Doc Group Pays for Gun Violence Research

Affirm Research rides #ThisIsOurLane momentum to fund firearm injury studies.

This article was first published on Monday, August 5, 2019 in MedPage Today.

By Kristina Fiore, Director of Enterprise & Investigative Reporting, MedPage Today.

In the absence of federal funding for firearm injury research, one physician group has taken matters into its own hands.

The organization is called Affirm Research -- the "Affirm" stands for the American Foundation for Firearm Reduction in Medicine -- and they say the nation's 40,000 gun deaths each year are "the epidemic of our lifetime."

They're using the momentum of #ThisIsOurLane, along with partnerships with organized medicine, to crowdsource dollars for investigating gun violence.

"We founded Affirm Research because we tried working through traditional channels for many years but got frustrated by the lack of movement. Meanwhile, we watched patients coming into our emergency departments or die on the streets," co-founder Megan Ranney, MD, MPH, an emergency physician at Rhode Island Hospital in Providence and associate professor at Brown University, told MedPage Today. "We said it's time to do something, so we created Affirm with the goal of making gun violence about health, rather than a political debate."

Ranney and co-founder Chris Barsotti, MD -- who is a gun owner himself -- launched Affirm in 2017, after the Las Vegas mass shooting, though it's recently been propelled into the spotlight by the #ThisIsOurLane movement. The hashtag came as a response to a National Rifle Association tweet in November 2018 telling "self-important, anti-gun doctors to stay in their lane" when it comes to gun regulation. Physicians responded by flooding social media with examples of why gun violence should be considered a public health issue, including images of blood-stained scrubs and hospital rooms where families are informed that they've lost a loved one.

This weekend's mass shootings in El Paso, Texas and Dayton, Ohio, have once again reignited that debate, though many organizations -- including the American Medical Association (AMA), the American College of Physicians (ACP), and the American College of Emergency Physicians (ACEP) -- have firmly labeled gun violence a public health issue that deserves the same research treatment as seat belt safety, tobacco, obesity, and HIV.

The challenge has been paying for that kind of research, Ranney said. Federal funding has been lacking due to a 1996 rider to an omnibus spending bill known as the Dickey Amendment. It prohibited use of CDC funds for "advocacy" or "promotion" of gun control.

Although the amendment didn't explicitly ban federal funding for firearm research, Congress still has not allocated any money to the CDC to study gun violence. In 2018, as part of yet another omnibus spending resolution, Congress included language from HHS Secretary Alex Azar clarifying that CDC can conduct research on gun violence but can't use government funds specifically to advocate for gun control; but no effects are yet apparent.

"I was told early in my career as an injury prevention researcher that I couldn't talk about gun violence as a public health problem, because it's too political," Ranney said. That only began to shift after the 2012 mass shooting at Sandy Hook elementary school in Connecticut, she said, with leadership of organized medicine beginning to talk about it as a public health issue so that members of those organizations "felt comfortable doing so as well."

Affirm's goal is to support work that will ultimately "stop the shooters before they shoot." A major effort will be to create guidelines for physicians on how to identify and counsel those patients who pose a risk to themselves or others, Ranney said.

She declined to say how much Affirm has raised to date, but said the organization is "well on its way" to its $2.5-million funding goal, with the majority of its donations coming from "individual donors from all walks of life," including healthcare professionals. She said the organization currently uses funds to support community health programs, and awarded its first research grants in June, in partnership with the Emergency Medicine Foundation.

One of those grants was a two-year, $150,000 career development grant to Kristen Mueller, MD, of Washington University in St. Louis, to assess the characteristics of patients with firearm injuries who are treated at level-1 trauma hospitals. Mueller's team is also identifying patients at the highest risk of repeat injury.

Also, Henry Schwimmer, a medical student at Emory University, received $5,000 for a trial aimed at developing and expanding screening tools and tailored interventions to reduce firearm injury risk among patients in rural emergency departments.

The AMA, ACP, ACEP, the American Psychiatric Association, the American Academy of Pediatrics, the American Association of Family Physicians, and the American College of Obstetricians and Gynecologists are just some of the 20 medical organizations that have partnered with Affirm to fund research on gun violence.

In a statement, ACEP says it is actively participating in Affirm and its mission to "end the epidemic of gun violence through research, innovation, and evidence-based practice."

"Firearm injuries -- accidental or otherwise -- should be addressed as a public health epidemic, with investments in research and a sweeping commitment to change that matches or exceeds the level of a number of diseases, outbreaks or disorders that capture the public conscience but have exacted far less of a human toll in recent years," the statement said.

It remains to be seen whether Affirm and its collaborators will have an impact on firearm injury research, let alone eventual policy change. Ranney says the $2.5-million goal is "enough to jump start this field," which hasn't really progressed since the 1990s.

Garen Wintemute, MD, MPH, of the University of California Davis, who has famously spent more than $1 million of his own money to fund his firearms research, told CBS News that gun violence prevention measures can become more effective if the research happens.

Between #ThisIsOurLane and partnerships with physician, nursing, and public health groups, Ranney is hopeful that the time is right for the message that "gun violence is a public health epidemic, and we can solve it using public health tools."

"We want to create evidence using the collective will of medicine to create real change," she said.