Every political state should guarantee certain fundamental provisions such as the health and wellbeing of its citizens as well as their freedom, except when this freedom infringes upon the liberty of others. In America today, these two provisions intersect within discussions on gun rights and gun laws. Although these two provisions are not mutually exclusive, suggestions to protect one provision evoke fear of losing the other. According to the Federal Bureau of Investigations’ (FBI) online publication titled “A Study of Active Shooter Incidents in the United States Between 2000 and 2013,” an average of 6.4 incidents per year occurred between years 2000 and 2006 while an average of 16.4 incidents per year occurred between 2007 and 2013. 40 percent of these active shooter incidents classified as mass shootings (defined as at least 3 people killed). In a second report, the FBI recorded 20 active shooter incidents for each of 2014 and 2015. 37.5 percent of these classified as mass shootings. Mass shootings in America have become commonplace, with one tragedy bleeding into the next. It’s like an epidemic — an unstudied, mysterious epidemic — that has no end in sight unless we empower ourselves with its knowledge.
As I write this article, 49 people have been confirmed dead after a mass shooting at a popular nightclub in Orlando, FL, with an additional 53 reported injured. In recent times, similar shootings have occurred with frightening regularity. In 2015 alone, we can recount San Bernadino, California; Colorado Springs, Colorado; Roseburg, Oregon; Chattanooga, Tennessee; and Charleston, North Carolina. People are being killed in unprecedented numbers, yet we have a poor understanding of the disease that is taking their lives. Gun violence is now a concerning public health issue and it begs the question: where are the patient advocates?
In 1854, there was a cholera outbreak in Soho, London in an area now called Carnaby Street. At that time, disease was believed to be spread by “polluted or bad air” — the so-called miasma theory. During this outbreak, John Snow, who later became one of the forefathers of epidemiology, studied the distribution of the ensuing illnesses and deaths. After geographically plotting the disease occurrences, he deduced that the water pump on Broadwick Street — now famously known as the Broad Street Pump — was the most likely source of the outbreak. Initially, Dr. Snow’s theory was met with a lot of resistance because the spread of disease by contaminated water seemed absurd. However, using his extensive data set, Dr. Snow convinced the Board of Guardians to take action. They removed the pump handle and halted the cholera outbreak.
In medicine, we are taught to “know” what we are treating. We begin to treat only after data collection (patient history, physical exam findings and diagnostic testing as needed) and commitment to a leading diagnosis. That is “good” medicine. We never treat a disease we don’t know, because that is bad medicine. That is why we do not, for example, give every patient with abdominal pain a trial of proton pump inhibitors to “just see” if they get better. We must first make a diagnosis of heartburn (based on high clinical suspicion) or peptic ulcer disease (based on upper endoscopy) before we begin treatment with PPIs.
Physicians have an impressive knowledge of the human body and the human condition. Every day, we advocate for our patients to start taking their cholesterol medications. We advocate for them to get their colonoscopies. We advocate for them to start an exercise regimen. We are advocating for their health. We have come to value human life in a unique way because our everyday tasks are geared towards keeping people alive. Unfortunately, 49 of these people just died. They succumbed to this devastating contagion called gun violence. Again, where are these patients’ advocates?
It is not news that the National Rifle Association (NRA) has an effective ban on the study of gun violence by the Center for Disease Control and Prevention (CDC). However, early last month, Barack Obama at a town hall meeting gave us a timely reminder of this fact. According to The Washington Post, this effective ban began in 1996 when the NRA’s accusation of “the CDC trying to promote gun control” led to a $2.6 million slash in the CDC’s research budget. That was the amount the CDC had spent on gun violence research in the previous year. Reflexively, I imagined a fast food chain restricting scientific studies on high cholesterol foods as cardiovascular risk factors. That seemed unreasonable and outrageous to me. In the same vein, the restriction on studies of gun violence should be seen as such.
The NRA states that guns do not kill people, rather it is the bad people who use guns to kill people. That may be true, but the hypothesis needs proper testing. Important research questions might include: what kind of interventions can reduce active shooter incidences? What risk factors predispose active shooters to make the final move? Is gun violence driven more by ideological extremism, gang violence or gun accessibility? Can interventions be made while still protecting the freedoms of people and their right to bear arms? Are interventions even feasible? The answers to these questions may provide important turning points in our approach to this epidemic of gun violence. Perhaps good data will strengthen the NRA or allow the NRA the opportunity to work research findings into their mission and operations. One thing, however, is for sure — we need to study this disease to protect our patients.
The victims of gun violence are coming to a hospital near you. In fact, they may have come to you already. Heartbreaking, but true. Especially true if we do not do something about it as healthcare providers. With our silence we risk more 49s and 53s, hurting families and broken societies.
Well, what can you do about this issue even if you wanted to? For starters, let’s talk about the issue. Let’s make “Let’s Study Gun Violence” our message through the hashtag #LSGV on every social media platform. Let’s focus our message on the need for more information, not the need for a specific line of action — we will let the research tailor future recommendations. Secondly, if you feel bold enough, contact your local, state, or federal representatives and let them know in your own words how concerned you are about the lack of research on gun violence. Lastly, let’s involve the whole health care spectrum in this battle, including physical therapists, nurses, podiatrists, pharmacists, the list goes on. With our collective voices, we can start a movement that will change the face of guns in America.