Editorial
Addressing Firearm-Related Violence in the United States
A
Hal C. Lawrence III, MD
Dr. Lawrence is the Executive Vice President and Chief Executive Officer of the American Congress of Obstetricians and Gynecologists, Washington, DC; e-mail: [email protected]. Financial Disclosure The author did not report any potential conflicts of interest. © 2015 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved. ISSN: 0029-7844/15
VOL. 125, NO. 4, APRIL 2015
t the end of February 2015, the Annals of Internal Medicine published “Firearm-Related Injury and Death in the United States: A Call to Action From 8 Health Professional Organizations and the American Bar Association.”1 This important article is available to the public without a subscription (http://dx.doi.org/10.7326/M15-0337). This call for policies to reduce firearm injuries and deaths in the United States includes consensus-based recommendations from the leaders of eight health professional organizations: The American College of Physicians, the American College of Surgeons, the American Psychiatric Association, the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Emergency Physicians, the American Public Health Association, and the American Congress of Obstetricians and Gynecologists. This is not the first time the leadership of these health professional organizations has come together in response to policy challenges that affect the ability of providers to care for their patients. In October 2012, authors from the American College of Physicians, the American College of Surgeons, the American Academy of Family Physicians, the American Academy of Pediatrics, and the American College of Obstetricians and Gynecologists published an article titled “Legislative Interference with the Patient–Physician Relationship” in the New England Journal of Medicine (http://www.nejm.org/doi/full/10.1056/NEJMsb1209858)2 to highlight the fact that recent laws and proposed legislation improperly infringed on clinical practice and the physician–patient relationship. Now, we have come together again with more of our colleagues because we believe that addressing firearm-related death and injury in the United States is important and, moreover, is appropriate from a public health perspective. The group also was pleased to have the support of the American Bar Association. In a country with 300 million guns owned by individual citizens, the United States ranks first among 178 countries for the number of privately owned guns.3–5 Additionally, more than 32,000 individuals die each year from firearm-related violence, suicide, or accidents, which also puts the United States first among the other industrialized countries in the world.6,7 Such violence comes at a substantial cost to our nation, with a total societal cost of $174 billion in 2010.8 Our article supports: • Eliminating both the gun show and private sale loopholes through universal background check requirements for gun purchasers. • Eliminating physician gag laws that prevent physicians from discussing guns and potential gun violence with their patients. We also addressed this legislative interference in our 2012 article.2 • Restricting the manufacture and sale of military-style assault weapons and high-capacity magazines for civilian use. • Increasing support for research to identify strategies to reduce firearmrelated injuries and deaths.
OBSTETRICS & GYNECOLOGY
Copyright ª by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
769
Whenever one talks about gun violence, the issue of mental health is also raised. In our article, we stress how the United States needs to improve access to mental health evaluation and treatment: “Although mental and substance use disorders in and of themselves are only a small factor in societal violence, they can be a significant factor in firearm-related suicide.”1 Access to mental health care is critical for all patients who suffer from mental health disorders. That is why we address the need to facilitate coordination among state, local, and community-based behavioral health systems to ensure access to care and reduce social stigma. Of course, among our counterparts in the health professional community, obstetrician–gynecologists are uniquely situated to address the intimate partner violence that sometimes can lead to firearm-related violence in our patients’ lives. We also play a role in screening for mental illness and depression among our patients. Because of this, we must not allow restrictions on our ability to communicate openly with our patients. I recognize that there will be some differences of opinion regarding the points expressed in this article. However, each of these organizations—and all physicians—are dedicated to improving the care of our patients. Reducing gun violence, gun-assisted suicide, and accidental gun-related injuries is in the best interests of our patients’ health. All eight of the health professional organizations involved in this important article are committed to collaborating through educational and political perspectives to encourage legislation
770
Lawrence
Firearm-Related Violence
that will reduce the incidence of firearm-related death and injury in this country. REFERENCES 1. Weinberger SE, Hoyt DB, Lawrence HC III, Levin S, Henley DE, Alden ER, et al. 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 Feb 24. doi: 10.7326/M15-0337. [Epub ahead of print]. 2. Weinberger SE, Lawrence HC III, Henley DE, Alden ER, Hoyt DB. Legislative interference with the patient–physician relationship. N Engl J Med 2012;367:1557–9. 3. Karp A. Completing the count: civilian firearms. Available at: http://www.smallarmssurvey.org/fileadmin/docs/A-Yearbook/ 2007/en/full/Small-Arms-Survey-2007-Chapter-02-EN.pdf. Retrieved February 26, 2015. 4. Krouse WJ. Gun control legislation. Washington, DC: U.S. Congressional Research Service; 14 November 2012:8-9. Available at http://www.fas.org/sgp/crs/misc/RL32842.pdf. Retrieved February 26, 2015. 5. Alpers P, Rossetti A, Salinas D, Wilson M. Rate of civilian firearm possession per 100 population. United States—gun facts, figures and the law. Sydney, Australia: Sydney School of Public Health, The University of Sydney; 2015. Available at: http://www.gunpolicy. org/firearms/region/united-states. Retrieved February 26, 2015. 6. Centers for Disease Control and Prevention. FastStats: all injuries. Available at: http://www.cdc.gov/nchs/fastats/injury.htm. Retrieved February 26, 2015. 7. Richardson EG, Hemenway D. Homicide, suicide, and unintentional firearm fatality: comparing the United States with other high-income countries, 2003. J Trauma 2011;70:238–43. 8. Miller TR. The cost of firearm violence. Calverton, MD: Children’s Safety Network; 2012. Available at http://www. childrenssafetynetwork.org/publications/cost-firearm-violence. Retrieved February 26, 2015.
OBSTETRICS & GYNECOLOGY
Copyright ª by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
Addressing Firearm-Related Violence in the United States
A
Hal C. Lawrence III, MD
Dr. Lawrence is the Executive Vice President and Chief Executive Officer of the American Congress of Obstetricians and Gynecologists, Washington, DC; e-mail: [email protected]. Financial Disclosure The author did not report any potential conflicts of interest. © 2015 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved. ISSN: 0029-7844/15
VOL. 125, NO. 4, APRIL 2015
t the end of February 2015, the Annals of Internal Medicine published “Firearm-Related Injury and Death in the United States: A Call to Action From 8 Health Professional Organizations and the American Bar Association.”1 This important article is available to the public without a subscription (http://dx.doi.org/10.7326/M15-0337). This call for policies to reduce firearm injuries and deaths in the United States includes consensus-based recommendations from the leaders of eight health professional organizations: The American College of Physicians, the American College of Surgeons, the American Psychiatric Association, the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Emergency Physicians, the American Public Health Association, and the American Congress of Obstetricians and Gynecologists. This is not the first time the leadership of these health professional organizations has come together in response to policy challenges that affect the ability of providers to care for their patients. In October 2012, authors from the American College of Physicians, the American College of Surgeons, the American Academy of Family Physicians, the American Academy of Pediatrics, and the American College of Obstetricians and Gynecologists published an article titled “Legislative Interference with the Patient–Physician Relationship” in the New England Journal of Medicine (http://www.nejm.org/doi/full/10.1056/NEJMsb1209858)2 to highlight the fact that recent laws and proposed legislation improperly infringed on clinical practice and the physician–patient relationship. Now, we have come together again with more of our colleagues because we believe that addressing firearm-related death and injury in the United States is important and, moreover, is appropriate from a public health perspective. The group also was pleased to have the support of the American Bar Association. In a country with 300 million guns owned by individual citizens, the United States ranks first among 178 countries for the number of privately owned guns.3–5 Additionally, more than 32,000 individuals die each year from firearm-related violence, suicide, or accidents, which also puts the United States first among the other industrialized countries in the world.6,7 Such violence comes at a substantial cost to our nation, with a total societal cost of $174 billion in 2010.8 Our article supports: • Eliminating both the gun show and private sale loopholes through universal background check requirements for gun purchasers. • Eliminating physician gag laws that prevent physicians from discussing guns and potential gun violence with their patients. We also addressed this legislative interference in our 2012 article.2 • Restricting the manufacture and sale of military-style assault weapons and high-capacity magazines for civilian use. • Increasing support for research to identify strategies to reduce firearmrelated injuries and deaths.
OBSTETRICS & GYNECOLOGY
Copyright ª by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
769
Whenever one talks about gun violence, the issue of mental health is also raised. In our article, we stress how the United States needs to improve access to mental health evaluation and treatment: “Although mental and substance use disorders in and of themselves are only a small factor in societal violence, they can be a significant factor in firearm-related suicide.”1 Access to mental health care is critical for all patients who suffer from mental health disorders. That is why we address the need to facilitate coordination among state, local, and community-based behavioral health systems to ensure access to care and reduce social stigma. Of course, among our counterparts in the health professional community, obstetrician–gynecologists are uniquely situated to address the intimate partner violence that sometimes can lead to firearm-related violence in our patients’ lives. We also play a role in screening for mental illness and depression among our patients. Because of this, we must not allow restrictions on our ability to communicate openly with our patients. I recognize that there will be some differences of opinion regarding the points expressed in this article. However, each of these organizations—and all physicians—are dedicated to improving the care of our patients. Reducing gun violence, gun-assisted suicide, and accidental gun-related injuries is in the best interests of our patients’ health. All eight of the health professional organizations involved in this important article are committed to collaborating through educational and political perspectives to encourage legislation
770
Lawrence
Firearm-Related Violence
that will reduce the incidence of firearm-related death and injury in this country. REFERENCES 1. Weinberger SE, Hoyt DB, Lawrence HC III, Levin S, Henley DE, Alden ER, et al. 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 Feb 24. doi: 10.7326/M15-0337. [Epub ahead of print]. 2. Weinberger SE, Lawrence HC III, Henley DE, Alden ER, Hoyt DB. Legislative interference with the patient–physician relationship. N Engl J Med 2012;367:1557–9. 3. Karp A. Completing the count: civilian firearms. Available at: http://www.smallarmssurvey.org/fileadmin/docs/A-Yearbook/ 2007/en/full/Small-Arms-Survey-2007-Chapter-02-EN.pdf. Retrieved February 26, 2015. 4. Krouse WJ. Gun control legislation. Washington, DC: U.S. Congressional Research Service; 14 November 2012:8-9. Available at http://www.fas.org/sgp/crs/misc/RL32842.pdf. Retrieved February 26, 2015. 5. Alpers P, Rossetti A, Salinas D, Wilson M. Rate of civilian firearm possession per 100 population. United States—gun facts, figures and the law. Sydney, Australia: Sydney School of Public Health, The University of Sydney; 2015. Available at: http://www.gunpolicy. org/firearms/region/united-states. Retrieved February 26, 2015. 6. Centers for Disease Control and Prevention. FastStats: all injuries. Available at: http://www.cdc.gov/nchs/fastats/injury.htm. Retrieved February 26, 2015. 7. Richardson EG, Hemenway D. Homicide, suicide, and unintentional firearm fatality: comparing the United States with other high-income countries, 2003. J Trauma 2011;70:238–43. 8. Miller TR. The cost of firearm violence. Calverton, MD: Children’s Safety Network; 2012. Available at http://www. childrenssafetynetwork.org/publications/cost-firearm-violence. Retrieved February 26, 2015.
OBSTETRICS & GYNECOLOGY
Copyright ª by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
