Guns and public health: Applying preventive medicine to a national epidemic

It happened again … twice in less than twenty-four hours. Are any of us surprised? And can anybody help?

When a panel of seven doctors was asked how many had seen a gunshot victim within the past week, three hands went up. "I think people think that if their loved one gets to the hospital, that there's magic there. But sometimes it's just too much for us," said Dr. Stephanie Bonne.

If there was ever a time for preventive medicine, it's now, says a group of doctors. 

"A grandfather was shot yesterday," said Dr. Roger Mitchell. "A son was shot yesterday. Yesterday – a mother was shot yesterday. And then the day before that, there were five other people that were shot that were connected to Americans in this country."

They've had enough, and seen enough.

"The only thing worse than a death is a death that can be prevented," said Dr. Ronnie Stewart. "And to go and talk to the mom of a child who was normal at breakfast and now is not here, is the worst possible thing. And honestly, it drives us to address this problem."

Drs. Stewart, Boone and Mitchell, along with Drs. Albert Osbahr, Niva Lubin Johnson, Chris Barsotti and Megan Ranney were in Chicago this past winter as more than 40 medical organizations, who normally operate separately, joined forces to address the 40,000 firearm-related deaths that occur each year.

Nothing like this has ever happened, they said. "And we recognize that this is an epidemic that we can address," said Dr. Barsotti.

Their meeting followed a tweet from the National Rifle Association last November that helped fuel a movement: "Someone should tell self-important anti-gun doctors to stay in their lane."

In response, Dr. Bonne, a trauma surgeon in Newark, N.J., snapped a picture of the waiting room and posted it to Twitter along with this message: "Hey, N.R.A., do you wanna see my lane? Here's the chair that I sit in when I tell parents that their kids are dead."

"And you hit send. And then what happens?" asked medical correspondent Dr. Jon LaPook.

"I was part of a chorus," Dr. Bonne replied.

A chorus of thousands of medical professionals who responded #ThisIsOurLane.

"Our motto is do no harm, for physicians. But I think the community felt that harm was being done to us by that tweet," said Dr. Lubin-Johnson.

Dr. Ranney said, "I remember sitting there and thinking, how can you lecture docs, many of whom are gun owners, about what we do and don't know?"

Dr. Ranney is chief research officer for Affirm, an organization trying to address gun violence through the same tools doctors use to combat problems like obesity, the opioid crisis, and heart disease.

This public health approach is not new: in the 1950s, doctors worked with the auto industry to help make cars and roads safer. In the '60 and '70s, they spoke out against the dangers of tobacco; and in the '80s and '90s, to combat HIV and AIDS, they promoted safe sex and research.

Today, the focus is gun violence in all its forms. It may surprise you to know that mass shootings make up less than 1% of firearm-related deaths. The leading cause is suicide, followed by homicide, and then accidents.

But good answers on how best to prevent these deaths are hard to come by. That's because of 1996 legislation defunding any research at the Centers for Disease Control and Prevention promoting gun control.

Rep. Jay Dickey (R-Ark.), who appended an amendment to a spending bill disallowing government funds from beings used to, in whole or in part, advocate or promote gun control, told the House, "This is an issue of federally-funded political advocacy … a[n] attempt by the CDC to bring about gun control advocacy all over the United States." $2.6 million from the CDC's budget was re-allocated, and it had a chilling effect on almost all firearm research. 

"What was lost was 20-some years of effort to understand and prevent a huge health problem," said Dr. Garen Wintemute, whose work on handgun violence lost government funding after Congress passed that 1996 legislation. "Consciously, deliberately, repeatedly, over and over, we turned our back on this problem. It's as if we, as a country, had said, 'Let's not study motor vehicle injuries. Let's not study heart disease or cancer or HIV/AIDS.'

"And the result, I believe, is that tens of thousands of people are dead today whose lives could have been saved if that research had been done."

In 2018, Congress said government dollars could be used to research gun violence, just not to promote gun control. But Dr. Wintemute says federal research into gun violence is still underfunded.

While private donations for research are now increasing, Dr. Wintemute has over the years spent more than $2 million of his own money to continue his research at the University of California-Davis.

Dr. LaPook asked, "Are you a wealthy man who can afford to just do that, as a rounding error?"

"It's not rounding error," he laughed. "But I live a very simple life. I earn an academic sector, ER doc's salary."

"So, you are changing your lifestyle in order to fund this research or have in the past?"

"Yes, that's correct."

"What drives you to do that?"

"People are dying," Dr. Wintemute replied. "Given the capacity to do it, how can I not? It really is just that simple."

His work has led to some surprising conclusions. For example, his studies revealed that in some states comprehensive background checks as implemented had no effect on the number of firearm-related deaths. That's in part because of a lack of communication among agencies.

"We have learned that probably hundreds of thousands of prohibiting events every year do not become part of the data that the background checks are run on," Dr. Wintemute said.

Consider the 2017 shooting of 46 parishioners at a church in Sutherland Springs, Texas. Due to a domestic violence conviction, the shooter should had been stopped from buying any guns, but that information was never shared with the FBUI, which oversees the background check system.

"So you think, okay, it's not as effective as we want, but it can become effective if we do A, B, and C?" Dr. LaPook said.

"There's no question about it," Dr. Wintemute replied.

But it's policy proposals from doctors on issues like background checks and registrations that concern gun-rights advocates.

Dr. LaPook said, "The point the N.R.A. was trying to make with its ["stay in your lane"] tweet was, what makes doctors experts on gun policy?"

"Doctors are not experts on gun policy unless they do their homework," said Dr. Wintemute. "What doctors are experts on is the consequences of violence. If doctors choose to be, they can become experts on policy."

When asked if advocating for gun control part of the mission of Affirm, Dr. Megan Ranney said no. "This is about stopping shooters before they shoot," she said.

The NRA did not respond to "Sunday Morning"'s repeated requests for an on-camera interview. However, in a phone conversation earlier this year, two representatives said the organization does support research into gun-related violence, but expressed concern that – say what they will – the ultimate goal of many who advocate such research is to take away the guns of responsible citizens.

Dr. Ronnie Stewart said, "We're not well-served by this overly-simplistic view of simply two sides fighting each other. We have to work together. And that includes engaging firearm owners as a part of the solution, not a part of the problem."

For these doctors, the issue isn't about whose lane it is; it's about what they can do.

As Dr. Stephanie Boone said, "I know that the house of medicine can fix this."

And, Dr. Albert Osbahr added, "Enough is enough."

       
For more info:

• Affirm

       
Story produced by Dustin Stephens.