Executive Actions

Written by Sarah Kimball, MD, NPA Gun Violence Prevention Taskforce Co-Chair
“If a Democrat is elected, you’d better use the License to Carry before they take all our guns away.”  I’ve heard that suggestion hundreds of times, but it took me off guard as the introductory statement of the Firearm Safety Course I attended one recent Saturday morning.  I was there because I am a doctor who talks to my patients about gun violence prevention and I wanted updated training about current safety technology and safe-storage best practices.
I live in Massachusetts, one of many states that requires firearm safety training for anyone seeking a license to carry a firearm.  The course I took was not taught by a state employee or an off-duty police officer.  It was offered by a private company that had been certified by the Massachusetts Department of State Police.  Because this was a state requirement, I was taken aback by the flow of political statements that came with the safety advice.  While I learned never to hold a gun with the barrel towards a person, I also learned that my instructor thought that the same laws that earned Massachusetts an A- grade for firearm regulation from the Law Center to Prevent Gun Violence also earned us the title of “Stupid-chusetts.”
I was led to understand that our instructors believed everyone should own a gun.  We were advised that one should consider keeping fingerprint-activated gun safes on each floor of the house, so that guns would be locked but easily accessible in the case of home invasion.  The training was devoid of any discussion of the possible harms of having firearms in the home.  There was no mention of the more than 21,000 completed suicides that occurred by firearm in 2014—no suggestion that suicide risk might be considered before making a purchase.   Nor was data mentioned showing that on average, for every time a gun is used to protect someone in their home, a gun is used in 11 attempted suicides, 7 assaults, and 4 unintentional shootings (http://www.ncbi.nlm.nih.gov/pubmed/9715182).
I want to have as many tools as possible to understand how to keep my patients and their families safer.  Knowing how to safely handle and store guns is important knowledge; so is knowing the statistical risks of bring a weapon into one’s home.  State-sanctioned courses on Basic Firearm Safety should exclusively address safety and harm prevention, barring all political agendas.
Physicians understand that gun violence is a public health issue and that evidence should inform our discussions with patients regarding gun safety.  Statistically speaking, it is a myth that a gun in the home inherently makes people safer.  In fact, a gun in the home is 43 times more likely to cause harm to the gun owner or their families than it is to stop an intruder.  For patients who want to own a firearm, I have to be able to offer risk/benefit evidence as well as practical harm reduction strategies such as keeping guns locked, unloaded, and out of reach of anyone who may be suicidal.
I compare this to other areas of safety counseling.  For example, when I talk to patients about safer sexual practices, I explain harm reduction techniques such as using emtricitabine/tenofovir to reduce the risk of HIV transmission for people with frequent high-risk sexual encounters.
I was excited by President Obama’s recent Executive Orders and his town hall meetings reporting that his final year will include important acts on gun violence prevention, including improved background checks, working to strengthen mental health services, and gun safety technology.  But a part of my heart sinks when I see that this issue is yet again being framed politically and that it takes Executive Orders to move this critical public health issue forward.  Rather than action from our elected congressional leaders on policies that have overwhelming support from their constituents, we are stuck with the half measures that our president can enact independently.  Why do we need to wait, when the majority of voters support common sense gun safety laws, such as universal background checks?
Historically, industry has often fought against the things that we now consider staples of our public health infrastructure, such as mandatory air bags in cars. Our voice is needed to help shape the public health dialogue around gun violence prevention.  We have to have the courage to stand up and state that this issue is important for our patients.  We must reiterate that we as physicians don’t see life-saving measures as a political game.

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Find more information and other helpful resources related to this important public health issue at NPAlliance.org/gun-violence-prevention