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<\/a><\/p>\nPhysicians support proposed gun legislation – VTDigger<\/a>.<\/p>\n I’m going to take a break from working on clinical validation of ECG systems and toss in my perspective here. \u00a0Since I’m wearing my clinical hat today, I’ll take it from that perspective. \u00a0Forgive me for speaking to him in his language…<\/p>\n First, you’re making a common clinical mistake. \u00a0Treating the presentation rather than the underlying etiology. \u00a0We learned the danger of that back when I was doing cardiac drug trials. \u00a0Give the patient anti-arrhythmics to make the arrhythmia go away and the V-tach and V-fib goes away. \u00a0Sounds good until the CAST study (in which I was also involved) proved that not only were we ineffective by only treating the symptom, but we were exacerbating the problem by causing proarrhythmic deaths. \u00a0This is repeated over and over in medicine. \u00a0For long term efficacy, you need to treat the cause. \u00a0Guns are merely a mechanism of violence, not a cause of violence. \u00a0In your demographic guns are a major mechanism – a presentation, but only at about a 50% level. \u00a0Considering the high number of other presentations, there is no reason to presume that removing the guns will reduce mortality and every reason to believe that mortality will change presentation.<\/p>\n Now, you talk about preventative intervention in removing guns from those with high risk factors. \u00a0Prophylaxis is a valid means of intervention, however correct use is typically a mitigation of the risk factors. \u00a0Based upon your criteria, a case could be made for prophylactic appendectomy for the general population. \u00a0Should we also do preventative CABG based simply on risk factors and not as a treatment of documented CAD?<\/p>\n Again, if you want to treat gun violence, it is necessary to focus on the underlying etiology – violence<\/em> rather than the presentation. \u00a0That is simply a matter of good clinical practice. \u00a0What studies have been conducted to review the cause of the underlying violence? \u00a0What would be the appropriate intervention to address those causes? \u00a0Rather what ethical methods are available for intervention? \u00a0There are many unethical methods. \u00a0Those are no more acceptable gun prohibitions with regard to violating patient rights.<\/p>\n Second, with regard to self inflicted injury and suicide, there is certainly precedent of restricting an individual’s rights or freedom due to a clear and present danger of self injury. \u00a0However, this is always within a framework of due process. \u00a0More important, such intervention is always made in the context of treatment with the objective being the restoration of the restricted freedom or rights. \u00a0Follow-up must be mandatory in that regard. \u00a0If the clinical presentation no longer indicates the risk, then the gun right should be immediately restored with their other liberties. \u00a0There is no ethical clinical indication for a multi-year waiting period, as is often imposed for mental health issues.<\/p>\n With regard to the recommendation of extended background checks, the research presented notes that there is no indication of the extent of effect of the intervention. \u00a0Particularly important, as in all medical treatment, is compliance. \u00a0Interventional policy without sufficient evidence of efficacy is not sound medicine. \u00a0Since several states have implemented the checks proposed the appropriate studies should be possible. \u00a0Indeed, in Illinois where background checks for all sales is a recent implementation, this check is recent enough that a prospective study should be able to be developed to test the effectiveness of the checks against recent historical data. \u00a0Epidemiological data should also be sufficiently available to assess compliance as a subcomponent of such a study. \u00a0Data should also be collected to determine the scope of such checks that would be most appropriate. \u00a0I.e. gun type, age, race and income of purchaser, residence, social history, etc. \u00a0It is entirely possible that the data would indicate intervention needed in only specific demographics. \u00a0In such case, there is no need to create an undue burden for the populace at large and to restrict the checks to only those high risk cohorts. \u00a0If the objectives are clinical outcome, this would be sufficient.<\/p>\n To close, one must serious consider the degree of burden the proposed intervention presents. \u00a0Excluding the suicide where the patient is under active care with the endpoint of restoration of rights as suggested above, homicide by gun accounts for only 0.43% of death in the United States according to 2013 CDC data. \u00a0For such a small demographic it is necessary to question the justification for a large social engineering program that will negatively impact between 37-44% of of households according to recent studies by Pew and Gallup, respectively. \u00a0The only way to ensure the necessary compliance would be blanket registration of all guns.<\/p>\n Note: one limitation of this analysis to be considered is that it focuses on mortality and does not take into account non-fatal injury. \u00a0Another limiting factor is that the data discussed includes all gun fatality. \u00a0It does not, for example, distinguish between legal homicide (self-defense) and illegal murder. \u00a0This may skew the interpretation of the data.<\/p>\n Abuse of clinical authority is a particular pet peeve of mine. \u00a0While I’m not an M.D., I have been involved in clinical research from a research assistant through a clinical scientist to a investigational sponsor for over 30 years. \u00a0Articles and statements like this doc gives makes us all look bad.<\/p>\n","protected":false},"excerpt":{"rendered":" Physicians support proposed gun legislation – VTDigger. I’m going to take a break from working on clinical validation of ECG systems and toss in my perspective here. \u00a0Since I’m wearing my clinical hat today, I’ll take it from that … Continue reading