Another Two Mass Shootings: Déjà Vu All Over Again
Authors: Douglas M. DeLong
Journal: Annals of Internal Medicine (2021)

Ideas and OpinionsJune 2021Another Two Mass Shootings: Déjà Vu All Over AgainFREEDouglas M. DeLong, MDDouglas M. DeLong, MDBassett Healthcare, Cooperstown, New York (D.M.D.).Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M21-1505 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail To paraphrase the late, great philosopher Yogi Berra, it is, unfortunately, “déjà vu all over again.” The medical profession in the United States has, rightly, been focusing on the SARS-CoV-2 pandemic, but another relentless public health threat has continued its lethal course in the background. Although mass shootings decreased during 2020, almost 40 000 people lost their lives to firearms, a record number that is, if anything, accelerating (1). In March 2021, as vaccines promise relief from the SARS-CoV-2 pandemic, the United States has experienced 2 mass shootings taking a total of 18 lives within the span of less than 1 week. The first of these targeted women and Asian Americans, and the motive for the second one remains unknown at this time. One can't help but notice the usual “blah, blah, blah” of “thoughts and prayers” along with the predictable responses from both sides of the political divide. It is difficult to get beyond the “blah, blah, blah”—yet we must.The American College of Physicians (ACP) has been at the forefront of medical activism in dealing with firearm injury for decades. ACP and its editorially independent Annals of Internal Medicine have published numerous policy papers, scientific articles, testimonies, letters of support, statements, and editorials. Annals provides a publicly available collection of this work at Annals.org (2). As recently as 2018, the College updated its comprehensive firearms policy (3). As a member and past Regent of ACP, I am immensely proud of the organization for this activism, exemplified by standing up to the National Rifle Association (NRA) when it suggested that we physicians “stay in our lane” when it comes to firearms (4). Stay in our lane indeed. Physicians are literally at the bleeding edge of firearm injury and have an obligation and duty to address this public health crisis. The health consequences of firearms include not only homicides and suicides but also accidental deaths and injuries. Further, a full picture of the adverse consequences of firearm injuries and fatalities must recognize the toll on the well-being of individuals and communities that suffer in their wake.Americans are not a uniquely violent people, yet we stand out from the rest of the world in our apparent acceptance of gun violence and other firearm injury. This is not the exceptionalism for which America should stand. The problem is simple: We are awash in a sea of firearms that are readily available to almost anyone, while the constitutionally protected right to bear arms challenges efforts to increase the safety of firearm ownership. Even so, in conjunction with the American Bar Association and other professional societies, ACP has crafted policy recommendations on firearm ownership that are in accordance with the Second Amendment of the U.S. Constitution (5). Among the proposed recommendations are developing child access protection measures, closing loopholes that enable those prone to commit domestic violence to easily access firearms, enacting extreme risk protection laws, outlawing assault-style weapons and high-capacity magazines, and mandating waiting periods for gun purchases.Unfortunately, none of these proposals are new, and none to date have been implemented. Despite being in financial trouble, the NRA continues to have substantial political clout in state and national legislatures. If we are ever going to have meaningful change, it will need to come from the vast majority of Americans who favor common-sense firearm laws and vote to support those who share their concerns. In particular, gun owners, like myself, need to make it clear to the NRA that it is time to get back to its roots of hunter safety and sportsmanship and to jettison the current uncompromising policies.Physicians, given our respected role in society and obligation to promote individual and public health, need to both command our place in the lane and be at the head of the line with respect to efforts to reduce firearm injury. Each of us needs to double down to work in our clinics, in our local communities, and within our profession to prevent needless firearm-related deaths and injuries. We must talk to our patients about reducing the risk for injury when firearms are accessible in their households (6). We must educate them about the need for safe storage of guns and ammunition, especially in homes with small children or other vulnerable individuals. When our patients have depression, we must address their access to firearms and ammunition. We should write letters advocating sensible firearm policy to the editors of our local newspapers and to our local politicians. We can work with our professional societies to lobby at all levels for sane firearm injury prevention laws. We can contribute to advocacy organizations and politicians who support initiatives to reduce firearm-related harm.Given the paucity of federal action despite the heavy toll of firearm injury in the United States, it seems that local leadership will need to drive change. Borrowing from the successful incremental game plans of such groups as Mothers Against Drunk Driving, the medical community must add its strong, principled, and respected voice to those of the majority of Americans who agree that we need common-sense changes to mitigate, if we cannot eliminate, the threats of firearms to the health of the U.S. public. Closing with more advice from Yogi Berra, “When you get to the fork in the road, take it.” Now is not a time for more “blah, blah, blah.” It is time to educate, advocate, and legislate.References1. Gun Violence Archive. Mass shootings in 2021. 2021. Accessed at www.gunviolencearchive.org/reports/mass-shooting on 30 March 2021. Google Scholar2. Annals of Internal Medicine: Firearm-related injury content. 2021. Accessed at www.acpjournals.org/journal/aim/firearm-related-content on 30 March 2021. Google Scholar3. Butkus R, Doherty R, Bornstein SS; Health and Public Policy Committee of the American College of Physicians. Reducing firearm injuries and deaths in the United States: a position paper from the American College of Physicians. Ann Intern Med. 2018;169:704-707. [PMID: 30383132]. doi:10.7326/M18-1530 LinkGoogle Scholar4. Taichman D, Bornstein SS, Laine C. Firearm injury prevention: AFFIRMing that doctors are in our lane [Editorial]. Ann Intern Med. 2018;169:885-886. [PMID: 30458522]. doi:10.7326/M18-3207 LinkGoogle Scholar5. Weinberger SE, Hoyt DB, Lawrence HC, et al. Firearm-related injury and death in the United States: a call to action from 8 health professional organizations and the American Bar Association. Ann Intern Med. 2015;162:513-6. [PMID: 25706470]. doi:10.7326/M15-0337 LinkGoogle Scholar6. Pallin R, Spitzer SA, Ranney ML, et al. Preventing firearm-related death and injury. Ann Intern Med. 2019;170:ITC81-ITC96. [PMID: 31158880]. doi:10.7326/AITC201906040 LinkGoogle Scholar Comments0 CommentsSign In to Submit A Comment Bernard J. Grimes, MDUMPC1 April 2021 Gun safety Frank Bruni wrote a commentary in the NY Times on Sunday March 28, that we should not use negative terms like "banning assault weapons. gun control" etc. The 70% of Americans who favor our well being should have a more positive spin on this topic such as laws "to Improve gun safety." Anthony M Vetere, MD, FACPNone1 April 2021 Gun violence Mass shoootings are not historically done by law-abiding gun owners. It is the criminals and or mentally unstable that perform these horrible acts! Unfortunately, no matter what is done these people will always find a way to obtain weapons, ie " assault weapons" and or high capacity clips, etc. We should not punish the law-abiding citizens. Let's enforce gun laws that already exist and prosecute the offenders to the maximum. David L. Keller MD, FACPInternal Medicine physician2 April 2021 Comment on Dr. Delong's editorial In his editorial response to two recent mass shootings, Dr. Delong states: "The problem is simple: We are awash in a sea of firearms". His assessment implies that our core problem is that there are too many firearms. His reasoning appears to be that fewer people will be killed by gunfire if we can only reduce the level of the "sea of firearms" we are awash in. I disagree. The problem is not as simple as Dr. Delong imagines. In fact, the true problem is not that there are too many guns, but that the guns are in the wrong hands. Again, the problem is not an over-supply of guns, but a maldistribution of guns. The pattern is similar at nearly every mass shooting: a well-armed lone gunman unexpectedly opens fire on a large number of unarmed victims. Note the presence of one or more guns in the shooter's hands, and zero guns in the hands of the shooter's victims. The death toll from mass shootings can clearly be reduced by encouraging sane, law-abiding citizens to carry a concealed handgun as often as they see fit. This would increase the odds that the next aspiring mass shooter would be met with an immediate hail of gunfire from his intended victims. The more law-abiding citizens who choose to carry a concealed weapon, the more likely it would be that violent criminals could be shot down before they could cause the deaths of any innocent victims or bystanders Experience has demonstrated the futility of laws intended to reduce violent crimes by restricting the right to own and carry a gun. Likewise, whenever and wherever laws have been changed to allow more law-abiding citizens to own and carry firearms in public, crime rates have inevitably fallen. [1] "Gun free zones" have proven to be counter-effective at preventing mass-shootings. What better way to attract a would-be mass-murderer to a school, house of worship, market, transportation hub, or other site, than to assure him that all law-abiding persons there would be disarmed and unable to defend themselves or others? It seems incredible to me that intelligent, well-intentioned people inevitably react to every mass shooting with an outcry to disarm the law-abiding citizens, leaving them totally defenseless against the many well-armed criminals who will never comply with gun-control laws. The inverse relationship between the percentage of persons carrying a concealed weapon and crime rates may seem paradoxical; if so, remember the scenario of an armed mass shooter in a room full of unarmed potential victims. Increasing the number of guns in the room will decrease the number of deaths, if the guns are put into the right hands. [1] Mustard, David & Lott, John. (1997). Crime, Deterrence, and Right-to-Carry Concealed Handguns. The Journal of Legal Studies. 26. 1-68. 10.1086/467988. Heather E. Gantzer, MD, MACPPark Nicollet Clinic and Methodist Hospital, Minnesota; Chair, Board of Regents, American College of Physicians1 April 2021 Support of Dr. DeLong's article Dr. DeLong points out clearly the impact of current firearms policy in the USA upon mortality and morbidity. Practical approaches are needed to support the health and wellbeing of our patients. John Funder MDHudson Institute/Monash University2 April 2021 Look elswhere Almost 30 years ago a conservative Prime Minister in Australia radically reformed the gun laws in the wake of a mass shooting in Tasmania. We may never stamp out mass shootings, but despite the initial fierce opposition it has saved many lives. Way to go. David L. Keller, MD, FACPInternal Medicine physician, retired5 April 2021 Ban semi-automatics & promote revolvers for concealed carry The ability to hold large numbers of bullets and fire them rapidly classifies semi-automatic guns as offensive weapons. Revolvers, in contrast, can be classified as defensive weapons, because they hold a small number of bullets (typically 5 or 6) and fire them relatively slowly. In addition, revolvers are safer and less liable to misfire or jam than semi automatic guns, because revolvers employ a simpler, stabler, and more reliable firing mechanism. I cannot recall any mass-shooting that was committed using a revolver. Therefore, any proposal to encourage concealed carry of guns by sane, law-abiding citizens should include only defensive guns, namely revolvers. Furthermore, I do not object to a ban on the sale of all semi automatic guns to the public. Pro-gun and anti-gun extremists will probably unite to oppose this proposal, which may be its best recommendation as a means to allow law-abiding persons to defend themselves and others from violent criminals, with the least concomitant danger from the number of bullets fired or misfired. Author, Article, and Disclosure InformationAffiliations: Bassett Healthcare, Cooperstown, New York (D.M.D.).Disclosures: The author has reported no disclosures of interest. The form can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M21-1505.Corresponding Author: Douglas M. DeLong, MD, Bassett Healthcare, One Atwell Road, Cooperstown, NY 13326; e-mail, douglas.[email protected]org.Author Contributions: Conception and design: D.M. DeLong.Drafting of the article: D.M. DeLong.Final approval of the article: D.M. DeLong.This article was published at Annals.org on 1 April 2021. 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