The AMA's goal and role in preventing gun-related injury

AMA Leader Commentary. By Richard F. Corlin, MD. Dec. 17, 2001.

AMA LEADER COMMENTARY

A few words about current events in medical practice

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A message to all physicians from AMA President Richard F. Corlin, MD.

If you're a member of the National Rifle Assn. as well as the AMA, you might have seen my picture recently in the NRA journal, taking up a full page. It was my inaugural address that drew the group's attention. I said it's about time we acknowledged the scourge of gun violence in our nation, just as we would any other public health crisis, such as polio, tobacco or drunk driving.

What I called for in my inaugural is very much in keeping with the more than 20 AMA policies concerning firearm safety: Policies approved by the AMA House of Delegates. And, let me remind you, neither those policies nor my inaugural address attack the Second Amendment to the U.S. Constitution. Nor do they call for a ban on guns of any kind. Rather, they are concerned with how we as a people and physicians as a profession can work together to avoid preventable injury and death.

Our first step, as I outlined in my speech, is to gather the data we need to address the crisis of gun-related violence and injuries. We took our first major step in doing that at a conference I chaired last month. We convened a small group of people representing the whole spectrum of organizations involved with the issue of gun violence.

The meeting had representatives from Federation organizations; academicians who are key staff for the National Research Council study on gun-related violence; representatives of advocacy groups, both pro- and anti-gun; and representatives from three foundations.

This meeting in Oakbrook, Ill., was a follow-up from what I had called for in my inaugural -- a nonpolitical look at the state of gun-related deaths and injuries using a public health or epidemiological model. And in just two days of civil yet provocative discussion, we identified the little we know about guns, and what great deal more we need to know not just about guns, but about the people who use them, and the settings in which they are used.

Conference participants agreed that gun-related injuries and deaths are a serious public health issue, that physicians and the AMA have an important role to play in this issue, and that much more research and education are needed in this area.

Participants also agreed that although gun-related injuries could be reduced by improving gun safety education, by designing better guns and by reducing the availability of guns to certain groups of people, none of these strategies was adequate by itself. All three need to be included in a comprehensive strategy.

There was strong support for the need for a systematic, national violent death recording system. Three caveats were identified: The need to separate the process of data collection from the process of policy development; the need to ensure that the mechanism for developing the system includes representatives from all key stakeholders; and the need to report the information so it cannot be associated with individuals to ensure that it will not be used inappropriately. AMA policy supports the funding of a national violent death recording system, housed at the Centers for Disease Control and Prevention.

What we are interested in is reducing injuries and death. As health professionals, our goal is to reduce such injuries from all causes, guns included.

In Oakbrook that weekend, our AMA brought together a number of people from various sides of the issue who had never sat in the same room together to discuss the issue. And they all welcomed the opportunity to share their views with one another.

Not only did the Oakbrook conference help legitimize the problem of gun violence as a public health issue, it also revealed the relevance of AMA's involvement. Our AMA now has partners and allies on all sides of the issue who can attest to the seriousness of this public health issue and help bring it out of the political no- man's-land in which it has been held hostage.

When asked to think about the AMA's role in the issue of gun-related death and violence, conference participants saw the AMA as the one national organization that can reframe the issue, partner with a wide range of public and private stakeholders, investigate physician attitudes, provide physician education, coordinate the development of a gun violence data set and lead public health efforts. They recognized us for our ability to bring physician leadership to this issue -- as well as others.

One of the pro-gun participants, who early on had expressed skepticism that there would be a balanced discussion of gun issues, came around to a different frame of mind by the time the meeting ended. At Sunday morning's closing session, he stated, "If people outside of this room knew how the AMA conducted the meeting, it would go a long way to changing the perception of the AMA." That's high praise from a physician we didn't think was on "our side."

And maybe that's the secret: not to take sides. The AMA is the largest physician organization in the United States. Shouldn't we take a pluralist approach, accepting that there will be many sides on many questions, all deserving of our consideration? On some issues, we may need to rise far above the political level to get a better view of the entire landscape. As I said in my inaugural, our goal is to help cure the epidemic of gun violence, not to win a victory over some real or imagined political enemy. Anyone who helps in this fight is an ally -- anyone. And that's still true.

What do you think about the AMA's role in preventing gun-related injury -- our only goal in this issue? I'd like to hear from you about it.

Dr. Corlin, a gastroenterologist in private practice in Santa Monica, Calif., served as AMA president during 2001-02.