A nearly palpable uproar continues over gun violence in the aftermath of the mass killings in a Newtown, CT elementary school last week. This was the latest bullet-induced atrocity and among the most horrific in recent memory, as the majority of those killed were young children.
As everyone tries to examine the whys behind the tragedy, physicians are moving closer to the front lines of the debate, with mass murder becoming a chronic condition in this country.
Indeed, even as authorities continue to gather whatever information they can on the Newtown shooting, the American Medical Association has been involved in heated litigation 1,000 miles away in Florida. There the debate is over whether physicians can take steps to prevent guns in homes if they feel it's necessary.
Who can say when the level over gun violence is suitably horrific that we have had enough? Maybe the latest uproar over the loss of such young and innocent lives is the threshold.
The caskets are so small as to remind us how much life was missed. Surely, concerted outrage is rife, as President Obama has supported a plan by Sen. Dianne Feinstein, (D-CA) to introduce legislation to reinstate an assault weapons ban. He has also appointed Vice President Joe Biden to lead a group to conduct an in-depth examination of the country's gun issues.
As in many of these cases, gun control is only part of the debate, as AMA President Jeremy A. Lazarus, MD, acknowledges that some may question whether "physicians missed an opportunity to protect the public from individuals who might perpetuate such actions."
In an interview, he also raises soul-searching questions about this country's mental health programs, which he says are overburdened, underfunded and inadequate.
"I do think physicians are educated about the public health issues about guns and gun safety, so we could always do more, and this will probably spur us to do more," Lazarus tells me. "This issue has been a policy of the AMA for a long time about educating physicians about gun safety."
As for as the mental health system, "we presume we have sufficient ability to evaluate people, but where do we put them?" Lazarus says. "It raises the issue of a mental health system that is underfunded, and overburdened. Basically, these people are put in jails and prisons, and we don't have a lot of hospital beds. It raises a lot of issues along those lines."
Whether there were opportunities to stop Adam Lanza before he allegedly carried out his rampage will always be an unknown. Lanza, 20, is believed to have shot his mother four times in her bed, and then gunned down 26 other people, including 6 adults, in the killing spree at Sandy Hook Elementary School.
As far as his condition, there is media speculation, but no confirmation, that Lanza had Asperger's syndrome—which is not a mental health issue.
Referring to mass killings in America, Lazarus says that "more than half of those [killers] had [acknowledged] mental illness and a significant number did not." But mass murders by shooting aren't the only problem facing America related to violence, he says.
In 2010, there were 31,000 people killed in gun violence in some way, "homicides, suicides, or accidents," he adds. "You've got an enormous number not in mass killings."
For those whose mental illness is a contributing factor in their decision to shoot people, the system that could help them, if they seek help, is severely strained, Lazarus says. "A lot of family physicians treat patients with depression and anxiety disorders, but those with severe mental illness put a severe strain on the system."
One of the most concrete things the AMA is doing regarding gun control, is attempting to protect the "doctor-patient relationship to assure that physicians can discuss firearm safety with parents and adults." The AMA last month filed a friend-of-the-court brief opposing the state of Florida's attempt to revive a law preventing doctors from asking patients and families about guns in the home.
"Questions about home firearm possession should be and are a routine part of the patient history inquiries that physicians ask of their patients, usually conducted near the onset of the relationship as part of the general assessment of everyday risks, " the AMA said in court papers.
"If the governor prevails, this could have a chilling effect on doctors asking about guns in the home and gun safety," Lazarus says. "Other states might consider the same which would be terrible from our point of view. We feel strongly that physicians shouldn't be gagged in any way from talking to their patients about things that would be important to their health," he adds.
"We should not be prevented from discussing anything with patients about their health. So that's the overarching concern even beyond the gun issue."
Bernard Wollschlaeger, MD, FAAFP, a family practice physician in Miami who is among the group of physicians who successfully sued to halt the Florida law, has counseled patients about gun use.
"We need a collective effort of our entire society. I do not see politicians as catalysts of change," Wollschlaeger told me after the Connecticut shootings. "We can't rely on politicians to resolve this problem. It's a collective effort. For a mentally unstable person, to give him a weapon of war, it is crazy. These are weapons intended to hunt, not weapons to be used for self-defense. These weapons should be in the hands of law-abiding citizens. For what purpose could it be? Armageddon? It's insane."
The AMA is expected to discuss the shootings soon. Lazarus says in the interview that education is needed among "public and policy makers and there is also a need for more (mental health) services" including more specialists in mental illness care.
In his blog, Lazarus health leaders must "work together as a medical community and [with] the public to make evidence-based interventions when available, and continue public discussions on some of the important tradeoffs between individual rights and protection of the public. We must not keep blaming ‘the system.'"
When will the gun control debate return to a subterranean slumber as it often does, waiting for the next tragedy to wake it up? It won't go back underground, at least, not if some physicians have their way.
Joe Cantlupe is a senior editor with HealthLeaders Media Online.
