How Doctors Can Address Gun Violence: Lessons from Tobacco


It is emotion, not reason, that drives belief.

People defend their beliefs with reasons, but they are really rationalizations – conscious explanations for unconscious causes.

This is how we vote; this is how we believe or do not believe in religion; this is how we take sides on a multitude of social and cultural issues.

A century of psychiatric knowledge and research, including twin studies, supports these statements. Twin research unravels the genetics of environmental sources of behavior, and such studies showed that social and political attitudes are almost purely family, inherited from one’s family or immediate subculture. If you are raised by people who like tobacco or guns, you are much more likely to like tobacco or guns, and vice versa if you are raised by people who don’t. It is not a matter of personal decision-making, logic, facts or reason.

Keep this concept in mind as we pose the question: What can doctors do to address gun violence in the United States?

The doctor’s role is not only to treat a single patient’s illness, but also to prevent the patient from entering the practice in the first place. We need to promote health, not just treat disease. We have to stop the shot wound to happen around the corner, not just treat it once it reaches the emergency room. Public health is part of clinical medicine.

We have dealt with this kind of problem before, with more success with smoking. Physicians were at the forefront of tobacco control in the face of a powerful and wealthy lobby, the tobacco industry. His political allies were mostly in the southern states where tobacco was grown and were mostly on the conservative end of the political spectrum.

Armed violence is analogous. There is a powerful industrial lobby of firearms manufacturers backed by political allies, mostly on the conservative end of the political spectrum and mostly located in southern states.

I went to medical school in Richmond, Virginia, home of the Philip Morris tobacco company, the largest in its industry. Tobacco was king in Virginia politics, but at our hospital at Virginia Commonwealth University, most doctors wore a small button on the lapel of their white coats that depicted a cigarette with a red diagonal across it. The message was simple: doctors opposed tobacco because it was harmful to public health; it killed people.

I imagine a similar possibility today. Medics could walk around with a small button showing an AK-47 rifle crossed out with a red diagonal line. The message would be: Doctors oppose firearms, especially semi-automatic rifles, because they are harmful to public health; they kill people.

Like tobacco, guns should not be a political issue. Doctors are not very politically active, with drop in voting rates than the general public.

Doctors are also politically dividedwith about half of doctors making campaign contributions to Republicans and the other half to Democrats.

Medical political views reflect those of the general population: those with the highest incomes – surgeons – are the most conservative, while those with the lowest incomes – pediatricians and psychiatrists – are the most liberal. In short, as citizens, physicians reflect the general population; as twin studies show, they believe what their family believed. But as doctors, committed to the principles of science, we have other standards.

Regardless of their personal political views, almost all physicians are opposed to tobacco. It should be the same with firearms.

If we’ve learned anything from the COVID pandemic, it’s that scientific facts are not influenced by anti-science cynicism, whether held by supposed progressives who reject the “Medical Establishment” or by conservatives. who distrust the government. Regardless: COVID infects progressives and conservatives alike. Firearms kill anyone, regardless of an individual’s social or economic status.

Doctors can undermine the false argument that guns are safe. Guns kill just as tobacco causes cancer and heart disease. There is nothing certain in either one. Sure, people use weapons like people smoke cigarettes. But the person does not cause cancer, the person does not kill; gun and cigarettes do. Of course, other factors are relevant, such as psychiatric illness; psychiatrists would be the first to welcome more funding to treat psychiatric illnesses. But research shows that people with mental illnesses are no more likely to be violent than others overall, and that the last common pathway – excessive access to firearms, especially the semi-automatic type – is where intervention can be most effective.

The success of the anti-tobacco campaign shows how things can go. Doctors influenced public opinion to such an extent that it became less popular; people know that smoking is harmful to them and to others. They can always choose to smoke, but they can’t pretend it’s safe.

It should be noted that tobacco consumption has really declined not through moral suasion but through coercion – the effect of class action lawsuits against the tobacco industry by state attorneys general. But there was no longer any scientific defense for the tobacco industry. Eventually the tobacco industry had to admit that cigarettes were harmful and that they had been lying about it for half a century. The same could happen with firearms.

Yet it is a free country.

I tell my patients this all the time. I give you my best medical opinion based on the best scientific evidence I know and my best clinical judgment and experience. I could be wrong, of course, but I give you my best opinion for your personal benefit, not mine. I’m not the patient, you are. But you are free to reject this advice. You are free to do, in my opinion, the wrong thing.

We can take the same approach for firearms. You, as a patient, may like to hunt, so you have guns. You might think, for some reason, that most people should have access to all kinds of weapons, including semi-automatic rifles designed for human warfare, not animal hunting. You can choose to buy such weapons. But I will always wear my little button and tell you that excessive access to guns is harmful.

In other words, doctors can and should use their scientific knowledge to weigh in on the facts. We can’t tell people what to do, but we can tell them what is medically true. Firearms are harmful to public health in the same way as tobacco.

Our role is not moral: we are not saying that it is wrong to use guns or that it is wrong to smoke cigarettes. Our role is informative: we say what is true and what is not true, as a matter of scientific fact.

We won’t convince most of our patients to change, because we humans don’t reason; we rationalize. No one will be convinced logically or by moral suasion to change their position on guns, just as they did not change their views on tobacco.

But by disproving the factual claim that guns are safe, doctors can remove one more piece of a crumbling foundation to champion gun violence, and when the larger culture finally decides to constrain the gun industry firearms, whether through prosecution or through a later change in the law, it will be that much easier.

Humans won’t change their minds. But doctors can pass on scientific truth until society dictates a change in behavior.

It’s a free country, but scientific truth is not a matter of popular vote.


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