Putting a Gag on Doctors: The Wrong Approach for Gun Rights

We need to talk about gun safety. Really. For years now, the gun lobby, driven by the NRA, has had considerable success at thwarting the flow of information to doctors concerning gun-inflicted injury.
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We need to talk about gun safety. Really.

At a typical well-child visit, pediatricians talk to parents and kids about everything from nutrition to proper seat belt use. Our advice is based on evidence: What, statistically, is the most common scenario for a toddler drowning in a pool? (Entering it from their own home through an unlocked door.) What is the most common method of suicide in teenage boys? (A firearm.) Doctors rely on good information and an unimpeded communication between doctor and patient in order to be effective.

The American Academy of Pediatrics is dedicated to child safety, and that includes recommendations to parents on how to prevent gun injury. Opponents of gun regulation feel threatened when health professionals collect data about or even bring up the topic of gun safety. In 2011, the Florida state legislature passed a law that imposed stiff disciplinary action on any physician who asked parents about the presence of guns in a child's home or play areas. The AAP and other major medical organizations across the country immediately denounced the legislation. The law was struck down in a U.S. District Court, but the state continues to appeal that ruling, and three other states have attempted to pass similar laws.

For years now, the gun lobby, driven by the NRA, has had considerable success at thwarting the flow of information to doctors concerning gun-inflicted injury. The Center for Disease Control was at one time an important pipeline for such research. In 1996, Republicans in Congress passed legislation that defunded the CDC's research studies on gun safety, claiming that gun-related injury and death was not a public health matter. The CDC can still collect and report data, but it is prevented from studying the issue.

More recently, gun-rights advocates were successful in shaping a provision in an amendment to Title I of the Affordable Care Act, called Title X, Protection of Second Amendment Gun Rights, which prohibits the collection of data on gun ownership at doctor visits. A few of the provisions are just silly posturing. For instance, we cannot require disclosure of gun ownership or storage. Well, no kidding. A doctor visit relies on self-reporting. Patients can lie about anything from smoking to how many doughnuts they eat if they want to, but the reality is that most parents, including gun owners, are more than willing to talk openly to their doctor about anything that affects the safety of their child.

A more concerning provision is that, while not explicitly preventing the doctor to talk about gun safety, the law prohibits doctors from collecting or maintaining that information in a record -- effectively putting a gag on the health record instead of directly on the doctor. Data collection, even without research and analysis, is critical. Data gathered by the CDC reveals that 42 percent of gun owners with teenagers in their household do not keep their guns locked up. When there are younger children in the household, 29 percent of gun owners do not lock their guns. Those sobering statistics give us focus for discussions with parents. Measures to suppress this kind of information have no place in a health care law.

Even freedom to collect data, however is not enough, since data alone does not establish cause and effect, or the efficacy of interventions. For that we need research -- the kind the CDC is currently prohibited from carrying out. Shouldn't we firmly establish whether or not the teens in these households with unlocked guns are any more likely to successfully commit suicide than if the guns had been locked? Or at how young an age a child can be reliably taught gun safety?

As both doctors and the National Rifle Association know, information is power -- the power to make decisions that are based on reason rather than fear. Gun-rights activists are working very hard, with surprising success, to make sure we do not have that power. NRA-funded lobbyists and pandering politicians need to stay out of the exam room, out of the health record, and out of public health research. Otherwise we are all just shooting in the dark.

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