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ACP Recommends Physicians Take Steps to Reduce Gun Violence — Physician’s First Watch

Medical News |
April 11, 2014

ACP Recommends Physicians Take Steps to Reduce Gun Violence

By Kelly Young

The American College of Physicians recommends counseling patients on the risks of keeping firearms in their homes, especially when minors or people with dementia, mental illness, or substance use disorders live there.

In a new position paper published in the Annals of Internal Medicine, the group says that physicians should also counsel patients on the best practices to reduce firearm-related injuries and deaths.

The ACP also supports regulating the purchase of firearms to reduce injuries and deaths, including universal background checks, waiting periods, and banning assault weapons.

Asked to comment, Katherine Bakes, an associate editor of NEJM Journal Watch Emergency Medicine, wrote: "Since physicians see the devastation firsthand, I believe we are obligated to be more outspoken and uncompromising against guns."

Reader Comments (31)

MEREDITH LASH-DARDIA Physician, Internal Medicine, NYC

Very glad to see our group take a stand on this. This is not "political," as some of my esteemed colleagues believe. There is nothing political about keeping our patients safe. No right, no matter how safe-guarded, is limitless.
Guns, unlike other things we regulate and control, often are used against other, innocent people. I have never understood the controversy here; keeping people safe is our job. We have clearly done a less than stellar job around gun control.

Samuel Eby, MD Physician, Nephrology, Fort Wayne, IN

I had to reread the original ACP position to see if I'd missed something. It advocates background checks, a waiting period and bans on assault weapons (broadly those guns designed for police and military use). Where in there is there ANYTHING about disarming the populace, Dr. Baskes comments aside. Y'awl can still kill animals, minority teenagers and turn as much money into noise at the firing range as you want but it shouldn't be as easy for a schizophrenic off his meds to shoot dozens of people with guns he purchased legally off of the internet--or at Gander Mountain or any of dozens of gun and knife shows that come through down each year. I shoot, I enjoy the sport, I could defend my home if forced to (after first making all reasonable efforts to escape). Pump the NRA fueled hyperemotionality out of it. The position is well reasoned and in the interest of doctors and of patients.

Matt Marshall Physician, Internal Medicine

The ACP is a disgrace.

Stephen Beene, MD Physician, Hospital Medicine

ACP is smoking the "stuff" and drinking the liberals cool-Aid! Thanks for saving me the time and money of beloning to the ACP or the AMA.

John Van Aalst, MD Physician, Pediatrics/Adolescent Medicine, FQHC Medical Center

Anyone the least bit observant of human behavior would question the notion that a "well armed society is a peaceful/polite society". It most certainly would be an even more fearful society. Have you ever observed how mindlessly, and often maliciously, many people drive (and they've had "training")? You are advocating that they be armed! There are those of the guns-unlimited crowd who believe the requirement of training is a government intrusion into second amendment rights! The problem is not the gun (a sometimes useful tool). The problem is the promulgation and glorification of the gun. It emboldens the timid, the cowardly, the insane, as well as tragically erroneous wanna-be heroes. The NRA's stance is like those who believe that criminalization of child porn and snuff films is a violation of the first amendment.

Christopher Chuirazzi M.D. Physician, Internal Medicine, Private Solo Practice

We all have a professional and moral duty to keep our patients out of harms way. Counseling patients and their families about gun safety is one thing, advocating gun control is quite another.

I am very disappointed that the ACP is taking a POLITICAL stand on this topic. As a responsible gun owning citizen, I am offended and embarrassed that I am a member of ACP. I thought I joined a physician and patient advocacy organization not a liberal political group.

TAKE NOTICE! ACP needs to concentrate on medical education and health advocacy. If this article is a taste of things to come, you will have one less physician member. Based on other member's comments I am clearly not alone.

John Kolb, DVM, Dipl ABVP Other Healthcare Professional, Epidemiology/Statistics, Boehringer Ingelheim

As a professional organization, it would be nice if ACP would recommend practices that are shown to be effective in their end point, not just politically or philosophically pleasing. It will be of little solice to patients that you "supported politically right" choices that provided no help.

J ROSS HESTER Other Healthcare Professional, Psychiatry, Edcom Associates

By this rationale, all providers should question the presence, storage, supervision, sharpness (the "a dull tool is more dangerous" adage) of knives,Axes,Chainsaws, table saws, pool chemicals, and any other item that can cause violent injury in irresponsible hands. This should all be added to the EMR... Diagnosis clearly being ancillary to risk assessment.

J.Hubert,MD

Let us stay in the practice of medicine - not gun control !! Personal opinions and convictions should not enter ( unless asked for ). Any accidental death or injury is a tragic event , we repair where possible . But guns are of highly proven value in self defense , just as cars are for personal transportation ( some 40,000 death/automobile / year ! )

F v mitek md Private practice internal medicine

This is the usual east coast, liberal crap. This is also why I no longer subscribe to or belong to acp. Your organization should spend time and effort protecting patients from injury inflicted by Obama care, but then that would not be "iiberal". Good luck

Robert Dedmon MD MPH FACP Physician, Internal Medicine, RETIRED

Another misguided diatribe by left wing liberal anti 2nd amendment and anti gun academics who are taking the ACP into murky political waters. Physicians should be concerned about health and safety, but not delve into areas for which they have had no or little training. Many physicians have been hunters and shooters for years without mishaps, and my wife and I have taught our daughters to shoot and handle guns safely. A better focus is educating parents about firearm safety, storing guns and ammunition separately, and supporting gun/hunter safety education. This thinly-veiled effort to completely disarm the citizenry won't work. Several states are pushing back against such outrageous government abuse. Also my wife and I are happy to be 2 of the 600,000+ deer hunters on opening day in Wisconsin!

Michael Douglas, DO Resident, Urology

So a device that can be used safely for sport and in the rare case of self defense to deter crime needs to be talked about, but a service that universally is used to end a human life in utero y'all are just cool with?

This is why academic medicine is losing it's influence. You just can't escape the creep of liberalism into your practice.

Daryl N Zeigler, MMM, MD Physician, Other, Retired from the practice of Physical Medicine and Rehabilitation

The following is an e-mail comment I sent to Consumer Reports yesterday since my concern about the daily notice of gun related deaths is scary.
----------------------
As a USA citizen, physician, and military colonel, I am very alarmed at the increasing numbers of mostly one individual using a gun of multiple ammunition capability firing at and most often killing more than one person. This is a news item in virtually every news day media I check for general news. Younger folks are also more involved in addition to the aberrant adults who have access to guns and do their gunning of folks, adults and children. Younger folks, not yet adult, have frequently gotten their gun(s) from a parent who owned it/them (guns that is).

Attempts to regulate gun control including background checks of people wanting to purchase a gun have been defeated due to the NRA and conservatives who lobby strongly to block legislation of this kind. Folks in Ohio are now allowed to get the right to carry weapons on their person legally out of sight to others who cannot know, in any way, that this person is bearing a firearm.

In brief, the US Constitution Second Amendment is always cited as the justification for no regulation of firearms which I type here:
Amendment II "Right to Bear Arms: A well regulated Militia, being necessary to the security of a free State, the right of the people to keep and bear Arms, shall not be infringed."

I point out the words: REGULATED, MILITIA and PEOPLE.

What did our founding fathers really mean???? This also must be considered in the context of the times in which this Amendment II was written. Folks were mostly hunters and farmers in those slightly more primitive days of America. Use of generally SINGLE SHOT rifles were used.

The meaning of the word REGULATED was never defined, but is a word in legislation attempts to change the open ability of virtually anyone to buy firearms which were originally designed for our MILITARY to use in fighting every growing complexity of wars. Now those weapons have been allowed to be purchased when there is absolutely no need for personal or family safety to have one or more of these weapons.

The meaning of the word MILITIA vs the PEOPLE is not clear either. Is this Amendment II only pertinent to a legally established MILITIA and the PEOPLE in that MILITIA are the one's who have the right to bear arms which cannot be infringed upon? This as opposed the people of a State are the one's with the right to bear arms? The Amendment II is too vague and should be traced back to what part of the Constitution was amended.

I suggest a study of the number of incidents of firearm killings and woundings compared to the number of folks who legally only used a weapon to defend themselves or their family. I have never seen this self-defense with a firearm in the news. The Florida law of protecting oneself by firearm is in controversy over the “neighborhood watch dude who shot and killed an unarmed ‘suspicious looking’ African-American teenager wearing a ‘hoody’.” This should also be a point for the great debate this “right to bear arms” involves.

For overall safety for anyone who steps into this country, whether US citizen or not, this firearm issue should be compared to the number of deaths and injury due to other events such as vehicle accidents, airline crashes, bridge collapses, violent weather, etc. Not a comparison of what terrorists can do to cause massive killings. That is a concern of our government and measures are in place and constantly evolving (now with information of personal nature a major topic of government spying).

Safety is the central concern of Consumers' Union. I strongly suggest it become involved in the concern for safety over firearms, particularly the extremely fateful firearms designed for use in our military only originally.

Daryl N Zeigler, MMM, MD Physician, Other, Now retired.

Former Supreme Court Justice on Gun Control

WASHINGTON — Former Supreme Court justice John Paul Stevens wants to reduce gun violence, abolish the death penalty, restrict political campaign spending, limit states' independence and make Congress more competitive and less combative.

His solution: Amend the Constitution.

Four years into a hard-earned retirement after serving 35 years on the nation's highest court, Stevens is still speaking out, writing books and book reviews, even swimming in the ocean as long as someone's nearby to help him out. His latest book,Six Amendments: How and Why We Should Change the Constitution, calls attention to some of the nation's most intractable problems.

His main focus is on a half-dozen issues that he believes have been wrongly decided or avoided — issues that can best be addressed by altering a document that's been amended only 18 times in history, and just once since he joined the court in 1975.

"It's certainly not easy to get the Constitution amended, and perhaps that's one flaw in the Constitution that I don't mention in the book," he said during a wide-ranging interview with USA TODAY in his chambers at the court. Noting his book's half dozen proposed amendments, he mused, "Maybe I should have had seven."

Among the amendments Stevens suggests:

•Changing the Second Amendment to make clear that only a state's militia, not its citizens, has a constitutional right to bear arms.

The rest of this article is available at

http://www.usatoday.com/story/news/politics/2014/04/21/justice-stevens-s...

Since Supreme Court Justices are to be Constitution experts, then consider my comments about "I point out the words: REGULATED, MILITIA and PEOPLE" and what did our U.S. Constitutional fathers really intend in the few words of the second Amendment?

The heated debate goes on. Which belief is right? Sort of like what is the correct religious belief? Many religions in our world.

James P Richardson Physician, Geriatrics, St. Agnes Hospital

The ACP is right to counsel physicians to discuss gun safety with their patients. This recommendation in no way infringes on the right of U.S. Citizens to own guns. Virtually all physicians have treated patients who have been injured or killed by guns. Why should we physicians ignore this scourge? And if we ask our patients to secure their guns does this mean we won't also advise against other potentially dangerous behaviors? Of course not! Gun owners are by and large very careful with their guns, yet every day someone is killed or injured by a gun purchased legally by a citizen who has no criminal record (see Sandy Hook Elementary). Clearly we need to do better, and physicians should be part of this effort.

Michael R. Schaub, M.D., FAAFP, LTC, US Army (ret) Physician, Family Medicine/General Practice, Northern Lights Family Medicine

Great, another liberal medical organization proving that they know diddly squat, but like to squawk.

I believe in gun control - hitting what I aim at, and should that target be a threat to me or mine, dropping said target w/ the least number of rounds. I own. I carry. I practice. I served this country to defend our constitution. I instruct all my patients to train their children about firearms (handling, storage, rules of the range). I also, recommend a few local gun clubs and ranges.

The biggest threat is not, and has never been, guns or gun owners. It is liberal idealouges who believe they know better than the founding father, and the rest of us. Their goal is a socialist utopia, w/ them in charge. The biggest threat to them is an armed society.

Oh yes, and an armed society is a polite society.

Leo Pisculli, M.D. Physician, Psychiatry, Bishop, CA

I am in full agreement with this person's comment.

Edward Hall M.D. Physician, Obstetrics/Gynecology
Competing Interests: Potential conflict of interest : I may or may not own a firearm. It is nobody's business but mine.

Amen,brother !!!

J Physician, Other, Hospital

The ACP should probably stick to medicine and stay out of politics. I'm not sure they should be speaking for everyone within their organization.

Michael Physician, Pediatrics/Adolescent Medicine

Common sense gun safety goes without saying. Does the ACP understand the greater threat to children, I wonder? Socialism/Communism will systematically kill more children in a single day than all the privately owned "assault weapons" (whatever that is) will in 100 years. Perhaps the ACP needs a historian on the staff (of non communist leaning) to keep them from regurgitating what CNN feeds them. Come on guys, your smart enough to think this trough and reach your own conclusions.

Jared Ellis, MD Physician, Family Medicine/General Practice, The USA

I have little problem with background checks (those laws are in place for the vast majority of firearm sales) and limited waiting periods. However, In medicine, we espouse evidence based medicine focusing on outcomes. Can we document places in the US where gun free zones, semi-automatic weapons bans, etc. have helped? Chicago? Washington DC? Theaters? Schools? Shall we includes knives (PA this week) and Dodge Durangos (FL).
When I was a student in the 80s, I had a shotgun in my truck, a pistol under the seat, and a knife in my pocket AT SCHOOOL. There was no such mass violence then. Maybe we need to focus on the effects of having removed morality, responsibility, religion and family. There is your evidence based outcome!

Richard Bartucci, D.O. Physician, Family Medicine/General Practice, New Jersey

The four basic rules of firearms safety had been parsimoniously and completely stated by Lt. Col. "Jeff" Cooper (USMC) and came to their definitive form in 2003. They are:

(1) All guns are always loaded. (Even if they are not, they must always be treated as if they were.)

(2) Never let the muzzle cover anything you are not willing to destroy.

(3) Keep your finger off the trigger until your sights are on the target. (Failure to follow this rule is responsible for about sixty percent of all injuries due to accidental discharges.)

(4) Identify your target, and what is behind it. (Never fire at anything you have not identified, and ensure that penetration will not injure anything or anyone you cannot see.)

These rules are so simple that they can be imparted even by a physician who has no experience whatsoever with firearms, and are the sum and substance of appropriate "gun control."

Jeff H Portner M.D. Physician, Family Medicine/General Practice

The ACP has no business advocating against the second amendment rights of its patients. Using a purported health benefit to support restricting the constitutional right to own and bear arms has no basis in fact. It is not clear that denying law abiding people the right to defend themselves and their families will result in improved health for the American people. Taking divisive positions such as this can only harm the ACP in its efforts to be taken seriously as a source of accurate health care information,

DAVID SMITH

Counseling patients never to allow distractions while driving (texting and cell phone use) would save more lives. However, this topic isn't as sensational as a mass shooting. That's unfortunate.

William Corporon MD Physician, Family Medicine/General Practice, Concentra Medical Clinic, Grandview MO

Committees do not speak for me. All the gun owners I know are responsible with their guns. People who do not own guns, shoot for fun, or hunt should try immersion therapy rather than rail at us. YOu might learn something. I know of no responsible gun owner, much less gun owning physician, who would not intervene if an unsafe situationwas presented. We all strive to be range-masters...guys who would D/Q and dismiss thier own mother for unsafe conduct.

David Smith, MD Physician, Pediatric Subspecialty, NHRMC Wilmington NC

Amen! The situation in the US is a disgrace! It is clear that other countries, with courageous politicians (ie Australia) have passed legislation to save lives! Our politicians are being held hostage at gunpoint by the NRA and they don't have the moral fiber to stand up for the safety of the citizens they serve. Getting re-elected trumps doing the right thing. What a shame!

Bob Teets, MBA Other, Other, Retired

It's interesting how many MD's realize the importance of personal responsibility and safety. Gun Free Zone are the perfect killing zones in America. No worry about being stopped. As for statistics from Australia, recheck you violent crime statistics they have actually went up since the "Gun Ban". For the statistics on how many lives concealed carry has saved, there is a significantly higher number than records would show. Why because if the perpetrator isn't shot the incident doesn't get reported, a crime stopped is better all around than someone dying on either side.

J Neese

Ridiculous. The emphasis needs to be on gun safety and responsibility of locking weapons up so they are not available to children and unauthorized users. Here we go with "assault" weapons again. It doesn't matter what the gun looks like. You put a round in, pull the trigger, and the bullet exits the barrel. If you take the pistol grip off a rifle does it become less lethal? Of course not! You have heard it before, guns don't kill, people kill people. Take away the gun, and they'll use something else like they have for thousands of years, and will continue to do until we're extinct. A change in American attitude and teaching children to respect others, their views, and property is a great starting point. Oh by the way that process starts in the home. Of course, that means parents actually need to parent. The first lesson should be 'the stars, sun and moon does not revolve around you my child.'

Wayne Amendt MD Physician, Orthopedics, Jackson, OH

Maybe the NRA should start campaigning about hospital acquired infections? No, wait.... that would be silly...
Just like the ACP campaigning about gun control and the second amendment.
"The only thing that will stop a bad guy with a gun is a good guy with a gun."

Earl Eye Physician, Infectious Disease

Here we go again, pushing a political agenda as a obligation to speak out. OK-since we kill 10 times more people with our drugs-I don't hear speaking; hospitals kill many times more with infections, errors, etc-silent voices there too. The death rate from auto crashes is way higher-should we counsel no driving, and lets ban some of those sports cars-they are dangerous. Where are the voices on the death panels in the Obama care-silence is deafening on this, oh I forgot-this groups supported it.

What is dangerous is letting idols like these join political forces with people like Sarah Brady, Michael Bloomberg, and others who will take away your second amendment rights, then when you are defenseless they will take as many of your other rights as they desire.

Bryan Fusco, PharmD Other Healthcare Professional, Emergency Medicine, University of the Pacific

First of all I have spent my fair share of time working in ER's and ICU's and have seen the damage inflicted by guns. Guns are not destructive, when used correctly they are no more dangerous than a hammer. Its when placed in the wrong hands that they become destructive, Put knives in the same category.

I cannot believe that a physician organization would take a stand in a very politically heated topic. Instead what ACP's paper should support and recognize is mental illness and develop an assessment for screening individuals prone to violence. Background checks don't go far enough in some cases, and gun controls don't work. You disarm innocent folks that have the RIGHT to protect themselves against thugs and persons bent on doing evil that will obtain guns illegally. Note...CA Senator Leland Yee. ACP take a stand on the mental illness aspects and leave the guns out of it. The gun CAN NOT do anything without the person behind it...its amoral.

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