As an ACEP member, I share what many other members desire from membership: ACEP should make my life easier by seeking legislation and policies that make me work less hard, preserve our practice environment, and enhance our ability to care for our patients. That’s what people want. We did not join ACEP for broad-based, political advocacy. Thus, when ACEP gets involved in issues not specific to the practice of emergency medicine, such as the separating of families at the border, climate change, or the firearms issue, ACEP runs the risk of alienating a good number of members. In other words, emotionally charged issues, which are polarizing, can and often do become divisive, creating a “no win” situation for ACEP.
The firearms issue may, in some cases, be less about patient safety than about furthering a political agenda. If it were solely about patient safety, then we would look to the multitude of peer-reviewed articles and data analyses outside the medical literature that prove that gun control efforts are not effective in reducing crime and injury.
If we examine the issue of research, testimony by John R. Lott, Jr., president of the Crime Prevention Research Center, before the House Committee on Appropriations on March 7, 2019, clarified several important issues:
- The Dickey Amendment has been misinterpreted. It does not prevent (and has not prevented) firearm research. It merely states that the Centers for Disease Control and Prevention cannot advocate for gun control.
- After 1996, firearms research fell as a percentage of all research. However, this is artifactual because there was an increase in new journals and published articles, creating a larger denominator. Accounting for this, firearm research remained relatively constant from previous years.
- This has not been widely publicized, but there were three federal funding amendments for firearms research in 1996, 2003, and 2012.
- By 2013, the number of firearms articles rose to 121, to 196 in 2014, and to 344 in 2015.
- The share of federally funded research before 2000 was 2.9 percent, but after 2000 it was 3.3 percent. The share of research that mentioned any funding source before 2000 was 8.5 percent and 18.2 percent after 2000.
- In 2015–2018, the total federal funds for firearms research was $43.2 million, a 465 percent increase from 2011–2014, which resulted in 83 projects.
- One cannot apply the “medical method” of studying disease to studying firearm-related issues. (Incidentally, referring to firearm violence as an “epidemic” is erroneous and misleading because “epidemic” refers to a widespread occurrence of an infectious disease, not an action.)
- There is an abundance of firearm literature outside medicine in the economics and criminal justice literature that is peer-reviewed and scientifically sound, but is often ignored by those in medicine. These links direct to the Crime Prevention Research Center (https://crimeresearch.org/cprc-research/ and https://crimeresearch.org/data/) and a policy analysis from the Cato Institute. They are a good starting point for a review from “the other side.”
The directive followed by the ACEP task force when creating the existing firearms policy in 2013 was not to “legislate” or contradict existing laws. Thus, if we examine legislative issues, ACEP recently advocated for H.R. 8 (requiring a background check for every firearms sale). Unfortunately, the support for that bill may not effect the desired change, because it still does not prevent criminals from obtaining firearms.
Interestingly, California recently decided that a ban on high capacity magazines (more than 10 rounds) is unconstitutional. Should ACEP’s current firearms policy be updated to delete the referral to “high capacity magazines” in the last bullet?
I would prefer ACEP concentrate its efforts on the many challenges before us to make our lives easier, such as protecting patient’s rights, advocating for access to emergency care, preserving the interests of emergency physicians, ensuring fair reimbursement, etc. We need to stay out of divisive politics and issues.
Dr. Coppola is chair of the ACEP Leadership Development Advisory Committee and Compensation Committee; past ACEP Council Speaker; brigadier general, commanding, Texas Medical Brigade/Medical Component Command of the Texas State Guard, Texas Military Department. Disclosure: He chaired the task force that created ACEP’s current firearms policy in 2013.