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Guns are a public health problem

My entire professional life has been practicing internal medicine, primarily cardiology. This was overlapped with two special experiences with guns. The first was the two years that I served in the United States Army Medical Corps during the Vietnam War, when I was instructed in the first version of the M16 assault rifle. The second was serving as a juror in a gun store robbery case in which two robbers and two clerks were alone in the store, all carrying handguns.

Seemingly lost in the conversation following the tragic gun deaths in Newtown, Conn., is the fact that for over two decades multiple physician organizations have published firearms position statements. This includes the American College of Physicians (ACP), which is the association of internists of which I was a member. The fundamental assertion in the ACP stance is “Gun violence and prevention of firearm-related injury and death are public health issues that demand high priority for public policy.” The purpose of this review is to outline the basics of this stance.

Some relevant statistical statements in the ACP paper are: “Despite surveys of firearm owners that indicate they believe guns provide them with protection, studies show that firearms in the home pose more of a threat to members of the household than to intruders (by at least 3:1)...the risk of suicide is fivefold greater...the risk of homicide three times...the greatest risk is from family members and close acquaintances...More teenagers die of gunshot wounds than of all natural causes combined...For every death involving firearms, twice as many victims need hospitalization and five times as many need outpatient care...the financial costs can be staggering...up to $4 billion annually in direct medical costs and $19 billion in indirect costs such as temporary or permanent loss of work.” (Annals of Internal Medicine, Vol. 128, Number 3, 1998. 236 - 241).

Based on such evidence, the ACP Position Paper made 16 recommendations, including the following basic three:

The college favors strong legislation to ban the sale, possession, and manufacture for civilian use of all automatic and semi-automatic assault weapons.

The sale and possession of handguns should be restricted.

Purchases should be subject to a background check...

The response of the gun lobby to such medical recommendations is to dismiss them and argue instead that unrestricted guns in more private hands are the best way to a safer society. The logical question is, however, since the U.S. has the highest per capita gun ownership in the world — six times more than the average of 24 other democratic nations — why do we have over 2 1/2 times more per capita gun deaths than these other countries? Why do we have six times the per capita gun homicides than Canada, and seven times gun suicides of Germany? Japan, South Korea, and Poland, average 1/10 the ownership and death rates of the U.S. The pro-gun argument predicated the opposite relationship — unless “safe” refers to something other than wrongful deaths.

Although assault weapons have justifiably been center stage because of recent tragedies, over 80 percent of gun homicides in the U.S. have usually involved handguns. In the case where I served as a juror, the “slippery-slope” for the defendant began when he exercised his constitutional right to buy one gun a week in rural Minnesota so he could resell them at 100 percent profit on gang-infested big city streets. The robbery to get more guns faster ended up with both armed store clerks shot in the face from six feet away. Laws work against this sort of enterprise, as was demonstrated in the difference between Seattle and nearby Vancouver after Vancouver adopted stricter handgun laws.

Long before Sandy Hook, the American Psychiatric Association pointed out that “...the risk of dangerous violence by persons with mental illness can most cost effectively be reduced with proven methods of prevention and treatment, especially for those who do not have access to care.” Most of the countries with significantly lower gun death rates than the U.S. have universal health care that greatly facilitates such prevention measures. However, newsworthy mass shootings by mentally disturbed persons account for a very small percentage of our 30,000 annual firearm deaths.

For decades the NRA and the AMA have opposed each other on gun issues. The NRA lobby helped kill a CDC research program on gun violence. The NRA didn’t like its study results but would not support supposedly better studies. The NRA also helped pass a Florida law that for privacy reasons prevented physicians from asking patients if they had guns as an occasion to remind them about gun safety. The AMA helped overturn the law.

International statistics demonstrate that despite a few cultural outliers, two of the most important correlates of national gun deaths are per capita gun ownership and the rigor of regulation. The NRA rebuttal of this evidence has been that unrestricted gun rights trump health concerns about collateral deaths and injuries. This approach allowed hundreds of millions of guns to flow into a populace with many careless, thoughtless, lawless, drug- or alcohol-addicted, and mentally ill persons. Now the NRA opposes background checks but expects the healing professions to identify the dangerous mentally ill to solve a problem they fostered. Gun privacy trumps health record privacy.

Gun rights are more legal than moral in that the law generally does not establish positive duties to the extent that ethics does. Slavery was once legal, but it was never moral. The second amendment includes the words “well regulated” but it does not set an ethical per capita “arms death limit.” Many democratic countries have low gun-death rates because part of their commitment to health is that dangerous items should be restricted. One benchmark is their record. Medical ethics is basically first to do no harm, and then produce maximum possible good. Because of political and ethical divides we lack the moral will to set a specific goal of gun-death reduction. Because of all our embedded guns, progress in reducing gun deaths will be slow. But moral duty dictates that change is the right thing.

CHARLES R. “DICK” PETERSON is a resident of Nisswa, a retired physician and a member of the Brainerd Dispatch Editorial Board.