[Editor’s note: The ACEP recently hosted a Pro-Con Advocacy Debate about gun violence in ACEPNow, its publication of record. In that discussion, Marco Coppola, DO, ably spoke against blaming guns for their misuse as if that were a “public health epidemic”. Our Dr. Wheeler left a comment reminding readers that Congress banned political advocacy by the CDC, not violence research. Dr. Margulies responds to the moderator’s question, “how far should emergency medicine go in advocating for or against gun control?”]
Kevin Klauer, DO, EJD, FACEP August 2, 2016 Medical Editor in-Chief ACEP Now
Dear Dr. Klauer:
In ACEP Now’s July 15 gun control debate you asked whether the American College of Emergency Physicians (ACEP) and by implication, any other medical organization, should become involved in questions regarding the Second Amendment to the Constitution. We should, without a doubt.
As an emergency medicine physician, sworn law enforcement officer, retired Navy Medical Corps captain, and firearm trainer with multiple certifications from the National Rifle Association and the Massad Ayoob Group, I am extraordinarily qualified to comment on this subject.
As physicians we bear extraordinary privileges and responsibilities, not only because of what we do, but also because we are Americans. All American physicians (and we are the American College of Emergency Physicians) should stand behind all of the amendments to the constitution, especially the Second Amendment, without which none of the others are enforceable. The first ten amendments to the Constitution are called the Bill of Rights. Those amendments are actually a Bill of Restraints on the federal government. History teaches us that without them we would not have had the Constitution, and likely not a country.
Now we are engaged in a great civil discussion regarding the nature and culture of our country. On one side are those who believe that it is the province of the federal government to control and provide for all actions and resources within our society. Those on the other side of the discussion maintain that although there are some constraints upon individual and group actions, progress has been made more by individuals, and freeing the people to make progress yields more liberty.
It is ludicrous that some are trying to prohibit citizens from owning the very firearms that our police use to protect us—pistols and rifles with a modern design. Yet we know that the police are rarely on the scene when desperately needed. Therefore, since it is natural instinct for all animals, including Homo sapiens, to defend themselves and their young, it seems only fitting that the people have access to the same firearms that we expect our police to use to defend and protect us.
Statistics can be twisted, but I have yet to find a study that produces significant evidence of crime going up as firearm ownership and use have increased in the United States. We also find studies that show that in countries that have recently restricted firearms, rates of violence have not trended up. The exception is the United Kingdom, specifically Britain, where criminal violence has increased dramatically since civilians were disarmed.
The states of California, New Jersey, Illinois and Maryland have seen significant increases in criminal misuse of all weapons including firearms. It must be clear to anyone paying attention that those states have the strictest firearms laws in this country. Why would anyone expect more even more draconian gun control laws to somehow work?
While the total number of firearms and the population of the United States have increased dramatically, both the rates and absolute numbers of firearm deaths have decreased. Poorly done and often discredited studies such as the 1993 Kellerman study are still referenced by those who wish to decrease our freedoms.
Supporters of still more gun control laws often point to innovations in motor vehicle safety reducing auto fatalities as a model for mandating similar safety modifications to firearms. This comparison is false on several levels. First, better trauma care has reduced fatalities and mitigated injuries from both motor vehicles and firearms. Decreasing gasoline prices encourage drivers to log more miles, thus increasing the probability of collisions.
But the auto-to-firearm comparison really falls apart when one ponders the obvious—auto deaths are almost all accidental, but firearm deaths are almost all intentional. Expecting a safety device to stop a killer is ridiculous.
About two thirds of firearms deaths are suicides. Countries with strict firearms restrictions have higher rates of suicide than we do. Mentally ill persons who choose to commit suicide can always find a way. We also know that too many firearm deaths in this country occur in inner cities and are a result of black on black violence. A significant subset of Hispanic on Hispanic violence takes a toll as well. These deaths number far greater proportionately than we find in either Caucasian on Caucasian or Asian on Asian violence. Terrorism (Fort Hood, San Bernardino, Orlando) is increasing both in the U.S. and abroad, and police and EMS response is by necessity reactionary.
Death is inevitable. None of us will leave this world alive. But reducing the already declining number of avoidable deaths in America will not be accomplished by passing even more gun prohibition laws. We should renew our allegiance to the constitutional principles that made America great instead of looking for even more ways to limit the freedom of good Americans.
Yours truly,
Robert A. Margulies, MD, MPH, FACEP, FACPM
Richland, Washington
—Robert A. Margulies, MD, MPH, FACEP, FACPM is an emergency medicine specialist, retired Navy Medical Corps captain, sworn peace officer, and firearm trainer with multiple certifications from the NRA and the Massad Ayoob Group.