March 14, 2001|11:15 PM

?Getting shot and being dead is certainly a clinical issue.? ? Dr. Jeremiah Barondess

Medical Machers Ask: Should Guns Be Part of Patient Profile?
by Josh Benson

If Jeremiah Barondess, the patrician elder statesman of the New York medical community, has his way, the average doctor?s examination in the near future will include questions not only about a patient?s consumption of red meat and alcohol, but of ammunition, too. Dr. Barondess, who is president of the august New York Academy of Medicine, thinks physicians should know if their patients have guns in the house. Some 600,000 doctors nationwide are seconding that opinion.

Under Dr. Barondess? direction, an organization representing approximately two-thirds of the practicing doctors in America is about to inject itself into the national debate on gun violence. Inviting the wrath of the gun lobby, the group not only will advocate further gun regulation, but will urge doctors to ask their patients specific questions about guns in their homes and tell them about the risks of gun ownership.

The Observer obtained a copy of a report put together by the ad-hoc coalition called Doctors Against Handgun Injury. In it, the group recommends that health professionals engage in what it calls ?upstream intervention??that is, using regular checkups as an opportunity to ask patients about firearm ownership and storage in their homes. ?To promote public safety, health professionals and health systems should ask about firearm ownership when taking a medical history or engaging in preventive counseling,? the report states. ?Patients should be provided with information about the risks of having a firearm in the home, as well as methods to reduce the risk, should they continue to choose to keep them.? The recommendation was based on an analysis of recent gun-related suicides, homicides and accidental deaths across the country.

The group is also calling for more conventional measures, such as mandatory background checks of purchasers at gun shows, limits on the number of guns that can be purchased by individuals and a waiting period for all gun buyers. This is the first time that such a large group of doctors has taken a position on gun control. Doctors Against Handgun Injury is made up of the American Medical Association, the American Psychiatric Association, the American Academy of Pediatrics and 10 other organizations.

Dr. Barondess, an author and medical-school professor with a reserved demeanor and a taste for starched shirts, tried to minimize the political fallout over his group?s report, describing the findings as purely clinical. ?We are neutral politically, academically and intellectually,? he said. ?Without politicizing this, it is possible for medical professionals to proselytize for this and point out the dangers of gun violence. Getting shot and being dead is certainly a clinical issue.?

Whatever the group?s intentions, the recommendations come in the wake of yet another public-school shooting?the early March incident in Santee, Calif., in which two students were killed. The double murder, allegedly carried out by a 15-year-old student armed with a handgun, has been seized upon by both sides in the contentious debate over gun regulation. And while the timing is coincidental, one of the organizers of Doctors Against Handgun Injury conceded that the report is almost certain to provoke strong reactions all around, and stiff resistance from the gun lobby in particular.

?The National Rifle Association will probably say that we?re threatening gun rights, no matter what,? said Robert Seltzer, the group?s executive director, who worked for almost two decades on Capitol Hill for a number of Democratic Senators. ?I?m sure they?ll say this is disgusting and wrong and bad, and that we?re trying to take away people?s guns?which we?re not.?

The proposals are expected to receive strong support from New York physicians. ?Disability and death from injury are the No. 1 problem for children and young people in United States, and a major piece of that is guns, so any objections wouldn?t even register with me,? said Katherine Lobach, a clinical professor of pediatrics at Montefiore Medical Center in the Bronx. ?I would hardly see it as a problem that doctors would be concerned with gun violence. I certainly hope that this becomes common practice.?

It may, but certainly not without a fight in those parts of the country where the gun culture is more prevalent. ?I think in New York this will all be pretty easy, but out west and even upstate, people and guns are a different story,? Dr. Lobach said.

The gun lobby already staunchly opposes one seemingly benign recommendation which would not directly affect gun owners?the collection of data on gun accidents by the federal government. (Such a program was created in 1992, but funding was discontinued by Congress in 1997 after heavy lobbying by the N.R.A.) Wayne LaPierre, the executive vice president of the N.R.A., has described such measures as the ?knock on the door in the middle of the night? that will inevitably lead to tighter restrictions or even a ban on the ownership of guns.

The doctors? report also is likely to face opposition from at least one group within the medical community. Doctors for Responsible Gun Ownership claims a membership of about 1,300 physicians and exists, according to its Web site, ?because social activists in the medical and public health fields have used their authority to misrepresent gun ownership as a disease.? Dr. Tim Wheeler, who heads Doctors for Responsible Gun Ownership, assailed the recommendations of the newly formed coalition. ?The reason that this group is getting involved in gun politics has nothing to do with public health,? Dr. Wheeler told The Observer from his home in California. (The N.R.A. referred calls about Doctors Against Handgun Injury to Dr. Wheeler.) ?Handgun ownership is not a medical issue and never has been, but is politicized by political activists and medical organizations. Most of the useful scientific research on handguns is not in the medical field but in criminology, and these medical groups have not only ignored but suppressed this information.?

Dr. Wheeler expressed particular alarm at the prospect of doctors mixing lectures about gun ownership into the standard checkup routine. ?This is a real hot-button privacy issue,? he said. ?When doctors talk about guns for political purposes, they are committing an unethical act, and their patients who are responsible gun owners feel violated. Most of these doctors don?t know squat about guns. They don?t know anything about personal safety, and they?re usually very hostile to gun ownership for political reasons.?

Dr. Barondess? vigorous assertions of respect for gun owners? rights?in an interview, he noted several times that many of the doctors in his coalition owned firearms?may do little to assuage the likes of Dr. Wheeler. But if he is in for heavy combat, Dr. Barondess will have some experience on his side. He is no stranger to controversy.

Washington?s Dentures

Dr. Barondess was responsible for transforming the 153-year-old New York Academy of Medicine from a sleepy repository for medical antiquities?the medical library at its East 103rd Street headquarters boasts both a 3,700-year-old papyrus and a set of George Washington?s dentures?into an active policy organization. A 76-year-old native New Yorker, a professor of clinical medicine at Cornell University Medical College and a co-author of The Oxford Medical Companion, he has used his stature to weigh in on an array of issues and thus raise the Academy?s profile.

Over the last decade, Dr. Barondess has spoken out on such issues as care for AIDS victims and hospital conditions for the urban poor. Most recently, he fueled a national debate over ergonomic standards in the workplace, when a panel he chaired issued a report on the scientific basis for such rules in January. Both the report?carried out under the auspices of the National Academy of Sciences?and Dr. Barondess? subsequent testimony before Congress have been cited by unions, business groups, U.S. Representatives and the federal Occupational Safety and Health Administration in support of their arguments. Just before leaving office, former President Clinton issued new regulations requiring employers to take action to prevent such ailments as repetitive-stress syndrome. Congress overturned those regulations in early March.

Dr. Barondess also gained attention in 1996 when he implored Supreme Court Chief Justice William Rehnquist to prohibit the legalization of doctor-assisted suicide. Before that, Dr. Barondess made his first major push into the area of gun violence, declaring on behalf of a coalition of New York?based medical officials that it had become an ?epidemic? in the city and surrounding area.

Dr. Barondess? statements, whether on gun violence or medical care in the inner city, appear to have a common thread: an expansion of the medical community?s role in shaping public policy. ?We are in the business of helping to redefine health in ways that would include any kind of population-based risks like, for example, handguns and workplace injuries,? he said.

With his Doctors Against Handgun Injury, however, Dr. Barondess has embarked on his biggest undertaking ever. He believes that the coalition will be by far the largest organization of doctors ever to offer a unified opinion on such a contentious issue. And although he refuses to discuss something as vulgar as political considerations??Let?s just say that some political figures appreciate what I have to say more than others,? he remarked?he can hardly doubt that, with George W. Bush in the White House and Republicans in control of Congress, most of his group?s recommendations are unlikely to become law anytime soon.

But Dr. Barondess believes that his group may be able to change the tenor of the discussion over gun violence. ?This is not in any way about gun control,? he said. ?We can think of handgun injury as being like a disease that afflicts many people in our society, and we?re going to introduce mandatory immunizations for this disease. Part of this mayhem is preventable, and doctors are in the prevention-of-premature-death business. The number of people killed by guns every year is indisputable, and criminal justice is not the only way of solving this.?

You may reach Josh Benson via email at: [email protected]

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