Whats everyones thoughts on this?
http://www1.mosby.com/scripts/om.dll/serve?arttype=full&article=a9182403
To the Editor:
I am writing in regard to the editorial by Bradley in the July issue entitled “ACEP Endorsement of the EAST Position Paper on Firearms Violence” (Ann Emerg Med 1998;32:79-92). I have 2 concerns regarding the editorial. The first is the belief that the firearm is the central element of interpersonal violence. It is certainly easier to place blame on an object that cannot argue back. I agree that firearms make killing easier and that there are horrible accidents that are bound to happen with a device such as a firearm; however, I believe you are missing the point if you blame the gun and do not place some blame on the person. If you place a loaded handgun in the middle of a room, nothing bad will happen until it is touched by a human hand. After all, if a drunk driver kills a family of 4, or a mother allows her child to go without a seat belt, do we blame Ford, Chevrolet, or another manufacturer ... or do we blame the person behind the wheel? There have been great strides made in this country in regard to drunk driving and seat belt use through education. In the article, there is one small piece devoted to education; the rest is devoted to making it harder to buy and sell a firearm. Why don’t we make firearms illegal ... that would stop all crime ... just like marijuana is illegal and nobody uses it any more. Do you really think that the criminal element (of which, is responsible for the most deaths and injuries) would stop using firearms because they are harder or more expensive to buy? The only people affected would be the law-abiding citizen who has no intention of holding up a liquor store. Why not look at a means to educate the public in the uses and dangers of firearms? Give away trigger locks free with the purchase of a firearm—that may help with the small percentage of accidents in the home. Go to the inner cities and set up educational programs and activities for the young adults, give them someone to look up to and admire. Of course, these ideas would cost money, not MAKE money, like a tax placed on a new firearm.
The second concern regarding the editorial is the manner in which ACEP agrees with the paper. It sounds as though ACEP is trying to “fit in” or be a “buddy” to the Eastern Association for the Surgery of Trauma (or maybe to the surgery field as a whole). I think that ACEP can make its own decisions and should involve more members, not just a small committee, to make a decision such as this. I certainly do not agree with the paper, nor do I agree with the idea of “rolling over” to have our bellies scratched by another medical field.
Firearm violence should certainly be addressed in this country; however, we are missing the point. Until someone realizes that there are human beings behind every shooting, whether intentional or not, nothing will be solved. To borrow a phrase from a redneck somewhere in this great country, “guns don’t kill people, people kill people.”
Charles W Brian, MD
Department of Emergency Medicine
Akron General Medical center
Akron, OH
--------------------------------------------------------------------------------
In reply:
Thank you for the opportunity to reply to Dr Brian’s letter about my editorial in the July issue of Annals.
Clearly, the issue of preventing injury by gun is one that engenders controversy. A close reading of the EAST Position Paper brings forward a strong case, based on the literature, to refute Dr Brian’s first concern that interdicting the gun will not have an effect on firearms injuries.
The analogies that Dr Brian cites bear some examination. He equates the gun to a blameless object, using the automobile as a comparison. Cars are indeed an apt example to demonstrate the appropriateness of the EAST Position Paper’s proposals:
Comprehensive studies on the causes of injuries from motor vehicle crashes have resulted in changes that have been effective.
There are databases on a variety of aspects of motor vehicle crashes that have given us information impelling corrective action.
Campaigns to enhance automobile safety have been successful.
The National Highway Traffic Safety Administration (NHTSA) is a centralized government agency that addresses automobile issues.
Potentially dangerous or irresponsible individuals are not allowed to drive cars.
The manufacture of automobiles is strictly regulated to meet safety standards.
Cars are registered, owners tested and licensed, and dealers regulated to ensure a safe vehicle and its use.
The manufacture and sale of cars is taxed.
Manufacturers, dealers, and owners are liable for their actions that cause damage or injury.
Cars have been substantially modified to improve their safety.
Mandatory sentencing for crimes such as drunk driving and failure to properly restrain passengers is becoming the norm.
Cars must be properly maintained to minimize environmental contamination.
Substitute “gun” for “car” and its synonyms and you mirror the 12 recommendations of the EAST Position Paper. What has been successful in reducing motor vehicle injuries can and should be applied to firearms, as well.
Dr Brian compares laws against marijuana use with making guns illegal. The EAST Position Paper does not take the more radical step of calling to make private gun ownership illegal. Putting aside whatever position one has on the decriminalization of marijuana, it would be hard to argue that marijuana being illegal does not inhibit its use throughout the population. If, as Dr Brian postulates, guns were illegal, it would be very likely that the number of guns available to, using his words, “make killing easier and ... horrible accidents that are bound to happen with a device such as a firearm” would also be less.
The “criminal element,” theoretically unaffected by gun regulation, is responsible for less than 30% of deaths by firearms. To follow Dr Brian in borrowing a phrase, a favorite bumper sticker of mine is “If guns are outlawed, then only outlaws will have guns ... and we’ll know exactly who they are and arrest them!”
Important components of the EAST Position Paper address the aspects of the multifactorial nature of violence and call for a “national campaign against all aspects of violence.” Injury prevention models have taught us that there are complex interactions involved in a traumatic event. But to ignore the gun, the instrument of injury whose presence clearly escalates the catastrophic potential, would be losing the simplest and more direct opportunity to halt the morbidity and mortality from these events. Working hard to remedy the myriad of elements contributiing to interpersonal violence is essential. However, there is a quantum leap in bad outcomes from fists, sticks, and even, knives to when the gun is involved.
Dr Brian’s second concern, specifically about how the ACEP endorsed the EAST Position Paper, has 2 elements: the process of this endorsement and the concept of endorsement at all.
The process of endorsement, as described in the editorial, followed a demanding path through the appropriate channels of the organization to the Board of Directors. The side-by-side comparison of the ACEP Council Resolutions and Board-approved Policies and the recommendations in the EAST paper unequivocally demonstrates that ACEP has supported similar positions long before being asked for the endorsement by EAST. Then, to be sure that working together with other organizations and doing so specifically on the issue of preventing firearm injuries was embraced by the College, a resolution on the question was brought to the Council. This resolution began by citing the EAST Position Paper as its stimulus. The resolution was overwhelmingly approved. Only after this rigorous process had been followed over the course of more than 2 years did the Board of Directors approve the endorsement.
Dr Brian’s viewpoint that ACEP’s endorsement of the EAST Position Paper is “‘rolling over’ to have our bellies scratched by another medical field” shows that you can interpret the same information in opposite ways. Saying that someone’s beauty halts the march of time or that their face would stop a clock gives the same information, but a very different message. I would offer that this endorsement represents a collaborative effort that speeds up the march of time toward a new, more effective way for our and other specialties within the house of medicine to improve the public health.
As an emergency medicine resident in the days before our recognition as a specialty, I can empathize with Dr Brian’s “us versus them” perspective. However, emergency medicine has grown beyond that siege mentality. ACEP, as the representative organization for emergency physicians, is strong enough, mature enough, and secure enough that we can take the high road when asked to help on such a patient-centered issue. The old turf battles are giving way. Forging this path of working together with our surgical and other colleagues is the paradigm of the future. Synergistic outcomes are enhanced by allied efforts; poor outcomes by isolated, duplicative undertakings.
Great energy will be placed into the battle to prevent firearms injuries. Much as opposition to smoking in the 1950s and 1960s was seen as impolitic, impossible, and not an issue for the medical community, so is firearms control often viewed today. If our colleague physicians in those decades past had led the attack against cigarettes, think of the millions of lives that would have been saved. We have the opportunity to make part of that same impact on future firearms injuries by advocating for sensible gun regulation. Joining EAST in this effort does credit to ACEP and to us as emergency physicians.
Keith Bradley, MD, Chair
ACEP Violence Prevention Committee
Department of Emergency Medicine
Bridgeport Hospital
Yale University Emergency Medicine
Residency Program
Bridgeport, CT
--------------------------------------------------------------------------------
------------------
Dead [Black Ops]
http://www1.mosby.com/scripts/om.dll/serve?arttype=full&article=a9182403
To the Editor:
I am writing in regard to the editorial by Bradley in the July issue entitled “ACEP Endorsement of the EAST Position Paper on Firearms Violence” (Ann Emerg Med 1998;32:79-92). I have 2 concerns regarding the editorial. The first is the belief that the firearm is the central element of interpersonal violence. It is certainly easier to place blame on an object that cannot argue back. I agree that firearms make killing easier and that there are horrible accidents that are bound to happen with a device such as a firearm; however, I believe you are missing the point if you blame the gun and do not place some blame on the person. If you place a loaded handgun in the middle of a room, nothing bad will happen until it is touched by a human hand. After all, if a drunk driver kills a family of 4, or a mother allows her child to go without a seat belt, do we blame Ford, Chevrolet, or another manufacturer ... or do we blame the person behind the wheel? There have been great strides made in this country in regard to drunk driving and seat belt use through education. In the article, there is one small piece devoted to education; the rest is devoted to making it harder to buy and sell a firearm. Why don’t we make firearms illegal ... that would stop all crime ... just like marijuana is illegal and nobody uses it any more. Do you really think that the criminal element (of which, is responsible for the most deaths and injuries) would stop using firearms because they are harder or more expensive to buy? The only people affected would be the law-abiding citizen who has no intention of holding up a liquor store. Why not look at a means to educate the public in the uses and dangers of firearms? Give away trigger locks free with the purchase of a firearm—that may help with the small percentage of accidents in the home. Go to the inner cities and set up educational programs and activities for the young adults, give them someone to look up to and admire. Of course, these ideas would cost money, not MAKE money, like a tax placed on a new firearm.
The second concern regarding the editorial is the manner in which ACEP agrees with the paper. It sounds as though ACEP is trying to “fit in” or be a “buddy” to the Eastern Association for the Surgery of Trauma (or maybe to the surgery field as a whole). I think that ACEP can make its own decisions and should involve more members, not just a small committee, to make a decision such as this. I certainly do not agree with the paper, nor do I agree with the idea of “rolling over” to have our bellies scratched by another medical field.
Firearm violence should certainly be addressed in this country; however, we are missing the point. Until someone realizes that there are human beings behind every shooting, whether intentional or not, nothing will be solved. To borrow a phrase from a redneck somewhere in this great country, “guns don’t kill people, people kill people.”
Charles W Brian, MD
Department of Emergency Medicine
Akron General Medical center
Akron, OH
--------------------------------------------------------------------------------
In reply:
Thank you for the opportunity to reply to Dr Brian’s letter about my editorial in the July issue of Annals.
Clearly, the issue of preventing injury by gun is one that engenders controversy. A close reading of the EAST Position Paper brings forward a strong case, based on the literature, to refute Dr Brian’s first concern that interdicting the gun will not have an effect on firearms injuries.
The analogies that Dr Brian cites bear some examination. He equates the gun to a blameless object, using the automobile as a comparison. Cars are indeed an apt example to demonstrate the appropriateness of the EAST Position Paper’s proposals:
Comprehensive studies on the causes of injuries from motor vehicle crashes have resulted in changes that have been effective.
There are databases on a variety of aspects of motor vehicle crashes that have given us information impelling corrective action.
Campaigns to enhance automobile safety have been successful.
The National Highway Traffic Safety Administration (NHTSA) is a centralized government agency that addresses automobile issues.
Potentially dangerous or irresponsible individuals are not allowed to drive cars.
The manufacture of automobiles is strictly regulated to meet safety standards.
Cars are registered, owners tested and licensed, and dealers regulated to ensure a safe vehicle and its use.
The manufacture and sale of cars is taxed.
Manufacturers, dealers, and owners are liable for their actions that cause damage or injury.
Cars have been substantially modified to improve their safety.
Mandatory sentencing for crimes such as drunk driving and failure to properly restrain passengers is becoming the norm.
Cars must be properly maintained to minimize environmental contamination.
Substitute “gun” for “car” and its synonyms and you mirror the 12 recommendations of the EAST Position Paper. What has been successful in reducing motor vehicle injuries can and should be applied to firearms, as well.
Dr Brian compares laws against marijuana use with making guns illegal. The EAST Position Paper does not take the more radical step of calling to make private gun ownership illegal. Putting aside whatever position one has on the decriminalization of marijuana, it would be hard to argue that marijuana being illegal does not inhibit its use throughout the population. If, as Dr Brian postulates, guns were illegal, it would be very likely that the number of guns available to, using his words, “make killing easier and ... horrible accidents that are bound to happen with a device such as a firearm” would also be less.
The “criminal element,” theoretically unaffected by gun regulation, is responsible for less than 30% of deaths by firearms. To follow Dr Brian in borrowing a phrase, a favorite bumper sticker of mine is “If guns are outlawed, then only outlaws will have guns ... and we’ll know exactly who they are and arrest them!”
Important components of the EAST Position Paper address the aspects of the multifactorial nature of violence and call for a “national campaign against all aspects of violence.” Injury prevention models have taught us that there are complex interactions involved in a traumatic event. But to ignore the gun, the instrument of injury whose presence clearly escalates the catastrophic potential, would be losing the simplest and more direct opportunity to halt the morbidity and mortality from these events. Working hard to remedy the myriad of elements contributiing to interpersonal violence is essential. However, there is a quantum leap in bad outcomes from fists, sticks, and even, knives to when the gun is involved.
Dr Brian’s second concern, specifically about how the ACEP endorsed the EAST Position Paper, has 2 elements: the process of this endorsement and the concept of endorsement at all.
The process of endorsement, as described in the editorial, followed a demanding path through the appropriate channels of the organization to the Board of Directors. The side-by-side comparison of the ACEP Council Resolutions and Board-approved Policies and the recommendations in the EAST paper unequivocally demonstrates that ACEP has supported similar positions long before being asked for the endorsement by EAST. Then, to be sure that working together with other organizations and doing so specifically on the issue of preventing firearm injuries was embraced by the College, a resolution on the question was brought to the Council. This resolution began by citing the EAST Position Paper as its stimulus. The resolution was overwhelmingly approved. Only after this rigorous process had been followed over the course of more than 2 years did the Board of Directors approve the endorsement.
Dr Brian’s viewpoint that ACEP’s endorsement of the EAST Position Paper is “‘rolling over’ to have our bellies scratched by another medical field” shows that you can interpret the same information in opposite ways. Saying that someone’s beauty halts the march of time or that their face would stop a clock gives the same information, but a very different message. I would offer that this endorsement represents a collaborative effort that speeds up the march of time toward a new, more effective way for our and other specialties within the house of medicine to improve the public health.
As an emergency medicine resident in the days before our recognition as a specialty, I can empathize with Dr Brian’s “us versus them” perspective. However, emergency medicine has grown beyond that siege mentality. ACEP, as the representative organization for emergency physicians, is strong enough, mature enough, and secure enough that we can take the high road when asked to help on such a patient-centered issue. The old turf battles are giving way. Forging this path of working together with our surgical and other colleagues is the paradigm of the future. Synergistic outcomes are enhanced by allied efforts; poor outcomes by isolated, duplicative undertakings.
Great energy will be placed into the battle to prevent firearms injuries. Much as opposition to smoking in the 1950s and 1960s was seen as impolitic, impossible, and not an issue for the medical community, so is firearms control often viewed today. If our colleague physicians in those decades past had led the attack against cigarettes, think of the millions of lives that would have been saved. We have the opportunity to make part of that same impact on future firearms injuries by advocating for sensible gun regulation. Joining EAST in this effort does credit to ACEP and to us as emergency physicians.
Keith Bradley, MD, Chair
ACEP Violence Prevention Committee
Department of Emergency Medicine
Bridgeport Hospital
Yale University Emergency Medicine
Residency Program
Bridgeport, CT
--------------------------------------------------------------------------------
------------------
Dead [Black Ops]