Evidence-based policies to promote gun safety

During ACP’s annual meeting in Orlando recently, the American College of Physicians released a new position paper on reducing injuries and deaths from firearms — the first comprehensive update of College policy since the late 1990s. (I am a co-author of the paper.)

Published as an online-first article in the Annals of Internal Medicine, the paper is the result of an extraordinarily comprehensive review of the evidence of the causes and solutions to firearms-related injuries and deaths in the United States conducted by ACP staff and its Health and Public Policy Committee.  (Of note, the members of HPPC included several internists who themselves own firearms.) A team of four reviewers examined over 120 studies and utilized CDC, ATF and other databases.

A draft of the paper was reviewed by outside experts in mental health and firearms issues, by expert reviewers selected by the Annals of Internal Medicine, and by ACP’s Board of Regents, Board of Governors, and Councils during a 45-day review period; appropriate revisions were made in the final draft to address the substantive comments from reviewers. The paper was approved by the Board of Regents on April 7, 2014.

As we developed our recommendations, we had one simple standard: What does the published evidence say about the causes, effects, and prevention of firearms injuries and deaths?    (To read about all of the evidence behind our recommendations, click on the link in the executive summary to appendix 1).

In assessing the evidence, we identified where the evidence was strongest before we advocated for a particular policy recommendation, where it was weakest, and where more research is needed.

Our paper found strong evidence that having firearms in the home is associated with a greater risk of deaths and injuries (accidents, homicides, suicides combined) especially when children, adolescents, people with mental illness, and drug and alcohol abusers are present.  It found strong evidence for treating firearms violence as a public health issue. For universal background checks,  for subjecting firearms to consumer safety standards, for incorporating safety features like trigger locks, and for firearms owners themselves adopting best practices to reduce the risk of accidental or intentional injuries and deaths from their guns.

We also found that, although there is limited evidence that banning future sales of firearms with features that allow them to kill as many people as possible, as quickly as possible (commonly called “assault” weapons and certain types of semi-automatics) and large capacity ammunition would be effective in reducing overall homicide rates, such a ban would be warranted to reduce casualties in mass shooting situations.

We also found very limited evidence that waiting periods  are effective in reducing overall homicide rates from firearms although there is evidence that waiting periods may be effective in reducing suicides.  We found limited evidence on the impact of concealed carry laws in increasing or reducing deaths and injuries from firearms.  We called for better access to mental health services while calling for more research on the impact of laws requiring physicians to report persons with mental illnesses who may be a risk to themselves or others.

A companion original research paper published in Annals found that ACP’s policy prescriptions had strong support from large majorities of surveyed ACP members.  Although members’ views are of obvious  interest to us, the policy paper was not based on the opinion survey, but on the published evidence on what is effective in reducing firearms injuries and deaths.

Predictably, the National Rifle Association (NRA) unloaded over on ACP’s recommendations, calling us “the anti-gun” American College of Physicians. It linked release of ACP’s policy paper to the fight over confirming Dr. Vivek Murthy, an ACP member, who has been nominated as surgeon general but whose confirmation vote has been put off because of strong NRA opposition.  (ACP strongly supports Dr. Murthy’s nomination — and he is absolutely right that firearms injuries and deaths are a public health issue — but release of our position paper was purely coincidental and unrelated to his nomination.)  “Murthy’s nomination is currently on hold, due to concerns about his true motives for seeking the Surgeon General’s post,” says the NRA. “The ACP’s endorsement of massive federal gun control only underscores how well-founded those concerns really are.”

Anti-gun? Massive gun control? 

ACP’s policy recommendations are neither pro nor anti-gun; they are pro-gun safety.  Our paper acknowledges that any regulations must be consistent with the Second Amendment right to bear arms.  We do not propose banning any guns, except certain types of semi-automatics that have features that would allow a mass shooter to kill as many people as possible as quickly as possible, as well as high capacity ammunition clips.  Closing the “gun show loophole” in the current background check system would ensure that prohibited purchasers, such as felons, persons involuntarily committed for mental illness or otherwise “adjudicated mentally defective,” cannot own firearms because of the risk they present to themselves and others.

Unlike the NRA, we followed the evidence on what will be effective in reducing firearms injuries and deaths, resulting in a common-sense and scientifically rigorous position paper.  We encourage all physicians to read our paper and speak out for evidence-based policies to reduce the number of Americans — 32,000 a year, 88 per day — that are killed by firearms, and the 74,000 that are injured each year by a gun.

Bob Doherty is senior vice-president, governmental affairs and public policy, American College of Physicians and blogs at The ACP Advocate Blog.

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