Straight Talk with Steven E. Nissen, MD: Physicians, Gun Violence, and Public Health

I am writing this commentary in the days following the gun murders of 27 people, including 20 young children, in Newtown, Connecticut, at the hands of a single deranged individual. Unfortunately, it is not the first time we have endured such a tragedy.

There have been 62 mass shootings in America during the last 30 years, including 12 at schools, but few have touched the soul of the nation as poignantly as the incident on December 14, 2012. Whenever these mass shootings occur, physicians are especially affected, perhaps because we hold a special reverence for life and its preservation. As cardiologists, cardiac surgeons, and nurses, we struggle on a daily basis to protect the lives and health of desperately ill patients, fighting for single individuals as if they were the only person in the world. We are particularly horrified when so many of our fellow citizens, including 6- and 7-year-old children, have their lives abruptly ended through a random act of violence.

Gun violence is a public health issue, just as much as influenza or coronary heart disease is. A staggering 31,224 firearm-related deaths occurred in 2007 in the United States, including 17,352 suicides and 12,632 homicides.1 In contrast, there were only 1,800 deaths due to rheumatic heart disease. Through the efforts of physicians and other public health measures, we have largely defeated rheumatic heart disease during the last century, only to see our children die prematurely from gun violence. We stand alone amongst industrialized countries in our propensity to kill each other with guns. In the United Kingdom in 2009 there were 39 firearm-related murders.2 In America, homicide now ranks as the 15th leading cause of death. Surprisingly, many of the victims are children. From 1979 to 2009, 116,385 children and teenagers have been killed by firearms, including 5,740 alone in 2008 and 2009.3

Gun violence is now a major public health epidemic. As a society, how have we responded to this grave threat to the public health? We have liberalized gun laws to make it easier to obtain and conceal firearms. In Ohio, in 2011, the State Senate and House of Representatives passed a law legalizing carrying a concealed firearm into bars, restaurants, shopping malls, museums, and stadiums. The bill was quickly signed into law by Governor John Kasich.4 In fact, state legislatures seeking to curry favor with the gun lobby have engaged in a competition to see who could pass the most outrageous pro-gun laws. In Michigan, on December 13, 2012, the day before the Newtown shootings, the legislature passed a law permitting citizens to carry concealed firearms in schools and hospitals. Governor Rick Snyder vowed to sign the bill into law, although he may now have second thoughts about the political costs.5 (Editor's note: Governor Snyder vetoed the aforementioned legislation on December 18.)

Some physicians and physician groups have attempted to stem the epidemic of gun violence only to be met with derision and organized opposition. The American Academy of Pediatrics encourages physicians to counsel parents on establishing a safe home environment by offering practical advice to help avoid preventable accidents; the recommendations include mostly innocuous tips, such as suggesting that parents keep plastic bags and balloons away from children and requiring them to wear bike helmets. Pediatric physicians also are encouraged to advise parents to remove guns from places where children live and play. Outraged by the pediatrician's guidelines, the Florida legislature in 2011 passed a bill barring physicians from asking parents about gun ownership, which was promptly signed into law by Governor Rick Scott. The penalties for violating the law could cost a doctor their medical license or a fine up to $10,000. I'm not kidding—they really did that. The law has been challenged in court, but the outcome is not yet certain.6

What can thoughtful and responsible physicians do to stem the public health crisis of gun violence? We must not be silent. Despite a powerful tobacco lobby, we spoke out about smoking when evidence showed that these deaths were preventable. We must do the same to educate the public about the epidemic of preventable guns deaths. Talk to patients about the risks of guns, support candidates brave enough to challenge the gun lobby, and speak out at public forums. It may be more difficult than defeating rheumatic heart disease, but it is every bit as important.

1. Xu J, Kochanek KD, Murphy SL, Tejada-Vera B. Natl Vital Stat Rep (CDC). 2010;58(19):1-135.
2. Cole J. "39 Murders by Gun Annually in Britain; 9,000 in US." 2012 December 14.
3. Children's Defense Fund. "Protect Children, Not Guns 2012."
4. Stuckey A. "Guns in bars OK as of today." The Columbus Dispatch. 2012 September 30.
5. Eggert D. "Concealed weapons could be allowed in 'gun-free zones' under bill headed to Michigan Gov. Snyder." Michigan Live. 2012 December 13.
6. Moisse K. "Florida Law Bans Doctors from Asking About Guns." ABC World News. 2011 June 3. #.UNDHsY62w1g

Steven E. Nissen, MD, is Chair of the Department of Cardiovascular Medicine at the Cleveland Clinic and co-author of Heart411: The Only Guide to Heart Health You'll Ever Need.

Clinical Topics: Prevention, Smoking

Keywords: Cause of Death, Influenza, Human, Public Health, Rheumatic Heart Disease, Pediatrics, Coronary Disease, Violence, Firearms, Smoking

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