Gun Safety is a Public Health Issue

Conference Spotlight: The American College of Physicians (ACP) Internal Medicine 2014 (April 10-12, Orlando, FL) brought together internal medicine physicians, subspecialists, medical students, and allied health professionals to discuss a variety of clinical issues and healthcare policy mandates.

Physicians have a right and responsibility to discuss gun issues with their patients, according to a new policy paper from the American College of Physician (ACP). 

 Principal in the 9 strategies to address societal, healthcare, and regulatory barriers is the idea that firearm safety should be considered a public health issue. 

The ACP’s policy position was developed after conducting a comprehensive data analysis on access to firearms, mental health, state and federal firearms laws, and efforts to reduce firearms violence. In a nationwide survey of internists in the US, 85% believed that firearm injury was a public health issue and 76% supported stricter gun control legislation.¹ 

The statistics are sobering: 32,000 people are annually killed by guns in the US, which equals to 88 gun deaths per day.¹ “Access to firearms, especially firearms in the home, increases the likelihood the person will be a victim of gun violence—by homicide or suicide,” said Robert B. Doherty, senior vice president of Government Affairs and Public Policy for the ACP. “And that’s a key finding because there is a big debate about whether the protective value of the self-defense of having guns in the home outweighs the potential risk. The evidence is very clear—the risk is higher.”

The ACP recommendations include:

• Physicians should counsel patients on the risk of having firearms in the home, especially when children, people with dementia, mental illness, and substance abuse, or are at an increased risk for harming themselves or others are present. 

• Support of appropriate regulation on the purchase of legal firearms to reduce firearms-related injuries and death, acknowledging that any such regulation must be consistent with the Supreme Court ruling establishing that individual ownership of firearms is a constitutional right under the Second Amendment of the Bill of Rights.

• Guns be subject to consumer product regulations regarding access, safety, and design. Plus, the ACP supports law enforcement measures to aid in the identification of weapons used in crimes.

• Firearms owners should adhere to best practices to reduce the risk of accidental or intentional injuries or deaths. 

• Legislation to ban the sale and manufacture of civilian use of
firearms that have features designed for rapid killing capacity and large-capacity ammunition, and retain the current ban on automatic weapons for civilian use. 

• Support of efforts to improve and modify firearms to make them as safe as possible, including the incorporation of built-in safety devices.

“The pattern is interesting: In cities, when [guns] are used for bad purposes, it’s often a homicide. In rural areas, the nature of the firearms-related deaths is often suicide. These are isolated people; in both cases, the existence of substance abuse, especially alcohol which is disinhibiting, combined with ready access to a gun leads to these very sad deaths,” said Molly Cooke, MD, president of the ACP. 

Finally, the ACP cautions against broadly including those with mental illness in a category of dangerous individuals. Thomas G. Tape, MD, regent of the ACP, noted that if individuals with mental health feel that their position will be compromised if they report to physicians that they own a gun, they may avoid getting treatment at all and that can be a significant adverse effect that could potentially increase risk. 

Note: If you include depression and anxiety, over 30% of the patients in primary care practices can be considered as suffering from mental illness. 

The panel stressed the need for additional research on intervention and prevention strategies to reduce injuries caused by firearms. For example, there is no question that a physician should report a patient who owns a firearm when he believes that the patient possesses imminent threat to themselves or others. But, the question is if a physician should be required to more broadly report on patients with a mental illness who may pose a threat. ■

Each year, firearms kill more than 32,000 persons in the United States, or approximately 88 people per day.¹

• Firearm injury is the second leading cause of death due to injury after motor vehicle crashes.¹
• Homicide and suicide by firearms result in 11,000 and 19,000 deaths, respectively, each year.¹
• The number of nonfatal firearm injuries in the United States is more than twice the number of fatal firearm injuries, with 73,883 nonfatal firearm injuries documented in 2011.¹

Reference:

1. Butkus R, Doherty R, Downey H. Reducing firearm-related injuries and deaths in the United States: executive summary of a policy position paper from the American College of Physicians. Ann Intern Med. 2014 Apr 10. Available at: http://annals.org/article.aspx?articleid=1860325. Accessed April 10, 2014.