The ‘Consensus-Based’ Approach To Gun Violence Is Wrong.
Now that physicians no longer have to fear being
prosecuted for talking to their patients about guns, a whole cottage industry
appears to have sprung up within the public health and medical communities to explain
to doctors how they should talk to patients about guns. Because most doctors
don’t own guns, and while the medical associations have all issued statements
deploring gun ‘violence,’ such statements don’t give doctors any real insights
into talking about a particular consumer product found in many of their
patients’ homes. It’s easy to talk about seatbelts – every doctor drives a car.
It’s not so easy to talk about guns.
Now it just so happens that guns as a medical risk has
been understood for more than twenty-five years, thanks to the two New
England Journal of Medicine articles published
by Kellerman, Rivara and colleagues in 1993 and 1994. When these two articles
appeared, Gun-nut Nation went on the offensive, a political assault which
included getting CDC gun-research money thrown out. Nevertheless, from a
medical point of view, what Kellerman and Rivara said back then still stands
now.
If only
the current-day physicians clamoring most loudly for increased concern about
gun violence would follow the evidence-based findings of Kellerman and Rivara –
but they don’t. Instead, the narrative being promoted within the medical
community is to take a ‘consensus-based’ approach to counseling patients about
guns.
With all due respect to my many friends in the medical
and public health communities who are trying to find some way to reduce the
125,000+ intentional and unintentional gun injuries which occur every year,
this ‘consensus-based’ approach
is not (read: not) supported by any evidence-based research. Instead, it
reflects the adoption of a narrative designed to shield these physicians from
what they believe would otherwise be another assault from Gun-nut Nation and
the alt-right.
If doctors actually believe that by saying they respect
the ‘rights’ of their patients to own guns, they will somehow protect
themselves from criticism from gun-rights groups, they have absolutely no idea
how Gun-nut Nation views any attempt to question access to guns, particularly
by people who, for the most part, don’t own guns. Much of the evidence-based
data on gun violence comes from solid studies done at the Bloomberg
School. That’s B-L-O-0-M-B-E-R-G. You think there’s a single gun owner out there
who would ever believe anything coming from a program funded by the person now
being referred to in gun magazines and gun blogs as the head of the ‘nanny
state?’
And once the physician who wants to counsel his patients
on gun risk makes it clear that he ‘respects’ the patient’s ‘right’ to own
guns, he then can continue building his consensus-based approach by telling the
patient that all he has to do is safely store his guns. To be sure, there are
studies which find that when patients are counseled about safe
storage, they go home and sometimes store their guns in a safer and more secure
way. Is there one, single study which compares before-and-after safety
counseling to changes in gun-violence rates? Not one. The assumption that safe
storage leads to a significant decrease in gun violence is a nice idea, but medical
treatments and counseling aren’t based nice ideas.
Let me break it gently to all my medical friends who
find it easy and convenient to believe that once they tell a patient to go home
and lock up his guns, that they have done what they need to do in this area of
public health. The Kellerman/Rivara
studies which indisputably found both a suicide and homicide risk from guns in
the home did not – ready? – did not find any significant difference between
stored and unstored guns. A slight difference perhaps in suicides; no
mention of storage issues in homicides at all. Nor is there any mention about the
need to be concerned about those beloved 2nd-Amendment ‘rights.’
Take it from a lifetime gun-nut like me. Want to reduce
gun violence? Cut the bullsh*t. Get rid of the guns that create this violence –
semi-automatic pistols, assault rifles and tactical shotguns.
That would only leave about 250 million guns floating around the United States. That’s not enough?
