[Editor: DRGO reprinted a letter in August that our Dr. Robert Margulies sent his specialty association newsletter, ACEPNow, after it published a “Pro-Con” debate about gun control. The next month, the ACEP president issued a baldly political statement about “prejudice which has been directed toward those who are black” by police. Two days later, the statement was reissued, dramatically changed. We thought it worth sharing the whole story.]
First, the article in ACEPNow that got Dr. Margulies’ attention. He was acquainted with Dr. Coppolo, who defended the value of arms and the Second Amendment. This was an unusual attempt at a balanced presentation by a medical society:
- Gun Control Issue Fosters Pro–Con Advocacy Debate in Emergency Medicine
July 15, 2016 by Kevin Klauer, DO, EJD, FACEP
Gun violence is an ever-growing concern in the United States, and there’s no question that emergency physicians are at the front line for treating its victims. But how far should emergency medicine go in advocating for or against gun control?
ACEP Now asked two physicians with opposing views for their opinions on the matter. The following is a summary of their conversation.
Kevin Klauer, DO, EJD, FACEP, chief medical officer–emergency medicine and chief risk officer for TeamHealth, executive director of the TeamHealth Patient Safety Organization, and medical editor-in-chief for ACEP Now
KK: Do you think that ACEP should be weighing in on Second Amendment rights?
AF: I think that we should be active on certain things that are specifically relevant to physicians. Regarding the Second Amendment, it’s the law of the land, and I don’t think there’s any debate about that. I think there are certain bills that are more relevant to our members, and those are the ones we should take a position on.
MC: Firearm injury is a very important topic in emergency medicine because we’re on the front lines. However, there are some facts that need to be addressed.
According to the Centers for Disease Control and Prevention, the top-four most common non-fatal accidents in 2007 were caused by falls, motor vehicle accidents, other specified injuries, and poisonings. Non-fatal accidents and hospitalizations due to firearms were second from the bottom; only dog bites were lower. If you are involved in an accident such as a motor vehicle accident then its best to make sure you’re covered. Companies such as Money Expert are a reliable company for van insurance, and there are plenty more that can be found depending on the type of cover you’re after and for what vehicle. While not common, some motor vehicle accidents could result in spinal injuries. If you or anyone you know has been involved in a similar situation, you may be able to get help online from Frekhtman & Associates or a law firm more local to you.
As far as fatal accidents in 2007, only 0.5 percent were from accidental firearm fatalities and injuries. The top four that year were motor vehicle accidents, poisonings, falls, and otherwise unspecified, and at the very bottom were firearms. Since 1993, gun violence in this country has dramatically dropped, from 15.2 to 10.5 deaths by firearm per 100,000 people, in 2013. We cannot infringe on the right to bear arms, the Second Amendment. Andrew’s right about that.
KK: Andrew, Marco has given a bunch of stats and his perspective on things, and I want to give you an opportunity to respond. I assume that you don’t necessarily agree with everything he said.
AF: I don’t agree with everything he said. One thing I will respond to is the issue of mental health. I think it’s a big issue, and it’s important. I think more funding for mental health treatment is absolutely necessary in this discussion, and we do have to keep in mind that those individuals with a mental health diagnosis have actually been shown to be less likely involved in firearm violence, but we know that anyone who commits suicide is mentally ill.
We also need more funding toward research. We’re all aware that Congress restricted funding in the late 1990s to the CDC and the National Institutes of Health, preventing them from doing adequate studies on firearm injury prevention. These are difficult things to study, but there have been well-designed studies on this issue that have given us some answers; there just haven’t been enough. If you look at the last 40 years, there have been 65 cases of rabies in this country, yet the NIH has funded 89 studies about rabies. In the meantime, in the last 40 years, there have been over 4 million people killed by firearms, and the NIH has funded only three studies on firearm injury prevention. That’s sad.
I’ve seen different statistics than those Marco refers to. You have to look at homicides and suicides to see the whole picture. Obviously, medical treatment of firearm injuries has gotten better, though most firearm injuries are still fatal. I think there’s some evidence that shows things are getting better, but all you have to do is open up the newspaper to know that we still have a major problem in this country. Since the Sandy Hook Elementary shooting, there has been an average of one school shooting a week in this country, and the number of mass shootings has also increased. There were 33,000 deaths from firearms last year. Eighty-seven people will die today from firearms, including five kids. What Congress has done, and what our communities have done since Sandy Hook, has been inadequate at best.
KK: Do you think we need stricter statutes and more regulation of firearm ownership?
AF: I think we could be doing a lot more. I’ve mentioned that we need to reinstitute the research funding that was cut by Congress so that we can understand the issue better. I do think there are some commonsense firearm regulations that can be put into place, like expanded background checks. Most people agree with that. I think that we could be doing more when it comes to regulating gun sellers and making certain that when someone purchases a firearm he or she is safe to own it. With regard to background checks, 40 percent of firearms transactions don’t include a background check, and you can go online and buy a gun without one. There are a lot of things we need to do as a society to address this issue (eg, addressing mental health), and we just haven’t taken any definitive steps.
KK: Marco, any response regarding firearm regulation?
MC: What is the actual number of mass murders since Newtown [Sandy Hook]? Andrew, I admire you immensely because of your passion. But with increased numbers of people who are able to carry a gun, either concealed or openly, the crime rates in those states have plummeted. There’s a correlation, yes, but is there cause and effect? We don’t know because in a lot of those states, crime rates are coming down.
KK: Marco, do you think that more guns or fewer guns will improve safety regarding firearms?
MC: There are a lot of gun studies in the medical literature that are biased and methodologically flawed. Andrew’s correct: The NIH doesn’t fund many gun control studies, but there are a lot of studies in the economics and criminal justice literature based on data readily available from the CDC and other sources that show that more guns in the hands of law-abiding citizens are not associated with more crime. The data clearly show that crime is reduced in states that have enacted right-to-carry laws.
KK: Andrew, are more or fewer guns better?
AF: I can’t imagine how more guns could make us safer. We already have about as many guns in this country as we have citizens. There are more guns in this country per capita than in any other country. I just don’t think that we can shoot our way out of this problem.
The data out there and the studies that have been done have some methodological flaws, I agree, and that includes a recent study that showed that in states that have tighter firearm regulations there’s less firearm violence. They didn’t prove causation, but there was a correlation. Another study noted that someone who has a firearm and is an assault victim is four to five times more likely to be shot and killed. So, in general, the more you increase firearms in a community, the more firearm violence you’re going to have.
KK: If you or your family was threatened and you had access to a firearm, would you use it?
AF: I don’t own a gun, Kevin. I do keep a 2-iron underneath my bed because I figure I might get some use out of that club that way. For the average person, though, when you bring a gun into the home, it does increase your risk of someone dying by homicide two to three times. The risk of suicide in that household goes up five times
MC: In recent years, children have been involved in accidental shootings, but there have been fewer than 10 per year. More kids die from drowning in a 5-gallon bucket than they do from an accidental discharge at home. Most accidental discharges occur with men who have long histories of violent crime, alcoholism, and suspended or revoked driver’s licenses. Would I use a weapon if I had access to one? The question for me is not if I have a weapon but how many.
KK: OK, let’s give Andrew a chance to respond.
AF: The Washington Post noted that there were 43 toddler shootings in 2015. The rate has increased to about one a week now. In 2015, 13 toddlers accidentally killed themselves with a firearm. Most of the time, they shoot themselves, but they also shoot others, usually other members of the family. It’s a major public health issue that there are guns that toddlers have access to.
One study noted the allure of handguns. There were 29 groups of boys age 8 through 12. The boys were left alone for 15 minutes in a room containing two water pistols and a modified .38 caliber handgun in different drawers and were observed via one-way mirror. Three quarters of those that found the gun handled it, half pulled the trigger, half thought it was a toy or were unsure if it was real, even though 90 percent had gun safety training.
MC: Can I ask you, though, who’s going to do that at home? What right-minded individual is going to leave a gun at home for a kid to play with?
KK: If you had one wish that you could accomplish regarding this issue, what would it be?
MC: I feel that the majority, if not 100 percent, of the injuries are caused by people who are mentally ill and need treatment. It is my wish that we live in a nation where people who are suffering from mental illness would have access to and receive treatment for their illness.
AF: My wish would be to take the issue seriously, take the politics out of it, and for us to truly treat this as the public health epidemic that it is. Incidences like Sandy Hook should never happen again in our country.
Gun violence was again at the forefront of the news in June, with the June 12 shooting at the Pulse nightclub in Orlando where 50 people, including the shooter, died, making it the deadliest mass shooting by a single shooter in American history. ACEP Now asked Dr. Fenton and Dr. Coppola for their thoughts.
AF: After the unthinkable tragedy at Sandy Hook Elementary, our country was resolved to address the senseless violence within our communities and our culture that was killing even our youngest citizens. Because of opposition, our public leaders dithered, our resolve withered, and daily distractions led to national inaction.
Since that day in December 2012, more than 100,000 of our citizens have died through firearm violence, and there have been over 1,000 mass shootings. Now our country mourns again after the latest and worst mass shooting in American history. We again have the responsibility to honor the memory of those who were murdered by creating needed change in our country.
Since the Orlando tragedy, the American Medical Association has shown leadership by recognizing firearm violence as a “public health crisis” and by committing to actively overturn the Congressional ban on firearm violence research. ACEP needs to demonstrate similar resolve and to also lead in confronting this crisis. Only through strong and sustained action can we honor those who have been victims while creating a safer and saner future for our children.
MC: The killings in Orlando were horrific, and my thoughts and prayers are with the victims, their families, and friends. It is abhorrent that many, including our so-called leaders, have taken this tragedy to further a misguided agenda with calls for gun control. Turning this terrible event into demands for gun control is insulting to the victims, and it detracts from the real issues. What happened in Orlando has less to do with gun control than with extremism, terrorism, intolerance, and this administration’s failed policies to combat ISIS. Data have consistently shown that crime rates are lowest in states with concealed-carry or open-carry laws, and crime- and firearm-related deaths are highest in cities with the strictest of gun control. Perhaps if one of the patrons at Pulse that night was trained and carrying, the number of those killed and injured would have been a lot less.
As a sworn police officer and ACEP member (Tactical Division), Dr. Margulies felt the ACEP was not fully and fairly representing emergency physicians, police or even Americans in general. He wrote his letter to editor Klauer August 2. But August and September saw a flood of politically correct media sympathizing with the supposed war on African-Americans by police, and the ACEP leadership piled on with this official statement. It is no longer on the ACEP site, but can still be found here:
- ACEP Statement on Violence and Bias Involving Police
WASHINGTON, Sept. 23, 2016 / PRNewswire-USNewswire/ — In response to a series of events involving acts of violence by and against police, the president of the American College of Emergency Physicians Jay Kaplan, MD, FACEP released a statement:
“Emergency physicians every day care for all patients who enter the doors of our emergency departments regardless of their race, religion, or beliefs. The American College of Emergency Physicians, representing more than 37,000 of those physicians, has been deeply distressed by the ever more apparent sense of divisiveness and bias being demonstrated in our society. The recent shooting deaths of African American men by police in Tulsa, Okla. and Charlotte, N.C., just months after similar violence in Baton Rouge, La. and St. Paul, Minn. are appalling evidence of the prejudice which has been directed toward those who are black.
In addition, the lawless shooting and killing of police officers in Dallas, Texas and Baton Rouge, La. and others who wear blue in the line of duty is unconscionable. As the physicians who most often care first for all victims of violent injury, we call for an end to all forms of gun violence. Our prayers go out to the families of all those who have been slain or injured.
ACEP joins with other professional physician organizations in supporting the institution of measures that will prevent the continued loss of life and eradicate racial prejudice in the enforcement of law. It is irrational that people of color or different religious beliefs cannot walk their own streets without fearing violence against them and the sudden loss of life. We must confront the role of racism and bigotry in our culture, and we must not allow those who promote continued escalation of hate, anger and violence to divide us.”
Dr. Margulies and like-minded colleagues in the Tactical Division (many of whom are sworn police officers) were outraged by ACEP publishing that statement. They started working the phones, telling ACEP leaders how unacceptable was the association’s descent into race and identity politics, victimology, and police blaming. Amazingly, two days later a fairer and more professional statement came out in response to that outcry:
- ACEP President Issues Revised Statement on Violence
September 25, 2016
The following statement is from ACEP President Jay A. Kaplan, MD, FACEP:
As an organization that represents more 37,000 emergency physicians around the country and the world, the American College of Emergency Physicians applauds our members who stand on the front lines of the violence that occurs in our country every day. Some of that violence makes the nightly news. Sadly, the majority does not.
Our members treat victims and perpetrators, abusers and the abused, law enforcement officers, paramedics, firefighters, prisoners, and death row inmates. We treat the destitute and the wealthy, men and women, citizens and foreigners, and Presidents and pariahs.
ACEP members do it without regard to race, religion, sexual orientation, creed, nationality, socioeconomic class or the ability to pay. We daily see in our emergency departments, victims of violence and abuse who no one ever hears about and who we continue to worry about; sometimes that violence is directed against us, just as it is against the law enforcement officers with whom we work.
We are saddened by recent events that that seem to dominate the news every day, as well as by the stories we experience recurrently which do not make the news. We join the call for an honest dialogue about how to turn the tide on the lack of humanity and compassion that leads to the violence we witness outside and inside our departments every hour of every day. Until the day it ends, our members will be on duty around the country to heal the wounds that afflict the victims and our country.
Dr. Margulies’ letter of August 2 to editor Klauer was finally published on October 20 which elicited mostly comments in agreement, including from DRGO Director Dr. Timothy Wheeler.
We see two lessons in this. First, the appearance of an actual two-sided debate over gun control in an official medical professional organ is encouraging, compared to the usual anti-gun advocacy opinion pieces masquerading as objective science. Equally important is the need to hold accountable the leadership of our medical organizations, and to insist they represent all their members and the whole truth. Dr. Margulies and his colleagues showed that this can be done. Stay tuned for Part 3.
—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.
All DRGO articles by Robert A. Margulies, MD, MPH.
— DRGO editor Robert B. Young, MD is a psychiatrist practicing in Pittsford, NY, an associate clinical professor at the University of Rochester School of Medicine, and a Distinguished Life Fellow of the American Psychiatric Association.