An ongoing dialogue on HIV/AIDS, infectious diseases,
August 11th, 2019
The United States Needs Stricter Gun Control Now — and Yes, This Is an ID Issue
It’s not been difficult. The ID and HIV community includes many smart, like-minded individuals involved in all sorts of interesting and challenging work, both domestically and abroad. As one of our ID fellows recalled, after he did a rotation in our ID clinic during his medical residency, “I realized I’d found my people.”
Today, however, I’m going to write about something on the sadder side, an issue tearing up our country.
We need stricter gun control in the United States. And we need it NOW.
Yes, this is a departure from prior controversies here, such as should doctors wear white coats, estimating the infectious risk of food tongs, or whether the correct abbreviation for P. jirovecii pneumonia is now PJP instead of PCP.
I’m venturing into this more contentious* issue because it’s just too painful to ignore.
(*But to my dear readers of the ID persuasion, there’s an excellent chance you’re in complete agreement. And how do I know? Easy.)
How many of you thought, Oh no not again, when you heard the news of last week’s shooting in El Paso? And then less than 24 hours later, Oh no not again, with the news from Dayton?
And we could go on and on listing these mass shootings — sadly, we even have a Wikipedia page cataloguing them for us. It’s getting so bad that voices outside of the usual crowd feel compelled to weigh in — here’s sportswriter Joe Posnanski taking a break from his usual (brilliant) baseball coverage to write a poem describing his heartbreak.
It’s very moving. But a sportswriter writing a poem? Must be time to do something.
And lest some think this isn’t a problem related to Infectious Diseases, that I should “stay in my lane” — how wrong to think that. It’s a problem for all of us in healthcare, and, for several reasons, especially for us ID-specialists.
Crystal Zheng and David Mushatt, two ID doctors from New Orleans, astutely make the case:
During the initial hospitalization, gunshot wounds can become infected, causing skin and soft tissue infections, as well as intra-abdominal, thoracic, and brain abscesses ….Long after the initial event, gunshot survivors with spinal cord injury face a lifetime of disability, marked by recurrent infections due to autonomic dysfunction, decreased airway clearance, sensory loss, and paraplegia. These patients are at increased risk for urinary tract infections, pneumonias, infected sacral ulcers, and chronic osteomyelitis. Infection is the leading cause of death in this population.
Most of the cases we see, of course, aren’t from mass shootings. Events like El Paso and Dayton (and Gilroy and Newtown and Orlando and Parkland and Charlotte and Pittsburgh and …) get the big news, but there are way more injuries and deaths from individual shotgun wounds happening every day and night somewhere in our country.
For the victim, it doesn’t matter if the injury is from a mass shooting, an unfortunate urban skirmish, a heated domestic squabble, or the result of a deranged individual who has ready access to a gun. Their lives are irrevocably changed if they survive, often with infectious complications.
Yes, if they survive. If they don’t, those left behind suffer unbearable sadness and trauma at the loss — family, friends, colleagues. We have personal recent experience at our hospital when, in 2015, one of our rising stars in cardiac surgery was shot during an outpatient clinic session.
Oh no not again.
But look — it doesn’t have to be this way.
After last weekend’s events, I tweeted about the New Orleans perspective piece cited above, and received this response:
I’ve not seen gun shot wounds in Australia, despite 35+yrs of clinical ID practice. But I looked after the Bali bombing burns/multi-trauma victims that were evacuated to Perth, in Australia. I’ve also seen every other type of multi-trauma & injuries that I can think of…
— Christopher Heath (@Christo37020634) August 7, 2019
That’s right — 35 years of clinical ID practice, no gunshot wounds. Other countries have angry people. Other countries have urban violence. Other countries have terrorists. But only in the United States can these lead to such efficient killing.
And it’s the easy access to guns that makes our country an outlier in gun violence. It’s that simple:
In 2017, we looked at possible explanations for why the U.S. has so many mass shootings. This is what we found. https://t.co/AzcBigwEaw
— The New York Times (@nytimes) August 3, 2019
I hope you’ll read the linked article, which debunks several popular alternative theories about why we have more gun violence (specifically mass shootings) than any other country. But if you don’t have the time:
Americans make up about 4.4 percent of the global population but own 42 percent of the world’s guns. From 1966 to 2012, 31 percent of the gunmen in mass shootings worldwide were American.
New Yorker writer Adam Gopnik has written frequently on this topic, perhaps because he lived in France, a place with far more sensible gun control. After the Orlando mass shooting in 2016, he wrote a piece called “One Person, One Gun” highlighting the horrible power we Americans grant our citizens — criminals, terrorists, people with mental illness, perpetrators of domestic violence — by giving them ready access to guns.
And it’s not just any handguns, but weapons designed for military use specifically to kill as many people as efficiently as possible:
So, yes, one person did do that, but it was a weapon that empowered him to do it—a weapon designed only for mass killing on the battlefield, a weapon so dangerous that soldiers keep their version locked up when not actually training with it, out of respect for its rapid-fire lethality, but a weapon that now, in Florida and elsewhere, can be placed freely and without constraints into the hands of almost anyone who wants one.
Last week, numerous medical organizations weighed in on the need for stricter gun control in this country, calling for specific actions that make so much sense it only adds to the pain that these restrictions are not already in place — among them, requiring background checks before sales, prohibiting gun ownership among those guilty of domestic violence, special regulation of high-capacity firearms, and removal of physician gag-orders on counseling about gun violence.
I can’t speak on behalf of the Infectious Diseases Society of America (our own medical society), even though I’m a member.
But I can unequivocally say that 100% of the ID clinicians I’ve spoken with agree that this is an urgent issue for all of us.
Take it away, Stephen. It may not be your funniest clip on the topic of gun control — search YouTube for “Stephen Colbert gun control”, there are plenty.
But it could be your most important.