Medical establishment: Your guns are dangerous

David Heitz

Second Amendment rights advocates can rest assured Hillary Clinton won’t be coming for their guns anytime soon.

But the medical establishment may be.

In a massive, unprecedented report on gun safety research, JAMA Internal Medicine published exhaustive commentary, analysis, and research. They posed questions including:

· Should the medical community have a right to counsel patients about gun safety?

· With access to guns a proven driver of suicide, why aren’t we doing more to stop it, and how can we get laws changed to make it easier for us to do that?

· What has been the result of Florida’s “Stand Your Ground” self-defense law?

“Firearm violence in the United States has continued unabated,” JAMA writes in an editorial leading off the series.

“In June 2016, a mass shooting at the Pulse nightclub in Orlando, Fla. killed 49 people and wounded 53 others. As of October 15, 2016, Chicago had recorded more than 570 homicides this year, levels not seen since the 1990s.

“Shootings in which four or more people are injured or killed (including shooters) occur almost daily.”

The study is a few years old. Chicago’s gun violence has worsened.

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After reviewing the research, the oft-heard argument, “Guns don’t kill people, people kill people” still rings true.

However, findings regarding suicide prevention make solid arguments for physicians being able to counsel those at risk of hurting themselves.

The authors reported that if the United States implemented a vast campaign to prevent firearm violence, it would save lives.

“In 2014, firearm injuries were responsible for about the same number of deaths in the United States as motor vehicle crashes,” the authors wrote.

“Although deaths from motor vehicle crashes have substantially decreased since 2000, deaths from firearm injuries have substantially increased, mostly from suicides.”

Accounting for 33,599 U.S. gun deaths in 2014

The grisly death-by-firearm breakdown goes like this:

· Suicide: 21,334

· Homicide: 19,945

· Unintentional: 586

· Legal intervention: 464

· Undetermined: 270

For a total of 33,599 gun deaths in the U.S. in 2014.

Few studies have been conducted about firearm violence.

“From 1985 to 1999, publications increased markedly,” the authors explained. “Soon after the 1996 ban on the Centers for Disease Control and Prevention’s funding for such research, publications plateaued at about 90 articles annually through 2012.”

Research picked up again in 2013 and 2014 after the 2012 Sandy Hook mass school shooting in Newton, Conn.

Federal ‘gun control advocacy’ research banned

In a systematic review of firearm laws and firearm homicides, Dr. Lois Lee and colleagues from Boston Children’s Hospital, Harvard Medical School and Harvard T.H. Chan of Public Health found inconclusive data.

There is no “magic bullet” for stopping the bloodshed, they said.

Stronger gun policies were associated with decreased rates of firearm homicides. Other laws directed at firearm trafficking, improving child safety, or the banning of military-style assault weapons were not associated with changes in firearm homicide rates.

The authors called for better research and more funding for such research, as did the accompanying JAMA editorial.

“Given the 19,000 deaths from firearm homicide each year, many of which are preventable, it continues to be a national shame that the United States does not fund sufficient robust research to inform this public health imperative and establish which types of firearm laws work.”

An analysis of Florida’s ‘Stand Your Ground’ self-defense law

In an original investigation, researchers from University of Oxford, London School of Hygiene and Tropical Medicine, and University of Pennsylvania, Philadelphia, examined whether Florida’s “Stand Your Ground” self-defense law had an impact on homicides.

“Throughout the United States, the application of lethal force as a means of self-defense is governed by criminal law,” the authors wrote. “Since the colonial era, it has been an individual’s ‘duty to retreat’ from perceived threats before resorting to any use of force.”

Florida’s law removed that “duty of retreat” when a threat is made on a person’s property, as almost half the states have. Florida’s law went further and removed “duty of retreat” when threats are made in public places.

“Advocates of the laws suggest that the increased threat over retaliatory violence deters would-be burglars, resulting in fewer intruder encounters,” the authors wrote.

“Critics are concerned that weakening the punitive consequences of using force may serve to escalate aggressive encounters," they said.

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“They also argue that these laws may exacerbate racial disparities in homicide where threats motivated by racial stereotypes produce unnecessary fatalities.”

The role of physicians in preventing firearm suicides

Perhaps the strongest arguments made in the JAMA firearm series are for finding ways to better prevent firearm owners from committing suicide.

Ironically, states with some of the strictest gun control laws have made it difficult to transfer ownership from a suicidal person to someone else, even temporarily.

In a “Special Communication” in the JAMA series published by Alexander D. McCourt of Johns Hopkins Center for Gun Policy and Research and Johns Hopkins Bloomberg School of Public Health and colleagues, policies in Maryland, Colorado, and California are examined. All take different approaches to firearm transfers.

Suicides account for about two-thirds of firearm deaths in the United States. It affects all ages.

The letter makes the case that some individuals experiencing psychological distress can be talked into giving up their guns, at least temporarily. Public health experts say no data is available to back up this claim.

“Reducing access to firearms and other lethal items is a recommended, evidence-based practice to prevent suicide,” claim the authors.

“In the case of a firearm owner at elevated risk of self-harm, the recommendation would be to temporarily store the gun away from home or store it locked in such a way that the at-risk person does not have access at least until the mental health crisis has resolved.”

While many doctors’ organizations have encouraged members to talk to patients about gun control when appropriate, many admit they choose not to.

“Universal background checks before firearm purchase are effective public health measures but should be supplemented with specific protocols for temporary transfer of firearms from the home and for storage,” the authors recommend.

“Protocols for temporary transfer may help to reduce the risk of other forms of firearm violence, including intimate partner violence situations where the firearm owner can be persuaded to voluntarily remove a firearm from the home.”

The authors recommend “incorporating and improving on aspects of Colorado’s exemptions to background checks” to include:

  1. “Clear statutory provisions that allow for temporary storage by federally license firearm dealers, law enforcement, officials, family members and friends.”
  2. Allow period of transfer to last at least 14 days or longer if recommended by a physician or mental health professional. Make sure children or any other unauthorized user cannot access where the firearm is being held.
  3. Limit the liability related to these temporary transfers to instances of gross negligence or reckless behavior by the person who transfers the firearms.

“Efforts to educate physicians and the public should carefully explain these provisions to allay fears about potential liability associated with the temporary transfer of firearms from the home and to encourage transfers for suicide prevention,” the authors conclude.

“Public health professionals and firearm organizations should collaborate to develop tailored and effective messaging that is acceptable to physicians, mental health professionals, and the public.”

Reducing gun violence: Compromises that have worked

In yet another JAMA viewpoint in the series titled, “Reducing Suicides Through Partnerships Between Health Professionals and Gun Owner Groups – Beyond Docs vs. Glocks,” the authors from Harvard Injury Control Research Center says that in some states firearm retailers have been part of the solution.

“In New Hampshire, where over 85 percent of firearm deaths are by suicide, a group of firearm retailers, gun rights advocates, public health and mental health professionals began meeting in 2009 to examine the role gun shops might play in reducing suicide,” according to the piece.

“The New Hampshire Firearm Safety Coalition’s first products were posters and brochures aimed at gun shop customers that promoted the ‘11th Commandment of Firearm Safety:’ Be alert to signs of suicide in friends and family and help keep firearms from them until they have recovered.”

Materials suggested options like temporarily storing guns away from home (with a friend, if local law allows, at a self-storage unit or at a gun shop) or keeping the guns at home under new lock and key that the vulnerable person has no access to until they have recovered.

I never have been a fan of guns and cannot imagine owning one, even though I have been the victim of violent crime more than once.

But I have come to understand in recent years why people should have the right to bear them. It is a fundamental right granted us by our forefathers.

Any attempt to restrict it in even the slightest of ways should be made with great caution, particularly in an uncertain nation and an uncertain world.

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I have been in the news business more than 30 years, spending much of my career at some of the best local newspapers in the country. Today, I report on Denver City Hall, homelessness and other topics for NewsBreak, much like I did in my twenties covering Newport Beach, Calif. for the Daily Pilot. I consider myself a lucky guy to still be doing what I love after so many years.

Denver, CO
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