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ACP issues new recommendations to reduce gun violence

Editor’s Note: This story has been updated to reflect comments from the National Rifle Association and ACP.

ACP updated its policy recommendations for reducing gun-related injuries and deaths in the United States by building on, strengthening and expanding on current policies, according to a position paper published in Annals of Internal Medicine.

Following the release of the paper, the National Rifle Association on Twitter questioned whether the ACP should be involving itself in the gun control debate, prompting a swift and angry response by many clinicians in social media and leading the ACP to reassert its responsibility to speak out on a public health issue.

In a separate study, also published in Annals of Internal Medicine, researchers found that most Americans underestimate the frequency of firearm-related violent deaths.

ACP recommendations on gun violence

“Firearm violence remains a problem — firearm-related mortality rates in the United States are still the highest among high-income countries,” Renee Butkus, BA, of the Health and Public Policy Committee of ACP, wrote.

ACP’s Health and Public Policy Committee searched for disparities in policy and existing positions and reviewed all reports and surveys related to firearm violence to update its policy position on gun violence.

In the position paper, ACP made several essential recommendations to reduce firearm violence, including:

• A public health approach should be implemented to prevent firearm injuries and deaths.
• Medical professionals should advocate for the prevention of firearm violence and counsel patients on the risks associated with firearms in the home, particularly when children, adolescents, people with dementia, people with mental illnesses or people with substance use disorders are present.
• The purchase of legal firearms should be appropriately regulated.
• Firearms should be subject to consumer product regulations regarding access, safety and design.
• Best practices to reduce the risk for accidental or intentional injuries or deaths from firearms should be enforced, such as ensuring that firearms cannot be accessed by individuals with greater risk or harming themselves and others and reporting theft or loss of firearms within 72 hours.
• Classifying patients with mental illness as dangerous individuals should be done cautiously. Diagnosis, access to care, treatment and appropriate follow-up are imperative.
• Legislation should be enacted to ban the manufacture, sale, transfer and subsequent ownership of semiautomatic firearms for civilian use and the current ban on automatic weapons for civilian use should be retained.
• Firearms should be improved and modified to make them as safe as possible.
• Further research should be conducted to determine the best intervention and prevention strategies to reduce firearm-related injuries.
• Extreme risk protection order (ERPO) laws should be established to allow the removal of firearms from those at imminent risk of harming themselves or others.

“The ACP has pressed for the adoption of policies to reduce the number of deaths and injuries related to firearms for more than 20 years and is disheartened by the lack of action to protect the American public,” Butkus and colleagues wrote. “Although there is more to learn about the causes of firearm violence and the best methods to prevent it, the available data support the need for a multifaceted and comprehensive approach to reducing firearm violence that is consistent with the Second Amendment. Firearm violence is a public health threat in the United States that must not be allowed to continue.”

On November 7, following the release of the position paper, the NRA tweeted: “Someone should tell self-important anti-gun doctors to stay in their lane. Half of the articles in Annals of Internal Medicine are pushing for gun control. Most upsetting, however, the medical community seems to have consulted no one but themselves.”

The tweet sparked outrage among the physician community.

Judy Melinek, MD, forensic pathlogist, responded to the NRA in a tweet, stating, “Do you have any idea how many bullets I pull out of corpses weekly? This isn’t just my lane. It’s my [expletive] highway.”

“Doctors are not at war with the NRA,” Heather Sher, MD, radiologist, told The Washington Post.

We want both sides to come together to find a solution to this national health problem, she said.

“Physicians are on the front lines of treating the victims of gun violence, both at the point of care and often for years to come,” Ana María López, MD, MPH, MACP, president of ACP, told Healio Internal Medicine. “ACP’s updated paper offers common sense recommendations to stem gun violence, and urges physicians to counsel patients on safe firearms behavior and to take further action if a patient is at risk. Internists will continue to speak out on gun violence and  advocate for smart firearms policies that will keep patients safe and healthy. There have been over 300 mass shootings in 2018. If our efforts prevent even one act of violence or one victim from being hurt, we must speak out.”

Public misperceptions on the frequency of firearm-related violent deaths

In a separate study, survey results indicated that a majority of Americans are not aware of the true rates of homicides and suicides that involve firearms in the United States.

“In the United States, suicide is twice as common as homicide, and suicide by firearm is more common than homicide by firearm,” Erin R. Morgan, MS, from the School of Public Health and Harborview Injury Prevention and Research Center at the University of Washington, and colleagues wrote. “However, no nationally representative study has assessed public perceptions of the relative frequency of these leading causes of violent death.”

Morgan and colleagues analyzed data from the 2015 National Firearms Survey to identify how the national public perceives the relative frequency of violent death by intent (homicide vs. suicide) and means (firearm vs. nonfirearm). Nearly 4,000 participants completed the survey. The survey asked participants to rank four options on the intent and means of violent death, including homicide with a gun, homicide with a weapon other than a gun, suicide with a gun, and suicide by a method other than a gun, in terms of frequency in their state per year.

Between 2014 and 2015, every state had higher rates of suicides than homicides. In 29 states, the most frequent violent cause of death was suicide by firearm.

The survey results demonstrated that the most frequent cause of violent death was accurately identified by just 13.5% (95% CI, 11.5-15.8) of participants.

A total of 1,880 responded reported their occupation. Of those, 20% (95% CI, 10.3-35.4) of those who identified themselves as a health care professional answered correctly. Additionally, 12.4% (95% CI, 8.3-18.2) of respondents with a history or mental illness answered correctly.

About a quarter (95% CI, 23.2-28.8) of participants accurately recognized that suicide was the most frequent intent for violent deaths involving firearms. Respondents' firearm ownership status did not affect correct identification.

“Our findings suggest that correcting misperceptions about the relative frequency of firearm-related violent deaths may make persons more cognizant of the actuarial risks to themselves and their family, thus creating new opportunities for prevention,” Morgan and colleagues concluded. “If communication strategies could enhance the accuracy of perceived risk, some persons living in households with firearms might be motivated to remove these weapons from their home or at least keep unsafely stored firearms locked and unloaded to reduce access by potentially vulnerable family members.” – by Alaina Tedesco

Disclosures: Butkus and Morgan report no relevant financial disclosures. Please see study for all other authors’ relevant financial disclosures. Lopez is the president of ACP. Healio Internal Medicine could not confirm the disclosures of Melinek or Sher prior to publication.