The American Medical Association (AMA) voted this week to adopt several new policies to address gun violence during the AMA’s House of Delegates 2022 annual meeting in Chicago. There was a lot of support among hundreds of delegates following several recent mass shootings.
Many physicians in the AMA view gun violence as a healthcare issue and say it needs to be outlined as a healthcare epidemic, not as an unrelated political or social issue. The AMA has come out in support of what it calls common sense gun legislation over the past two decades with calls for requiring background checks and waiting periods to purchase a firearm to reduce firearm trauma, injury and death.
The murder of two orthopedic doctors in one of the shootings at a medical office building in Tulsa, Oklahoma, because a patient was not happy with a post-surgical outcome also impacted AMA delegates. Some delegates knew the victims. Several delegates also noted in comments to the house that even healthcare offices and hospitals are not safe from gun violence.
"We are all just steps away from a mass shooting, there is no better time than now to adopt these policies," said Ryan Mire, MD, incoming president of the American College of Physicians (ACP).
Several delegates noted that if prior AMA policy positions had been adopted for waiting periods, a couple of recent shootings where the gunman purchased the weapon right before using them may not have occurred. However, national laws to require background checks and waiting periods have been defeated in Congress with the backing of a strong gun lobby.
"We need real-life, common sense action," said Mary Carpenter, MD, a family medicine doctor from South Dakota and chair on the AMA Council on Legislation.
Other physician delegates related stories of treating gunshot wounds at their hospitals and seeing patients die.
“America’s physicians treat gun violence victims every single day, and we see it for the public health crisis that it is," said AMA Trustee Thomas J. Madejski, MD, a specialist in internal and geriatric medicine. "We see the urgency of the moment, and we call on Congress to meet the moment. The AMA has exhaustive policy to address the public health crisis of gun violence. These policies, and laws, need to be constantly updated to address the pernicious ingenuity of gun manufacturers.”
During comments on these policies, a younger house delegate related the story of being in lockdown because she was at a neighboring school during the Sandy Hook School shooting in 2012. A cardiologist from California related the story of how his son was caught in the crossfire during a shooting at their local park.
"Guns are now the leading cause of death in people under 18 and we see it in our hospitals and unfortunately in our morgues," said Leanna Knight, a medical student at the University of Rochester School of Medicine and Dentistry, with the regional student delegation with the Medical Society of New York.
Suicides lead gun deaths and mass shooting are on the rise in U.S.
The most recent published statistics from the Centers for Disease Control and Prevention (CDC) show 45,222 people died from gun-related injuries in the U.S. in 2020. That figure includes murders, suicides, unintentional gun accidents and shootings by law enforcement.
Suicide by gun made up 54% of the deaths. Murders made up 43%. The remaining causes made up 3%, according to the CDC.
The Pew Research Center said the 2020 number shows deaths by firearms are increasing. This is the highest numbers of gun-related deaths since the CDC started tracking gun death statistics in 1968.
The Pew Research Center said statistics show handguns were used in the majority of deaths, 59%. Guns classified as "assault weapons," military style guns with higher capacity magazines, were involved in just 3% of firearms murders.
There also has been a significant increase in mass shootings, also called active shooter incidents. These rose from 3 in 2000, with a steady increase to 40 in 2020, according to Federal Bureau of Investigation (FBI) numbers.
The prevention of gun violence policies adopted by the AMA
The AMA House of Delegates took several actions this week to reinforce the medical communities' concern and lend support legislation on new gun control measures:
Advocating for warning labels on ammunition packages
The AMA will support legislation requiring that packaging for any firearm ammunition produced in, sold in, or exported from, the United States carry a boxed warning. However, this came with a lot of debate on the floor ion the House of Delegates. The measure was originally recommended to be sent back to committee, but it quickly became apparent most delegates wanted to vote on the full measures.
"Gun violence is quite prevalent, it is a crisis," explained Ramin Manshadi, MD, a cardiologist with the California delegation. "We as physicians should pass this resolution."
Many physicians said supporting things like this may turn off a lot of patients and physicians who strongly support 2nd Amendment rights. Several called for referring this policy back to committee for a year and to add more scientific research before adopting the position. Other delegates argued showing graphic warnings on ammunition boxes would reinforce what is in the box can cause massive trauma and death, so they should be less lax about how it is stored and who has access to it. In a vote on referral, 54% of delegates wanted to push forward and adopt the policy.
"Most deaths by guns are from suicides, so we need to let people know they need to store their ammunition safely and to keep it away from their angst-ridden teenagers," said Kenneth Certa, MD, a delegate from the American Psychiatric Association (APA).
At a minimum, delegates said the warning should be text-based statistics and/or graphic warning labels related to the risks, harms, and mortality associated with firearm ownership and use. It also should include an explicit recommendation that ammunition be stored securely and separately from firearms.
“Evidence suggests that graphic warning labels on tobacco packaging reduced tobacco use. With the frightening frequency of mass shootings, this approach on ammunition might save lives as part of a comprehensive approach to firearm dangers,” Madejski explained.
Numerous delegates opposed a vote on the measure until an AMA committee could review the science behind labeling. Some delegates also feared alienating patients or some gun-owner physicians with the policy.
The final vote to adopt passed with 75% of delegates supporting the measure.
AMA supports regulating ghost guns
With the rising availability of homemade “ghost guns,” the new AMA policy will called on state legislatures and Congress to subject these weapons to the same regulations and licensing requirements as traditional firearms.
AMA will not support candidates that oppose research-backed firearms regulations
Another policy that was approved calls for the AMA Political Action Committee (AMPAC) to no longer donate money to political candidates who vote in opposition to evidence-based firearm regulation policies. The resolution noted AMPAC gave $54,889 to 17 candidates in 2018 who are also backed by the National Rifle Association (NRA) and voted against gun regulations recommended by the AMA.
Ensuring active-shooter and live-crisis drills consider mental health of children
With school shootings continuing at a troubling pace and few regulations in place to address the country’s firearm crisis, some schools prepare faculty and children to respond. While well intentioned, there are concerns that the style of drill may have unintended harmful effects on children’s mental health. To address these concerns, the AMA adopted policy today encouraging active-shooter and live-crisis drills to be conducted in an evidence-based and trauma-informed way that takes children’s physical and mental wellness into account, considers prior experiences that might affect children's response to a simulation, avoids creating additional traumatic experiences for children, and provides support for students who may be adversely affected.
The AMA will work with relevant stakeholders to raise awareness of ways to conduct active-shooter or live-crisis drills that are safe for children and developmentally appropriate. The AMA will also advocate for research into the impact of live-crisis exercises and drills on the physical and mental health and well-being of children, including the goals, efficacy, and potential unintended consequences of crisis-preparedness activities involving children.
“In the wake of another spate of school shootings in the U.S., schools around the country may hold active-shooter and live-crisis drills to prepare their schools and staff to respond. However, it’s important that these drills and exercises are conducted in an evidence-based way and that we understand the potential consequences for the mental health and well-being of children,” said AMA President Gerald E. Harmon, MD.
The AMA House or Delegates also adopted a policy to allow the Board of Trustees to take further action to address the gun violence public health crisis.
AMA Foundation collecting donations for medical group gun violence victims
The AMA Foundation began collecting donations at the AMA meeting for two organizations helping gun violence victims.
The first is the Saint Francis Employee Emergency Fund through the Tulsa Community Foundation. Donations were to support the families of victims of the Tulsa shooting. The health system is offering pastoral care, pet therapy, employee assistance program services, counseling and other help for employees affected by the shooting.
The second is the Johns Hopkins Center for Gun Violence Solutions. Two gun-violence prevention organizations, the Educational Fund to Stop Gun Violence and the Coalition to Stop Gun Violence, recently merged to form the Johns Hopkins Center for Gun Violence Solutions. The organization combines research with advocacy and policymaking.
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Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: dfornell@innovatehealthcare.com