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Tuesday Jan 08, 2013

Time for a National Conversation About Gun Violence

Growing up in the Pacific Northwest blessed me with a love, and respect, for the outdoors. I am an avid cyclist and experienced skier. I also grew up with guns, and I own sporting guns to this day.

At the same time, my hospital -- Children's Hospital Colorado -- has served as a treatment center for wounded kids after two of the most horrific shootings in our nation's history: the Columbine High School massacre in 1999 and the more recent attack at a movie theater in Aurora, Colo. Twelve students and one teacher were murdered at Columbine, and 12 people were killed in the theater shooting. Seventy-nine others were wounded in the two incidents combined.

Children from my practice, as well as children of my friends and practice partners -- were at the theater on that horrible night in July.

It's time that we, as a country, recognize gun violence as a major public health issue. According to the CDC, more than 31,000 Americans were killed with firearms in 2009, rivaling the number of those who died in traffic accidents. The number of Americans killed by guns in one year on U.S. soil is more than four times the total of U.S. deaths from the wars in Iraq and Afghanistan combined. 

Following the recent school shooting in Connecticut, the White House formed a task force to develop policy to prevent these tragedies and reduce gun violence. On Jan. 3, I participated in the first of a series of stakeholder meetings when HHS Secretary Kathleen Sebelius, White House staff members and others met with representatives from groups representing health care professionals and public health organizations.

The causes of this problem are complex, and there is no simple solution. The White House and HHS are expected to meet with a wide variety of those involved in the issue, including mental health experts, law enforcement, gun owner groups and youth advocacy organizations, to listen to their analyses and recommendations.

As family physicians, we focus daily on prevention to improve the health of our patients. Today, we need to help our country focus on prevention that addresses all of the causes of violence in our communities.

Our country needs better mental health care, including improved access to care, substance abuse counseling and coordination with primary care. These points were made loud and clear during the Jan. 3 meeting.

The need to address violence in media -- from television and movies to video games and music videos -- also was part of our discussion. Studies have shown that children exposed to media violence are more likely to cause harm to others. The Academy has a position paper on that topic 

We also talked about firearm safety. Guns are not the only source of violence, but gun safety clearly needs to be part of the conversation and part of the solution. Our Academy has long standing policy -- endorsed and upheld by our Congress of Delegates -- supporting legislation requiring trigger locks and safe storage of firearms, as well as policy opposing ownership of assault weapons.

Family physicians need to be able to have appropriate medical conversations with our patients about gun safety, and researchers need the ability to study gun safety. Currently, state and federal laws restrict their ability to do so

The White House has asked the Academy for input, and we shared with them our policies related to violence, including media violence, gun safety and improving mental health care.

I recognize the diversity of our membership and the fact that there are strong feelings on both sides of the issue when it comes to guns. Yet, all family physicians are advocates for decreasing violence in our communities. This is an opportunity for family physicians to be heard as strong advocates of prevention during the development of national policy that will affect the health and safety of our patients.

Jeff Cain, M.D., is the president of the AAFP.

Comments:

A hunting rifle is more powerful than an assault rifle, yeah that's true check the ballistics on a 30.06 caliber vs a .223 (M16) or even a 7.62 (AK47). So in the hands of a motivated and skilled gunman with just a short magazine(s), he could dispense more than 30 rounds in under a minute. Why does everyone think banning assault rifles will solve the problem? We still have semi-automatic pistols and single and double action revolvers that will put down 60 rounds in under a minute. And why does governor Cuomo think that because you don't need an assault rifle to shoot a deer, then you don't need assault rifles? Does everyone remember the purpose of the 2nd Amendment? It's not so the citizens have guns to shoot deer with (read it again). You can't solve the problem of gun violence until you solve the problem of man's violence. It's short sighted to think if you remove his tools then you'll remove his violence. What a lazy solution (and patriotically irresponsible). And another thing, even "sane" people go crazy from time to time so you're never going to solve this problem.

Posted by Jamiel Ambrad on January 10, 2013 at 07:26 AM CST #

How do I say this kindly. . . the hell w/ that, RESIGN IMMEDIATELY!!!! As a private citizen you may spout out whatever you wish (the 1st Amendment gives you that right, and the 2nd gives the teeth to back it up). As the President (hopefully soon to be ex-) of the AAFP, using the bully pulpit for your own political blather is inappropriate and unconscionable. I guarantee that to a man/woman, our casualties overseas were staunch 2nd Amendment supporters. The recent events in Aurora and Connecticut are tragic. A much bigger tragedy is the daily mass murder of unborn children -- say what you to that???? The greatest tragedy, however, would be to undo the constitution, specifically the 2nd Amendment which gives us ("We the people. . .") the ability to insure that government does not infringe on our other rights. As Thomas Jefferson said, "The beauty of the 2nd Amendment is that it is not needed until they try to take it away." LOVE MY COUNTRY ALWAYS. GOVERNMENT ONLY WHEN DESERVED.

Posted by Michael R. Schaub, MD, FAAFP, LTC, US Army (retired) on January 10, 2013 at 07:42 AM CST #

As a former Air Force physician and staunch supporter of our military, I have to take grave exception to the comments by Dr. Schaub. He is using the same repetitive tactics used by those that support his side of the argument: if we scream loud enough and attempt to bully and intimidate people enough, than we will get our way. The NRA has made a science out of this and it continues. No mention of common sense and human decency. And to accuse Dr. Cain of using a "bully pulpit", that's just plain insulting and shows no rationale. I did not read anything into Dr. Cain's comments like that and I am proud that he chose to make a stand that something needs to be done. I would expect nothing less from my AAFP president.

Posted by John Cavacece, D.O. on January 10, 2013 at 08:41 AM CST #

31,000 gun deaths are terrible, one death is terrible.What about the million deaths in abortions every year????? The problem is lack of respect for life and moral numbness. WHAT HYPOCRISY!!!!!!!!!!!! WE HAVE OUR PRIORITIES BACKWARDS!!!!!!!!!!!!!!

Posted by Glenn on January 10, 2013 at 08:43 AM CST #

The statistics on countries or states with more or less restrictive laws on guns do not clearly give us an answer as to whether more laws will help. Sometimes yes, sometimes not. I would suggest a better focus on research and development of clinical guidelines to help behavioral health workers better predict the potential for violence. I would suggest a "Break the glass" rule on HIPAA, and a national directive that allows individuals involved in the care of individuals who have committed these acts to convene with national experts and discuss what they saw privately in the weeks prior to these horrific events, and we if we can improve the predictability of these events, without fear of being sued. I believe we have focused too much on the tools, and not the users. Regardless of whether the mass killing was done with knives, bombs or guns - the focus needs to be on being better at predicting the events, and finding better ways to intervene before the event, not react to them.

Posted by Gus Geraci on January 10, 2013 at 09:12 AM CST #

I see your 31000 and raise you 50+ million. In 1929, the Soviet Union established gun control. From 1929 to 1953, about 20 million dissidents, unable to defend themselves, were rounded up and exterminated... ------------------------ In 1911, Turkey established gun control. From 1915 to 1917, 1.5 million Armenians, unable to defend themselves, were rounded up and exterminated. ------------------------ Germany established gun control in 1938 and from 1939 to 1945, a total of 13 million Jews and others who were unable to defend themselves were rounded up and exterminated. ------------------------ China established gun control in 1935. From 1948 to 1952, 20 million political dissidents, unable to defend themselves, were rounded up and exterminated. ------------------------ Guatemala established gun control in 1964. From 1964 to 1981, 100,000 Mayan Indians, unable to defend themselves, were rounded up and exterminated. ------------------------ Uganda established gun control in 1970. From 1971 to 1979, 300,000 Christians, unable to defend themselves, were rounded up and exterminated. ------------------------ Cambodia established gun control in 1956. From 1975 to 1977, one million educated people, unable to defend themselves, were rounded up and exterminated. Guns are not for fun, hunting, collecting or any other selfish purpose. They are to keep the power in the hands of individuals to safeguard us from developing a tyranical government. The AAFP's stance on while on the surface rightous, is near sighted and outside the scope of the organization's useful intent.

Posted by Don Woodhouse MD on January 10, 2013 at 12:35 PM CST #

Simplistic approaches to the excessive and increasing violence in our society will not solve the problem. We need to have a balanced approach, and I am glad that AAFP President Cain and the Board is leading us in that direction. We can find a solution that protects privacy of mental health patients, and also allows therapists and clinicians to act when necessay to prevent impending violence. Part of that is access to care and good communication between all members of the health care team, as Jeff suggests. There is a way to protect citizens' 2nd amendments right and still take reasonable actions to lessen the chance of violence; we just haven't had enough calm discussion to find that way. I am proud that the AAFP will be part of the deliberation towards finding those best paths forwards.

Posted by Alan Schwartzstein on January 10, 2013 at 01:10 PM CST #

Dr. Cain's posting above is both timely and relevant. The mission of the AAFP is "to improve the health of patients, families, and communities..." and our organizational involvement in the national debate on guns and gun violence absolutely is necessary. As Family Physicians we are on the front lines of patient care. We have a valuable role in public health; we discuss seat belts, smoke alarms, and safe storage of toxic chemicals and medications. Why should guns be off the table when they clearly have the potential for so much harm to persons and communities? Dr. Cain in no way advocates for banning the sale of any particular firearm. Dissenters to the Dr. Cain's post point out that limiting consumer access to firearms will not solve the problem, and I agree. Any gun in the hand of any person who intends to kill can find a way of ending a life. The AAFP therefore must be part of a holistic approach to reducing gun violence, which includes addressing many important factors referenced by Dr. Cain above, particularly disparities in mental health care. Momentum toward creating positive change for our communities can no longer be influenced by lobbyists. As Family Physicians we must engage in rational and professional debate toward protecting those we have sworn to heal and keep well. We must not attempt to invoke the contextually irrelevant Second Amendment; Redcoats with muskets are not slaughtering children in their elementary schools. And we must not waylay this important conversation by brining up unrelated social issues or details of foreign genocide. America needs a uniquely American strategy to prevent further tragedy. I am proud the AAFP is taking a leadership role and look forward to an open discussion.

Posted by Scott Nass, MD MPA on January 10, 2013 at 02:32 PM CST #

It pains me to once again watch national medical organizations lean to the political left in response to issues of controversy. As the face of Family Medicine to the world, the AAFP must be more careful to be even-handed regarding divisive issues and try to represent all of its membership.

On this topic, for instance, multiple polls estimate that at least 40% of households in the United States own a firearm. Here is one example: http://www.gallup.com/poll/20098/gun-ownership-use-america.aspx . Chances are, many physicains who practice family medicine are among that 40% and may feel differently from the "official" AAFP stance on placing further restrictions on gun ownership.

Meanwhile, there is no conclusive data that more restrictive gun laws result in a lower violent crime rate (which is, I hope, the reason that this topic is being addressed by the medical community). In fact, data exists that suggests the opposite - that more restrictive gun laws hinder law-abiding citizens and empower criminals.

And, finally, it is time for an honest conversation. Dr. Cain sites "more than 31,000" gun deaths in 2010 (the raw number is 31,347). While this number is true, it is also deceptive (lies, darned lies, and statistics...). If you follow the link that he sited, you will find that the number of homicides by firearm for that year is actually 11,493, or about 1/3 of the sited number number. The remaining almost 2/3 are from suicides and accidental deaths. All deaths are tragic, and as physicians we fight daily to protect our patients. However, don't poison the pot by starting the discussion with rediculously skewed statistics.

A real discussion on this topic would need to include (1) a frank discussion on mental health, particularly with an eye toward (a) identifying individuals early who have violent tendancies (b) curbing the horrific suicide rate in our nation, (2) a logical discussion about how to make firearms safer. This would help reduce the number of accidental firearms deaths. Here is an opportunity for the AAFP, for the good of our patients, to partner with other groups interested in gun safety including (my more liberal colleagues may want to close their eyes here) the NRA, and (3) streamlining and enforcement of existing gun-control laws.

The next time a contentious topic arises, the AAFP may want to stow the political agenda and consider a response that focuses on evidence-based ways of improving the lives of our patients.

Posted by Richard Conn, MD/PhD on January 10, 2013 at 02:43 PM CST #

As an avid gun enthusiast and staunch supporter of our Second Amendment right to keep and bear arms (Constitutionally, for defensive rather than sporting purposes), I appreciate Dr. Cain's initiating the conversation among AAFP members regarding violence in general and gun safety in particular, as it relates to our Nation’s culture of violence. I would urge my colleagues to speak to each other with respect and humility as we address this very emotional issue. Despite opposing viewpoints, I think we can gain much by a calm discussion of ideas without attacking each other. A gun is simply a tool. As with any tool created by Man, guns can be used for good or for harm. So can shovels, hammers, and screwdrivers. Guns are inanimate. They do not shoot themselves; they require a person to fire them. The problem, then, is not what is in the hand, but what is in the heart. On this side of Eternity, evil people will do evil things. Bad people will use whatever means they can find to carry out their evil plans. Passing more laws will not stop these folks, and we will never be able to control their violent behavior by limiting the types or numbers of weapons they have legal access to. We must, instead, address the root issues of evil in our society. By passing laws limiting access to guns, the government limits the ability of a law-abiding citizen to defend him or herself and his/her family from the evil person who will use a firearm, despite any restrictions placed by law. In any of the horrible tragedies that have plagued our nation recently, the perpetrator broke numerous laws just in procuring the firearms. These people were not stupid, either. They chose locations for their crimes that were “gun-free zones,” knowing there would be very little chance that anybody would be there to resist them. Hence the theater, the Sikh temple, and the schoolhouse shootings most recently. Had there been a high likelihood that someone would have a legal concealed carry permit in any of these locations, the outcome might have been entirely different! When we examine the crime rate data not only in the U.S. but also around the world, we notice that areas with the highest violent crime rates (lawless people assaulting law-abiding people by whatever means), are the areas that limit guns the most. Take Washington, D.C. and Chicago. Or the UK and Wales, whose violent crime rate was higher than the US in 2006. Yet, crime rates are lower in areas with more gun freedoms, because criminals see these areas as unsafe working environments! In Switzerland, every adult male is issued a military rifle by the Government and is expected to be proficient in its use. Semiautomatic weapons are legal there. Tens of millions of rounds are fired by Swiss civilians during target practice annually. Citizens carry rifles openly on their way to the range. And the violent crime rate there is extremely low! As physicians, many of whom enjoy the shooting sports and many of whom use firearms as part of their personal and family protective plan, we need to encourage our patients in the safe and legitimate use of firearms. The National Rifle Association is responsible for training thousands of citizens annually in firearm safety. This should be our thrust – the safe and responsible use of firearms as tools. Tools that can be used for good, not only for sport, but also and more importantly, for the defense of life, liberty, and property against criminals or other aggressives who would cause us bodily harm or seek to limit our freedoms.

Posted by Allan R. Macdonald, MD, FAAFP on January 10, 2013 at 03:25 PM CST #

Being an active member of both the AAFP and the NRA, I would suggest the following to see if we might be team up and form an effective partnership. The two groups agree wholeheartedly in gun safety, improving mental health, and exposure to media violence. Unfortunately the NRA feels that "Liberal Physician's" talking to their patients about guns will be all about getting rid of guns, and have therefore taken a stand trying to prevent us from being able to do that. The AAFP has taken a stand that access to "Assault Rifles" cause more gun deaths, a stand which is disputed by the NRA. Could the AAFP drop their assault weapon position (which I don't agree with and is probably the most contentious point of their positions within the membership.) We would then be in a position to ask the help of the NRA to come up with a Educational campaign to teach our patients gun safety, keeping guns out of the hands of children and the mentally ill, and thereby cutting down on all THREE aspects of that 31,000+ number of deaths cited - murders, accidents and suicides. A liason between the two organizations would carry much weight in this discussion.

Posted by William M. Bailey, MD on January 10, 2013 at 03:28 PM CST #

Unfortunately ,the most dangerous place in America is not Sandy Hook or a theater in Aurora, it is in a woman's uterus!!!!

Posted by Glenn Schexnayder on January 10, 2013 at 09:43 PM CST #

I agree with my colleagues who point out the hypocrisy of the AAFPs concern with gun violence---and lack of concern for the 50 million babies killed in the uterus since Roe vs Wade in 1973.

Posted by Michael Wulfers on January 10, 2013 at 10:37 PM CST #

Thank you, Dr. Cain. You thoughtful comments that we " need to address violence in media", that we "need to be able to have appropriate medical conversations with our patients about gun safety" are appreciated. And yes, as a society, we need to act collectively to protect our children. You are right that "causes of this problem are complex, and there is no simple solution". It is for this reason, that I find the comments of some of our colleagues above both baffling and sad. We need to start someplace, even if it is not the entire solution! The idea that a person should not act to save children from gun slaughter because they advocate against abortion makes no sense. Neither does the idea that we must have high powered weapons to defend against our elected government. We have a constitution that spells out how we are to solve our disagreements! Stay strong, Dr. Cain. Now is the time.

Posted by David Lynch, MD on January 10, 2013 at 11:28 PM CST #

The very fundamental reason that abortion IS RELEVENT is that we have a culture that does not value life!!!!!!! And that is THE fundamental problem.If not guns,then it will be bombs,bats, knives,etc.Banning guns will not protect children!!!!

Posted by Glenn Schexnayder on January 11, 2013 at 07:10 AM CST #

I see the problem. We have folks who do not know the constitution. That beloved document does not spell out how disagreements are solved. It established our form of government, assigned responsibilities, and most importantly set out limits of government. The bill of rights (the first 10 amendments) were specifically spelled out because historically these are the rights most needed to insure a free people, most inconvenient and feared by governments, and most often trampled by said governments. To believe that any of them are irrelevant is naive and extremely worrisome. Want to protect our children? Then we should dust off our bibles, learn and respect our United States history, learn to take individual responsibility for our actions, and most importantly -- teach our children well. Those are our jobs, not government.

Posted by Michael R. Schaub, MD, FAAFP, LTC, US Army (retired) on January 11, 2013 at 07:38 AM CST #

We owe it to ourselves to include guns in any discussion of violence. The suggestion that the second amendment forbids us from talking about gun violence is absurd. The AAFP is an excellent organization to model research and debate on violence, and the HOD seems to have started on that already. Thank you for prioritizing this, Dr. Cain.

Posted by D. Scott McCracken, MD on January 12, 2013 at 12:40 PM CST #

Thank you for your thoughtful article, Dr. Cain. A similar article was published in the NEJM that highlighted the AAP's stance: “the absence of guns from homes and communities is the most effective measure to prevent suicide, homicide, and unintentional injuries to children and adolescents.” And why we should care: "Gun injuries cause twice as many deaths as cancer, 5 times as many as heart disease, and 15 times as many as infections." Few gun-advocate arguments have evidence to support their claims: 1. "I want a gun in my house to protect my family." Case control studies suggest that guns in the home make a home LESS safe and a source of more homicides and suicides. 2. "Banning assault weapons violates the 2nd amendment."In 2008, the Supreme Court stated that any law entirely regulating ALL handguns conflicts with the 2nd amendment, but keeping guns away from high profile people (universal background checks and closing loopholes) does NOT contradict the constitution. 3. "The mentally ill are the problem." People who are mentally ill are at no higher risk of gun violence. This is a misguided detour. Other countries were in similar positions as the U.S. and then instituted more stringent background checks and assault weapon bans, which proved to be very successful (e.g. Scotland, Australia). In fact, there has been no single mass shooting since Australia enacted more gun restrictions.

Posted by Stephanie Van Dyke, MD on January 13, 2013 at 06:44 PM CST #

I agree that it's time we have a "national conversation about gun violence." But, I sincerely hope that does not lead to an increase in restrictions for mentally healthy, law abiding American citizens to own guns. And, yes I do believe that the 2nd Amendment to our Constitution is and will always be "relevant." In addition, I think it's time we had an internal conversation about the AAFP's policy statement in support of a ban on private ownership of assault rifles. I don't remember being asked about that prior to my professional organization publicly representing my opinion on this subject.

Posted by Scott on January 13, 2013 at 10:30 PM CST #

My thanks to Dr. Cain for speaking out on an important issue that affects our patients. I have been increasingly disturbed by the ability of NRA leaders to convince members of Congress to accept limits on CDC research that could improve gun safety and by efforts to limit the free speech of physicians in the exam room by trying to pass legislation that would make it a crime for doctors to ask about safe gun ownership and storage. I also firmly believe that background checks need to be universal. When convicted felons and mentally ill people can easily by guns without a background check, none of us are safer. I also think we need to demand research on which technical devices actually work to make guns safer. No parent, even one firmly committed to the right to own guns, wants to worry that their 5 year old could accidently injure or kill himself with a weapon. Technology exists that would allow only the gun owner to fire a gun. Would universal use of such devices have prevented Newtown's shootings? Would it prevent a criminal from taking a weapon from its legal owner and using it against him or her? As long as we allow NRA leaders to muzzle research, we will fail to get answers to these questions. We need to demand that our Congressional leaders be answerable to us and to their constitutents, rather than to an NRA leadership that no longer reflects its own members' opinions.

Posted by Cheryl Bettigole on January 15, 2013 at 07:11 AM CST #

"as well as policy opposing ownership of assault weapons " ... That is AAFP's departure from "dialog" and their entry into political propoganda. Labelling some guns with 'scary words' just based on their appearance (not including nice looking guns that are functionally identical), and then wanting to ban their ownership based on the 'scary word' label ... all this is rather obvious political taticics and gamesmanship. I'll make you a bet. Yet another group of firearms will be re-labelled with 'scary words' soon after the next media cause celebre. Then we will hear the same drumbeats and the same arguments for banning these as well. And the same "stakeholder" meetings and political arm-twistings that you were recently hauled into will happen again, and our AAFP president will be invited to help implement yet another partisan agenda. Just say no. We have enough real work to do on behalf of family medicine without being enticed into ego-fulfiling well-scripted Washington meetings and losing credibility within the AAFP membership by endorsing politically driven "task forces" of any stripe, right or left. It is not your job, and is not this organization's job. Do it on your personal behalf if you really want to, but not on AAFP time, and not with the AAFP imprimatur.

Posted by Rudolf G. Bickel, MD, FAAFP on January 18, 2013 at 03:18 PM CST #

I do not think Stephanie VanDykes statements or statistics match the FBI's.

Posted by Glenn Schexnayder on January 20, 2013 at 08:30 AM CST #

Glenn Schexnayder, My statistics are from the NEJM, AAP and public health lawyers and advocates at the Johns Hopkins Bloomberg School of Public Health - folks who have been studying gun policy and law for over 20 years. We (Hopkins) just held a fantastic two day Gun Policy Summit, if you are interested in learning more: http://www.jhsph.edu/events/gun-policy-summit

Posted by Stephanie Van Dyke, MD on January 22, 2013 at 03:55 PM CST #

I went to the Hopkin's site and looked at the summit agenda. Nowhere does the agenda from the summit show gun violence perpetrated by tyranical states upon their own citizens. Not 10s, 100s, 1000s, 10000s, or even hundreds of thousands begin to match the gun violence perpetrated by the state. Millions have been slaughtered in defenseless conditions. Please see my earlier post. The AAFP while well intentioned opening up on this topic is misguided and short sighted. Look at deaths in modern history and the governments are by far the biggest killers. While an assault rifle is meaningless against modern military weaponry, it does offer a chance to keep our government from becoming tyranical. Will this happen in our lifetimes? Probably not. Will it happen in our future? Absolutely, as it has happened in every state that has ever existed. Please AAFP spend your time educating us, putting on a first class convention, and represent the family doctors of this country against all those who feel need to control us through coersion and legislation. While public health and patient advocation is noble, it is going to cost membership numbers just as the AMA has seen. We need the AAFP to represent us and dedicate all resources to those of us that pay the bills.

Posted by Don Woodhouse MD on January 29, 2013 at 10:26 PM CST #

I support Dr. Cain's efforts in bringing gun safety up for debate. Mass shootings are tragic, but so are the individual lives lost and severe injuries due to guns. Since Newtown, our attention has been drawn to the topic of gun injury prevention and mental health. Previous mass killings of adults and adolescents have not been enough to bring proper debate and change behavior in our society. It took the murder of 20 first-graders and 6 school employees on December 14, 2012 to rekindle the discussion. Many people want to “do something” to prevent this type of horrible event from happening in the future. Doctors have the proverbial “bully pulpit” and ear of their patients and community and therefore are positioned to promote improvements. In 1963, the beating and jailing of children and adults during the Birmingham civil rights march became known as “Bloody Sunday”. Speaking of this event, President John F. Kennedy said, “Those who do nothing are inviting shame as well as violence. Those who act boldly are recognizing right as well as reality.” The second amendment states, "A well regulated militia, being necessary to the security of a free state, the right of the people to keep and bear arms, shall not be infringed." From the Legal Information Institute of Cornell Law School this may mean the following. The opposing theories, perhaps oversimplified, are an “individual rights” thesis whereby individuals are protected in ownership, possession, and transportation, and a “states’ rights” thesis whereby it is said the purpose of the clause is to protect the States in their authority to maintain formal, organized militia units. Whatever the Amendment may mean, it is a bar only to federal action, not extending to state or private restraints. I also agree with trying to ban large clips and "assault weapons". During my 19 years in medicine I have cared for 14 patients killed and over 30 injured by guns. I have helped many more through the psychological suffering of losing a loved one to gun violence. One of the most painful states I see patients suffer through is that of having a loved one killed by guns. It is always preventable. This is a public health problem that requires our attention. We are here to prevent illness and heal. Let's ask all patients if they own guns and if so then keep them locked with ammunition separated. The only problem is not just murder but the lethality of guns on the suicidal. 90 % of gun suicide attempts take their lives and 3% o non-gun attempts do. Thanks Dr. Cain

Posted by Enrique Leon on April 23, 2013 at 01:51 AM CDT #

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The opinions and views expressed here are those of the authors and do not necessarily represent or reflect the opinions and views of the American Academy of Family Physicians. This blog is not intended to provide medical, financial, or legal advice. All comments are moderated and will be removed if they violate our Terms of Use.