Action to address gun violence is long overdue

David O. Barbe, MD, MHA
Immediate Past President
American Medical Association
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Yesterday in Parkland, Florida, 17 students and teachers were murdered in yet another school shooting. Yet another mass killing. More than a dozen others were injured and some are fighting for their lives under the care of physicians and nurses.

The pervasiveness of gun violence and the weapons used in these crimes have changed the way we live. In movie theaters, places of worship, offices, restaurants, night clubs and schools, people today make clear note of escape routes. Schools, including the one attacked yesterday, regularly practice for active shooter situations.

And in emergency departments and trauma centers, we struggle with much more complicated, dangerous injuries inflicted by lethal ammunition fired by military-grade weapons.

At the 2016 AMA Annual Meeting, which began the day after the deadly shooting at the Pulse Nightclub in Orlando, physicians from across the country and at every stage in their career spoke about treating gunshot victims and the scale of violence we are experiencing today. Their stories resonate as much today as they did nearly two years ago.

Wednesday’s shooting at Marjory Stoneman Douglas High School was the 30th mass shooting—a shooting in which four or more people are killed or injured—of 2018. It was also the 17th time a gun has been fired on the grounds of an American school this year. The problem is getting worse—the regularity of, and death from, mass shootings is increasing. With yesterday’s shooting in Parkland, three of the 10 deadliest mass shootings in modern U.S. history have come in the past five months.

Time to act

Gun violence in America today is a public health crisis, one that requires a comprehensive and far-reaching solution. And that is not just my own sentiment; that is the determination of the AMA House of Delegates. With more than 30,000 American men, women and children dying from gun violence and firearm-related accidents each year, the time to act is now.

Today, more than ever before, America’s physicians must lend their voice and their considerable political muscle to force lawmakers to examine this urgent health crisis—through federally funded research—and take appropriate steps to address it. Let me be very clear about this. We are not talking about Second Amendment rights or restricting your ability to own a firearm. 

We are talking about a public health crisis that our Congress has failed to address. This must end.

In the wake of the Sandy Hook shooting in 2012—a massacre that left 20 first-graders and six adults dead—the AMA wrote to President Obama and to the leaders in the House and Senate. We expressed our sense of grief and sadness and offered our expertise and experience in finding workable, commonsense solutions to reduce the epidemic of gun violence—indeed the overall culture of violence—in America.

We noted that the relatively easy access to the increased firepower of assault weapons, semiautomatic firearms, high-capacity magazines, and high-velocity ammunition heightens the risk of multiple gunshot wounds and severe penetrating trauma, resulting in more critical injuries and deaths. Even for those who manage to survive gun violence involving these weapons, the severity and lasting impact of their wounds, disabilities and treatment leads to devastating consequences for the families affected and for society as a whole, contributing to high medical costs for treatment and recovery. 

We called for renewing and strengthening the assault weapons ban, including banning high-capacity magazines, as a step in the right direction. We also called for more resources for safety education programs that promote more responsible use and storage of firearms, and noted that part of ensuring firearms safety means that physicians need to be able to have frank discussions with their patients and parents of patients about firearm safety issues and risks to help them safeguard their families from accidents.

We also urged the nation to strengthen its commitment and resources to comprehensive access to mental health services, including screening, prevention and treatment. While the overwhelming majority of patients with mental illness are not violent, physicians and other health professionals must be trained to respond to those who have a mental illness that might make them more prone to commit violence.

On an average day, more than 100 Americans die from gun violence and firearm-related accidents. In communities like yours—regardless of where you live or how safe it feels—people are losing their lives to this scourge.

For many Americans, gun violence used to be a distant idea relegated mostly to the nightly news, movies and faraway places. But today, in communities such as Parkland, it is horrifyingly real. The victims are our friends, neighbors and, unfathomably, our children.

As physicians, we have dedicated our lives to public health. And at the AMA, our mission is improving the health of the nation. That mission today must include determining the root causes of this epidemic and turning the tide on gun violence.

We must do more than pray for families who lost loved ones. It is time to act to prevent future deaths and injuries.

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There 1000s of laws on the books for gun control, which are not currently or only selectively enforced. Let's get realistic about the problem. If you ban all firearms, then they become the next hot smuggling item and we have even less control. Look at how well the ban on alcohol or the war on drugs worked. If you really want to substantially reduce the gun violence at schools, churches and hospitals... Do NOT make them gun free zones. The folks doing the shooting may be having mental challenges, but that doesn't mean they are stupid. Given the choice of walking to a location where guns are allowed or walking into a play where guns are not allowed. The latter will always be the choice. One of the early victims of the Stoneman shooter was the unarmed security guard. What would the situation look like if the security guard had been armed? I would guarantee that there wouldn't have been 17 dead. Similarly, studies have shown that once a shooting event starts, the first 9-1-1 calls don't start arriving until 2-3 minutes in. Then you have 5-8 minutes of time lapse for swat to show up, followed by 30--45 minutes to clear the facility to allow medical personnel in. It is a fallacy, to think that any government action with respect to ownership of firearms will make any substantive change in the number of shootings and corresponding fatalities. The bad actor will always have access to a weapon and there will always be someone willing to supply the bad actor. Should we arm everyone, no. Should we allow those that have passed the background and proficiency test to carry their weapons with then at all times, yes.
I strongly support the AMA working with lawmakers to insist upon federally funded research into gun violence. It is indeed a public health crisis, and unique to this country. Research in this must finally be allowed, and immediately begun.
Lindsey Tanner of the AP reported your comments on 20 Feb in "Could Have Prevented This One". While not attributing this directly to you, she stated in the article "Mental health professionals welcome more resources and attention, but they say the administration is ignoring the real problem — easy access to guns..." THIS is part of the problem! Mental health professionals cannot or will not acknowledge that the real problem isn't the means by which these killings occur, but the heart and thoughts of the perpetrators. While it may not be a specific DSM defined illness, it is nonetheless disordered thinking that convinces the perpetrators that killing others is acceptable. We have mass killings by AR-15, ANFO laden truck, airliner, explosive filled pressure cookers, knives.... The common denominator is not the weapon, but the MIND that rationalizes such atrocities. The perpetrators may not be mentally "ill" such that they cannot understand right from wrong, or recognize reality, but to consider such actions as right or acceptable is sick thinking! THAT is the primary and root cause. Directly in the mental health bailiwick and they ignore it. Let's have some outrage directed at them instead of the NRA.
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Sep 18, 2018
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