ORLANDO – Gun violence is a public health threat that needs to be addressed with the best scientific evidence to help reduce injuries and deaths, a new policy from the American College of Physicians proclaims.
"Access to firearms, especially firearms in the home, increases the likelihood that a person will be a victim of gun violence by homicide or suicide," Bob Doherty, ACP senior vice president of governmental affairs and public policy, said April 10 at the annual meeting of the American College of Physicians. "The evidence is very clear – the risk is higher.
Naseem Miller/Frontline Medical News
From left, Bob Doherty, Dr. Molly Cooke, Dr. Thomas Tape, and Dr. Charles Cutler detail the updated ACP policy on gun violence at the college's annual meeting.
The policy, published simultaneously in Annals of Internal Medicine (2014 April 10 [doi: 10.7326/M14-0216]), calls for universal criminal background checks and favors a prohibition on assault and semiautomatic weapons and large-capacity magazines. It updates the ACP’s 1996 policy.
"As an organization representing physicians who have firsthand experience with the devastating impact of firearm-related violence, ACP has a responsibility to participate in efforts to mitigate needless tragedies," Dr. Thomas Tape, chairman of the ACP health and public policy committee, said.
The ACP sought to balance its recommendations on gun violence and mental illness, Dr. Tape said, adding that any restrictions on gun ownership should not broadly target people with mental illness. Only a small portion of those who are mentally ill may be at risk for harming themselves or others, he said.
Of the 32,000 gun-related deaths in the United States each year, 11,000 are homicides, 19,000 are suicides, and the rest are unintentional, according to evidence from the 120 studies reviewed for the policy paper.
Determining who’s at the greatest risk for harming themselves or others "clearly begs for more research," said Dr. Tape. "We need better predictors."
Dr. Molly Cooke, ACP president, agreed, and noted that 30% of patients in primary care practices have a mental health diagnosis. With a high prevalence of illness and a low proportion of those who might actually do harm, "you’d be prohibiting lots of people from owning guns who would never harm anyone," Dr. Cooke said.
Dr. Tape also said the ACP believes that "the physician’s judgment is critically important." He said that often, patients will disclose their state of mind, allowing the physician to determine whether it is appropriate to alert the authorities or offer follow-up care.
Physicians are required by law to inform authorities when they believe a patient poses an imminent threat. "But the question is whether physicians should be required to more broadly report on individuals with mental illness who may pose a threat," Dr. Tape said.
Reporting requirements should not act as a disincentive to seek care, or interfere with the patient-physician relationship, according to the policy paper.
"The ACP strongly believes the patient-physician relationship should be protected from laws that prevent physicians from initiating a discussion about guns," Dr. Cooke said.
The policy paper also voices the ACP’s support for devices such as trigger locks, as well as efforts to keep guns out of the hands of children, adolescents, people with dementia, and those with substance use disorders.
According to a 2013 survey of ACP members, the vast majority agree that firearm injury is a public health issue. Close to 90% also said they supported mandatory background checks, mandatory registration, and a ban on assault weapons (Ann. Intern. Med. 2014 April 10 [doi: 10.7326/M13-1960]).
Of the 573 respondents, 64% reported having had patients who were injured or killed by a gun, and 14% said that they or someone in their family had been threatened or injured by someone with a gun.
However, more than half (58%) said they had never asked patients whether they had guns in the home, and 80% reported never discussing gun use with patients. More than three-quarters said they had never discussed ways to reduce the risk for gun-related injury or death, and 62% had never talked about keeping guns away from children. Gun-owning physicians were more likely to ask about guns in the home.
Three-quarters of the physician respondents said there was a need for an educational program to help physicians counsel patients in firearm injury prevention.
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Listen to audio from the press briefing here: