That is what it is coming down to according to the talking
heads on the Sunday morning TV circuit this week. Both the NRA and several politicians agree
that there are not enough votes for an assault weapons ban. There may be enough votes for a high capacity
magazine ban but both sides acknowledge that these clips are inexpensive and
there are already a lot of them out there.
The background checks issue is also debatable. The NRA and the pro-gun factions are talking
a lot about mental illness and needing to have a mechanism to prevent people
with mental illnesses from getting guns.
There is minimal discussion of improved mental health services. On CNN Sunday
morning there was acknowledgement that during tough budgetary times the
line items supporting mental health treatment are the first to go.
So basically despite all of the hype about how the Sandy
Hook incident was going to energize politicians to actually solve a problem –
they appear to be rapidly reverting to form and not solving anything. The NRA President seemed confident that
nothing would happen (the NRA opposes any assault weapons ban or high capacity
magazine ban), but cautioned that the President has a lot of political capital
and might be able to influence the high capacity magazines.
I wanted to file this post tonight before the final
recommendations of the Vice President because I think that there have been two
recent articles in the medical literature that are very relevant. At the
legislative level Jerome Kassirer, MD has a recent article in Archives of
Internal Medicine. Dr. Kassirer is a former editor of the New England Journal
of Medicine and I corresponded with him on this issue nearly 30 years ago. He clearly has not lost interest over the
years and brings several concepts into focus in his editorial. The first concerns
the fundamentals of screening and how any effort to identify potential shooters
would result in the false positives greatly outnumbering the true positives and
how that renders screening impractical. His
primary focus has to do with countering political initiatives. As an example the National Center for Injury
Prevention and Control at the CDC is currently prevented from studying gun
related injuries. He advocates for countering that. He advocates for a
comprehensive analysis of gun ownership. He also advocates for resistance to any laws
that restrict physicians being able to talk about firearms with their patients.
He wants to see universal background checks from gun purchases, gun safety
devices including coded weapons, and restrictions on large capacity magazines
and sales of large amounts of ammunition. His article refers to firearms as
"Weapons of Mass Destruction". Small arms and light weapons are in fact a major global problem. This Federation of
American Scientists primer
highlights the issue and the fact that there have been over 1 million deaths due to small arms in
the past decade. Some advocacy organizations estimate that as many as 250,000
people per year are killed by small arms fire worldwide.
The second very important article comes from the Journal of
the American Medical Association. The authors of this article emphasize the
public health approach to curbing gun violence. This is a very important
concept that people have a difficult time grasping. Whenever I bring up the
issue of psychiatrists being involved at the level of primary and secondary
prevention most people distill that down to whether or not psychiatrists can
predict violence. A public health
approach to violence prevention is much more comprehensive and
multidimensional. The authors give
several good examples in this paper including modifying sociocultural norms. They use the example of tobacco being media
symbol of “modernity, autonomy, power, and sexuality" and how that was
changed. They suggest an analogous
campaign to equate gun violence with weakness, irrationality, and cowardice.
The article has a table that has 18 evidence-based public health interventions
that have been successful in other areas that could be applied to gun violence. This is actually the preferred strategy that
I have been advocating for the past decade and the authors of this article
state it very eloquently.
At this point in time it will be interesting to see if the Vice
President's recommendations include any of the interventions suggested by these
two articles or the recommendations from the APA.
George Dawson, MD, DFAPA
1: Kassirer JP. Weapons of Mass Destruction. Arch Intern
Med. 2012 Dec 21:1-2. doi: 10.1001/jamainternmed.2013.4026.
[Epub ahead of print] PubMed PMID: 23262523.
2. APA Recommendations
to the Biden Task Force
3. Mozaffarian D,
Hemenway D, Ludwig DS. Curbing Gun Violence: Lessons From Public Health
Successes. JAMA. 2013 Jan 7:1-2. doi: 10.1001/jama.2013.38.
[Epub ahead of print] PubMed PMID: 23295618.
