We need solutions for firearm morbidity and mortality in the U.S. Firearm violence is a leading cause of premature death in the U.S. and the leading cause of death overall among kids, recently surpassing car crashes, cancer, and drug overdoses. We need to and we want to do things. But it’s not clear
As a primary care doc I have to push back a bit... although much of what you say dovetails with the American Academy of Family Physicians 2018 statement on gun screening:
Our visits encompass a crushing number of biological, social, and psychological problems, with just the # of diagnoses addressed in a supposedly 20 minute visit routinely topping 15.
Have you ever tried to get patient in with a psychiatrist? To stay with that psychiatrist? The hurdles and barriers are often formidable.
We are a sick country, physically and mentally, and healthcare workers are increasingly the verbal and physical targets of violent individuals. Asking about gun ownership (after tending to someone’s diabetes, prostate cancer, coronary artery disease etc) sounds less like a preventative goal and more like a political wedge than ever. Who knew you could follow a calling to be a doctor and then get trashed with online reviews like a Subway, or maybe murdered because... it doesn’t matter.
I know we are a part of the solution, and I’m happy to step up to the degree I can. But simply stated, this country has outpaced the world by an order of magnitude in gun ownership. There are too many guns. That’s where the evidence based solutions come from.
As usual, I love your column, and I have an addition to your list I will mention again: we have a national suicide prevention hotline, we need a national homicide prevention hotline. We need to bring out of the closet the reality that humans are a species with thoughts that move toward both suicide (suicidal ideation, SI) and homicide (homicidal ideation, HI). In their milder forms, people self harm or do drugs (for SI) or get in fights or have road rage incidents (HI). Once we stop denying this shadow side of human nature and build out a care network, we can be of greater assistance to these folks, and help stop the carnage. Of course, means reduction with common sense gun laws, is a must. But first, like with suicide, we must, as a culture, bring this issue out of the closet to be effective.
Again, thanks. A tough one to read, and, I imagine, to write. So much work to do, but at least there are some directions. I agree with Dr. McCormick that the state of the healthcare system and the demands on primary care physicians make addressing guns a near-impossibility. A huge. number of issues must be thoroughly addressed in well-child checks; a tiny amount of time is allotted to visits for patients at any age; an appalling percentage of patients lack decent insurance to reimburse for their visits; and mental health treatment is less available now than it was ten years ago. All this at a time when we are finally facing the fact that ACE's and Social Determinants of Disease are recognized as major factors in health but the country is seven parsecs away from having the will to address them.
I haven’t heard of restricting particularly military class ammunition. I think these AR class rifles as used are almost all fitted for 5.62 mm NATO caliber which is specifically designed to deliver a huge amount of energy therefore Highly damaging wounds because the small caliber bullet is fired with very high velocity. Restricting large magazines AND such military rounds with very high energy will increase control. I believe, without specifically checking, that some other kinds of ammunition are restricted since they are designed to penetrate body armor and sheet metal.
Thank you! Practical steps is what we need. We can (rightfully) bitch about the senate not doing their job but also need to be actively involved in change at the individual and community levels. I emailed my kids school district and leadership at my work (hospital) to see if we can work together to do more to prevent gun violencein our community- the response has been encouraging so far! It’s easy to feel discouraged and helpless but there’s definitely steps we can take.
So sad that this is what we are resorting to. We needed the Swiss cheese model for a novel problem like COVID. This is a problem primarily effecting us in the United States.
The arms manufacturers would love if it spread across the world but apparently it is containable. 🤷♂️
Thanks. I am old and somewhat apocalyptic in my outlook, so hope is may be a thing with wings, but sometimes I find her elusive. You tend to bring hope each column, and I appreciate it.
Looking for your post about the lack of evidence for active-shooter drills in schools. "Active shooter drills are not evidence-based, and some research suggests the risks outweigh benefits. (I have a full post coming this week if you want to read more about this topic.)"
Thank you for your calm, clear writing about many public-health topics.
First, I have been reading your blog for about a year. Love it! I have shared it with many people and on social media, and not just for COVID information. With this topic, great job so far! I only see one thing that I think needs to be addressed. Police and law enforcement are not in this post (it's possible I missed their part in other posts). Why not? As the saying goes, if you aren't part of the solution you are part of the problem. As long as we are addressing this beast, let's be thorough.
I do not believe that guns are the core issue that needs to be addressed. Certainly, safe storage, proper handling and minimizing access for high risk individuals are valuable steps. However, why do individuals turn to guns and violence? While there are many reasons, two stand out for me. The first is “fatherless homes. Stats say there about 65 million fathers in the US, but only about 25 million are living in a family unit. Here are the stats for children from those homes---https://lifeisbeautiful.org/statistics-on-fatherless-homes/
The second is the scourge of child sexual abuse. NIH stats in the 1990s said 1 in 4 girls and 1 inn6 boys would be sexually abused before their 18th birthday. Sexual abuse is kind of a “sanitary “ description. It means that a perpetrator performed oral sex on a child or forced the child to perform oral sex on them, or the child experienced vaginal or anal penetration, or any of the other emotional or physical attacks that are degrading to the child. The level of rage, isolation, violation and powerlessness that one feels is frequently out of control. One needs only to read the news to see arrests for child sexual violation or pornography. Frequently there is no mention of the children as victims who carry the damage their entire life. Here are stats about the effects of child sexual abuse. --https://victimsofcrime.org/child-sexual-abuse-statistics/
If you do the math, using current demographics, you find that there are 10s of millions of these victims working or worshiping next to you and walking the streets. They smile and share a coffee, while screaming with rage inside. Is it unreasonable to believe that some few of these victims will be overwhelmed by their emotions and aggressively attack themselves or others?
Blaming the guns is an easy out. Addressing the root causes of violent rage in a person’s heart, while much more difficult, is the real long term solution.
In this article you mention an upcoming post about why it's not evidence based to have active shooter drills in school. Then... no upcoming posts were done!
Can you please post that information? Others have pointed this out as well. Our school is one of thousands that do these drills and while I can find information online that range from DRASTIC... literal costumed actors running around through schools... to tame - ok kids were all going to be quiet in our rooms and lock the doors... Obviously, the huge span of perception on what a 'drill' means is a problem.
The kids perception & ability to understand is a problem... and the lack of other drills is a problem! If my kid comes home and says - yay we didn't die today - uh... that's a problem!! Mixing it up with tornado drills, another kid loose & running in the halls, who knows... 'other' drills...
Anyways, I can figure out some of these things, but having evidence would be great :)
This is the best article I've read on this subject. I love your common sense approach. People need to better understand the swiss cheese analogy and risk reduction.
Firearms: What you can do right now
As a primary care doc I have to push back a bit... although much of what you say dovetails with the American Academy of Family Physicians 2018 statement on gun screening:
https://www.aafp.org/pubs/afp/issues/2018/1101/p560.html
Our visits encompass a crushing number of biological, social, and psychological problems, with just the # of diagnoses addressed in a supposedly 20 minute visit routinely topping 15.
Have you ever tried to get patient in with a psychiatrist? To stay with that psychiatrist? The hurdles and barriers are often formidable.
We are a sick country, physically and mentally, and healthcare workers are increasingly the verbal and physical targets of violent individuals. Asking about gun ownership (after tending to someone’s diabetes, prostate cancer, coronary artery disease etc) sounds less like a preventative goal and more like a political wedge than ever. Who knew you could follow a calling to be a doctor and then get trashed with online reviews like a Subway, or maybe murdered because... it doesn’t matter.
I know we are a part of the solution, and I’m happy to step up to the degree I can. But simply stated, this country has outpaced the world by an order of magnitude in gun ownership. There are too many guns. That’s where the evidence based solutions come from.
As usual, I love your column, and I have an addition to your list I will mention again: we have a national suicide prevention hotline, we need a national homicide prevention hotline. We need to bring out of the closet the reality that humans are a species with thoughts that move toward both suicide (suicidal ideation, SI) and homicide (homicidal ideation, HI). In their milder forms, people self harm or do drugs (for SI) or get in fights or have road rage incidents (HI). Once we stop denying this shadow side of human nature and build out a care network, we can be of greater assistance to these folks, and help stop the carnage. Of course, means reduction with common sense gun laws, is a must. But first, like with suicide, we must, as a culture, bring this issue out of the closet to be effective.
Excellent information. We should all take as many measures we can in the individual, family and community level. This is a public emergency.
Again, thanks. A tough one to read, and, I imagine, to write. So much work to do, but at least there are some directions. I agree with Dr. McCormick that the state of the healthcare system and the demands on primary care physicians make addressing guns a near-impossibility. A huge. number of issues must be thoroughly addressed in well-child checks; a tiny amount of time is allotted to visits for patients at any age; an appalling percentage of patients lack decent insurance to reimburse for their visits; and mental health treatment is less available now than it was ten years ago. All this at a time when we are finally facing the fact that ACE's and Social Determinants of Disease are recognized as major factors in health but the country is seven parsecs away from having the will to address them.
I haven’t heard of restricting particularly military class ammunition. I think these AR class rifles as used are almost all fitted for 5.62 mm NATO caliber which is specifically designed to deliver a huge amount of energy therefore Highly damaging wounds because the small caliber bullet is fired with very high velocity. Restricting large magazines AND such military rounds with very high energy will increase control. I believe, without specifically checking, that some other kinds of ammunition are restricted since they are designed to penetrate body armor and sheet metal.
Thank you! Practical steps is what we need. We can (rightfully) bitch about the senate not doing their job but also need to be actively involved in change at the individual and community levels. I emailed my kids school district and leadership at my work (hospital) to see if we can work together to do more to prevent gun violencein our community- the response has been encouraging so far! It’s easy to feel discouraged and helpless but there’s definitely steps we can take.
So sad that this is what we are resorting to. We needed the Swiss cheese model for a novel problem like COVID. This is a problem primarily effecting us in the United States.
The arms manufacturers would love if it spread across the world but apparently it is containable. 🤷♂️
Thanks. I am old and somewhat apocalyptic in my outlook, so hope is may be a thing with wings, but sometimes I find her elusive. You tend to bring hope each column, and I appreciate it.
Looking for your post about the lack of evidence for active-shooter drills in schools. "Active shooter drills are not evidence-based, and some research suggests the risks outweigh benefits. (I have a full post coming this week if you want to read more about this topic.)"
Thank you for your calm, clear writing about many public-health topics.
First, I have been reading your blog for about a year. Love it! I have shared it with many people and on social media, and not just for COVID information. With this topic, great job so far! I only see one thing that I think needs to be addressed. Police and law enforcement are not in this post (it's possible I missed their part in other posts). Why not? As the saying goes, if you aren't part of the solution you are part of the problem. As long as we are addressing this beast, let's be thorough.
Thank you! So many actionable ideas, can we all try just one? 😻
I do not believe that guns are the core issue that needs to be addressed. Certainly, safe storage, proper handling and minimizing access for high risk individuals are valuable steps. However, why do individuals turn to guns and violence? While there are many reasons, two stand out for me. The first is “fatherless homes. Stats say there about 65 million fathers in the US, but only about 25 million are living in a family unit. Here are the stats for children from those homes---https://lifeisbeautiful.org/statistics-on-fatherless-homes/
The second is the scourge of child sexual abuse. NIH stats in the 1990s said 1 in 4 girls and 1 inn6 boys would be sexually abused before their 18th birthday. Sexual abuse is kind of a “sanitary “ description. It means that a perpetrator performed oral sex on a child or forced the child to perform oral sex on them, or the child experienced vaginal or anal penetration, or any of the other emotional or physical attacks that are degrading to the child. The level of rage, isolation, violation and powerlessness that one feels is frequently out of control. One needs only to read the news to see arrests for child sexual violation or pornography. Frequently there is no mention of the children as victims who carry the damage their entire life. Here are stats about the effects of child sexual abuse. --https://victimsofcrime.org/child-sexual-abuse-statistics/
If you do the math, using current demographics, you find that there are 10s of millions of these victims working or worshiping next to you and walking the streets. They smile and share a coffee, while screaming with rage inside. Is it unreasonable to believe that some few of these victims will be overwhelmed by their emotions and aggressively attack themselves or others?
Blaming the guns is an easy out. Addressing the root causes of violent rage in a person’s heart, while much more difficult, is the real long term solution.
Hello Katelyn...
In this article you mention an upcoming post about why it's not evidence based to have active shooter drills in school. Then... no upcoming posts were done!
Can you please post that information? Others have pointed this out as well. Our school is one of thousands that do these drills and while I can find information online that range from DRASTIC... literal costumed actors running around through schools... to tame - ok kids were all going to be quiet in our rooms and lock the doors... Obviously, the huge span of perception on what a 'drill' means is a problem.
The kids perception & ability to understand is a problem... and the lack of other drills is a problem! If my kid comes home and says - yay we didn't die today - uh... that's a problem!! Mixing it up with tornado drills, another kid loose & running in the halls, who knows... 'other' drills...
Anyways, I can figure out some of these things, but having evidence would be great :)
Super helpful and detailed, thank you!!
This is the best article I've read on this subject. I love your common sense approach. People need to better understand the swiss cheese analogy and risk reduction.
Please amend your Second Amendment.
Your allies in Australia are saddened and dumbfounded.