US doctors speak out on gun violence

The search for solutions to the public health crisis of gun violence in America continues in the wake of the latest mass shootings. Bette Browne reports.

The United States (US) seems unable to rein in the powerful gun industry even though guns now kill or injure more people than cancer. Doctors who speak out are told to stay in their lane, but the American Medical Association (AMA) refuses to be silent. It is aware of the human face of the statistics in a country where gun violence has reached epidemic proportions, with more than 120 people killed by guns every day. 

The Governor of Illinois, JB Pritzker, said gun violence was “our uniquely American plague” after a number of people were killed in a gun attack in Chicago suburb during a 4 July parade celebrating the independence holiday. 

Gun deaths in the US reached the highest number ever recorded in 2020, when more than 45,000 people died, according to data released by Centres for Disease Control and Prevention (CDC). 

“The CDC data paint an alarming picture of the epidemic of gun violence,” outlined a review of the CDC data by the Johns Hopkins Centre for Gun Violence Solutions. 

In the over 200 mass shootings in the country so far this year, children and young people have paid the biggest price for what is seen as America’s obsession with guns. “God forgive this country for loving guns more than children,” was the comment of one religious leader after the massacre of 19 children and two teachers in a school in Uvalde, Texas, on 24 May. 

Guns were the leading cause of death among children and teens in 2020, accounting for more deaths than Covid-19, car crashes, or cancers, according to the Johns Hopkins review. 

The Children’s Defense Fund, which has been in existence for 50 years, issued a report that revealed gun violence in America has killed more than 200,000 children and teens since the 1960s. “That’s more than the number of soldiers killed in Vietnam, Afghanistan, the Persian Gulf, and Iraq combined,” the report said. 

In a statement after the Uvalde massacre, AMA President Dr Gerald Harmon commented: “As physicians, our mission is to heal and to maintain health. But too often the wounds we see in America today resemble the wounds I’ve seen in war.” 

“Each year more than 45,000 Americans die from firearm violence, and recent data from the CDC indicate that firearm deaths are increasing and disparities are widening, with young people, males, and black people experiencing the highest firearm homicide rates. We call on lawmakers, leaders, and advocates to say enough is enough. No more Americans should die of firearm violence.” 

Public health crisis 

Back in 2016, the AMA declared that gun violence had become a public health crisis. Over the past two decades, the Association has supported several gun control measures, including expanding background checks to all firearm purchasers and requiring safety instruction and registration for all firearms. 

The American Academy of Paediatrics also expressed revulsion after the Uvalde killings. “When will we as a nation stand up for all of these children? What, finally, will it take, for our leaders in government to do something meaningful to protect them?” asked the Academy’s President, Dr Moira Szilagyi. 

The American Psychological Association (APA) reiterated its call for gun reform laws. In a statement, Dr Frank C Worrell (PhD), APA President, commented: “It is long past time to act to ensure that our schools are safe havens for our children, and that stores, places of worship, and our streets are safe for everyone. A public health crisis requires a public health approach.” 

“APA has long advocated for gun safety including background checks of prospective gun buyers, safe gun storage, laws implementing extreme risk protection orders, and substantially more research into the psychological factors that lead to gun violence.” 

The President of the American College of Physicians (ACP), Dr Ryan Mire, directed his ire at the National Rifle Association (NRA) in a statement after the Uvalde killings. “I remind the NRA, which has steadfastly opposed efforts to make the country safer from gun violence and which told ACP in 2019 to stay in our lane, that tackling gun violence is in a physician’s lane as a public health crisis. We will not be intimidated from speaking out for the care of our patients.” 

Another healthcare provider who says “enough is enough” was Limerick native Mr Michael Dowling, CEO of Northwell Health, New York’s largest healthcare provider. He told Newsday he was “trying to rally the healthcare industry in the region and across the country to join in fighting for stronger gun control measures”. 

Background checks should be a requirement, he said. “All firearm transactions should require universal background checks on buyers – a view supported by the vast majority of Americans.” 

Polls show a majority of Americans want an end to gun violence and strong gun control measures by the US Congress. Indeed, support for gun control measures is at its highest in a decade, according to a poll in June by National Public Radio, in which six-in-10 Americans said controlling gun violence was more important than protecting gun rights. 

Yet despite the wishes of most Americans and the pleas of medical professionals and community leaders, gun violence has continued at alarming levels. 

Before Uvalde, there was the horrific massacre a decade ago of 20 children, aged between six and seven years old, at Sandy Hook Elementary School in Connecticut. Since then, there have been at least 27 mass shootings at schools. Just a week before Uvalde, 10 people were killed in Buffalo, New York. 

In an attack in June, two doctors were killed at Saint Francis Hospital in Tulsa, Oklahoma, by a gunman who said one of the doctors had caused him pain from a recent back surgery. 

AR-15 

Like the massacre of the 19 children in Texas in May, the gunman who killed the doctors in Oklahoma in June used an AR-15- style rifle. The AR-15 is an assault weapon and has been used in many of the attacks across the country. 

The AR-15 inflicted such destruction on the bodies of the young schoolchildren in Texas that it was impossible to identify many of them because they were so mutilated by the large exit wounds. 

“Many children were left not only dead, but hollow,” said actor and Uvalde native Mr Matthew McConaughey, speaking from the White House podium after the attack. “It is easier for someone to buy one of these killing machines than it is to buy a drink in many parts of America.” Indeed, the killer in Uvalde couldn’t buy a drink because he was under 21, but he was able to buy the AR-15 on his 18th birthday, with no questions asked and no background checks. 

As physicians, our mission is to heal and to maintain health. But too often the wounds we see in America today resemble the wounds I’ve seen in war 

“Weapons of war, such as the AR-15, are designed to kill as many people as possible in as short a time as possible,” Dr Robert Glatter, an Emergency Medicine Physician at Lenox Hill Hospital in New York, told Medscape. “We see and experience the devastating effects of gun violence on a daily basis, ripping apart families for generations to come. The effects of deaths and injuries due to gun violence permeates through families with devastating mental health effects, including anxiety, depression, PTSD, and suicides.” 

Gun industry 

The gun industry wants to maximise profits and ensure the rise of politicians in Congress who support its agenda and the demise of those who do not. 

That is what happened almost three decades ago after President Bill Clinton pushed Congress to ban assault weapons, including the AR-15. In subsequent Congressional elections, many Democratic members of Congress who had advocated for the ban were targeted for defeat by the 

NRA and lost their seats. 

The 1994 assault weapons ban had a sunset clause and when it came time for renewal 10 years later, President George W Bush and the Republican-controlled Congress let it lapse. Democrats were unable or unwilling to mount a battle to protect it. “The expiration of the assault weapons ban in 2004 is partly responsible for the devastation that occurred yesterday (24 May in Uvalde),” said Dr Glatter. 

President Joe Biden now wants lawmakers to reinstate the ban on assault weapons and on high-capacity magazines (ammunition feeding devices capable of holding more than 10-rounds). If those weapons are not banned, he said, the age to purchase them should be raised from 18 to 21. 

The President also knows that to be effective, gun control measures must be enacted by Congress at federal level, which would make states subject to such laws. At present, not only are most states not introducing gun control measures, many are actively working to lift restrictions in place. 

Texas, for example, has the most relaxed gun laws in the US and massacres are routinely ascribed to mental health issues (even so, Governor Greg Abbott has slashed millions of dollars from the Texas office that oversees mental health programmes). As detailed in a BMJ analysis in 2019, US states with more relaxed gun control laws and higher rates of gun ownership have higher rates of mass shootings. 

President Biden has emphasised that there are countries which do not, or rarely have, mass shootings, but where people also have mental health issues. 

Dr Lori Post, (PhD) Director of the Buehler Centre for Health Policy and Economics at the Northwestern University School of Medicine, told NBC News after the Uvalde killings there was “no evidence the shooter is mentally ill, just angry and hateful. While it is understandable that most people cannot fathom slaughtering small children and want to attribute it to mental health, it is very rare for a mass shooter to have a diagnosed mental health condition.” 

The powerful NRA is also quick to cite mental health as the cause of mass killings, rather than the proliferation of assault weapons with minimal restrictions or background checks. The group has at least five million members and a multimillion-dollar war chest to promote its agenda. In 2016, it spent over $30 million to help elect President Donald Trump and his Vice-President Mike Pence. 

As Senate Leader Charles Schumer said after the Uvalde killings: “If the slaughter of schoolchildren can’t convince Republicans to buck the NRA, what can we do?” 

After the Uvalde massacre, some Republicans worked with Democrats to enact measures. But these measures are seen as modest and include limited controls and new spending on school safety and mental health. They fall far short of what is wanted by President Biden and many Democrats . 

However, it is also a fact that the NRA cultivates members of both parties. In 2012, 88 per cent of Republicans and 11 per cent of Democrats in Congress had received a hefty NRA contribution at some point in their career. 

‘Big Tobacco’ parallel 

There are many other powerful lobby groups in the halls of the US Congress. ‘Big Tobacco’, for example, still has powerful friends in Washington although its grip has loosened considerably in the years since 1994 after a disastrous congressional hearing. On 14 April 1994, each of the top executives of the seven biggest tobacco companies in the US solemnly testified at the hearing that they did not think nicotine was addictive. 

Five weeks after the hearing, the first lawsuit was filed in what became an avalanche of litigation that resulted in a $206 billion (€198 billion) judgment against the industry. Mr Mike Moore, the Attorney General of Mississippi, who initiated the case, told the companies: “You caused the health crisis – you pay for it” by reimbursing states for the extra costs that smoking imposed on their public health systems. 

It is now six years since gun violence was declared a public health crisis by the AMA – but the NRA has endured. The NRA and other gun lobby groups have the Second Amendment on their side – the right to bear arms. It was introduced when militias were fighting America’s battles before a standing army was established. 

The 1791 Amendment provides that “a well-regulated militia” is necessary to the security of a free State. It says the right of people to keep and bear arms “shall not be infringed.” 

There is another amendment, the 14th Amendment, which should have protected the children of Uvalde and the victims of hundreds of other massacres. The 14th Amendment declares the State may not “deprive any person of life, liberty, or property, without due process of law”. 

More and more Americans, especially doctors and healthcare professionals, are querying why an amendment that protects the right to bear arms seems to usurp another that protects life and liberty. 

Now, some families of victims of gun violence are following the Big Tobacco formula and turning to the courts for solutions and redress. 

The Protection of Lawful Commerce in Arms Act, passed by Congress in 2005, has shielded many gun manufacturers from legal exposure. But it was not enough to protect Remington, whose Bushmaster AR-15 was used to kill 20 children in the 2012 Sandy Hook school massacre. 

In February this year, Remington made a $73 million (€70 million) settlement in a case brought by a group of Sandy Hook families that focused on how the company marketed the rifle. Remington denied the allegations and said there was no evidence that its marketing practices were related to the shooting at Sandy Hook. The case, however, marked the first time a gun maker faced liability for a mass shooting in the US. 

“Our loss is irreversible, in the sense this outcome is neither redemptive nor restorative,” Mr Lenny Pozner and Ms Veronique De la Rosa, whose six-year-old son Noah was killed, wrote in testimony released after the settlement. “However, the resolution does provide a measure of accountability in an industry that has thus far operated with impunity.”