Facing Up to the US Gun Problem: Steps in the Right Direction
The United States has a gun problem, but if the Sandy Hook Elementary School shooting has any silver lining, perhaps the US public, and most importantly the US government, will finally acknowledge the problem as a first step toward addressing it. While every US physician and health care professional is affected by gun violence directly or indirectly, three initiatives resulting from the new urgency that emerged since Sandy Hook will directly affect health and medical research.
First, President Obama lifted the virtual ban on federal agencies conducting research on gun violence that was imposed 17 years ago . Banning research – a remarkable step in a long line of remarkable actions regarding guns– could only have benefited those threatened by the answers, gun manufacturers and the National Rifle Association. Research that had been conducted to date found that a major argument for gun ownership, protecting oneself at home, was not effective, and gun ownership was in fact associated with an increased risk of homicide. This threat to pro-gun lobbyists was blocked through NRA lobbying Congress, preventing research on a public health threat that claims 30,000 lives a year in the United States. Lifting the ban will reinvigorate this critical area of research; unfortunately, few researchers would pursue a career path with essentially no steady source of funding, so much-needed gun research will not happen overnight.
The second initiative is President Obama’s directive that a letter be sent to doctors indicating that they may ask patients about guns in their homes. The common sense preventive measure was challenged in June 2011, when Florida passed a law against doctors talking with patients about guns after the NRA and other pro-gun organizations claimed that doctors asking such questions of patients violated their Second Amendment right to keep and bear arms. While the law was passed in Florida only and promptly challenged in court, the controversy generated confusion on the part of physicians and did little to promote open discussion between doctors and patients. Prompted by American physician organizations, President Obama is clarifying that no federal law prohibits such discussions.
The third initiative is less clear cut but may have even greater consequences for healthcare, particularly for the substantial proportion of the population with mental health concerns. The issue of mental health and violence has erupted with each multiple-victim shooting incident, but a comprehensive approach has not been developed. Fundamentally, few such incidents are perpetrated by individuals with a psychiatric diagnosis, but new proposals include requiring therapists to inform agencies about any patients who may be a source of harm to themselves or others. Such proposals could have far more adverse consequences for patients fearing to come forward and wind up on national databases than the multi-victim shooting crimes they might prevent. At the same time, increased discussion of mental illness, how it manifests, and how it is diagnosed, is bringing with it increased awareness and even increased funding . While the new federal funding proposed for mental health treatment is only $155 million, new awareness of mental illness concerns may finally help it be recognized as a major noncommunicable disease with significant morbidity and mortality.
The lives lost at Sandy Hook are not isolated events; on January 16 President Obama stated that 900 more individuals had died in the US from gun violence since the shooting 1 month ago. However, with national attention focused on Sandy Hook, the US may have a unique opportunity to come to terms with its gun problem and begin having honest discussions about gun policy based on the will of the people, rather than the will of the lobbyists.