Doctor’s Orders

National Review Online, April 15, 2001

If you thought that the million moms were bad, just wait until you hear from the six hundred thousand docs. Next time you go for a check-up, you just might. Doctors Against Handgun Injury (a new coalition of organizations representing two-thirds of this country's physicians) is suggesting that "health professionals and health systems should ask [patients] about gun ownership when taking a medical history or engaging in preventive counseling." By itself, intrusive questioning is not enough, of course. The interrogation has to be followed by a lecture. "Patients should be provided with information about the risks of having a gun in the home, as well as methods to reduce the risk, should the ignorant peasants continue to choose to keep them." OK, so I added in the "ignorant peasants," but, have no doubt, a snooty assumption of technocratic superiority is indeed what underpins this latest anti-gun initiative. To the folks at DAHI, the rate of gun-related injury is an epidemiological issue, and like any other infectious disease, it is best to leave its control to the medical profession. It is a ludicrous argument, but to the people making it, it comes with one great advantage: Skill with the scalpel or the stethoscope is magically transformed into the right to act as an arbiter in a far wider field than the ER or the hospital ward. Those who are not as qualified are expected to watch in awe as these lab-coated loudmouths issue their self-important prescription for "public safety," a series of policy initiatives that have little or nothing to do with the practice of medicine.

With the exception of the proposed weapons counseling, DAHI's prescription itself is fairly standard gun-control boilerplate, the usual thin end of the anti-Second Amendment wedge. DAHI's agenda includes an extension of the Brady background checks, restrictions on the number of guns that can be bought within a given period, and, of course, that stalker-friendly favorite, the imposition of an interval "between the time an individual purchases a weapon and the time s/he takes possession of it."

As ideas they are nonsense, of course, but what makes these suggested "interventions" (as they are pretentiously labeled) particularly offensive is the way that they are an abuse of the aura and the authority of the physician. By pretending that these measures are a "healthcare" issue, DAHI is attempting to push through a partisan program without the bother of going through the normal political debate. Such debate may be messy, but it is essential part of democracy. These lordly doctors, seem to above such petty considerations.

Perhaps even worse, they also appear to consider themselves to be above the standards of accuracy and objectivity that we are traditionally entitled to expect from our physicians. To take a couple of examples, visitors to DAHI's website will, amid talk of "carnage," grudgingly be told that there has been a fall in gun-related deaths since 1993. It is explained, however, that this fall is at least "partly" attributable to the Brady Law. The fact that the decline began a year or two before the law came into force is not referred to, nor is there any analysis of how many lives might be saved by the defensive use of guns. Similarly, there is plenty of focus on accidental death from firearms, but no mention of the fact that, between 1980 and the late 1990s this total fell by nearly a half, despite rapidly rising levels of gun ownership. Tragic though it is, the death toll from firearms accidents is smaller than that from drowning, burning, or even simply falling over. It is not much larger than the number who come to their end while engaged in recreational boating, and it is less than one-thirtieth of the total killed in motor vehicle accidents.

DAHI's selective use of statistical data might be acceptable in the normal course of political polemic, but coming from people who are portraying themselves as participants in this debate on the basis of their "expertise and experience as physicians," it is a disgrace. DAHI tell us that "presenting basic facts and helping patients make informed decisions" is part of the doctor's job. If their website is any indicator as to how they judge the "basic facts," these physicians have a very strange way of going about their work.

After seeing what he had to say to the press, I would not even accept an aspirin from one of DAHI's leaders, Dr. Jeremiah Barondess, without a second opinion. In an interview with the New York Observer, Dr. Barondess, president of the important-sounding New York Academy of Medicine, felt able to claim that the pressure group was "neutral politically, academically and intellectually," an assertion that reveals the contempt he must feel for the reasoning powers of that newspaper's readers.

The extent of DAHI's "intellectual neutrality" can be seen from its approach to the "basic facts" discussed above. Quite what is meant by "academically neutral" is unclear, but it seems to include the publication of a key position paper that manages to cite such sources as the New Republic, the ABA's Coordinating Committee on Gun Violence, Congressman Patrick Kennedy, Senator Robert Torricelli, the Center to Prevent Handgun Violence, the American Prospect (twice), the Handgun Epidemic Lowering Plan, and the Cincinnati Post. The work of prominent gun-control skeptics such as Yale's John Lott Jr. does not, however, even merit a mention. Professor Lott is not alone. There's no room for the work of obscure gun-control skeptics, either. What of DAHI's supposed political neutrality? Of all the politicians who have looked into the issue of gun control, the organization only chooses to quote two liberal Democrats.

Dr. Barondess prefers, of course, to avoid such matters, preferring to repeat DAHI's dishonest dogma, "handgun injury…is like a disease…and we're going to introduce mandatory immunizations for this disease." It is difficult to decide which is the more repellent, the fraudulent assertion of "neutrality" or the creepily totalitarian claim that "we" are going to introduce these "mandatory" immunizations.

It can be no surprise, therefore, that in their legislative crusade, DAHI's physicians reveal a fundamental misunderstanding of the doctor/patient relationship. As private individuals they are free to campaign for any legislation that they choose, but when they do so in their capacity as doctors, they should take care. Laws are coercive. The physician who uses his professional qualification to press for DAHI-style legislation is, essentially, arguing that he has the right to tell his patients what to do. This is not what doctors are for. The role of a physician is to listen, to diagnose, and to give advice. A course of treatment is a suggestion, not an order. It must, in the end, be left to the patient, however misguided, to decide what to do.

That would be true, even if the advice were good. In this case it could be lethal. The proposed legislative changes will make it harder for law-abiding people to exercise their Second Amendment rights, something which flies in the face of evidence that such a development may in fact cost lives, evidence that Dr. Barondess and his friends are either too arrogant to consider or too disingenuous to discuss.

Worst of all, even if DAHI is unsuccessful in promoting its legislative agenda, the organization's supposedly objective "counseling" will, in the meantime, be likely to discourage people from keeping the means of self defense that they already have. As is noted on the DAHI website, "there is precedent for the view that [the counseling] would be helpful…in the context of removing guns from the home." That is probably right. To the people in their care, doctors can be very persuasive, especially when the "basic facts" are presented in such a one-sided way. And when patients are misled on the advantages and disadvantages of gun ownership, truth may not be the only casualty.

Bullying someone into giving up an effective means of self-defense may prove, quite literally, fatal. For the patient, that is. The consequences for the doctor will be rather less severe. In an unlikely, but deserved, worst case, he may risk a malpractice lawsuit, a threat to livelihood rather than life. Presumably it is in response to this somewhat remote danger that DAHI's cyber-offering includes the disclaimer that, "nothing in this web site is intended to be construed or to serve as a standard of medical care." Like all the best disclaimers, it contradicts everything that has gone before.

But it's a start.