About 15 years ago I sat in on the superb Doctoring programme at UCLA that taught medical students the art of medicine through role play with actors.
One scenario featured a teenage boy whose behaviour was causing concern at home and school. I don’t remember all the details of the case, but the gist was that the boy was truanting and was increasingly withdrawn. He replied to his student interviewer in monosyllables. He seemed angry. Was he depressed too?
Amid discussions about how to engage the boy and gain his trust, how much to involve his parents, and whether to offer counselling, someone mentioned almost in passing that there was a gun in the house. Might he use it? The discussion stepped up a gear: suddenly the boy’s condition looked highly risky. Should he start antidepressants? See a psychiatrist? Or be admitted to hospital?
I was just an observer. But, as nobody else asked the obvious question, I did. “Isn’t the first priority to get the gun out of the house?” It went quiet. Then Michael Wilkes, the professor, said “elsewhere, yes, of course. But not here in the USA.” The discussion moved on.
Back then, such questions seemed futile. In Florida in 2011 they became illegal, when the Firearm Owners’ Privacy Act banned physicians from asking patients about their access to guns. It turned out to be only temporary: the act was blocked permanently in July 2012 by a federal judge. But the fact that the law ever got made is chilling enough.
Legislators have also blocked federal funding for public health research on gun control. Take a look at the bibliographies of two public health institutes: the Johns Hopkins Center for Gun Policy and Research and the Harvard Injury Control Research Center. This kind of research is now dwindling, thanks to lobbying by the National Rifle Association which led to a ban on US Centers for Disease Control and Prevention grant money being used for “any proposed, pending, or future requirement or restriction on any legal consumer product, including its sale or marketing, including but not limited to the advocacy or promotion of gun control.” This year the ban was extended to grants from the National Institutes of Health. Under section 218 of the Consolidated Appropriations Act, 2012 (Public Law 112-74), which provides funding to NIH, it says, “None of the funds made available in this title may be used, in whole or in part, to advocate or promote gun control.”
At the vigil for the victims of the Newtown school shootings President Obama pledged: “In the coming weeks, I’ll use whatever power this office holds to engage my fellow citizens, from law enforcement, to mental health professionals, to parents and educators, in an effort aimed at preventing more tragedies like this, because what choice do we have?” His office may hold plenty of power to engage, but little power to control guns. Two things he could surely do, though, are to ensure that doctors can ask patients about firearms and that researchers can continue exploring what keeps people safe from guns.
Trish Groves, deputy editor, BMJ.
Trish is on Twitter @trished