish crimes where a gun is used should be placed on the books by the federal government. But this is not part of the president’s plan.
Now, I’m not denying that we have a problem here. I understand how devastating it is for families and communities to continue to deal with these horrific tragedies that are occurring in schools, at work, in shopping centers, etc. Something must be done. Better gun control must be instituted, but I believe it should first tackle the biggest problem: illegal guns. I’m also hoping that as the federal government and the Obama administration continue to debate how to keep America safe, that they pay better attention to mental health treatments and options for patients which— even with the proposed $500 million in federal funds— are still incredibly limited.
Doctors just want to be doctors. We want to deal with science and cure people of their ailments. We don’t want to be policemen for the federal government. And the sad thing is that with the exception of the American Psychiatric Association, I have not seen much coming from medical societies in this country on whether doctors should be part of the gun control policies that the president wants to institute? I’ll tell you what my answer is: No, we already have enough to do, and if we continue to put more of a burden on our doctors, we’re not going to have a lot of them left.”
Julie Barzilay, Dr. Laura Johnson, Gillian Monhney review puts things into perspective and that the U.S. Centers for Disease Control and Prevention studies a variety of public health threats every year, from infectious diseases to automobile safety. But for 15 years, the CDC has avoided comprehensive research on one of the top causes of death in the U.S.: firearms.
Again, to repeat-the top cause of death in our Country is: firearms and not Zika virus or Ebola or cancer or heart attacks. While the CDC keeps surveillance data on gun injuries and deaths, it has not funded a study aimed at reducing harm from guns since 2001. The CDC estimates that firearms are one of the top five causes of death in the U.S. for people under the age of 65, so advocates of gun safety say the lack of comprehensive research is particularly glaring.
The dearth of research funding goes back to 1997, when an amendment was added to an operations bill that passed in Congress with the language that the CDC will be barred from any research that will “advocate or promote gun control,” CDC spokeswoman Courtney Lenard told ABC News.
Called the Dickey Amendment after Rep. Jay Dickey, a Republican from Arkansas who served from 1993 to 2001, the amendment is often called a ban, but it did allow for research on injuries or deaths from firearms. However, Lenard pointed out that after the amendment, Congress cut funding for the CDC by the exact amount that had been spent on gun research in the year before. While that $2.6 million in funding was eventually restored, it was earmarked for traumatic brain injury research, according to a 2013 article in The Journal of the American Medical Association.
The CDC still focuses on surveillance of firearm deaths, but the steps taken by Congress have effectively blocked expansive CDC research on the public health effects of firearms, the CDC spokeswoman said. “CDC’s Injury Center has very limited discretionary funding to dedicate to firearm violence research and prevention,” Lenard said in a statement to ABC News. In 2012 the language in the Dickey Amendment was expanded to include all aspects of the Department of Health and Human Services, the CDC’s parent department. In fiscal years 2014 through 2017, President Barack Obama has asked for $10 million for research into firearms, according to the CDC.
The CDC’s budget for the National Electronic Injury Surveillance System–All Injury Program (NEISS-AIP), which tracks data on all injuries nationwide, including firearm-related ones, is about $50,000 a year, Lenard said. There are other surveillance systems, including the National Vital Statistics System and the National Violent Death Reporting System, but it’s difficult to pick out the cost of monitoring firearms deaths specifically.
The money spent on surveillance is a small fraction of the overall budget. According to its $7 billion 2016 operation plan, the CDC allotted $11 million for research and prevention of arthritis and $6 million for research into prion disease, a fatal illness that affects an estimated 300 people in the U.S. each year, according to the Johns Hopkins Medicine Health Library.
The effects of firearms on public safety have increasingly become a concern for public health experts. The American Medical Association voted on Wednesday to expand its policy to include support for waiting periods and background checks for all firearms, not just handguns. Earlier this week, the association called firearm violence “a public health crisis” and called for lawmakers to relax the Dickey Amendment so that the CDC can conduct meaningful research to understand the effects of firearms on public health. The group said it plans to lobby Congress to restore funding to the CDC for research into firearms as it relates to public health.
“With approximately 30,000 men, women and children dying each year at the barrel of a gun in elementary schools, movie theaters, workplaces, houses of worship and on live television, the United States faces a public health crisis of gun violence,” AMA president Dr. Steven J. Stack said in a statement this week.
“Even as America faces a crisis unrivaled in any other developed country, the Congress prohibits the CDC from conducting the very research that would help us understand the problems associated with gun violence and determine how to reduce the high rate of firearm-related deaths and injuries,” he added. “An epidemiological analysis of gun violence is vital so physicians and other health providers, law enforcement and society at large may be able to prevent injury, death and other harms to society resulting from firearms.”
Dr. Mark Rosenberg was the director of the National Center for Injury Prevention and Control at the CDC at the time that the Dickey Amendment was passed and funding for gun research was taken away. He told ABC News that without comprehensive firearm-injury research, public health officials cannot give research-based advice for reducing deaths and injuries associated with firearms use.
“There are basic questions … How do you get people to buy gun safes? How do you get people to store guns unloaded?” Rosenberg told ABC News. “Can firearms instructors who teach shooting also teach safe storage? Will that work? We don’t know.” Similar to how automobile-related deaths have steadily decreased in recent decades thanks to safety measure like airbags, seat belts and anti-lock brakes, Rosenberg said, science could be used to help reduce injuries and deaths associated with firearms in the U.S.
“We’re trying to do two things at the same time with interventions,” Rosenberg said of both reducing harm from firearms and complying with the Second Amendment. “It’s like treating a cancer patient with chemotherapy and you can treat them with chemotherapy and stop the tumor but at a certain point you kill the patient’s vital organs. The only way you can find the answer to what is a better chemotherapy is to do research … You can’t figure it out in your head.”
Many of the current proposals from both conservative and liberal policymakers are not based on sound science, Rosenberg said, because there have been few comprehensive firearm studies in the U.S. since shortly after the Dickey Amendment. Rosenberg, who is now the president of the nonprofit public health group Task Force for Global Health, pointed out that proposals such as arming every teacher or taking away assault rifles are not based on sound science.
“Doing the research suggests how people can have their guns and keep their communities safe,” he said. “You can’t lock up the science for 20 years and try to proceed by yelling.” Because some studies had been approved and funded before the Dickey Amendment, the CDC released multiple comprehensive studies on the effects of firearms on public health up until 2001. However, for the last 15 years, the CDC’s studies have relied on basic surveillance data.
Mary Woolley, the president of Research!America, a nonprofit organization that advocates for making medical and health research a higher national priority, pointed out how public health research has saved hundreds of thousands of lives, from diminished tobacco use to increased use of bike helmets and additional safeguards to reduce child drownings in pools.
“Swimming pools [are] a good example of minimizing tragic deaths from toddlers … They didn’t have fences around them” until studies showed they were safer with fences, Woolley explained. “Nobody thinks that we’re going to eliminate hazards. That’s not the point. It’s to minimize dangers from things that we need and enjoy.” She said public health is about finding ways to make life safer, not about eliminating risk.
“I think that firearms fall into both of those categories,” she said. “We need them, they’re protected by the Bill of Rights, can be enjoyable … But it doesn’t need to be dangerous.” “It’s really hard to know why we’re waiting,” Woolley said. “You want to know your Congress is doing everything in their power … It’s about figuring out how this can be a much safer environment.”
Even the man who lent his name to the Dickey Amendment has found the lack of CDC research chilling. In a joint op-ed that he wrote with Rosenberg in December 2015 in The Washington Post, they advocated for research.
“We have also come to see that gun-violence research can be created, organized and conducted with two objectives: first, to preserve the rights of law-abiding citizens and legal gun owners and, second, to make our homes and communities safer,” Dickey and Rosenberg wrote. “Well-structured research can be conducted to develop technologies and identify ways to achieve both objectives. We can get there only through research.”
What I don’t get still, is why we are protecting gun owner from using the type of weapons that in no way do they need for recreation, or even to protect themselves. Assault rifles just don’t belong in our homes or on the market. However, I realize that many of the assault weapons can be bought through illegal means and sometimes-just click on the Internet site and without any or minimal checks you have your weapon of choice, either delivered or pick it up at the mall! And I realize the guns don’t kill people, people kill people. But the guns are the vehicle that allow the person to complete the action of murder!
The British Journal last March came out with a study and the suggestion was to reduce firearm mortality; the study’s authors say the federal government should focus on implementation of universal background checks and firearm identification nationally. Such a move, the study’s findings show, could cut the rate of gun deaths by more than 90 percent. “It’s pretty clear to me that we will drop firearm mortality if we implemented those legislation nationwide,” says Dr. Sandro Galea, one of the study’s authors and dean of the Boston University School of Public Health.
The problem is the unending politics, politicians and special interest groups weighing in and blocking any and all progress this keep this epidemic growing. One of my suggestions is that each gun manufactured, even the ceramic, composite and plastic should all be required to have RFID chips embedded in the gun to allow tracking and data analysis. This is a very inexpensive first step and would allow us to look carefully into some of the clear and present dangers.
To do nothing except study and to blame each other, ISIS/ISIL, jihad terrorists, the police, blacks, Hispanics or whites or force physicians to tabulate gun owners does nothing to slow or even halt the violence that we continue to see both day and night in our cities and even yes, Moms and DADs (remember this is Father’s day) in our safe suburbs and towns.
How many more of our sons and daughters do we sacrifice to the politicians and special interest groups???? This is a relevant topic for Father’s Day in which we all agree that the father’s responsibility is to protect our family and so we must move forward and not simply tread water waiting for the next group of massacred bodies to be reported.
Happy Father’s Day to all of the Fathers out there. Enjoy our special day!