Doc­tors tell NRA why they are ex­perts on gun vi­o­lence

Af­ter be­ing told to ‘stay in their lane,’ physi­cians’ de­ter­mi­na­tion grows

Los Angeles Times - - THE WORLD - By Melissa Healy [email protected]­

It was the kind of im­pe­ri­ous broad­side that would strike fear into the hearts of most politi­cians.

In a con­temp­tu­ous tweet, the Na­tional Ri­fle Assn. ad­mon­ished a med­i­cal group for speak­ing out about gun in­juries and dis­missed any con­cern by say­ing that physi­cians should mind their own busi­ness.

“Some­one should tell self-im­por­tant anti-gun doc­tors to stay in their lane,” the NRA tweeted on Nov. 7. In draft­ing a pol­icy state­ment that “re­flects ev­ery anti-gun­ner’s pub­lic pol­icy wish list,” the Amer­i­can Col­lege of Physi­cians “seems to have con­sulted NO ONE but them­selves,” the NRA com­plained.

The re­sponse from doc­tors has been swift and sus­tained. And it has built on a grow­ing con­sen­sus among med­i­cal pro­fes­sion­als that firearm in­juries and deaths — whether self­in­flicted, ac­ci­den­tal, in mass shoot­ings or in the daily drum­beat of one-on-one gun vi­o­lence — amount to a “pub­lic health cri­sis that re­quires the na­tion’s im­me­di­ate at­ten­tion.”

This week, in the New Eng­land Jour­nal of Medicine, a group of doc­tors made clear that those who patch up the wounded, in­form fam­i­lies of a loved one’s violent demise and re­ha­bil­i­tate bod­ies shat­tered by gun­fire will not be back­ing off any­time soon.

“As a pro­fes­sion, we have be­come de­ter­mined not just to de­velop solutions to this epi­demic, but to make sure they’re im­ple­mented,” the doc­tors wrote.

Their mes­sage is echoed by tweets from physi­cians on the front lines of emer­gency and trauma medicine, who have shared com­men­tary and pho­tos of their blood-stained work­places with the hash­tag #ThisIsOurLane.

In the days fol­low­ing the NRA’s so­cial me­dia swipe, even U.S. Sur­geon Gen. Jerome Adams, nom­i­nated to the of­fice by Pres­i­dent Trump, begged to dif­fer with the pow­er­ful gun rights or­ga­ni­za­tion.

At the Amer­i­can Pub­lic Health Assn.’s an­nual meet­ing in Novem­ber, Adams de­clared: “As a trauma anes­the­si­ol­o­gist, if I want to talk to my pa­tients about gun safety, it’s to­tally within my lane.”

Johns Hop­kins Hos­pi­tal trauma sur­geon El­liott R. Haut said the NRA — and Amer­i­cans gen­er­ally — have only be­gun to hear from the physi­cians, nurses and first re­spon­ders who care for gun­shot vic­tims.

For the NRA to dis­miss the voices of pro­fes­sion­als en­trusted with the lives of the in­jured — and who are fre­quently ex­perts on in­jury preven­tion as well — is not only pro­foundly mis­guided, “it’s of­fen­sive,” Haut said.

Dr. Judy Me­linek, a foren­sic pathol­o­gist in San Fran­cisco, seemed to sum up many doc­tors’ views in her Twit­ter re­sponse to the NRA (pro­fan­ity edited):

“Do you have any idea how many bul­lets I pull out of corpses weekly?” she de­manded. “This isn’t just my lane. It’s my ... high­way.”

In its cri­tique of the Amer­i­can Col­lege of Physi­cians’ pol­icy state­ment, the NRA dis­par­aged the re­search on which the group’s rec­om­men­da­tions were based.

“The prob­lem is that the ACP cites ‘stud­ies’ that wouldn’t qual­ify as ‘ev­i­dence’ in any other de­bate,” the NRA’s In­sti­tute for Leg­isla­tive Ac­tion wrote on its web­site. “One cited study was fo­cused on a sin­gle ru­ral county in Iowa. An­other was of 106 out­pa­tients at a sin­gle clinic. The authors ac­knowl­edge ev­i­dence is lim­ited but cite their own be­lief there is ‘enough ev­i­dence’ or sim­ply ar­gue the pol­icy should be en­acted any­way.

“In­con­clu­sive ev­i­dence is not ‘enough ev­i­dence,’ ” the cri­tique added. “Ap­ply­ing nar­row find­ings to a larger pop­u­la­tion is not ‘enough ev­i­dence.’ ”

For all its short­com­ings, Haut ar­gued that even re­search that’s been starved of fund­ing has gen­er­ated some early guide­lines for ac­tion.

“We have re­search that shows all these as­so­ci­a­tions be­tween the num­ber of guns out there and deaths from gun­shot, be­tween de­pres­sion and gun sui­cide, be­tween a lack of safe gun stor­age and ac­ci­dents af­fect­ing kids,” he said. “Is it per­fect? No. We’re ad­vo­cat­ing for high-qual­ity re­search on what works to make a dif­fer­ence and what doesn’t.”

Dr. Me­gan Ran­ney, an emer­gency physi­cian at Brown Univer­sity and coau­thor of the New Eng­land Jour­nal of Medicine com­men­tary, de­fended the qual­ity of ex­ist­ing re­search. For any short­com­ings in the cur­rent state of un­der­stand­ing about what works, she and her coau­thors fault leg­is­la­tion passed by Congress in 1966 that has shut off most fed­eral re­search funds on gun-in­jury preven­tion for decades.

But that is chang­ing, Ran­ney said in an in­ter­view. States and pri­vate or­ga­ni­za­tions have be­gun to fill the vir­tual void in fed­eral re­search funds for firearms in­jury re­search.

Un­der a five-year, $5mil­lion state ap­pro­pri­a­tion, Cal­i­for­nia has es­tab­lished the Univer­sity of Cal­i­for­nia Firearm Vi­o­lence Preven­tion Re­search Cen­ter, link­ing gun-in­jury preven­tion re­searchers from UCLA, UC Berke­ley, UC Davis and UC Irvine.

In May, the Laura and John Arnold Foun­da­tion an­nounced it would com­mit $20 mil­lion — and help raise an­other $30 mil­lion — for a mul­ti­year re­search ef­fort on gun-re­lated vi­o­lence. The foun­da­tion’s com­mit­ment helped launch a na­tional col­lab­o­ra­tive ef­fort on gun vi­o­lence re­search at the Santa Mon­ica-based Rand Corp.

In April, Kaiser Per­ma­nente ponied up at least $2 mil­lion for the study of gun-in­jury preven­tion. And Ran­ney said that health­care lead­ers from mul­ti­ple spe­cial­ties have so far raised $100,000 to cre­ate the Amer­i­can Foun­da­tion for Firearm In­jury Re­duc­tion in Medicine, or AF­FIRM.

“Ten years ago young physi­cians, in­clud­ing me, were told not to talk about guns,” Ran­ney said. Newly minted re­searchers were dis­cour­aged from un­der­tak­ing gun-re­lated projects for lack of fund­ing, and be­cause the field was per­ceived as a po­lit­i­cal hot potato. “It’s dif­fer­ent now,” she said.

An­drew Mor­ral, di­rec­tor of the Rand ef­fort, said that in a com­pre­hen­sive re­view of re­search in the field, the think tank found only 63 stud­ies that met the stan­dards of rigor that its re­searchers con­sid­ered ac­cept­able. But he cau­tioned that it would also be wrong to say that in­jury-preven­tion mea­sures based on ex­ist­ing re­search aren’t work­ing.

“Some­times peo­ple hear there’s a lack of ev­i­dence for gun poli­cies and they in­ter­pret it to mean that the poli­cies them­selves are in­ef­fec­tive,” Mor­ral said. “That’s a log­i­cal mis­take.”

As new in­vest­ments in re­search be­gin to bear fruit, physi­cians will gain bet­ter am­mu­ni­tion in the de­bate over how best to re­duce the toll of firearms on Amer­i­cans’ lives. That’s not po­lit­i­cal, Ran­ney and her coau­thors wrote.

“We are not anti-gun,” the doc­tors wrote. “Our fo­cus is on stop­ping shoot­ings be­fore they hap­pen and on sav­ing hu­man lives.”

Chase Stevens As­so­ci­ated Press

DOC­TORS shared com­men­tary and pho­tos with the hash­tag #ThisIsOurLane. Above, a wounded per­son is treated dur­ing the mass shoot­ing in Las Ve­gas in 2017.

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