海角大神

Dean Winslow sat before the Senate Armed Services Committee last fall as President Donald Trump鈥檚 nominee to serve as the Pentagon鈥檚 top health official. His confirmation hearing, occurring two days after an Air Force veteran shot and killed 26 people inside a Texas church, appeared routine until a senator asked a question about the gunman鈥檚 military discharge status.

Dr. Winslow, a professor of medicine at Stanford University who deployed six times to Iraq and Afghanistan with the Air National Guard, offered his thoughts on the military鈥檚 discharge system. The retired colonel then added a personal aside听born of outrage at the country鈥檚 latest mass shooting.听

鈥淏ut I also would like to 鈥� and I may get in trouble with other members of the committee 鈥� just say how insane it is that, in the United States of America, a civilian can go out and buy a semi-automatic assault rifle like an AR-15, which apparently was the weapon that was used,鈥� he said.

The trouble arrived within moments. The late Sen. John McCain, (R) of Arizona, the panel鈥檚 chairman and a longtime gun supporter,听reproached听the nominee. 鈥淒r. Winslow,鈥� he said, 鈥淚 don鈥檛 think that is your area of responsibility or expertise.鈥�

McCain鈥檚 admonition foretold the end of Winslow鈥檚 nomination. The committee placed an indefinite hold on his appointment, and he withdrew from consideration a few weeks later.

But Winslow鈥檚 comment gave rise to an idea that could have deeper impact. He harnessed his frustration over mass shootings to co-found听Scrubs Addressing the Firearm Epidemic听(SAFE), a nationwide coalition of physicians, nurses, and other health care providers, along with medical students and professors. The nonprofit group supports public health research to shape strategies for reducing gun violence and advocates for public policy to encourage firearm safety.

鈥淲hat happened at my confirmation hearing really galvanized me,鈥� Winslow says. 鈥淎 lot of us in health care have seen what guns do to the human body up close, and it鈥檚 not pretty. We need common sense ways to address the problem.鈥澨�

SAFE has established chapters at medical schools in 16 states that will hold campus events on Sept. 17 to bring attention to the cause. The group joins a growing number of organizations formed by physicians in recent years to approach gun violence as a public health crisis. Their efforts sidestep politics and instead focus on gathering data to arm doctors with treatment guidelines for responding to a national scourge that claimed听38,658 lives听in 2016.

鈥淧hysicians and health care workers deal with the effects of guns every day,鈥� says Dr. Christopher Barsotti, who last year co-founded the听American Foundation for Firearm Injury Reduction in Medicine听(AFFIRM) in Williamstown, Mass. 鈥淪o the question is how to mitigate those effects upstream from policy. And the answer is that we need high-quality research, and we need a lot of it.鈥�

鈥榃e鈥檙e just guessing鈥櫶�

Congress gutted funding for gun violence research more than 20 years ago. Lawmakers passed an听amendment听to a spending bill in 1996 that barred the Centers for Disease Control and Prevention from seeking to 鈥渁dvocate or promote gun control鈥� and eliminated funding for firearm studies.

The chilling effect proved immediate and lasting, and in another setback for scientists, funding has expired for a National Institutes of Health gun research听program听launched in 2012. That further curtailed the agency鈥檚 limited work in the field aside from an听initiative听to examine gun-related deaths and injuries among children and a smattering of smaller projects.听

The gun lobby鈥檚 success in pressuring legislators to slash federal funding has听forced听physicians听to rely on听stale data听about听the causes and effects of gun violence in a country where civilians听own听more than 393 million firearms. Stephanie Bonne, a trauma surgeon at University Hospital in Newark, N.J., explains that doctors,听hampered by听decades-old statistics, struggle to identify, treat,听and refer听patients听who might present a threat to themselves or others.听

鈥淚f we don鈥檛 have the evidence, we鈥檙e just guessing,鈥� she says. For Dr. Bonne, co-chair of a听gun violence prevention task force听that the American Medical Women鈥檚 Association created in 2015, the daily flow of shooting victims through the trauma center reveals the human cost of outdated research.

鈥淵ou feel so helpless as a physician because these wounds are just so devastating,鈥� she says. 鈥淚t鈥檚 so frustrating to talk to families and mothers over and over and tell them their children are dead from gunshot wounds.鈥�

The campaign to cast gun violence as a public health crisis parallels earlier crusades that raised awareness about the hazards of smoking, unprotected sex, and failing to wear a seat belt. Yet broaching the topic of firearms with patients poses a dilemma for doctors because of the lack of evidence-based treatment practices and the country鈥檚 radioactive gun debate.

Suicide by firearm听accounted听for almost 23,000 deaths in 2016, or 63 a day. Dr. Barsotti, an emergency physician at hospitals in western Massachusetts and southern Vermont, recalls a pair of recent cases involving patients who had shown signs of suicidal intent. He found himself unsure of how 鈥� or whether 鈥� to talk about guns with them or their families even in the context of suicide.

鈥淲e have treatment guidelines for everything 鈥� alcoholism, opioid addiction, cancer,鈥� he says. 鈥淏ut we don鈥檛 have any for this really pressing issue that has a tremendous impact on health care.鈥�

The听Violence Prevention Research Program听based at the University of California, Davis launched an听initiative听earlier this year that offers suggestions to health care providers for discussing guns with at-risk patients, including counseling them on firearm safety. The Davis program听houses听a second research听center听devoted听solely听to gun violence that opened last summer with a five-year, $5 million grant from state lawmakers.

Prevention groups led by physicians seek to raise state and private funding for听firearm听research听that would help medical professionals update treatment methods.听Megan Ranney, the co-founder of AFFIRM and an emergency physician at Rhode Island Hospital in Providence, describes the opposition in Congress to funding gun studies as misplaced.

鈥淩esearch isn鈥檛 for or against gun control. It isn鈥檛 political or partisan,鈥澨齭he says.鈥淎t its core, it鈥檚 about saving lives.鈥澨�

Cold, hard, nonpartisan facts

Winslow served as commander of an Air Force hospital in Iraq in 2008, and in that role, he听signed the death certificates of US troops killed in combat and those who died by suicide. The sight of young lives cut short by their own hand influenced his perspective on firearm safety.

The annual toll of听civilian听suicides and a听litany听of mass shootings in recent years听inspired SAFE and convinced him听that the听harm听wrought by firearms deserves status as a public health priority.听

鈥淲e have a gun violence epidemic in this country that we can鈥檛 afford to ignore. We don鈥檛 want any more children to die,鈥� Winslow says. Mindful of the polarized nature of the gun debate, he regards the听high public standing听of physicians, nurses, and other health care practitioners as a buffer against charges of partisanship as SAFE and similar groups nurture research efforts.听

鈥淯ltimately, people always bring politics into the discussion with guns,鈥� he says. 鈥淏ut my hope is that the credibility of physicians will help defuse some of the political concerns.鈥�

The American Medical Association, American Public Health Association, and other major medical groups have declared gun violence a national crisis, advocating for legislative听reforms听and federal funding of firearm听research.

Lobbying听by prominent health care organizations听contrasts with the听neutral line听of nonprofits that doctors have formed in recent years. They听view听their mission asdefined by gun violence rather than gun ownership.

鈥淚t should be no different than talking about cars as a potential mechanism of injury,鈥� Dr. Ranney says. 鈥淲e can acknowledge that guns are allowed by the Constitution and still talk about how to keep people safe. These things are not mutually exclusive.鈥�

The听rallies听held听in Washington and cities nationwide to protest gun violence听earlier this year听after the fatal shooting of 17 people at a high school in Parkland, Fla.,听failed to persuade Congress to consider new gun laws.

The inertia has motivated a handful of听states听to act. David Studdert, a professor of medicine and law at Stanford University, asserts that the prospects of policy change at the state level could improve as SAFE, AFFIRM, and other organizations amass fresh data on gun violence.听

鈥淭he political climate is not really ripe for federal legislation,鈥� says Dr. Studdert, who has joined researchers at UC Davis to听analyze听whether owning a gun in California affects the likelihood of a person鈥檚 death. 鈥淏ut what happened after Parkland shows there is momentum for change, and physicians are a powerful constituency. White coats showing up in Sacramento could make a difference.鈥�

In his work with AFFIRM, Barsotti, a gun owner, skirts mention of the Second Amendment to avoid provoking suspicions about the group鈥檚 purpose. He believes cold, hard, nonpartisan facts will light the path to reducing gun-related deaths and injuries by grounding the decisions of policymakers in research instead of rhetoric.

鈥淚t鈥檚 specious when talking about violence prevention to say that physicians want to take away guns,鈥� he says. 鈥淲e鈥檙e focusing on science and knowledge. Science informs policy and law. It always has in America.鈥�