In November 2018, the National Rifle Association (NRA) taunted physicians by tweeting, “Someone should tell self-important anti-gun doctors to stay in their lane.” In response, physicians, including psychiatrists, insisted that firearm death, suicide, injury, and trauma are indeed our lane. Both before and after the NRA warned us not to cross their imaginary line, physicians and our professional organizations increasingly have been calling for gun violence to be addressed as a public health crisis and have been proposing interventions to stem the tide of blood.
The American Psychiatric Association has been a leader in confronting the problem of gun violence, the leading cause of preventable injury and death in the US. Each year, firearms kill close to 40,000 people and injure another 70,000. Two thirds of all firearm deaths, the largest single category, are firearm suicides.
In 2014, the APA issued a position paper (and updated it in 2018) calling gun violence a public health problem in need of immediate action.1 In 2015, the APA along with eight other professional medical organizations jointly issued a “Call for Action,” advocating policies intended to mitigate the rate of injuries and deaths due of firearms.2 In 2019, the APA participated in a medical summit of 44 major medical and injury prevention organizations to address the gun violence problem.3
The APA and other medical, injury prevention, and public health organizations have advocated for a number of actions: expanding background checks; requiring waiting periods on all gun transactions; requiring safe storage of all firearms in the home; banning assault weapons and high-capacity magazines; and allocating funding for federal firearms research. Many of these measures are widely supported by the American public across party and demographic lines. A September 2019 poll found that 86% of Americans support implementing red flag provisions allowing law enforcement to temporarily seize guns from people in crisis. Similarly, 89% support expanding federal background checks to cover private sales and gun-show transactions.4
Although the cultural status quo on gun reform is shifting, the political status quo, at least on the federal level, continues to block any legislative intervention. The nonpartisan Center for Responsive Politics (opensecrets.com) estimated that during the 2016 election, the NRA and its affiliates spent a record $54 million to secure Republican control of the White House and Congress, including at least $30 million to help elect Donald Trump. Thus, these politicians’ investment in (and defense of) the political status quo from which they personally benefit may have become more obvious but is hardly surprising.
In contrast, most psychiatrists are likely to be surprised to find that the APA’s Political Action Committees (PAC) contributes more money more often to the campaigns of federal politicians whose positions do not align with the APA’s stated public health policy on firearm regulation reform compared with those who do. In their study of the PAC donation patterns of the 25 largest professional medical organizations regarding firearm safety, Schuur and colleagues5 found that the APA PAC donated $172,500 to NRA A-rated candidates for Congress, and $154,500 to candidates with any other rating (B-F) in the 2016 election cycle. Politicians with NRA A ratings can be counted on to oppose evidence-based firearm regulation, to vote reflexively against gun reform legislation, to blame gun violence on people with mental illness, and to continue to deny federal funding for firearm research.
Dr Gold is Clinical Professor of Psychiatry, Georgetown University, Washington, DC.
1. American Psychiatric Association: Position Statement on Firearm Access, Acts of Violence and the Relationship to Mental Illness and Mental Health Services.
2. Weinberger SE, Hoyt DB, Lawrence HC, et al. Firearm related injury and death in the United States: a call to action from 8 health professional organizations and the American Bar Association. Ann Intern Med. 2015: 162:513-516.
3. Bulger EM, Kuhls DA, Campbell BT, et al. Proceedings from the Medical Summit on Firearm Injury Prevention: A Public Health Approach to Reduce Death and Disability in the US. J Am Coll Surg. 2019.
4. DeBonis M, Guskin E. Americans of both parties overwhelmingly support “red flag” laws, expanded background checks for gun buyers. Washington Post. September 9, 2019.
5. Schuur JD, Decker H, Baker O. Association of physician organization affiliated political action committee contributions with US House of Representative and Senate candidates’ stances on firearm regulation. JAMA Network Open. 2019;2:e187831.
6. Neufeld MY, Sanchez SE, Siegel M. Firearm policy: physician organizations’ role in political action committee funds, 2018. Am J Pub Health. September 19, 2019 [Epub ahead of print].
7. Sharfstein JM, Sharfstein SS: Campaign contributions from the American political action committee to members of congress: for or against the public health. N Eng J Med. 1994;330;32-37.