AMA members voting on the issue of gun violence research.

On June 14th the American Medical Association’s (AMA) House of Delegates in Chicago, IL voted almost unanimously to adopt a resolution supporting the idea that gun violence is a public health issue. The resolution also called for lobbying Congress to eliminate the ban on research into the causes of gun violence. The AMA reports:

“With approximately 30,000 men, women and children dying each year at the barrel of a gun in elementary schools, movie theaters, workplaces, houses of worship and on live television, the United States faces a public health crisis of gun violence,” said AMA President Steven J. Stack, M.D. “Even as America faces a crisis unrivaled in any other developed country, the Congress prohibits the CDC from conducting the very research that would help us understand the problems associated with gun violence and determine how to reduce the high rate of firearm-related deaths and injuries. An epidemiological analysis of gun violence is vital so physicians and other health providers, law enforcement, and society at large may be able to prevent injury, death and other harms to society resulting from firearms.”

The resolution is aimed primarily at a congressional ban on research into gun violence by the Centers for Disease Control (CDC). I will discuss this ban further, but first let’s address the underlying issue.

Is gun violence a public health issue?

According to the World Health Organization:

Public health refers to all organized measures (whether public or private) to prevent disease, promote health, and prolong life among the population as a whole. Its activities aim to provide conditions in which people can be healthy and focus on entire populations, not on individual patients or diseases. Thus, public health is concerned with the total system and not only the eradication of a particular disease.

Essentially, the field of public health tries to address systemic issues that affect the health of people in society. Public health includes safety, and concerns itself with safety measures such as avoiding accidental poisoning, requiring car seats for small children, and work-related safety. It also addresses issues of individual behavior that affect health, such as use of recreational drugs, and the calorie density of restaurant meals.

It seems ineluctable that gun safety and gun violence is a legitimate public health issue. Health care institutions addressing gun safety is also appropriate given the magnitude of the harm – about 30,000 Americans die from guns every year.

The CDC ban on gun violence research

The CDC has had a de facto ban on research into gun violence since 1996. The NRA accused the CDC of promoting gun control, resulting in Congress threatening to strip the CDC of its funding. In fact, a Republican congressman led a successful effort to strip $2.6 million from CDC funding, which was the amount the CDC spent on gun violence research the previous year. Congress defunded any gun violence research by the CDC with a clear threat to further defund the CDC if they did not comply.

The CDC reacted predictably – they interpreted these actions by Congress as a ban on research into gun safety and gun violence, and since 1996 there has been no such research at the CDC.

Following the Newtown shooting in 2012, President Obama, by executive Order, reversed the CDC ban. However, in the three years since this executive order the CDC has still not resumed any research into gun violence. The executive order essentially did not work – officials at the CDC are worried that any such research will threaten their funding, which is controlled by Congress rather than the President.

This fear is evident in the following report:

A Wisconsin delegate spoke of a conversation with US Centers for Disease Control and Prevention’s director [Tom Frieden, MD] in which gun violence came up. “He said ‘ stop we can’t have a conversation about this and don’t put it in a letter, stop,’,” the delegate said.

Congress still does not fund any gun violence research through the CDC. There have been bills proposed to reinstate funding, but none have passed.

This situation is the focus of the AMA resolution, to lobby Congress to fund gun violence research through the CDC and to end their standing threat to the CDC to cut off their funding if they start any gun research.

Pediatricians and guns

In a related issue, the Florida legislature passed a measure that would ban pediatricians from asking parents about guns in the home:

“We take our children to pediatricians for medical care — not moral judgment, not privacy intrusions,” [NRA lobbyist Marion Hammer] says.

NRA lobbyists helped write a bill that largely bans health professionals from asking about guns. Hammer says she and other NRA members consider the questions an intrusion on their Second Amendment rights.

“This bill is about helping families who are complaining about being questioned about gun ownership, and the growing anti-gun political agenda being carried out in examination rooms by doctors and staffs,” Hammer says.

The underlying issue here is the same – is gun violence a legitimate health issue? Pediatricians clearly think that it is, as much as wearing bike helmets, asking if they have child locks on their cabinets that may contain dangerous household products, use of a proper car seat, smoking in the home, water safety, etc.

The idea that a physician invades the privacy of their patient or their patient’s caregiver by asking personal questions is absurd. That is the very nature of the doctor-patient relationship, and why that relationship is privileged. Patients and their caregivers need to share personal and intimate information with their physicians, without judgement and without fear that this information will be shared without their permission.

That includes information about guns in the home. There is no reason to carve out gun questions as being exempt from the normal rules of the patient-physician relationship. This is similar to arguing that questions about recreational drug use violates a patient’s privacy, or questions about their sexual activity, or whether or not they intent to vaccinate their children.

Science should inform politics

The AMA is absolutely right to take a strong stand supporting research into gun violence as a public health issue. Regardless of where one stands with regard to the politics of gun control, it is hard to imagine how someone can legitimately be against scientific research to better understand the issue. Taking a stand against research, as the NRA has done, essentially is a statement that your ideology trumps scientific evidence. It also implies a desire to make up supporting claims without the risk of being contradicted by actual data.

Science must stand outside of politics in order to function optimally. Politics cannot be determined entirely by science, because there are subjective value judgments involved. People will make different compromises when it comes to safety vs personal liberty, for example. Seat belt laws are a perfect example.

Politics, however, should be informed by objective science, as much as possible. At least then we can make an informed decision about the implications of the specific compromises we choose.

Many politicians, however, seem unable to resist the urge to put their thumb on the scale of science. They want to break science to justify their political ideology, and this is a very destructive impulse.

The CDC is a government agency, one mission of which is to perform epidemiological research in order to inform policy decisions. Gun violence should not be exempt from this.

The AMA is not a government agency, and they have no regulatory power. They are a professional organization – for a profession that is dedicated to public health and the health of individual patients. They should be lobbying the government for laws that promote public health, based upon the best science available. In that light the recent resolution was clearly the correct move, and was long overdue.