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On the six month anniversary of the massacre at Sandy Hook Elementary School, I can't help but note the incredible generosity of spirit seen across the country as well as right here in Newtown. In the midst of tragedy, so many stepped up to the plate to help. In that sense, 12-14 was not just a day of incredible loss, it was also a day to renew the human spirit, a day where first responders, strangers and neighbors all reached out to help.

One small example of that were the pediatricians in town, who have been working to heal our families since that day in as many ways as they/we can (see Sandy Hook pediatricians share grief, advice, hope 6 months after tragedy, just published in AAP News, made available to the public). Working with our local multidisciplinary group, the United Physicians of Newtown, and our professional organization, the American Academy of Pediatrics, we pediatricians have sought to emphasize the public health aspects of gun safety.

In remembrance of the Newtown six month anniversary, I had the opportunity to interview the President of the AAP, Thomas K. McInerny on this topic.

Daily Kos: As a Newtown resident, my own local physician group that formed in response, United Physicians of Newtown, made public health research the focus of our commitment to decreasing gun violence.  Our state AAP chapter has endorsed the same principle as has the American Society of Pediatric Surgeons, the American College of Emergency Physicians and others. The idea was that with more data, arguments and controversies can be more easily settled. The Institute of Medicine has recently laid out a research pathway for the next few years. Can you comment on AAP efforts in this regard, especially as it pertains to federal level measures?

Dr. McInerny: One of the first things AAP did in response to Newtown was to encourage the White House to lift the ban on federally funded gun violence prevention research. Dating back to 1996, Congressional restrictions on research and funding cuts have had a chilling effect that curtailed critical research and drastically limited the workforce in this field. It is estimated that fewer than 20 academics in the United States currently focus on gun violence research, and most of them are economists, criminologists or sociologists. It is no coincidence that while motor vehicle fatality rates are at an all-time low, gun-related deaths remain high and are on pace to outnumber traffic deaths in 2015.

The IOM’s new report outlines a strong agenda, but without federal funding it will be unable to come to fruition. The AAP is advocating that federal policy address gun violence with the same attention given to other successful public health initiatives over the past 25 years, such as motor vehicle safety, immunizations and public sanitation.

Last week, the AAP sponsored a pediatric community letter on gun violence research to the Chairmen and Ranking Members of the House and Senate Appropriations Subcommittees that fund health, education and labor programs. The letter makes the case for strong investments in public health research on gun violence at the CDC and NIH to cultivate the knowledge needed to craft effective public health policy.


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Daily Kos: The AAP has been working to reduce gun violence in children for many years. What’s your historical perspective on this? Has Newtown changed anything? How?

Dr. McInerny: Gun violence is unfortunately not a new threat to children’s health, and is certainly not a new area of advocacy for pediatricians. In fact, the AAP first established its firearms policy statement in the mid-1990s during the height of the gun violence epidemic. Pediatricians saw then what we see today: far too many children and adolescents are injured and killed from firearms.

Gun injuries cause more than twice as many deaths as cancer, five times as many as heart disease, and 15 times as many as infections, and are one of the top three causes of death among youth. Although pediatricians and others who care for children have been speaking out about the dangers of guns in children’s lives for decades, what Newtown did was awaken a national consciousness; the magnitude of what happened inside of Sandy Hook Elementary six months ago brought the conversation about gun violence from the halls of America’s emergency departments to the halls of our nation’s Capitol.

With this came new platforms and opportunities for ways to make our country safer.

Pediatricians around the country are deeply concerned about this issue because we witness it on a regular basis. As a result, they are uniquely suited to lead an advocacy charge to protect children from gun violence, whether counseling parents about gun safety, operating on children with gunshot injuries in the emergency room or ensuring that children and teens have access to comprehensive mental health services to meet their needs.

4,800 people have died as a result of gun violence since the Newtown tragedy. AAP’s priorities for Congress are strong gun safety laws, robust gun violence prevention research, and access to mental health screening and services for children. Such change will not happen overnight, but as AAP President, I am determined to continue this advocacy without pause or apology until real progress is achieved.

Daily Kos: How do we best move from firearms policy statements (AAP, Oct 2012) to implementation in pediatric offices?

Dr. McInerny: We have learned that when pediatricians provide gun safety counseling, parents listen. Consistent  with the 2012 firearms statement, AAP clinical guidelines encourage pediatricians to counsel parents and children about the dangers of firearms and how to store guns safely (unloaded, locked, stored separately from locked ammunition) to prevent accidents and reduce suicide risk. The guidelines also address the importance of making sure that youth who may be suicidal do not have access to a firearm, and the dangers of violence and interpersonal conflict. It is important for pediatricians to talk with parents and children at developmentally appropriate stages to highlight potential dangers with firearms, in the same way that they counsel about bicycle helmets, car seats and pool safety.

Daily Kos: AAP has been a champion on physician rights (and not just for pediatricians!) pertaining to physician gag laws and educating our colleagues about the centrality of anticipatory guidance. Do you worry about federal level gag orders modeled after the 2011 Florida law that the courts struck down? Is this a battle that is ever over?

Dr. McInerny: Interference in physicians’ right to counsel their patients sets a dangerous precedent that could prevent doctors from sharing sound scientific information with patients. Asking about guns in the home is not emotionally charged in the exam room; it’s a routine part of pediatric care, no different than when we ask parents about safety seats in the car, whether there are household chemicals in easy-to-reach locations, or what the temperature is of the home’s hot water heater. If legislators can decide that they oppose physician counseling about one health risk, there is nothing to stop them from attempting to do the same with others. And that is a real threat to children’s health and pediatricians’ ability to keep them safe.

In June 2012, a U.S. District Court judge granted a permanent injunction to block a Florida law that would have restricted pediatricians from asking about firearms in the home. The legislation would have restricted physicians, nurses and other medical staff from asking a patient and patient’s parents about firearms and would have sent physicians accused of violating the law before the Florida Board of Medicine for disciplinary action. Following the passage of the law, the Florida chapters of the AAP, American Academy of Family Physicians and the American College of Physicians, along with six individual physicians, filed suit against the law. The judge sided with the medical community, ruling that the law interfered in the patient-physician relationship and harmed patients by imposing restrictions that prevent them from hearing important preventive health messages from their physicians. Though Alabama, Minnesota, North Carolina, Oklahoma, Tennessee, and West Virginia have introduced similar bills in 2011 and 2012, Florida is the only state that has enacted legislation restricting physician speech on firearm safety counseling.

While AAP believes this battle should be over, pediatricians remain vigilant in our opposition to any attempts to curtail our ability to provide the best medical care possible to children.

Daily Kos: What can parents and lay people do to help the AAP work for rational and sensible gun policy?

Dr. McInerny: There are many things parents and lay people can do to work for sensible gun policy. They can reach out to their federal legislators and urge a new way forward on strong gun safety legislation to keep children safe in their homes, schools and communities. They can also write opinion pieces to their local papers about the public health effects of gun violence and the importance of stronger laws. They can hold and attend events to educate members of their community about the public health toll of gun violence.

For those who do own firearms, this also means being sure to follow proper safe storage practices and encourage others to do so as well. Safe gun storage can reduce the risk of youth injury and suicide by more than 70 percent. One study found that in twelve states where such laws had been in effect for at least one year, unintentional firearm deaths fell by 23% from 1990-94 among children under 15 years of age (Fleegler, Eric et al. Firearm Legislation and Firearm-Related Fatalities in the United States. Journal of the American Medical Association Internal Medicine. Published Online March 6, 2013).

Specifically, this coming Friday, June 21, the AAP will join a national campaign sponsored by the Center to Prevent Youth Violence reminding parents about the importance of asking if there are guns in the homes where children will be playing. The campaign, National ASK Day, kicks off on the first day of summer as parents across the country are gearing up for a summer of play dates and family visits for their children. Keeping children and teens safe from preventable injuries is one of the most important things we do as pediatricians—we ask parents about guns just as we ask about swimming pools, car seats, and other safety issues. Parents should feel comfortable asking each other about these things as well. To learn more, parents can visit www.cpyv.org/programs/ask/parents/ask-day/.

Daily Kos: What has AAP done to push for federal policy reforms since Newtown?

Dr. McInerny: To date, nearly 400 pediatricians have gone to Capitol Hill since the Newtown tragedy to urge federal legislators to pass strong gun safety legislation like stronger background checks, anti-trafficking measures, and an assault weapons ban; provide funding for public health research on gun violence; and improve access to needed mental health services to address the effects of exposure to violence.

In addition to those efforts, the AAP sent a letter to the White House regarding gun safety and a letter to Vice President Biden from the pediatric community. I participated on behalf of AAP in the White House Task Force on Gun Violence Prevention’s health organizations session, which HHS Secretary Sebelius led, outlining the need for a comprehensive pubic health approach to gun violence. In addition, the AAP has convened a coalition of health professional, public health, and child advocacy organizations focused on addressing gun violence as a public health issue. The group has met with White House staff to discuss public health priorities related to the president’s plan to address gun violence and has met with senators to discuss gun violence prevention legislation. AAP sponsored a letter signed by 21 of the groups that urges senators to address gun violence as a public health issue.

Pediatricians can’t single-handedly prevent mass shootings or other violent acts from taking place. But through strong, persistent advocacy and reformed policies, we can place children’s needs square in the middle of media coverage and at the top of state and federal policy agendas. Our number one goal is to keep children safe. Six months after Newtown, we have not lost sight or that goal or our resolve to achieve it.

Daily Kos: Thank you, Dr McInerny.

Extended (Optional)

Originally posted to Daily Kos on Sun Jun 16, 2013 at 06:00 AM PDT.

Also republished by Repeal or Amend the Second Amendment (RASA) and Shut Down the NRA.

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