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JAMA Forum Archive, 2012-2019: Health policy commentary from leaders in the field
JAMA Forum

Background Checks and US Physicians

On February 27, 2019, by a vote of 240-190, the US House of Representatives passed HR 8, the Bipartisan Background Checks Act of 2019. This short and simple bill would close the loopholes that allow millions of guns to change hands each year in the United States without background checks on the purchasers. Support for universal background checks has exceeded 88% of the American people in every national poll by Quinnipiac University since 2013.

Image: Isaac74/Getty Images

However, success is far from assured. The Bipartisan Background Checks Act is now under consideration by the US Senate. Most observers place the odds of Senate passage of the bill somewhere near 0%. After 2 students were shot and killed in his home state, Senate Majority Leader Mitch McConnell (R, Kentucky) stated that other than providing funding for school security, “I don’t think at the federal level there’s much that we can do.”

Yet failure is not inevitable, and physicians and others can play a major role in advocating for change. After the shooting in Parkland, Florida, in February 2018, Jared Moskowitz, the Democratic state representative who represents the district that includes Parkland, predicted that “nothing” would happen as a result. “We’ve seen this show before,” he told the Miami Herald, expressing frustration about previous shootings that generated little policy response. “Politicians need to look these parents in the face and say: We will do nothing.” he said.

He was wrong. Upending the politics of guns were students from the Marjorie Stoneman High School and beyond. “The students have been the ones that have been able to articulate this message so clearly of what the failures were, what they want to see. And they’re not just talk. They’re action,” said Moskowitz, himself a 1999 graduate of Marjorie Stoneman High School, a few days later. Within several weeks, the Florida governor had broken from the National Rifle Association and backed a set of measures that included a law to keep people at extreme risk of using guns from having them.

The physician community is now mobilizing in support of bipartisan legislation on guns. The infamous tweet in November 2018 from the National Rifle Association urging “self-important anti-gun doctors to stay in their lane” set off an explosion of anger and frustration on social media. Doctors told stories of their daily tasks of removing bullets in surgery (and at autopsy) and telling family members about tragic and avoidable deaths. Multiple physician organizations took stands in favor of efforts to curtail gun violence.

4 Steps for Physicians

To address the major political obstacles to progress, physicians can consider taking these 4 steps.

First, physicians can educate themselves about the challenges of and solutions to gun violence. A great starting point is a series of JAMA podcasts. A major impact of background check legislation is to prevent people who live in areas without strong state laws from selling their guns to individuals who are at great threat of using them illegally. Combined with other measures, including permit requirements, background checks have been shown to reduce homicides and suicides substantially.

Second, physicians can team up with organizations advocating for change. Nationally, these groups include Everytown for Gun Safety, the Coalition to Stop Gun Violence, and the Brady Campaign. There are local organizations from coast to coast, from Marylanders to Prevent Gun Violence to the Seattle-based Grandmothers Against Gun Violence. Physicians can speak powerfully about their experiences at local events and fundraisers.

Third, physicians can directly put pressure on elected officials. In areas with Senators who are opposed to closing loopholes for background checks, physicians—alone, in small groups, or with their colleagues in medical societies—can ask for meetings to explain the urgency of the legislation. They can also engage in op-eds, letters to the editor, open letters to the National Rifle Association, social media, radio, and television.

Fourth, physicians can put their money where their heads and hearts are, by refusing to make political contributions to elected officials who defend loopholes for gun purchase. In the past, the political contributions of organized medicine have been inversely correlated with the views of physicians on such public health issues as guns and tobacco. What about recent contributions with respect to background checks? A analysis just published in JAMA Network Open found “physician organization-affiliated political action committee contributed more money and to a higher proportion of candidates who voted against expanding firearm background checks” (emphasis added). One author of this study stated, “Physicians groups have made advocacy for gun safety a big issue, and if it is such a big issue, it should be criteria by which political donations are screened.”

To date, however, medical societies have resisted linking political donations to support on any specific issue, including background checks—even in cases where legislation is supported by the overwhelming majority of US residents. A spokesperson for one medical society explained that it “is not a single issue organization, and our political giving … reflects the diversity of our membership.”

Continuing Toll

Since the Parkland shootings, nearly 1200 youth have died from gun violence. More than 20 000 people in the United States have killed themselves with guns. In 2018, more than 40 000 US residents have lost their lives to guns, the highest number in 50 years.

Some physicians respond directly to gunshot injuries. Many physicians address the consequences of violence and trauma. All physicians have the ability to work for policies that can stem the tide of this epidemic.

About the author: Joshua M. Sharfstein, MD, is Vice Dean for Public Health Practice and Community Engagement at the Johns Hopkins Bloomberg School of Public Health. He previously served as Secretary of the Maryland Department of Health and Mental Hygiene, as the Principal Deputy Commissioner of the US Food and Drug Administration, and as Commissioner of Health for Baltimore. He is also a consultant to Audacious Inquiry and to Sachs Policy Group. A pediatrician, he lives with his family in Baltimore. (Image: Chris Hartlove)