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Doctors want Congress to declare gun deaths a public health crisis

Emergency room physicians also say that people come in with far more gunshot wounds per incident than a decade ago—a likely consequence of semi-automatic weapons.
Un rifle AR-15 a la venta en una tienda de Atlanta, Georgia, 2012. Imagen por Erik S. Lesser/EPA.

The oldest and largest medical society in the country has declared gun violence a public crisis in the United States, and called on Congress to lift what gun control advocates call a ban on the Centers for Disease Control and Prevention, or CDC, from conducting research on the problem.

Noting that 6,000 people have died from gun violence in the US this year — with a gunman's shooting spree in a gay nightclub in Orlando last weekend the worst ever — the American Medical Association, or AMA, says gun fatalities should be treated like a disease.


"An epidemiological analysis of gun violence is vital so physicians and other health providers, law enforcement, and society at large may be able to prevent injury, death and other harms to society resulting from firearms," said AMA President Steven Stack in a press release.

But to conduct that analysis, said Stack, the federal government needed to get out of the way.

"Even as America faces a crisis unrivaled in any other developed country, the Congress prohibits the CDC from conducting the very research that would help us understand the problems associated with gun violence and determine how to reduce the high rate of firearm-related deaths and injuries," said Stack.

In 1996, after the National Rifle Association accused the CDC of lobbying to curb firearm ownership, Republicans who controlled Congress added a provision to the CDC's appropriations bill that said "none of the funds made available for injury prevention and control at the Centers for Disease Control and Prevention may be used to advocate or promote gun control." The CDC interpreted the language to mean it shouldn't pursue firearms research of any kind.

After the 2012 massacre of children at the Sandy Hook Elementary in Newtown, Connecticut, President Barack Obama issued an executive order that ostensibly lifted the ban, but the Centers reportedly have still not ramped up their research on firearms.

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Gun rights advocates, however, disputed that Congress imposed a ban. Lawmakers were making sure the CDC wasn't veering into public policy that has nothing to do with its remit, they said.

"Why would they study [gun violence]?" David Kopel, an associate policy analyst at the Libertarian Cato Institute, said. "They were created to do actual public health, like on cholera and communicable diseases. We made so much progress on those, they forged into mission creep and are doing everything else in the world like obesity and drug crimes."

Kopel similarly reacted to AMA's call to treat gun violence as a public health issue. AMA has called on American officials to address pain and suffering in Darfur in war-torn western Sudan and manufacturers to improve the brakes and steering systems of school buses, for example.

"The AMA has long been taken over by political correctness to favor a variety of causes that have nothing to do with the expertise of physicians," he said.

AMA has long pursued a political anti-gun agenda, Kopel added, even though they aren't sociologists, criminologists or economists who study the issue properly.

"People committing various crimes is not a disease," he said. "It's to pathologize gun owners. It's to say guns and gun owners are disease vectors."

Citing a study from the Crime Prevention Research Center that found private and other government funding was still going to gun research, Kopel questioned whether anyone needed the CDC funding.


"We have been able to outpace death in every type of trauma …but guns have outpaced out ability to give care."

But Angela Sauaia, a professor of public health, medicine, and surgery at the University of Colorado- Denver, said private funding for gun research often comes from organizations that have pro- or anti-gun control biases, and other public agencies don't necessarily focus on the disease-like aspects of gun violence. Researchers who study diseases need the CDC, she argued. "It's an issue of credibility," Sauaia said.

AMA's position on the CDC's ban stems from the experience of emergency room doctors and others who are seeing more and grislier gun injuries and fatalities in recent years, said Sauaia, who believes Congress should remove its 1996 language.

"We have been able to outpace death in every type of trauma," she said. "We have been able to make cars safe, streets safe, fall deaths more unlikely. But guns have outpaced out ability to give care."

United States Senator Lindsey Graham fires an AR-15 following a tour of Sampson Manufacturing in Keene, New Hampshire, on October 8, 2015, during a stop on what was then his presidential campaign. Photo by CJ Gunter/EPA

Sauaia co-authored a paper in the Journal of the American Medical Association that found that the number of shooting victims who came to the Denver Health Medical Center remained level at around 1,700 people a year from 2000 to 2013, but that around 6.5 percent more people died every two years and victims were around 5 percent more likely to have more than two wounds every two years.

Her study comported with recent Pew Research Center findings that detailed how gun-related homicides have fallen precipitously between the 1990s and 2000s before plateauing recently, she said. The problem, said Sauaia, is that physicians are no longer making the gains in preventing shooting deaths they achieved 20 years ago. Meanwhile, they have developed ways to save people from other potentially fatal traumas.


"Every other mechanism continues a downward trend," she said "So if you are in a car accident, if you are an old person and you fall, if you are stabbed by someone, your likelihood of dying of that injury is less now than in the 2000s."

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Guns are wreaking more damage on people that is harder to repair, said Sauaia. Trauma doctors are increasingly encountering multiple gunshot wounds, for example, that sometimes make treatment impossible. A doctor can't remove a bullet in someone's brain, for example, if their heart is also punctured or their liver is damaged. By the time surgeons fix one of those injuries, others will have killed the patient, she said.

"The number of organs injured in each patient is increasing over time," she said. "That's the major find of the study. We see more severe injuries. The size of the wounds is bigger. There is more damage."

Her study was specific to Denver. But Sauaia felt strongly that it corroborated anecdotal evidence from around the country.

"Our speculation is that we now have guns that are able to shoot many, many more times," she said, citing semi-automatic rifles like the one used in Orlando. "This type of gun is able to produce many injuries with a very high level of energy. That's our suspicion."

The US needs to beef up its mental illness care, too, said Sauaia. Numerous mass shootings have been blamed on mentally ill killers who fell through the cracks of the medical system. Mental illness has been cited in the Orlando shooting as a possible factor.

Most insurance plans limit the amount of care one can receive form a psychologist or other counselors, however. That's shameful, she said.

"You can be treated for any other condition under the sun, including fungus in your toenail, for the rest of your life but you won't be able to have treatment for a mental health condition for more than 20 visits," she said. "Put this into the equation of firearms. How can physicians not worry about it?"

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