Guns: Doctors’ next big fight?

For physicians and public health researchers, guns are not unlike cars, swimming pools, bicycles, alcohol and prescription drugs: They are a common cause of injury to their patients and to the population at large; but with knowledge, physicians and public health experts believe, that injury can be limited or mitigated.

It’s a perspective that the firearms industry and advocates of gun ownership roundly reject. And, as detailed in three leading medical journals, the gun lobby has been remarkably effective in their efforts to snuff out the notion that when it comes to guns, knowledge can reduce harm.

For physicians and public health researchers, the knowledge thing works this way: Researchers gather data on how all these modern conveniences -- be they motorcycles or assault rifles -- result in injury, and study what measures might make them less likely to injure. In the privacy of an exam room, doctors often ask patients about how often or how they make use of these everyday hazards. Then, drawing upon the work of researchers, physicians proffer advice on how their patients might limit their risk of injury.

Sometimes, medical professionals and public health researchers join forces and press for laws or regulations they believe will make us safer. That’s how the United States spearheaded such injury-prevention initiatives as seat belts in cars, age restrictions on the sale of alcohol, and regulatory agencies such as the Food and Drug Administration.

In late December, at the end of a year punctuated by murderous spasms of gun violence, three of the nation’s most respected medical journals published accounts of the gun lobby’s efforts to squelch federally funded research on gun-related injuries, and to silence physicians who would talk to their patients about gun ownership or use. Writing in the Journal of the American Medical Assn., the Archives of Internal Medicine and the Archives of Pediatric and Adolescent Medicine, editorialists suggested it is time for researchers and physicians to link arms and in the interest of the nation and their patients, let knowledge about guns lead the way.

Between 1985 and 1997, public health research on guns was beginning to make inroads in identifying what steps might curb gun injuries. But in 1996, wrote Drs. Frederick P. Rivara and Arthur Kellerman, pro-gun lawmakers set out to block further research into gun-related injuries by starving it of federal research funds. First, they tried eliminating the budget of the National Center for Injury Prevention and Control, a small office within the Centers for Disease Control and Prevention that studied injuries wrought by guns (and by swimming pools, automobiles, sports and prescription drugs, among other things). Failing that, lawmakers got $2.6 million in gun-injury research funds shifted to the study of traumatic brain injury and forbade the use of any CDC funds “to advocate or promote gun control.”

“Support for firearm injury prevention research quickly dried up,” wrote Kellerman, a Rand Corporation analyst, and Rivara, a University of Washington pediatrician. “Even today, 17 years after this legislative action, the CDC’s website lacks specific links to information about preventing firearm-related violence,” they added.

Doctors, too, have been warned to stay away from gun control. In 2011, Florida’s legislature passed a bill that calls on the state’s board of medicine to take disciplinary actions against physicians who would routinely ask patients whether they had guns in the home or how they were stored. While a federal judge has blocked enforcement of the Florida law for now, that decision is under appeal, with help from gun rights advocates. Virginia and West Virginia have considered such measures in the past, and legislatures in five other states — Alabama, Minnesota, North Carolina, Oklahoma, Tennessee — are currently considering legislation that would limit conversations between physicians and patients about guns and gun injury.

“We must resist all efforts” to muzzle physicians who would discuss with patients the potential for injury with gun ownership, wrote Dr. Jerome P. Kassirer, former editor of the New England Journal of Medicine and a professor at Tufts University School of Medicine. Kassirer called on the Institutes of Medicine to conduct a “comprehensive analysis of gun ownership,” and on doctors to use their clout to support more sweeping gun laws.

“We must find ways of reversing the trend” of growing gun ownership and escalating violence, Kassirer wrote. “And as physicians, this task should be part of our professional responsibility .... Opposing the gun lobby’s absolutist stance on regulation takes courage, persistence, and fortitude,” he wrote. But, he added, “It can be done.”

If they take up that clarion call, doctors and public health experts will have a fight on their hands, despite the recent vows of President Obama and many lawmakers to do something meaningful to reduce gun violence. Efforts to limit access to guns will run into solid opposition from the National Rifle Assn., which spent $2.2 million in 2012 and $2.9 million in 2011 to lobby against gun-control initiatives, according to the Center for Responsive Politics.