Viviana Goldenberg is a certified family physician practising in the United States
*disclaimer: the opinions expressed in this blog are those of Dr Goldenberg and do not represent those of the company at which she is employed
In the aftermath of the recent Charleston mass shooting, Americans find themselves looking for an explanation. This time the conversation has focused on the Confederate flag. After the Aurora and Newtown massacres, the finger pointed at “mental illness.” We choose to give a simple answer to a complex problem and move on without acknowledging the simple truth — that a racist driven by hatred or a mentally disturbed person could not have committed mass murder without a gun. It is, however, inaccurate to pass off the gun violence epidemic as nothing more than a “mental health issue.” In fact, a psychiatric diagnosis is not predictive of violence and the overwhelming majority of people with diagnosed psychiatric conditions do not commit crimes. Mass shootings, in turn, contribute but a small fraction of the 33,600 deaths attributed to guns annually in the USA. Alarmingly, those numbers increase every year. Roughly 20,000 cases are suicides but the rest are homicides, intentional shootings, unintentional shootings, and law enforcement interventions.
Despite denial in some circles, gun violence is a Public Health issue. The United States has the highest gun ownership rate in the world, and along with it the highest per capita rate of firearm-related murders of all developed countries. The consequences of gun violence are both physical and psychological. They take a toll on communities, families, and cost the health system over 170 billion dollars a year.
Because of the gun lobby’s power over legislatures, physicians in some states are not permitted to address the presence of guns in the home. When conducting a well-child visit a doctor can inquire about pets, hazardous chemicals in the home, pool safety, etc. But not guns. Roughly 1.7 million children live in homes with unsecured and loaded weapons. Every day we read heartbreaking stories about unintentional shootings involving a child. These shootings are totally preventable. Simple steps like keeping guns and ammunition stored in separate safes would go a long way toward stopping these tragedies. The public should be told that teen suicide is more an impulsive behavior than the result of a mental disorder and that easy access to guns makes it more likely that the impulsive attempt will be successful; that the presence of firearms in the house increases both the risk of homicide and suicide; that guns in homes with domestic violence makes it 7.2 times more likely for a woman will be killed by an intimate partner.
These things should be discussed as part of preventive care, particularly in a nation with a strong gun culture. But the NRA, the visible hand of the gun lobby, continues pushing laws that gag healthcare providers. These laws represent unacceptable political interference that infringe First Amendment rights, the doctor-patient relationship, and the physician’s duty of advocating for the well being of her patients.
Last February, eight health professional associations joined with the American Bar Association to publish a joint statement advocating for a comprehensive approach to these problems, including a call for universal background checks on gun sales, restrictions on access to assault weapons, a focus on mental health, elimination of physician “gag” laws, and the need for further research on these topics. Congress' answer was to continue the ban on any CDC research of gun violence because, in the words of Speaker Boehner, “guns are not a disease” and supporting such research will contribute to “gun control.” Not surprisingly, Speaker Boehner has an A+ NRA rating.
There is evidence showing that states with stronger gun laws have fewer gun deaths. Even so, any attempt to present reasonable and common sense gun laws is unfortunately shut down by politicians who insist on an anachronistic reading of the Second Amendment as they pander to extremist supporters of gun rights and gladly accept their NRA funding. Meanwhile, their position undermines the safety of the silent majority. I am personally tired of reading about “accidental shootings,” followed by the inevitable outpouring of “thoughts and prayers” going out to the families of the victims. Prayers do not stop bullets or bring the victims back, and there is nothing “accidental” about a child dying because he was playing with an unsecured, loaded weapon. On the contrary, it is, sadly, more accurate to consider it an “accident” when the inevitable does not happen. Changing the culture will take time but I will not give up because I am not “just“ a physician. I am also a mother of two children who cannot help thinking about Sandy Hook every time I drop them at school. We cannot live like this. The good news is we don’t have to. All it takes is for the silent majority to finally speak up and say, “Enough is enough.”