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Perspective – Preventing firearm violence: Can anything really be done?

One of the benefits of a medical education is an indoctrination into the art of critical thinking. Physicians are chronically subjected to information overload comprised of past and present patient histories, new and old clinical and basic science research, psychosocial factors that relate to patient care, and governmental and institutional rules and regulations. We are besieged by an ever-expanding and increasingly complex volume of data that we must organize and effectively synthesize and manage to maintain our professional competence. We regularly re-educate and re-certify ourselves toward this end. We integrate evidence-based data and evidence-directed guidelines that inform and influence the critical thinking that enables us to render optimal medical care.

Thus, it is insulting to us individually and collectively to repetitively be subjected to the inane pablum with which we are bombarded after every mass shooting (an event that routinely results in four or more deaths or casualties), including most notably the recent horrific episode at Tree of Life Synagogue in Pittsburgh. As of Nov. 21, 2018, there have been at least 15 additional mass shootings in the United States since the Tree of Life massacre.

What is it we hear after a mass shooting? We hear, “Our condolences to the families and loved ones of the victims.” We hear, “Something has to change. This has to stop.” We hear, “Gun safety could be assured if there were mandatory background checks and psychologic evaluations.”

Physicians, who are critical thinkers, must realize that background checks and psychological evaluations, although desirable, alone likely will be insufficient to quench firearm violence.

What we never hear is an idea, or a series of ideas, of creative concepts that might somehow help to staunch the flow of blood, death and destruction following mass shootings, as well as the far greater numbers of firearm deaths caused by homicide, suicide and accidental gun discharge. How is it that the country that spent $200 billion in today’s dollars to bring the Apollo program to fruition is unable or unwilling to devote the resources needed to quell gun violence?

There certainly appears to be little or no political will on the part of our elected lawmakers to deal with the problem or to even provide the mandate and funding to allow the CDC to conduct appropriate research. And yet, a majority of Americans favor stricter control on firearms, including, according to a recent NPR poll:

  1. Requiring background checks for all gun buyers (94 percent)

  2. Adding people with mental illnesses to the background check system (94 percent)

  3. Raising the legal age to purchase guns from 18 to 21 (82 percent)

  4. Banning bump stocks (81 percent)

  5. Banning high capacity magazines (73 percent)

  6. Banning assault style weapons (72 percent)

The medical community is always on the front line of the epidemic of firearm tragedy, directly involved in the aftermath of both mass shootings and of individual homicides and suicides. The America College of Physicians (ACP) and the American Academy of Family Physicians (AAFP) have issued position papers on how physicians in practice can help to control gun related violence. The Pennsylvania Psychological Association (PPA) has published research and guidelines on gun violence.1,2,3 These measures include the activities noted above as well as direct contact interview techniques to identify patients and families at risk, with suggestions of appropriate reporting in exigent circumstances that does not violate physician-patient confidentiality.

I will suggest, however, a series of more radical interventions that could directly help ameliorate firearm casualties.

First, I believe that effective security at vulnerable locations including schools, places of worship and hospitals, to name a few, should be established. A policy of one entrance and one exit point with trained armed security guards, metal detectors and identification upon entry and egress so all occupants in any one place at any one time can be monitored would be a first step toward securing vulnerable venues. This could become a legal commitment and mandate, funded by government in the same way that PSA became law following 911, if popular will can be attained to drive political will. Obviously, the climb and battle are uphill, in a milieu in which national legislation for background checks cannot even be agreed upon. But I will continue to indulge in a series of fantasies that could become reality given the proper convergence of circumstances.

Second, a resource such as a national think tank could be appointed and charged with the real development and implementation of technologies already in existence, including:

  1. Biometric devices that allow only recognized users to discharge a firearm using fingerprint technology.

  2. Radiofrequency technology that can enable only authorized users to discharge the firearm and only in authorized locations that are recognized by the weapon.

  3. Geo fencing, which can lock a weapon upon reaching certain unauthorized areas such as schools, places of worship and airports.

  4. A special wristwatch which recognizes the user and will then unlock the weapon for firing.

These are only a few of the available technologies that exist. None of these would likely infringe upon our Second Amendment rights, particularly as noted in District of Columbia v. Heller, the 2008 Supreme Court decision that guaranteed the right to maintain loaded firearms at home for self-defense.

Additionally, tight regulation of the sale and use of ammunition could be instituted on a national basis, with sales contingent on the authorized use (home protection, hunting, etc.). Smart ammunition that recognizes the firearm also could be developed, thereby rendering the millions of unregistered weapons in circulation obsolete.

The Heller decision guarantees the right to keep a loaded weapon in the home for self-defense, but states that the Second Amendment right is not unlimited in scope, implying that regulations that do not infringe upon the Second Amendment are permitted. Thus, any of the above noted endeavors would not be expected to infringe upon the Second Amendment right. Of course, the NRA and other advocates of untethered firearm rights will feel differently.

Unfortunately, rules that affect or proscript certain types of behavior to benefit the common good do tend to curtail individual liberties, but the world in which we live compels us to make such sacrifices. As physicians, nurses, mental health practitioners and advocates, and indeed, all who engage in the physical and mental health of our community, we should try to commit to meaningful input toward making America Safe Again.

The opinion expressed in this column is that of the writer and does not necessarily reflect the opinion of the Editorial Board, the Bulletin, or the Allegheny County Medical Society.


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