Politics & Policy

Doctors Can Be Wrong

The American Academy of Pediatrics doesn’t have the facts about children and gun safety.

There is much wailing and gnashing of teeth among physicians and medical societies, including the American Academy of Pediatrics (AAP), over the Florida law that forbids questioning patients about gun ownership. In late July, the 11th Circuit U.S. Court of Appeals ruled that this was “legitimate regulation” of physicians’ conduct, intended to protect “patient privacy and curtail abuses of the physician-patient relationship.” Physicians who can see past the perceived insult to their autonomy would understand that this changes nothing about good care.

A Florida pediatrician, Kristie Rivers, writes in the Huffington Post about her reaction to this restriction on her practice, in the context of her five-year-old son’s new fascination with gun play. In “The Questions I Can’t Ask about Guns,” she seems to equate her parental responsibility to teach her son about guns with her medical responsibility to teach patients about them. She gets individual gun safety right when teaching her son but follows the AAP’s misrepresentation of gun control as societal “gun safety.” Like a number of such associations, the AAP exaggerates the risk children face from guns, and do not respect the role of parents and gun owners in keeping children safe around firearms. “Gun safety” happens when guns are used properly, not avoided.

“Naïvely,” she had “never thought [she] had a need” to talk to her child about guns. The family had no guns or toy guns and didn’t play violent movies or video games. She had “thought he would not be interested in guns or would just KNOW they are dangerous and not to be touched.” To her credit, despite her “shock,” she responded appropriately. She explained their danger and discussed what to do if he saw one.

Naïveté doesn’t work. All children are exposed to guns — somehow, somewhere in our culture, in the media or as someone’s toys, and ultimately, for better or worse, to the real things. Children have their own ideas, whether we’ve inquired or not (so inquire!). Fortunately, Dr. River’s son already knew not to touch a gun, and especially not to pull the trigger. He is developing the “healthy respect for guns” that she wants for him, and that all of us should want for our children.

Dr. Rivers acknowledges that she does “not even pretend to understand the intricacies of the laws regarding gun control.” That’s clear, because she references the AAP. For example, she writes that “in the United States, approximately 500 children die each year from accidental gunshot wounds, with another 7,500 children hospitalized for non-fatal wounds, according to the [AAP].” But, as I explained recently on NRO, the latest data from the Centers for Disease Control show that in 2011 only 74 accidental firearm deaths occurred among children up to age 14. And there were 6,220 unintentional and intentional firearm injuries in this age group (hospitalized or not). That’s just 0.01 percent of all reported injuries among children 14 and younger. (CDC firearms statistics even include BB- and pellet-gun shootings!)

The AAP also claims that “the absence of guns from children’s homes and communities is the most reliable and effective measure to prevent firearm-related injuries in children and adolescents” (my emphasis). This is a call for gun confiscation. It’s like saying that eliminating cars would prevent against car crashes. Cars and guns are important tools to too many people. And as so many do, the AAP ignores the protection from harm that guns confer a half-million to 3 million times a year.

Why are the AAP’s figures so discrepant from the best current data? They may be old, as overall deaths and injuries from gunshots have steadily decreased for many years. Many reports have exaggerated youth mortality from firearms, mostly through deceptive definitions of “children” as those up to age 18 or 21 or even 24, depending on which studies you read. Most of us think “children” are those up to approximately twelve years of age, and “youth” up to 18 to 21, and neither as old as 24. By including older teenagers and even adults in their early 20s, some reports incorporate in “pediatric” firearms deaths and injuries the major uptick reflecting urban gang and drug violence carried out by and targeting those “youth.” And since these findings only associate nearby guns, whoever owns them, with gunshot wounds incurred, there is no demonstrable cause-and-effect relationship regarding legally owned guns within households. According to the CDC, total firearms deaths in 2011 through age 14 were 383 (74 accidental). By comparison, there were 2,255 (66 accidental) from ages 15 to 19, and 3,865 (64 accidental) from ages 20 to 24.

Violent deaths at any age are unacceptable, but this is not nearly the epidemic some would have us believe. For younger children, preventing injury from gun violence means adults acting responsibly in teaching about and controlling access to their firearms. For older youth, the same applies, with allowance made for the growth of their own good judgment. For all of us, it can also mean using firearms to defend children against others who would harm them. For doctors, it means not acting paternalistic toward responsible adults who seek their medical expertise.

So what are we to conclude? I recommend questioning authority. This includes medical societies and physicians giving advice about “gun safety” while disparaging responsible gun ownership. Gun safety is assured by individuals doing their duty to use and store weapons safely. Guns are not a health issue until they are misused. When they are, people, not the guns, are to blame.

— Robert B. Young, M.D., is a psychiatrist in private practice in Pittsford, N.Y., and a clinical associate professor at the University of Rochester Medical Center.

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