1. Gould, Kathleen Ahern PhD, RN

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Fear in and of itself can have significant effects, in terms of one's health and how one lives one's life, on the national economy, and how government policies get made.1


-Samuel Justin Sinclair, clinical psychologist at Massachusetts General Hospital, expert on responses to terror attacks.


When I pondered which subject to tackle for this editorial, my file of ideas seemed trite.


As I write this, another mass shooting has taken the lives of 14 people, leaving 21 others wounded and a community devastated. The gunman, and gunwoman, had stockpiled thousands of rounds of ammunition and made dozen of homemade bombs, prior to the assault. Just a normal couple, working and caring for a newborn baby, perhaps purchasing guns, bullets, gun power, and bomb supplies as easily as they did groceries and diapers.


How did this become a way of life in our country? Why should we continue to endure these senseless deaths over and over again? What makes a difference? The number of casualties, the motive, the location[horizontal ellipsis] or do those things just desensitize us because we can compartmentalize each event?


As health care providers, we must ask: How can we help? Perhaps we can unite, speak out against gun violence, stand up to political obstacles, and find research-based solutions to complement valid common-sense solutions to gun violence.


A few years ago, I wrote a "Tribute to Newtown,"2 inspired by the Sandy Hook shootings in 2012, asking my colleagues to stand together against gun violence. I supported the philosophy of Dr Vivek Murthy, a young, talented physician working at Brigham and Women's Hospital in Boston, who told us that guns were a threat to pubic health. Later, we learned that this comment held up Murthy's appointment to become our nation's top doctor.


President Obama nominated Dr Murthy for the post of Surgeon General for the United States in November 2013. Unfortunately, this talented young doctor fell into a political vortex when the National Rife Association opposed the appointment because of Murthy's support of gun control policies. This strong opposition allowed the position to remain vacant for over a year. Finally, the Senate health committee accepted Murthy in February 2014; 1 year, 1 month, and 2 days after his selection.3


A short time later, in 2013, I was compelled to write another piece called "Boston Strong,"4 a tribute to the many colleagues in my city that cared for the victims and families affected by the Boston Marathon bombing. Again, personal and political issues captured my thoughts as I grieved for the many people killed or injured by firearms and bombs made from assault weapons, handguns, and explosives purchased legally and illegally. Two brothers were able to assemble an arsenal of weapons fairly easily.


Close to home again in 2015, we were devastated by the murder of a local doctor, gunned down in his office in Boston, by a disgruntled son of one of his patients, another person who carried a gun, not for protection, but to do harm to another human being5 (Table 1).

TABLE Gun Violence i... - Click to enlarge in new windowTABLE Gun Violence in Hospitals

And later in 2015, a zealot at a Planned Parenthood clinic in Colorado Springs killed innocent people. A short time later, terrorist welding assault rifles killed more than 100 people in Paris. Weeks later, gunshots erupt in San Bernardino, California. One common denominator throughout all of these incidents is proliferating gun violence.



Heath care professionals know all too well how even a single bullet can ravage the body, causing death, permanent disability, and often a lifetime of medical complications. For me, caring for these patients is personal; therefore, the issue of gun control is always personal.


We also know that it does not have to be this way; just as we have eradicated other public health issues, we can search for solutions to gun violence. Perhaps a public health approach to this issue is possible.


Dr Murthy is right-guns are a threat to public health.


Journalist, educators, and health professionals add an educated voice to the conversation as many continue to link gun violence to public health. Using a public health methodology, guided by research and common sense, may be one solution.


Joaana Weiss,7 a local reporter, supports a common-sense approach. She reminds us that a prevention approach was used to protect children against aspirin poisoning, not because we banned baby aspirin, but because we created safety caps and regulated the amount of pills in each bottle.


Weiss also recalls an article written by a group of Boston doctors who suggested taking the same approach to guns that our society has taken to reduce deaths from smoking or car crashes. The article acknowledged that it is hard to ban or eliminate dangerous things. However, we can reduce the damage as we have with antismoking legislation and the enactment of seatbelt and helmet laws.


Dr Hemenway, a professor at the Harvard School of Public Health, and Miller8 argue for a public health approach to prevent gun violence, including designing and manufacturing safer guns, the same type of public health interventions that have reduced motor vehicle fatalities by 80%.


Weiss challenges us to consider these analogies to firearms laws and support ideas such as smart locks, fingerprint restrictions, reducing the size of a magazine clip, and of course tightening up the access to gun and ammunition purchases. I would suggest even tighter regulations such as restricting the sale of bullets to only those who can present verification of responsible ownership, granted by a governing agency-a prescription model of sort.


Clearly, bullets and gunpowder should be controlled substances that are highly regulated. Such regulation may also ensure that those buying guns and ammunition are trained in the proper use of firearms. These are not new ideas. Yet, safe use of firearms continues to be a community health problem. In 1995, Hemenway et al9 reported that only 56% of gun owners have received firearm training. Furthermore, only 21% of gun owners keep a firearm both loaded and unlocked in the home.


Common-sense suggestions come from professionals and people from all walks of life. A student blogger has some great ideas, as he suggests that gun ownership should be as boring and annoying as owning a car. He envisions a Department of Weapons where people sit for hours awaiting renewal, only after you have proven some skills and passed a test for mental and physical health. Once licensed, and reviewed over a given number of years, you may earn the right to own and operate a gun, just like the right to operate a vehicle.9


Another idea may be to require continuing education credits for gun owners! We could create a state or federal restriction that would entail some type of annual competency or educational requirement, similar to that of medical professionals.10


Aiyappa,10 the student blogger, makes a great point: "When you have a greater ability to take a human life[horizontal ellipsis] you have a greater responsibility to prove your fitness to wield the tools that may create that end."


As health care providers and leaders, we must work toward some solution to gun violence. Disaster drills, surgical training, and the logistic of response teams are late solutions to this problem. Perhaps we can do more to add an educated, scientifically informed voice to the political clamor.


We have all cared for victims, lived in an effected community, or known someone who is injured. And more recently, our children's schools have been attacked, and gun violence has shattered our workplaces. Regardless, the personal and political discord continues.


However, the political ramifications belong to all of us. Reducing gun violence does not have to be divisive; common ground should be our goal, as this issue affects all facets of life, even the safe haven of hospitals.



Many people, including health professionals, have opinions and strong emotions about the effect of guns on society. Doctors for America, founded by Dr Murthy, continue to search for answers to combat gun violence though education, advocacy, and community action. A few days after the San Bernardino incident, I received an e-mail from a Doctors for America group, entitled "For a Safer America." I signed my support-to ask congress to address gun violence, but frustration and anger still fueled my thoughts.


The e-mail included excerpts from a recent day that unfolded in Washington as former Congressman and Arizona Republican Jay Dickie explained that many problems exist simply because not many people have facts. Apparently, he once sponsored a bill, a budget amendment that restricts research funding for gun violence. He now works to have the amendment lifted. Reading this article, from The Washington Post, I was shocked to learn that our country has a ban on research to address gun violence!


The Post reports that just hours before the shooting in San Bernardino last December, physicians from Doctors for America and supporters were on Capitol Hill, calling on Congress to lift the ban on the Centers for Disease Control and Prevention (CDC) and National Institutes of Health gun violence research. The group joined members of Congress in calling for this common-sense move to lift a politically motivated ban.11


Wait[horizontal ellipsis] I thought, as I read these words again, this time more carefully-we have a ban on gun violence research?


Jay Dickey, former Congressman and original author of the amendment, released a letter expressing his regrets at the effect the language has had. Apparently this was not the intent of the original amendment, yet it has indirectly halted research funding related to firearms. In his most recent letter he said, "Doing nothing is no longer an acceptable solution."11


Dickie reported a truth that should send scientist, medical personnel, and anyone interested in truth seeking into action: "There is not enough research to inform us about guns, their effects on society, ways to control injury, and so many important questions." He asks, "How can we keep people safe without this work?"11


Dickie is right! Many people have opinions about the effect of guns on society. Not many people have facts.


Apparently, Congress has the opportunity to lift the ban in the coming days as they move through the appropriations process. We need to encourage our government to fund research that will help find solution to gun violence. We can do this without infringing on the rights of lawful gun owners, perhaps finding safer solutions for this group in the process. Dickie was interviewed recently on National Public Radio, and the host summarized the exchange.


There's a shortage of research, and a big reason is a provision in federal law sponsored by a man who now regrets it. He's an ex-congressman, Jay Dickey himself! His law ordered the CDC never to fund research that could be seen as advocacy for gun control. Since the 1990s, that provision has commonly stopped any gun studies because researchers don't want to risk losing federal money, and that is what Jay Dickey regrets. The Arkansas politician and owner of 2 shotguns says he just wanted the CDC to follow a simple rule.12


New research could inform in ways we can only imagine. However, a politically motivated ban on research on this topic is a daunting obstacle.


Dennis,11 a reporter for The Times, quotes Daniel Webster, who directs the John Hopkins Center for Gun Policy and Research in Baltimore who states, "Congressional lawmakers control the purse strings. They could change this today, if they wanted to."


Congress had one potential solution offered to them last December as physicians wearing white coats handed lawmakers a petition signed by more than 2000 health care providers. Their request was simple: Lift a decades-old funding restriction that blocks the CDC from conducting research on gun violence.13


Yet, only hours later, after the speeches, presentations, and group photographs ended, another mass shooting began to unfold in San Berardino.11



Kathleen Ahern Gould, PhD, RN


Editor in Chief


Dimensions of Critical Care Nursing Adjunct Faculty


William F. Connell School of Nursing


Boston College


Chestnut Hill, Massachusetts




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