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Doctor Calls For ‘Systemic Change’ to Decrease Gun Violence

By Cheryl Bettigole, MD, MPH

As physicians, some of us have the job of rising in the middle of the night to try to reverse the havoc that bullets make in the bodies of teenagers, many of whom are barely old enough to shave.  Others of us treat the traumatic wounds that gun violence causes in families who have lost fathers, brothers, and sons –- and less often mothers, sisters, and daughters — to bullet wounds.  Like the young men who often need a lifetime of care for their wounds, these families are never quite whole again, and the results show in their high blood pressure, and in worsening poverty that results from the loss of a wage earner.

Homicide is the second leading cause of death for youth ages 10 to 24.  Eight-two percent of these deaths are firearm-related.  Yet since 1994, Congress has systematically denied funds to the Centers for Disease Control for any research on gun violence and its prevention.   By contrast, the country has made significant investments in preventive research about motor vehicle accidents, the leading cause of death in this age group.  Based on this research, experts have been able to implement changes in the safety of our roadways, our cars, and driving regulations for teenagers that have significantly decreased deaths from car crashes.  It is time for physicians to speak out against the suppression of research on gun violence and the lack of common-sense safety regulations regarding guns.

Dr. Cheryl Bettigole

The death rate from gun violence in the US is as high as the total of that of the next 25 developed nations.  In 2009, the United Kingdom had 18 gun homicides and a total of 155 gun-related deaths.  The numbers for the US that year were 11,101 gun homicides and 32,163 total gun deaths.  Other industrialized countries report numbers much closer to those of the UK than the US. Through the private sale loophole, 40% of guns are sold without any kind of background check, allowing ex-cons, the mentally ill and even terrorists to have free access to weapons of astounding, destructive power.

In schools of public health, there is a parable often told to first-year students that speaks to this need for preventive action…. A man, standing on a riverbank, sees a child floating down the river.  He jumps in and saves it.  No sooner has he rescued the child, when he sees another child also floating down the river.  And then another.  He keeps jumping in the water and rescuing children, exhausting himself.  It finally occurs to him to go upriver and find out how the children are falling in the water in the first place.  As physicians who treat victim after victim, we must go upstream as well.

Just as it took systemic change to decrease deaths from motor vehicle accidents, it will take systemic change to decrease the epidemic of gun-related deaths.  It is unacceptable for Congress to suppress research on this important public health issue, and we need to say so.  We should research the efficacy of technical devices (such as protections that enable a gun to be fired only by its rightful owner) and we should press our lawmakers to require the use of simple devices that have the potential to save lives.  We should defend the doctor-patient relationship from statehouse over-reach, firmly opposing any laws that threaten physicians with fines, disciplinary action, or loss of license if they ask patients about gun ownership.   Clinical free speech is fundamental to providing patients fully informed consent; such politically motivated laws have dangerous implications that extend well beyond the gun debate.   Just as the second amendment right to bear arms does not trump the right to life, liberty, and the pursuit of happiness, neither does it trump the right to free speech guaranteed in the 1st amendment.

As physicians, most of us are more comfortable taking care of patients than speaking or writing publicly.  Yet after the Newtown shooting, which has affected many of us deeply, it is time for us – who see the impact of gun violence on our patients and their families – to engage in this public debate, along with the hunters, sportsmen, and majority of NRA members who believe that reasonable protections can and should be sought with a non-partisan commitment to the safety of our communities.   Gun makers’ lobby groups have controlled and even prevented conversations about gun safety for too long.  Enough is enough.   Physicians need to demand evidence-based solutions and the research freedom to find them.   Together, we can take on this tragic public health crisis that kills 30,000 people each year in our nation, including 2000 of our children.  We cannot satisfy ourselves with working harder and harder to pull the children out of the river – we need to walk upstream to the bridge, find the causes and effective solutions to the violence, and prevent our children from being put in harm’s way.


Cheryl Bettigole, MD, MPH, is President, National Physicians Alliance.


  1. This is one of the dumbest comments I have read in the gun control coversatio:

    “When the LAW ABIDING Citizen is permitted to carry a concealed weapon, the criminal is more at risk for being harmed as well, and frankly, his risk goes up. He is less likely to risk injury.”

    If the weapon is concealed how does the “criminal” know the LAW ABIDING Citizen is carrying a weapon? The criminal is pre-disposed to use his weapon, probably a whole lot better at using it and since he has no reason that chance to think the LAW ABIDING Citizen is armed, he is not at all deterred. He may or may not shoot the LAW ABIDING Citizen, but if the LAW ABIDING Citizen draws a weapon, it’s lights out.

    Maybe what you really meant to say that the concealed weapon shouldn’t be concealed — then I think you might have a point. Strp it on like in the the old west. OK corrals everywhere.

    The Doctor gave a very learned and informed response. To quibble about the actual number of gun deaths when they are at the U.S. scale is disrespectful of all who have been victims.

    Oh, and about cars: yes a lot of people die in vehicles not designed for the purpose of killing another human being. It’s an unintended consequence of human behavior.

    Guns on the other had have only one purpose — to kill.

    • Steve, if you think my comments are dumb, you should be listening to some of Vice President Biden’s comments. Of course, you don’t respond with anything to add to the conversation, you only respond with insults. Very good contribution to this problem.

      Of course, the good doctor speaks of evidenced based medicine, how do you practice evidence based medicine when the evidence you are using for decision making is wrong to begin with.

      For you to state that the doctor gave a very leaned informed response when her information is not just a little bit wrong, but she used numbers that are four times higher than the actual number shows how biased and flawed your thinking truly is. Evidenced based medicine is based on true evidence and not some flawed number that she pulled out of a rabbits hat.

      I was not speaking of open carry at all. We can look at Chicago where there are no carry laws and until 2010, no one was permitted to own a firearm. The criminals are shooting and killing with impunity. Chicago with their stringent gun laws is now rated as the number 1 most dangerous city in the US. So far 46 were killed in Chicago in January alone. How is it possible that last year, the Chicago Police confiscated over 7,000 weapons when there are not supposed to be weapons?

      Wisconsin and Kansas allowed concealed carry in the past two years and both have experienced dramatic drops in crime. Criminals don’t know who is carrying a concealed weapon and who is. Thus the risk is higher for injury to them.

      In 1991 when Miami Florida experienced a high rate of foreigners being killed they leaned that the perpetrators were targeting rental cars leaving the airport because Florida had very liberal concealed carry laws and they knew if they were coming from an airport, they were not carrying a weapon. This is what prompted the rental cars to remove their rental labels from the trunks of the cars.

      I can also go back to January of 1994 when my date and I were being followed by 8 individuals for blocks in the historic district in Philadelphia. We couldn’t find a police officer so we were heading in the direction of the Police Administration building. These guys were now about 30 to 40 feet behind us. We could hear what they were going to do to me (cut my throat) and what they were going to do to my date (all sexual)

      I finally turned around and drew my weapon and was ready for a fight. Once they saw I had a weapon, one said the MFer got a gun, lets leave them alone. They then casually walked away.

      The point is that I had a weapon and was capable of using it to defend us from being attacked. The 8 guys choose to leave since they didn’t want to get hurt or killed.

      I believe in my heart of hearts that my wife and I are alive today because I had a weapon and was able to defend myself on the streets of Center City Philadelphia.

      As for your comment about cars, I agree that cars have a wonderful intended purpose, however when you mix a car with a drunk, there are deadly consequences. Perhaps we should go back to prohibition? If we prohibit alcohol, wouldn’t that eliminate the problem of drunk driving?

  2. First and foremost Doctor, if you want to practice evidence based medicine, you should start with evidence based facts. According to the Justice Department Federal Bureau of Investigation, there were 9,199 gun homicides and not 11,101 gun homicides in 2009.

    The FBI is the Federal Agency charged with collecting all crime data which is required to be reported by every law enforcement agency in the United States.


    You also state there were 32,163 total gun deaths. I would love to know where you get these numbers as I suspect it came from a rabbit’s top hat. How is that possible Doctor? If according to the FBI 9,199 were murdered with firearms, you must be suggesting that (22,964)approximately 2.5 times the number who were killed in homicides (9,199)were killed accidentally? A preposterous number and I would challenge you to produce your reliable source of that information. If you tell me it comes from the CDC, my answer to you is that the CDC is not funded to collect actual numbers and I would suggest to you that those numbers are extrapolated and not accurate. The FBI on the other hand is funded to collect crime data and is required by statute to do so.

    Your comment that 40% of gun sales are made without a background check has been debunked numerous times as being false but those of you who oppose firearms continue to cite it. If my memory serves me correctly, I believe this number actually originated with either the CDC or the United Nations and the number was actually 37.6 and VP Biden rounded the number up to 40%

    As you look at this chart provided by the FBI, please take note that the rate of homicide has been declining every year for the past 6 years. It went from 10,225 in 2006 to 8,583 in 2011 which amounts to an 8.4% decline. While I would agree with you that that number is still too high, it is certainly an improvement and no where reflects the numbers that you have provided.

    You might wonder why the numbers have declined? There are many theories out there but one of those theories is that in the past 6 years, numerous states have liberalized their firearm laws and made it easier for the law abiding citizen to obtain and carry concealed weapons. We need to look no further than Chicago that in 2012 was named the Murder capital in the US with over 500 deaths. The problem with Chicago is that Chicago prohibited firearms until 2010 when the Supreme Court in McDonald v. Chicago overturned the complete prohibition on possession firearms in the home. However, Chicago in their effort to keep guns out of the city established so many rules in owning a firearm, it became extremely difficult and expensive for the law abiding citizen to purchase a firearm. If firearms are prohibited, how did over 500 people in Chicago get murdered?

    Next we can look at Washington DC, another City often named on the “murder capital” list. They too prohibited the possession of firearms until Heller v. DC was heard in the Supreme Court and overturned their laws. Now people may at least have them in their homes and now the murder rate in DC has declined.

    I believe it was in 2011 or 2012 that the Chief of Police in St. Louis Missouri called for law abiding citizens to obtain concealed carry permits because they had a high murder rate with firearms. St. Louis had been named on the “murder capital” list several times. Since the Chief made his statement, the crime rate has begun to decline in St. Louis.

    Do you see a common theme here? Where LAW ABIDING Citizens are permitted to have a firearm and carry concealed, the murder has declined. You might ask why? Well, it has been suggested that criminals don’t want to get hurt when they work their trade. When the LAW ABIDING Citizen is permitted to carry a concealed weapon, the criminal is more at risk for being harmed as well, and frankly, his risk goes up. He is less likely to risk injury.

    I think it is ironic that you cite the UK because after they completely banned the possession of firearms UK’s gun ban completely backfired. The UK banned handguns in 1997. They now lead Europe in violent crime, and even have more crime than South Africa and North America. The UK violent crime rate increased by 89% since the handgun ban in 1997.

    Despite the UK having the most restrictive gun laws on earth, in 2010, a mentally sick man shot 23 people with a bolt-action rifle and a shotgun. These are guns that anti-gunners generally think are “safer” than “mean” looking guns like what they call “assault weapons” which are not assault weapons at all.

    Of course, it doesn’t matter — when you have a man with a gun shooting at a defenseless person, the man with the gun wins. When you’re shooting unarmed people, any weapon will do. That’s why in gun-controlled China a man knifed over 20 children on the same day as Sandy Hook tragedy.

    If people can’t shoot back, then the mass killers don’t need to worry about where to strike. They can kill anyone, anywhere — they’re the only ones with the gun.

    Throughout history, tyrants have always known this. That’s why the Jews were disarmed. That’s why communists impose gun control. That’s why Chinese gun control is so strong. That is why they instituted gun control in Cambodia and Uganda and the Government leaders then executed millions of their own citizens.

    We had 32,000 auto deaths in the United States in 2011 and of those more than 13,000 (more than 1.5 times the number killed by firearms) of those deaths were caused by drunk drivers. We also had over 1,000,000. people die from tobacco related deaths. Perhaps as Physicians, your focus in saving lives should be directed where you can get the most bang for the buck.

    As far as practicing evidence based medicine, your evidence must first begin with accurate data.

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