ACP updates policy recommendations on firearm injuries, deaths

ACP issued policy recommendations this week updating its positions on reducing firearm injuries and deaths in the United States.

Using an analysis of newly available evidence, ACP refined the recommendations from its 2014 position paper on this topic, reaffirming six statements and issuing three that are new or revised policy.

The new and revised positions are as follows:

• ACP supports appropriate regulation of the purchase of legal firearms to reduce firearm-related injuries and deaths, acknowledging that any such regulations must be consistent with the Supreme Court's interpretation of the Second Amendment.
• ACP stated that those who own firearms should follow best practices to reduce risk of accidental or intentional injuries, including ensuring that children, adolescents, people with dementia or substance use disorder, and people with serious mental illness associated with higher risk of self-harm or harming others cannot access firearms. ACP supports child access prevention laws holding firearm owners accountable for safe storage and said that owners should report firearm theft or losses within 72 hours of becoming aware of them.
• ACP favors enactment of legislation to ban the manufacture, sale, transfer, and subsequent ownership for civilian use of semiautomatic firearms that are designed to increase their rapid killing capacity (often called “assault weapons”) and large-capacity magazines, as well as retaining the current ban on automatic weapons for civilian use.*

The authors, writing for the College's Health and Public Policy Committee, said that ACP has advocated for reduction of firearm-related deaths and injuries for over 20 years and noted that it is disheartening that no meaningful action has yet been taken. “Although there is more to learn about the causes of firearm violence and the best methods to prevent it, the available data support the need for a multifaceted and comprehensive approach to reducing firearm violence that is consistent with the Second Amendment,” they wrote. “Firearm violence is a public health threat in the United States that must not be allowed to continue.”

The full position paper was published Oct. 30 by Annals of Internal Medicine and is available free of charge online.

An accompanying editorial said that the premise of the position paper is that physicians should help prevent gun violence not only by advising patients but also via public advocacy. “This position paper provides useful guidance to those who are inclined to accept this important challenge,” the editorialist wrote. He noted that ACP and others identify gun violence as a public health problem, which has the advantage of promoting a comprehensive approach to solutions but does not consider policing gun violence as an important aspect of prevention. The editorialist also said he would have preferred that ACP take a more direct approach to the question of how to separate guns from people with chronic mental illness.

A second editorial argued that the most effective and efficient way to reduce gun violence may be simply to ask patients about gun safety in their homes. “Nicotine abatement programs, alcohol reduction plans, and HIV prevention efforts begin with questions being asked about a person's behavior and are successful when physicians provide information to empower patients, motivating them to prevent disease and avoid disability or death,” the editorialist wrote. “Guns should be no different.”

A research report also published Oct. 30 by Annals of Internal Medicine used data from the National Firearms Survey to determine whether U.S. adults were aware of the intent and means of violent death in their states. A total of 3,949 participants were asked to rank the average frequency of homicide with a gun, homicide with a weapon other than a gun, suicide with a gun, and suicide by a method other than a gun. Data on intent and means by state were obtained from the CDC.

Between 2014 and 2015, in every state, suicides were more common than homicides, with suicide by firearm being the most common cause of violent death in 29 states. Of the 3,811 respondents who answered the question about relative frequency of intent and means of violent death, 13.5% correctly identified the most frequent cause. This percentage was 12.4% among respondents with a history of mental illness and, in the 1,880 respondents who reported their occupation, 20.0% among health care professionals.

“Our findings suggest that correcting misperceptions about the relative frequency of firearm-related violent deaths may make persons more cognizant of the actuarial risks to themselves and their family, thus creating new opportunities for prevention,” the authors wrote. “If communication strategies could enhance the accuracy of perceived risk, some persons living in households with firearms might be motivated to remove these weapons from their homes or at least keep unsafely stored firearms locked and unloaded to reduce access by potentially vulnerable family members.”