Are Guns a Health Issue?

April 1, 2014

Confirmation of President Obama's nominee for Surgeon General is suspended as the debate over an answer to this question continues.

Florida legislators don’t think so. Two years ago they passed the Firearm Owners Privacy Act, which states that doctors should “refrain” from asking patients or their families questions about guns in the home. After several doctors sued, arguing that the law interfered with their ability to provide preventive care to patients, a federal judge struck down the law in 2012. The state is awaiting a decision on its appeal to the 11th Circuit Court of Appeals.

About 10 other states have introduced legislation that would prevent doctors from asking patients about guns. Most bills died, but in 2013 Montana passed a law that prohibits medical providers from requiring patients to answer questions about gun ownership, and Minnesota passed a law prohibiting the state health benefit exchange from asking people whether they own a gun or have one in their home, according to the Law Center to Prevent Gun Violence.

Some members of Congress in 1996 didn’t think guns were a health issue, either. The House of Representatives that year cut $2.6 million from the Centers for Disease Control and Prevention’s budget, the exact amount the agency had spent on firearm injury research the previous year, according to a 2013 JAMA“Viewpoint” by Dr. Arthur Kellermann, now the medical school dean at the Uniformed Services University of the Health Sciences, and Dr. Frederick Rivara, editor of JAMA Pediatrics. The final appropriation stated that no funds for injury prevention and control at the CDC may be used to advocate or promote gun control. As Kellermann and Rivara note, “even today…the CDC’s website lacks specific links to information about preventing firearm-related violence.”

And now, the debate over whether guns are a health issue has placed the confirmation of President Obama’s nominee for Surgeon General, Dr. Vivek Murthy, in limbo.

“This is a post that should be sacred,” says Dr. Christopher Lillis, a general internist in Fredericksburg, Va., who just finished up a term as a board member and now serves as state director for Doctors for America, an organization Murthy co-founded. Instead, Lillis says, “a narrow, single-interest special interest group” is threatening to derail Murthy’s nomination as surgeon general.

“It’s so ludicrous that nobody could have seen this coming,” Lillis says.

That special interest group is the National Rifle Association, which describes itself as “America’s longest standing civil rights organization.” Murthy did not mention guns in his opening remarks at his Senate confirmation hearing two months ago, but he had previously called out the NRA and urged elected officials to recognize that guns are indeed a public health issue. “Tired of politicians playing politics w/ guns, putting lives at risk b/c they're scared of NRA. Guns are a health care issue,” Murthytweeted in October 2012.

And after the mass shooting at Sandy Hook Elementary School in Newtown, Ct., Doctors for America (described on its website as a “national movement of physicians and medical students working together to improve the health of the nation and to ensure that everyone has access to affordable, high quality health care”) urgedstronger gun laws, assurance that doctors can counsel patients about gun safety, and the tracking of gun-related deaths and injuries the same as any public health problem.

A month ago, Chris Cox, the executive director of the NRA’s Institute for Legislative Action, wrote Senate Majority Leader Harry Reid, D-Nev., and Senate Minority Leader Mitch McConnell, R-Ky., to express his organization’s strong opposition to Murthy’s confirmation.

“For every Vivek Murthy, there are thousands of doctors across the country who support the National Rifle Association,” Chris Cox, executive director of the NRA’s Institute for Legislative Action and the son of a surgeon, said recently on Fox News . “My father’s one of them.”

On their editorial pages, a number of newspapers, such as the San Francisco Chronicle, the Charleston (W.Va.) Gazette, the Boston Globe and the Times-Tribunein Scranton, Pa., have criticized the NRA’s efforts to block the nomination of Murthy, a Harvard- and Yale-educated hospitalist, and what they describe as politicians’ cowardice. The New England of Medicineand The Lancet have also weighed in.

Clearly, many doctors think guns are a health issue. The American Academy of Physicians, the American College of Physicians, the American Academy of Pediatrics and the American Medical Women’s Association are among the professional organizations that have written letters supporting Murthy to congressional leaders.

And many professional medical organizations, including the American College of Surgeons and the American Academy of Pediatrics, have issued strongly worded statements calling for such measures as a ban on assault-style weapons, background checks for gun purchases, and evidence-based research into firearm injuries.

“We’re in the trenches, we’re in the trauma bay,” says Dr. Michael Nance, director of the pediatric trauma program at the University of Pennsylvania and lead author of the American Pediatric Surgical Association’s policy statement. “We see the consequences of violence day in and day out, and we can’t seem to do anything about it.”