8 health organizations, American Bar Association call for gun policies

A call for policies to help mitigate the rate of firearm injuries and deaths in the U.S. was announced by the American College of Physicians, 7 other national health professional organizations, and the American Bar Association.

Broadly, the organizations support a public health approach to reducing firearm injuries and fatalities, similar to approaches used to reduce tobacco use, motor vehicle fatalities, and unintentional poisoning.

The paper, which was published online Feb. 24 in Annals of Internal Medicine, recommends ways to reduce firearm-related injuries and death:

• Support criminal background checks for all firearm purchases, including sales by gun dealers, sales at gun shows, and private sales from one person to another;
• Oppose state and federal mandates that interfere with physician free speech and the patient-physician relationship, including physician “gag laws” that forbid physicians to discuss a patient's gun ownership;
• Oppose the sale or ownership of “assault weapons” and large-capacity magazines for private citizens; and
• Advocate for research into the causes and consequences of firearm violence and unintentional injuries so that evidence-based policies may be developed.

The American Bar Association notes in the paper that these recommendations “are constitutionally sound.” The health professional societies made 2 additional recommendations:

• Support improved access to mental health care, with caution against broadly including all persons with any mental or substance use disorder in a category of persons prohibited from purchasing firearms; and
• Oppose blanket reporting laws that require physicians to report patients with mental or substance use disorders, as these laws may stigmatize the patients and inhibit them from seeking treatment.

ACP was joined by the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Emergency Physicians, the American Congress of Obstetricians and Gynecologists, the American College of Surgeons, the American Psychiatric Association, and the American Public Health Association, as well as the American Bar Association.

In an accompanying editorial, the author stressed that firearm-related violence is a public health threat and that physicians should focus on studying and preventing it. The editorial called for new research and funding to fill knowledge gaps and referred to a study in the same issue of Annals finding that being hospitalized for a firearm-related injury is associated with a heightened risk of subsequent violent victimization or committing a crime.

Using a retrospective cohort study design, researchers identified all gun trauma patients hospitalized during 2006-2007 in the state of Washington and compared their risk of subsequent violent injury, death, or crime perpetration to the rates among a random sample of patients with a noninjury-related hospitalization and the general population of the state.

Patients with a hospitalization due to firearm violence were at a significantly greater risk for subsequent firearm-related hospitalization, firearm-related death, or violence-related arrest in comparison with noninjury patients. Among 613 patients with an index firearm-related hospitalization, when compared to than those with a non-injury-related index hospitalization, there was a greater risk for subsequent firearm-related hospitalization (subhazard ratio [sHR], 21.2; 95% CI, 7.0 to 64.0), firearm-related death (sHR, 4.3; 95% CI, 1.3 to 14.1), and firearm- or violence-related arrest (sHR, 2.7; 95% CI, 2.0 to 3.5).

The researchers noted that the condition of prior criminality had a stronger association with subsequent firearm or violence-related arrest than did a diagnosis of prior mental illness.

“One avenue for further research is to operationalize a collaborative intervention, considering that a FRH [firearms-related hospitalization] can potentially play an important role in identifying and reaching high-risk persons,” the authors concluded. “Those already involved in a cycle of violence who have a medical encounter may benefit from interventions to change a trajectory that would otherwise result in subsequent violent injury, death, or crime perpetration. Secondary and tertiary prevention measures may begin in the outpatient, emergency department, or inpatient setting and continue afterward in conjunction with community services and assistance from law enforcement to offer counseling on avoiding repeated injury and new criminal activity.”