In this edition of The Wired Practice video, originally published for MedPage Today, Vanguard CEO Ron Harman King discusses what healthcare providers can do to counteract the prevalence of gun violence in the United States.
Watch the video on MedPage Today
By Ron Harman King, M.S., J.D., CEO
Why doesn’t advocacy to reduce gun violence by medical professionals bring action?
Amidst the current white-hot controversy over gun safety, I am ceaselessly struck by the medical establishment’s unbending advocacy for change not just in the law but also in research, education and mental health in the pursuit of reducing gun violence.
The American Medical Association has long called for a renewal and strengthening of the assault weapons ban, which lapsed in 2004, including banning high-capacity ammunition magazines. The AMA also advocates for lifting Congress’s 1996 ban on using federal money to fund gun violence research and how to prevent it. And the AMA calls gun violence a public health crisis, especially now that the Centers for Disease Controls data reveals that firearm fatalities are the leading cause of death for children and teens.
Similar stances have been taken by the American Public Health Association, the American Medical Women’s Association, the American Psychiatric Association, the National Medical Association, and at least four other U.S. health-professional organizations plus the American Bar Association. Joining them in spirit is two-thirds of Americans who support at least moderate regulations or restrictions on gun ownership, 79% who support Congress making background checks mandatory and 74% support limiting the sale of automatic weapons.
Does the gun violence crisis call for sharing images as in the case of Emmett Till?
Clearly, overwhelming professional and individual support for multi-level change are not bringing action. So, I say that if the medical profession really wants to bring change, its members should start sharing some pictures.
I’m not alone in this view, of course. Plenty of pundits have suggested that the hour has arrived for a so-called “Emmett Till moment,” referring to the 14-year-old African American boy who white supremacists heinously tortured and lynched in Mississippi in 1955. His mother’s insistence of an open-casket funeral of Emmett’s mutilated corpse led to worldwide publicity seen as a tipping point for the civil rights movement.
In the same theme, more than a few commentators have suggested that physicians and nurses should start sharing photos of corpses of mass shooting victims arriving at their hospitals in hopes that the nation will fully appreciate the barbarity and that change will at last arrive
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An alternative to showing photos of murdered gun violence victims
I would like to humbly offer a slightly more civilized alternative, for which credit goes to two other commentators. First, NYU journalism professor Susie Linfield argued in the New York Times that not only would parents of murdered Uvalde school children likely refuse consent to publishing photos of their deceased offspring, but that also such publication would amount to sensationalist overreach and exploitation. She has a point.
Alternatively, a more civilized approach comes inadvertently from Dr. Heather Sher, a Florida radiologist involved in the treatment of victims of the Marjory Stoneman Douglas High School shooting in 2018. Dr. Sher wrote in an often cited online essay of how a bullet from the shooter’s AR-15 rifle shredded organs to the extent that, and I quote, “nothing was left to repair.” Dr. Sher describes a bullet from an AR-15 passing “through the body like a cigarette boat travelling at maximum speed through a tiny canal.” In a process called cavitation, the bullet causes “a swath of tissue damage that extends several inches from its path” and does not have to hit an artery to cause fatal hemorrhaging on the scene.
Confirming this is Dr. Donald Jenkins, a San Antonio trauma surgeon, who says that because an AR-15 bullet travels at three times the speed of a bullet from a handgun, it has so much energy that it can disintegrate three inches of leg bone, turning it to dust. If it hits the liver, the organ “looks like a Jell-O mold that’s been dropped on the floor.” Again, death comes quickly from massive bleeding.
Healthcare providers could make their point with anonymized image studies
This is the clinical disaster that American doctors and nurses face all too routinely. How do they maintain their sanity? One way, of course, is to advocate for change. Rather than providing grisly photographs of identifiable human gunshot victims, clinicians can get their point across to the masses from anonymized image studies.
For example, Dr. Sher vividly describes the damage from a high-velocity AR-15 bullet on a human liver, as is visible in a CT scan. Whereas most bullets merely lacerate an organ, the AR-15 bullet essentially explodes the tissue. Consequently, in Dr. Sher’s words, “Most [Stoneman victims] died on the spot; they had no fighting chance at life.”
A step toward gun safety that sidesteps HIPAA issues & charges of insensitivity
Therefore, to stress the AR-15’s extreme killing power, let’s NOT publish images of the poor child’s grossly wounded body but of an anonymous organ, thus sidestepping HIPAA issues and charges of insensitivity. A few dozen of these circulating on the internet would likely generate the same response as was created by the images of Emmett Till’s body, the naked Vietnamese girl running from a napalm attack in 1972, and the body of the three-year-old immigrant boy washed up on a Mediterranean shore in 2015.
Here, I shudder at the sound of my own words. Are we as a nation really at this point of desperation? I’m afraid we are. A check of gun laws in 117 countries reveals that the United States, with exception of eight states, is among just four nations that allow ownership of semi-automatic rifles without permits. We’re keeping company with Yemen, the Gaza Strip and an independently held section of Syria – some of the worst war-torn areas on Earth.
Right where I sit at this moment, I am equidistant from Columbine High School, the Aurora Movie Theater and the King Soopers grocery store in Boulder’s Table Mesa neighborhood – a trio of locations where gunmen killed a total of 35 people and wounded nearly 100. The common factors: mental illness and semi-automatic weapons. No matter where you live in this country, you and your family cannot be entirely safe at school, at the movies, at the grocery store, at church or in public.
Reducing gun violence doesn’t have to be a binary choice
Granted, handguns are more often used in mass shootings, defined as each resulting in four or more fatalities. But semi-automatic rifles were used in four of the five deadliest shootings in U.S. history, including the 2016 Orlando nightclub shootings that killed 49 and wounded 53. A recording captured outside the Orlando nightclub on the night of the massacre recorded 24 shots in nine seconds. And that was only the second worst mass shooting in history, exceeded by the 2017 shooting on the Las Vegas strip.
Reducing gun violence doesn’t have to impose a binary choice. We can improve access to mental health while also limiting access to the deadliest weapons. Background checks, secure gun storage, extreme risk laws, restricting or banning – yes, banning – high-capacity magazines are not the final and only answer. But it’s what most ordinary Americans and healthcare professionals would call a good start on eliminating images we’d all rather not see again.