PPGV member Kathleen Howard targets many of our issues in this Op-Ed.
June is National Gun Violence Awareness Month. And June 2 is the first National Gun Violence Awareness Day. We are to wear orange. Commit to wearing orange and engaging patients and colleagues in a conversation about gun violence on June 2. (See. http://wearorange.org).
For several years the Brady Campaign and the American Academy of Pediatrics has led us in the ASK Campaign in June. ASK is the acronym- Asking Saves Kids- and one question- is there an unlocked gun where my child plays? Brady estimates there are about 1 home in 3 with children have a gun and 1.7 million children in homes with loaded, unlocked guns. This leads to thousands of accidental injuries and deaths. (See ASK. http://askingsaveskids.org/content/about-ask)
My pediatric colleagues add an initiating question, “Where do our kids play when they come to your house?” This helps to go to the question “Are there guns in the home?” and then the question “Are they unlocked or stored safely?” “Where are they kept?” “Can the kids go into that room?”
These questions have somehow provoked attempts across the country to “gag the doctors” and make it illegal to ask about guns. Most of us physicians love and value this privilege of asking personal questions in a respectful way. It’s our privilege, really our right and responsibility, to shine light on personal problems that may help our patients. So I am angry with those who would interfere with our doctor-patient relationship and demand, even outlaw this responsibility to seek the best health for our patients. These legislators do not represent good medicine and for the most part are not doctors. And these interactions about guns like our questions about auto safety, drug use, depression and suicide risk, etc. are arguably the most important thing we do- they can save lives. In primary care they may save more lives than antibiotic prescriptions.
Gun questions are now usually part of a standardized health history. But, in Michigan, our legislature recently passed a law making it illegal to use the Freedom of Information Act to find out whether a neighbor has a registered gun! So a personal question is what can we physicians do to protect our patients and ourselves from becoming victims of gun lobby control? Our Physicians for the Prevention of Gun Violence is on the cutting edge of that question. Recently seven national medical societies added their voices. See http://annals.org/article.aspx?articleid=2151828#Background. National Physicians Alliance is another strong voice with 10 fellows in Gun Violence medicine. I am a member of their Gun Violence Task Force begun this year. (View or join. http://npalliance.org/)
Also, Sonya Lewis is leading the effort to remove guns from schools closing the loophole allowing persons with concealed carry permits to open carry in classrooms. Please help by signing the petition http://petitions.moveon.org/sign/keep-guns-out-of-michigan-1
We are becoming organized and vocal in our effort to keep our profession whole with the right to ask any reasonable question and act on the answer.
As part of our 2015 initiative to grow PPGV- we are going West. We have an invitation to speak at a Grand Rounds with MSU Pediatrics late in the year. This is good for our organization that has been centered in Washtenaw Co. Drs. James Peggs (board member) and William Wadland, recent retired chair of family medicine at MSU will lead this move to become a statewide orgainization. This is great!
And in Washtenaw County there has been a huge outcry over the “open carry” of guns in schools with one advocate showing up “packing” to a school event and causing fear and concern for safety. The Ann Arbor School Board stepped up and insisted on no citizen guns. A lawsuit has been filed against the board by the Open Carry group. Meanwhile, the senate leader and NRA supporter, Mike Green, wants to have “special training” to allow some concealed carry guns, but not open carry. HB 4261 calls for no guns in the schools, hospitals and bars going back to a former “safe zones” position. Please go here http://petitions.moveon.org/sign/keep-guns-out-of-michigan-1?source=s.fwd&r_by=1466697. to support this bill. The organizers, local parents and a PPGV physician, are working to get state wide support for gun free schools.
Schools are among the safest places in the country according to David Hemenway, Harvard expert on. gun violence. Allowing any civilian gun makes no safety sense and will inspire fear. PPGV has filed a letter to the editor of the Detroit Free Press and now the Lansing State Journal that in May, national mental health awareness month, there should be freedom from fear- a basic need for mental health. Again go to the link http://petitions.moveon.org/sign/keep-guns-out-of-michigan-1?source=s.fwd&r_by=1466697 to support this as well as to our website ppgv.org to comment or donate to our work.
And June is National Gun Violence Awareness month. More about this later.
Harvard’s David Hemenway, arguably the nation’s foremost expert on gun violence had a problem. The press often asked him for his opinion on gun violence issues and after he gave it he found they sought an opposite opinion. He felt that his was the majority opinion, but it was not treated that way. He was told that journalists would only treat his studies as conclusive when the literature showed a preponderance of opinion on one side. So he set out to survey his colleagues to see whether he could show that excess guns and lax laws were behind our marked excess in gun violence compared to other industrialized countries. This is what he found.
” I decided to determine objectively, through polling, whether there was scientific consensus on firearms. What I found won’t please the National Rifle Assn.
My first step was to put together a list of relevant scientists. I decided that to qualify for the survey the researcher should have published on firearms in a peer-reviewed scientific journal, and that he or she should be an active scientist — someone who had published an article in the last four years. I was interested in social science and policy issues, so I wanted the articles to be directly relevant. I was not interested in scientists doing research in forensics, history, medical treatment, psychiatric issues, engineering or non-firearms (for example, nail guns, electron guns).”
A 2014 meta-analysis, conducted by researchers at UC San Francisco, of the scientific studies on guns and suicide concluded that access to firearms increases the risk of suicide. Similarly, the 2012 National Strategy for Suicide Prevention from the National Action Alliance for Suicide Prevention and the U.S. Surgeon General concluded that “firearm access is a risk factor for suicide in the United States.”
Of course it’s possible to find researchers who side with the NRA in believing that guns make our society safer, rather than more dangerous. As I’ve shown, however, they’re in the minority.
Scientific consensus isn’t always right, but it’s our best guide to understanding the world. Can reporters please stop pretending that scientists, like politicians, are evenly divided on guns? We’re not.”
David Hemenway is a professor at the Harvard School of Public Health and director of the Harvard Injury Control Research Center.
Time for Docs to “Get our Game Face on” – Gun Violence
I love basketball! As I watched the NCAA finals last Monday night I loved the fierceness of the game and the desire to win and the strong team play. It didn’t really matter who won. It was a dog fight and both teams showed us their mettle. They wanted to win badly. They were a proud bunch. Like doctors can be at our best.
Taking a stand counts. Medical societies are joining together- our team- to try to get in the game that has been dominated by the NRA, gun companies, and many politicians. Nationally 8 medical societies have pledged to work harder to make us safe from guns:
Firearm-Related Injury and Death in the United States: A Call to Action From 8 Health Professional Organizations and the American Bar Association. Ann Intern Med. 2015;162(7):513-516. doi:10.7326/M15-0337
In Ann Arbor the school board recently made a strong statement about the determination to keep guns out of schools and allow kids to concentrate on their studies.
Meanwhile in Michigan some of our societies are pledging more leadership on this issue. It’s critical that they do so, as little by little Michigan is becoming less safe under our present legislature. For instance, they passed a bill that prevents a citizen from using the Freedom of Information Act to see if a neighbor has a gun license. Formerly, a parent could have checked to see if their child was playing in a home with guns. And last month over PPGV opposition, they did away with local gun licensing boards. These boards with a sheriff, prosecutor, and state police representative kept a small number of people from obtaining gun licenses and undoubtedly saved lives.
Now Senator Mike Green, beloved by the NRA and ALEC wants to stop open carry in schools in favor of “specially trained” concealed carry. He is readying a new bill. This doesn’t inspire me with a sense of relief that safety is going to win out, and Green’s dismissal of any expert argument by physicians on the above bills gives one pause. However, the call from our medical societies has gone out: Get in the Game! Get your Game Face On! You are a doctor, and you should have something to say about how society works.
NEWS | March 25, 2015
(SACRAMENTO, Calif.) —
In an editorial posted online today in the Annals of Emergency Medicine, Garen J. Wintemute and Megan Ranney, two practicing emergency medicine physicians from the University of California, Davis, and Brown University — both thought leaders at the forefront of finding solutions to the public health crisis of gun violence — urge their colleagues to take direct action to protect the health and safety of patients and communities.
Their editorial follows the Feb. 24 call to action by eight health professional organizations, including the American College of Emergency Physicians, and the American Bar Association, to reduce firearm injuries and deaths in the U.S. — unprecedented support that suggests mobilization to prevent firearm violence may be underway.
“Firearm violence causes nearly as many deaths as motor vehicle crashes,” said Garen J. Wintemute, an emergency medicine professor at UC Davis and a national authority on evidence-based strategies to prevent firearm violence. “Firearms are involved in most homicides and suicides, and the number of suicides by firearm is increasing — especially among older white men.
“Emergency medicine physicians have limited opportunities to prevent a death once a shooting has occurred, because most people who die from their wounds do so where they are shot. Gun ownership or having a gun in the household is a well-documented risk factor for a violent death. For that reason, we believe physicians should also work to help prevent shootings,” he said.
The authors describe how America successfully reduced motor-vehicle-related deaths by better vehicle and roadway design and public policies that make driving under the influence a crime. Yet no comparable public-health campaign focused on reducing gun violence has been launched.
The authors particularly emphasize the need for a national policy requiring background checks on all transfers of firearms to help prevent access to firearms by those who are prohibited from having them. They recommend adding two other high-risk groups to the list of individuals who are prohibited from purchasing firearms. These include persons with a history of violent misdemeanor convictions, such as assault and battery and domestic violence, as well as those with a documented history of addiction and alcohol abuse.
“Controlled studies of felons, those who have committed violent misdemeanors and persons prohibited for mental-health reasons have all shown reductions in risk for future violence of 25 percent or more when these individuals are denied firearm purchases,” said Megan Ranney, an emergency medicine physician and director of the Emergency Digital Health Innovation program at Rhode Island Hospital and the Warren Alpert Medical School of Brown University.
The authors also address mental illness and gun violence. While they agree with recommendations that focus on behavior and expanded access to treatment, they emphasize that serious mental illness directly accounts for only 4 percent of interpersonal violence. In contrast, mental illness is associated with between 47 and 74 percent of suicides. The risk of firearm injury increases when mental illness coexists with alcohol abuse, drug abuse and a history of prior violence.
“Physicians need to include questions about firearms when assessing risk of violence in their patients, and need to act on the information, especially when patients are expressing thoughts of dangerousness to themselves or others, are intoxicated or are in the emergency department for a violence-related injury,” Ranney said.
At a time when civilian fatalities from gunshot wounds for 2004 to 2013 have outnumbered combat fatalities from World War II, the authors welcome the unprecedented support from leading organizations of health and legal professionals for policy recommendations to reduce gun violence.
“Physicians can take direct action to protect the health and safety of patients and communities,” Wintemute said. “While we may not all agree on all the specifics, enough of us will agree on enough of them to make a difference for the better.”
About 2 weeks ago PPGV was part of an effort to defeat Senate Bill 789 that would allow some persons with protective orders against them to obtain a concealed gun permit. Governor Snyder vetoed that bill and made the New York Times and other news while doing it!
Now we are facing a new bill- SB 34. This bill lacks the domestic violence abuser problem, but still poses a public danger according to Daniel Webster MD, a national expert from Johns Hopkins.
The bill’s sponsors say it streamlines the process to a concealed carry permit. To more critical eyes it omits the county gun board made up of sheriff, prosecutor, and others. Instead of the sheriff doing a background check that would be done by the state police. Local eyes would be removed and the process slightly shortened and made less in cost $90 down from $110. But the state police have said it would take about 50 of their partrol officers and $8 million. They originally opposed it.
Michigan has 450,000 CPLs now! And most recently 87, 000 applications a year of which 3-4% were denies and about 250 were denied by local boards. But, these were important denials according to Dr. Webster.
“The best research on the topic of shall issue vs. discretionary concealed carry laws shows evidence that no discretion shall issue laws lead to more gun violence. There is also research showing that many individuals who are not prohibited from possessing guns to keep in their home – legal gun owners – are not so law abiding and most objective people and public safety officials would look at their backgrounds and conclude that it’s too risky for the person to be allowed to carry a concealed loaded firearm outside of their homes. Promoters of nondiscretionary concealed gun policies or no restrictions on concealed carry try to perpetuate a myth that all legal gun owners are God-fearing, rock-solid individuals who are poised to be heroes to take down the next person who attempts a mass shooting or predatory criminals lurking among us. I can try to counter that myth with some facts.
But what would be most effective is for someone on the local boards to give examples of people who they denied a carry permit – prior arrests, drunk driving violations, restraining orders, calls to police at their residences.”
Dr. Webster will voice his concern, but may well not be asked. This week has been a busy one this fast tracking senate action. Moms Demand Action is concerned as are we at PPGV. We will likely write a letter to be read on the Senate floor prior to the vote. It looks like that may not succeed, but clearly this bill creates problems and I think should voice our concern.
Thank you for hearing our plea. I am a co-leader of a group of 220 physicians with a mission to reduce gun violence. Gun violence is a public health epidemic with a yearly toll of 30,000 deaths and 70,000 injuries.
Removing discretionary authority from local law enforcement will allow dangerous people to obtain concealed pistol licenses (CPLs.) Physicians are often asked to identify persons who they think are a danger and should not have a gun. Michigan’s current system does just that. Our local concealed weapons licensing boards made up of sheriff, state police and prosecutors review applicants and can deny a problem person a license. Present law states “If the concealed weapon licensing board determines by clear and convincing evidence based on specific facts that the applicant poses a danger to the applicant or to any other person,” it has the authority to decline the application. This authority is important. It saves lives.
SB 34 will abolish county concealed weapon licensing boards and transfer their duties to county clerks, the courts, and the Michigan State Police (MSP). The new licensing entities will not retain any discretionary authority. Under SB 34, Michigan will become a “no discretion, shall issue” state. Proponents of the change argue that we can streamline the process, but who would want to arm someone that police and prosecutors would refuse? Local authorities know their people and know many of those no one wants to arm.
Michigan’s system works now and denials of CPLs are relatively rare. In 2011-2012, there were over 80,000 CPL applications. Only 255 were denied by the licensing boards. Local law enforcement often knows persons who are not safe to have a CPL. Examples of those denied licenses include former juveniles with serious records, domestic abusers with misdemeanors or no felonies because their victim would not go to court, serious alcoholics and drug abusers who will all be free to obtain a CPL under this new law.
“Shall Issue” states that include Texas. Alabama, Florida, and Indiana have found that there were more felons and other serious offenders given CPLs. For example, the Los Angeles Times looked at Texas and found that between 1995 and 2000; more than 400 criminals – including rapists and armed robbers – had been issued CPL licenses under the state’s permitting law. A similar study by the South Florida Sun-Sentinel found that people licensed to carry guns in the first half of 2006 in Florida included more than 1,400 individuals who had pleaded guilty or no contest to felonies, 216 individuals with outstanding warrants, 128 people with active domestic violence injunctions against them, and six registered sex offenders. And these people were more likely to commit crimes.
More CPLs don’t make you safer. According to a Violence Policy Center analysis of news reports, CPL permit holders have killed at least 14 law enforcement officers and 622 private citizens since May 2007. We
know, too, that removing guns from violent people is dangerous. These facts may be why both the sheriffs and state police opposed this bill at certain stages. We don’t want to lose officers and any violent altercation can lead to the death of our men and women in uniform.
Dr. Daniel Webster, a national expert on gun violence wrote me recently that there is evidence that this change to a “Shall Issue” state will cause more injuries and deaths. Changing our system may expedite licenses, but more people will get hurt or even killed. The local eyes of our current boards are saving lives. And the state police will have to do new clerical duties that may divert their resources. This bill creates a problem that has both health and administrative costs. Please don’t pass SB 34.
The Governor has a decision on Senate Bill 789 allowing some domestic abuse suspects to get a concealed carry gun permit. He will decide this very soon. Among other voices, including some of ours, Gabby Giffords and Debbie Dingell have written the governor. These two women are each significant to PPGV. Gabby’s shooting in 2011 sparked us to organize PPGV, asking each of you to join and have a physician voice on this issue- a louder, clearer voice than that of most of organized medicine. And Debbie’s husband, Rep. John Dingell, protested to me that personalizing a gun and making the manufacturers more responsible would not be a good idea. He has deep NRA connections. Now, his wife makes her case for a veto of this bill. The links to their voices are here and here
Playing Defense. My friend, Joe, talks about blocking and tackling, his words for life as sport. To do a good job in life you have to do the basics, blocking and tackling. Nothing fancy, but the job doesn’t get done without a ground game. On gun violence to try not to lose more lives and make us safer we need to get our “ground game” together. In playing defense, as we are now that there are few allies in the Michigan legislature, we need to be able to counter the NRA offensive. That said, how we become better at the basics and at building a winning coalition remains our job- our life. Short range go Everytown for Gun Safety call tool to call the governor. And go to our website ppgv.org or respond to this email to be involved in longer term.
In July Resolutions from the MAFP’s Annual Meeting were sent to the AAFP.
RESOLVED, That the American Academy of Family Physicians advocate for children’s firearm access prevention laws, and be it further
RESOLVED, That the American Academy of Family Physicians support firearm safety training programs.
Another step for the national academy that already had good policy, but we thought there was room for improvement. And the process may enable other medical societies to follow. If you are interested in the process that was used by family medicine let us know.
Two Michigan resolutions, one on criminal penalties for parents failing to safely store weapons and another on reinstatement of data collection on gun violence banned under Obamacare were not dealt with by the advocacy committee and were referred to the Board of Directors directly. Those decisions are not known.