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Wednesday Dec 09, 2015

Seeking Solutions to Gun Violence at the Scene of the Crime

A couple of months ago, I was invited to participate in an event at the Emanuel African Methodist Episcopal Church(ehhp.cofc.edu) in Charleston, S.C., which was the site of a racially motivated shooting earlier this year. The purpose of the event was to bring together stakeholders from legal/judicial, health care, public health, law enforcement, political, faith and other communities to address gun violence prevention.

From the time I started preparing for this event in early October until it actually took place on Dec. 4, the United States witnessed more than 50 other incidents(shootingtracker.com) in which three or more people were shot. In just two months, such shootings claimed 90 lives and wounded more than 200 others.

Michael Bowman/Voice of America
A memorial forms outside the Emanuel African Methodist Episcopal Church. Nine members of the congregation died during a June 17 shooting at the Charleston, S.C., church. I participated in a forum on gun violence Dec. 4 at the church.

As a nation, we cannot allow ourselves to grow numb to such tragedy. By the time we convened last week in the same room where nine members of Emanuel's congregation had been gunned down in June, places such as Colorado Springs, Colo., and San Bernardino, Calif. -- where other high-profile, deadly attacks occurred -- had been thrust into the national spotlight.

It was powerful and poignant to be in that church in Charleston. More than 300 people, including state legislators and the presidents of the American Bar Association and the American College of Physicians, participated. The AAFP was represented by state and national leaders, and I participated in a health care panel discussion.

We talked about the scope of gun violence, which has claimed the lives of more than 406,000 Americans in the past 14 years. In the past four years alone, gun-related deaths have exceeded the number of American lives lost in the Vietnam, Korean, Iraq and Afghanistan wars combined.

The issues discussed included adverse childhood experiences, domestic violence, racial disparities, the Second Amendment and more. We learned from a speaker from the American Psychiatric Association that most gun violence homicides are not related to mental health, although conventional conversations would make us believe otherwise. We also discussed the petitions physician groups delivered to Congress(www.medpagetoday.com) a few days earlier (hours before the San Bernadino shooting), seeking repeal of a shameful law that bans the CDC and NIH from conducting research on gun violence.

The obvious question is what can be done about this crisis -- which one speaker, from the Johns Hopkins Bloomberg School of Public Health's Center on Gun Violence, called a social contagion -- in a sharply politically divided country? On one end of the spectrum, there are those calling for bans on guns, while those on the other end believe the solution is to buy more guns.

How do we find middle ground that effectively addresses the problem? Can we reduce gun violence while respecting the Second Amendment? According to constitutional law experts who participated in the event, the answer is a resounding "yes."

For example, speakers pointed to the need to close loopholes in existing gun laws. The FBI has acknowledged that the Charleston shooter should not have been able to legally buy a gun(www.usatoday.com) because of his criminal record. However, federal law allows gun dealers to proceed with sales if FBI examiners do not respond within three days. In the Charleston case, clerical errors prevented the FBI from acting before the transaction was completed. Clearly, the system needs improvements, and the three-day period should be re-evaluated.

Meanwhile, some states are actually easing gun laws. Earlier this year, for example, Kansas passed legislation that allows people to carry concealed handguns without a permit and with no training(www.kansascity.com). Although the gun industry promotes its products as keeping families safe, too often, gun owners are doing the exact opposite(www.washingtonpost.com). During the first 10 months of this year, 13 U.S. toddlers inadvertently killed themselves(www.washingtonpost.com) when adults left loaded guns in places these children could access. Eighteen others injured themselves, 10 injured others, and two killed other people.

Family physicians can play a key role in helping keep people -- especially children -- safe, but the First Amendment rights of physicians aren't being held in the same regard as the Second Amendment rights of gun owners. Florida passed a law in 2011 that restricts physicians' rights to ask patients whether they own guns. Roughly a dozen other state legislatures have since introduced similar measures. The AAFP strongly opposes these dangerous restrictions on patient-physician conversations that focus on prevention.

Why would physicians ask patients about guns? For the same reason we ask parents about bike helmets and child car seats: We can help parents make good decisions that make their families safer. In this case, we can counsel them about safe gun storage.

Changing gun laws, or passing new ones, likely would be extraordinarily difficult in a political environment where our two major parties can't agree on far less divisive issues. But what if we instead approached gun violence as a public health issue? Cure Violence(cureviolence.org) is one such model that is showing success.

A combination of regulation, education and taxation has led to a dramatic decline in smoking rates, from 42.4 percent of U.S. adults in 1965 to 18 percent in 2014. What combination of education, public health, mental health and health care programs could help reduce gun violence?

Clearly, something has to change, but we must do it in a way that protects people's rights -- and not only their Second Amendment rights. This conversation will be coming to your community. When it does, what will you say as a family physician?

Wanda Filer, M.D., M.B.A., is president of the AAFP.

Posted at 12:52PM Dec 09, 2015 by Wanda Filer, M.D.

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