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Why your doctor wants to talk about guns

Medical student Mattie Renn, who distributed SAFE scrubs at Columbia University, says that doctors "have huge amounts of power in our society."

Your doctor already talks to you about sex, drugs and alcohol, but should they talk to you about guns, too? A newly-formed coalition of healthcare providers thinks so — and patient intervention is just one part of their plan to reduce what they call an “epidemic” of gun violence.

The organization, Scrubs Addressing the Firearm Epidemic, known as SAFE, is demanding an increase in federal funding for gun violence research, and is calling on lawmakers to implement “evidence-based policy” on guns.

At more than 30 medical schools across the country last week, students and physicians wore scrubs with SAFE’s bright red logo as they held demonstrations at their hospitals. According to Sarabeth Spitzer, a fourth-year medical student at Stanford who spearheaded the campaign, the group distributed about 2,700 of the special scrubs “to show the overwhelming consensus of health care providers that firearm violence is a public health crisis.”

Most of those scrubs went to medical students. Several said they receive little training on gun violence despite the thousands of lives lost due to firearms every year.

“There is no prohibition whatsoever on talking about guns with patients,” said Spitzer, “but most physicians and medical students have never been trained in how to talk about them.”

The ‘epidemic’ of gun violence

Medical professionals have grown increasingly vocal about guns in recent years. The American Medical Association, the American Academy of Family Practitioners and the American Academy of Pediatrics all released statements this year demanding federal action on firearms. And in 2016, over 100 medical and public health organizations penned a letter to Congress calling on the Centers for Disease Control and Prevention to directly fund research on the causes of gun violence.

“As future health professionals, especially physicians, we have huge amounts of power in our society,” said Mattie Renn, a medical student at Columbia University who helped plan a rally there and handed out about 40 branded scrubs. “I think there’s a certain level of responsibility that comes with that influence.”

Spitzer hopes to channel that energy through SAFE, which she co-founded alongside Dean Winslow, a physician and retired Air Force colonel who now teaches at Stanford. President Donald Trump once nominated Winslow to serve as assistant secretary of defense for health affairs, but his nomination was stalled after a Senate confirmation hearing in which he said it was “insane” that civilians could buy assault rifles. He eventually withdrew his name from consideration.

Back at Stanford, Winslow joined forces with Spitzer to launch SAFE after February’s mass shooting in Parkland, Florida. “We’ve addressed other public health issues in the past,” said Winslow, “and we can address this one, too.”

According to the CDC’s National Center for Injury Prevention and Control, 38,658 people died in the US due to firearms in 2016, the most recent year for which data is available. That same year, 116,414 people were injured by firearms, according to the CDC.

“Every single day there’s a new shooting or a new death,” said Celina Durbin, a medical student who organized a demonstration at Mount Sinai’s Icahn School of Medicine. “It really is an epidemic.”

A chilling effect on research

Currently, little government-funded research exists to explain the factors underlying those deaths and injuries. “It was striking how little there was written about firearms compared to the number of people who are known to be affected by them so drastically every year,” said Spitzer.

The lack of federally funded gun violence research is due in part to the 1996 Dickey Amendment, which had a chilling effect on firearm research by mandating that “none of the funds made available for injury prevention and control at the Centers for Disease Control and Prevention may be used to advocate or promote gun control.”

While this year’s omnibus spending bill clarified that the CDC may, in fact, conduct research into the causes of gun violence, Spitzer notes that “even if the CDC is legally allowed to fund firearm research, in practicality the money just isn’t there.” While some private funding exists for gun violence research, Spitzer says that “ultimately, government funding is needed to really solve this issue.”

‘You can’t completely separate politics from advocacy’

SAFE’s ambitions go far beyond research. While the organization describes itself as non-partisan, some of its goals — such as universal background checks and mandatory waiting periods for firearm purchases — are political flash points. The National Rifle Association, for example, routinely resists any efforts to limit gun access.

The NRA did not respond to repeated requests for comment, but its lobbying arm has criticized the characterization of guns as a public health crisis, writing in 2017 that “far more Americans meet their deaths at the hands of medical providers than at the hands of criminals with firearms.” The group also warned that medical professionals “must be cautious not to abuse their position of trust with invasive and intrusive questioning, particularly to fit a political agenda.”

Winslow, a registered Republican who says he is an expert in shooting the M9 pistol and the M16 rifle, concedes that “you can’t completely separate politics from advocacy,” but he maintains that SAFE is “not a political organization.”

“We have people in our organization that … are Democrats, Republicans like me, we’ve got gun owners, [and] we’ve got people that belong to the NRA,” said Winslow.

While asking patients about guns might be uncomfortable, Winslow doesn’t believe doctors are imposing a partisan agenda in doing so. “We ask patients invasive questions all the time and we’re supposed to,” he said. “It’s just a logical extension to get medical students and doctors of all ages comfortable with asking about weapons.”

Spitzer, for example, believes that doctors should “talk to patients about how they store their weapons and where they store their ammunition, whether they’re locked, [and] whether anyone has a history of mental illness or suicidal tendencies.” Those conversations can “decrease the likelihood that someone might use weapons inappropriately in the home or in a way that the purchaser didn’t intend,” she said.

SAFE doesn’t claim that doctors can prevent all gun violence, but to Winslow, who served as a hospital commander in Baghdad during the Iraq war surge, the issue is personal. The former flight surgeon saw the “devastating” effects of firearms first-hand, often signing the preliminary death certificates of those killed by guns.