Politics & Policy

Should Doctors Screen Their Patients for Gun Violence?

(Photo: Vadimgozhda/Dreamstime)
It’s a bizarre idea, but a popular one in much of the medical profession.

In a recent paper in the Annals of Internal Medicine, Garen Wintemute of the University of California at Davis encourages physicians to proactively screen patients for the sin of gun ownership. “We need to ask our patients about firearms, counsel them on safe firearm behaviors, and take further action when an imminent hazard is present,” he writes.

This is the clarion call of modern medicine: screening today, screening tomorrow, screening forever! In clinical terms, screening is a search for disease in healthy populations. It is generally a costly and harmful waste of time and money, and everyone from Obamacare apologist Atul Gawande to prominent health economists knows that it doesn’t work to control costs or save lives.

When it comes to suicide, Wintemute pins his strategy on a 2002 data point that “As many as 45% [of people who commit suicide] have seen their primary care provider within a month of their death.” It should be easy to identify half of a group of people and help them, right? After all, it’s a big group, with more than 40,000 suicides in the U.S. annually.

Not really. It isn’t even a search for a needle in a haystack; it’s looking for the tip of the needle somewhere in the barn. Americans make nearly 900 million primary-care office visits annually, an average of 2.8 per person. Fewer than 1 percent of these (7.8 million in 2014) are for depression, which most people agree is a precursor to suicide. But if we assume those 7.8 million visits are made by 2.875 million people, and that these include every single one of the 45 percent of suicide victims who saw their doctor in the month before their death, that still suggests that just 0.7 percent of people seen for depression kill themselves in a given year.

I am all for physicians’ asking depressed patients about their state of mind and encouraging the suicidal not to own guns, but I am not optimistic that this will reduce the suicide rate (overall or by firearm), given the difficulty of asking the right question at the right time and then venturing out to tell the right person, such as a mental-health professional or family member, who can intervene appropriately.

The notion that physicians should screen gun owners to prevent homicide is also bizarre, for similar mathematical reasons. There are 11,000 gun homicides each year; to simplify things, say that a single criminal is responsible for each death. And just for the sake of argument, imagine that doctors really can identify all 11,000 people.

That’s 0.003 percent of the U.S. population, which is 323 million. So if doctors also misidentify even 0.3 percent of the population, or one out of every 333 people, as potentially dangerous — they own too many guns, they get mad or ostentatiously lie when asked about guns, they voted for Donald Trump, they don’t have a gun safe, or, God forbid, they taught their kids to shoot — they will misidentify 100 people for every correct identification. And can you imagine the civil liability for wrongly reporting someone as a homicide threat?

Wintemute also asserts: “Nationwide in 2016, there was an average of 97 deaths from firearm violence per day: 35[,]476 altogether. In the 10 years ending with 2016, deaths of U.S. civilians from firearm violence exceeded American combat fatalities in World War II.” But these kinds of comparisons are meaningless. Every year in America, for example, so many people die from medical errors (about 245,000) that it would take almost four Vietnam conflicts to rival the medical mayhem. But that tells us absolutely nothing about what we could do to reduce medical errors.

Wintemute’s tally of “firearm violence,” by the way, includes gun suicides — and of course it leaves out similar violent acts committed without guns. In 2014, guns accounted for only about half of all suicides. Do we not care about the other 21,440? Or how about the fact that the absolute risk of suicide is 14 percent higher now than 20 years ago?

More than twice as many Americans died in 2014 from unintentional injury (135,928) as from homicide and suicide combined (58,698). But there are no calls to ban ladders, throw rugs, electricity, power tools, cars, pools, or cell phones.

And if we did magically eliminate firearms, would the overall homicide or suicide rate improve? Probably not.

The number of guns in circulation has soared over the past couple of decades, and states have liberalized their concealed-carry laws, while the gun-homicide rate has fallen. Meanwhile, Japan, a developed nation with highly restrictive gun laws, has a suicide rate almost a third greater than ours. Another OECD country, South Korea, has gun laws somewhat less restrictive than Japan’s, but a suicide rate more than double that of the United States. Want something more Western? France has strict gun laws, but its suicide rate is greater than the U.S.’s. In fact, among the developed nations making up the OECD, in which gun laws vary widely, the U.S. is just slightly higher than the median.

As the son of a severely ill bipolar depressive man, I completely get how awful depression is, and I am all too aware of how the severely depressed can seek death as a release. However, I don’t quite get why this segment of the medical community is so obsessed with acts committed with firearms in particular. Maybe wanting to help desperately ill people who don’t have a gun in their hands just doesn’t generate grants.

This quasi-scientific demagoguery is just an industry product — the anti-gun subculture of the academy — looking for press, props, and money from benefactors. I get it; we all have to make a living. The fact Wintemute is published so often, while almost never producing a result that challenges the gun-control orthodoxy, speaks to how debased the peer-reviewed scientific literature has become. It is, to paraphrase Stanford physician John P. Ioannidis, a swamp of biases, agendas, and preordained answers, in which both authors and journal editors are complicit. It is just no longer credible.

The overwhelming majority of guns in private hands are never used criminally, and these gun owners have the right to be left alone.

If anti-gun researchers want to be heroic, instead of merely being celebrated as heroes in the media, here is what they can do: Support firearm-safety classes in schools; find a better way to keep crazies like Stephen Paddock and Devin Kelley out of our midst and not just away from the gun store; speak out against the unspeakable incompetence of a federal government that cannot keep its gun-buyer screening database up to date; admit that gun violence is driven by race, class, and local criminal phenomena such as gangs and the drug trade, and in black communities is closely tied to the Great Society’s destruction of the black family; and, finally, acknowledge that prohibition doesn’t work — didn’t work with alcohol, doesn’t work with drugs, and won’t work with guns, because the only people who will abide the strictures will be the victims.

My gun heroes are Stephen Willeford, the plumber with an AR-15, and Johnnie Langendorff, driving the pickup truck that Willeford jumped into, who acted as first responders, at great personal risk, to end the Texas carnage. And don’t forget Robert Caleb Engle, the usher at a Tennessee church who obeyed his sanctuary’s “gun-free zone” dictate but retrieved his gun from his vehicle and stopped the shooter when the church was attacked. I like to think that many other responsible gun owners would have tried to do the same thing.

Mass shootings justifiably horrify all of us. If they don’t horrify you, there’s something wrong, and you should see your doctor. But the fact remains that the overwhelming majority of guns in private hands are never used criminally, and these gun owners have the right to be left alone.

We may never find a broadly acceptable and sustainable solution to this problem. If we do, however, it’s unlikely to come from the medical-care industry. The fact that a problem has a medical impact — injury or death — does not mean that a medical intervention is what’s needed to solve it.


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