According to a recent study by the World Health Organization, Americans are 25 times more likely to be victims of a gun related murder and 8 times more likely to commit suicide by firearm than the citizens of other developed countries. Is there a way for us to come together and change these sad statistics?
Like most trauma surgeons, MarinHealth’s Dr. John Maa has operated on his share of gun violence victims. In this podcast, Dr. Maa discusses his recent article in the New England Journal of Medicine. The article makes a powerful case for reframing the national firearms debate as a public health issue. Regardless of where you stand on gun control, this podcast will give you a lot to think about.
Selected Podcast
Gun Violence Prevention: A Trauma Surgeon Weighs In
Featured Speaker:
John Maa, MD
John Maa, MD is a Trauma Surgeon at Marin Health. Transcription:
Gun Violence Prevention: A Trauma Surgeon Weighs In
Bill Klaproth (Host): Americans are 25 times more likely to be victims of a gun related murder and 8 times more likely to die by firearms suicide than people in other developed countries according to a study by the World Health Organization. So, is a possible US Surgeon General’s report on firearm violence prevention, what’s needed to address this concern? Well let’s find out with Dr. John Maa, the Immediate Past Chief of the Division of General Surgery at MarinHealth Medical Center and the 2018 Past President of the San Francisco Marin Medical Society. He is also a trauma surgeon at MarinHealth.
This is The Healing Podcast from MarinHealth. I’m Bill Klaproth. Dr. Maa, thank you for your time. So, in an article that you wrote, that was published in the New England Journal of Medicine, you say the increases in the frequency and lethality of mass shootings in the United States and the approximately 90 gun deaths that occur each day, argue for efforts to reframe the national debate about firearms as a public health issue. Is that what it’s going to take to establish thoughtful gun control in the United States?
John Maa, MD (Guest): The New England Journal of Medicine article reflects my personal belief that reframing the conversation as a public health challenge will identify new solutions and lead to a deeper understanding of the problem and to allow our nation to move the needle forward in discussing this very important public health topic.
Host: So, in the past, a Surgeon General’s report has been used to influence a national discussion about a public health issue such as back in 1964 the Surgeon General’s report on smoking and health. What is the stumbling block? Why is there no Surgeon General’s report on gun violence?
Dr. Maa: I believe that one of the major challenges to a US Surgeon General’s report has been the politics on Capital Hill. After he left office, US Surgeon General C. Everett Koop, tried to issue standards for firearm ownership and maintenance of certification to own a weapon but he had left the office of the US Surgeon General at that time and the idea didn’t catch national attention. There are very powerful forces on Capital Hill that would oppose the concept of the US Surgeon General’s report. During his Senate confirmation hearing, then candidate Vivek Murphy was criticized for his social media postings about the topic of firearm injury prevention. I believe that it will take a multiyear effort to have a US Surgeon General’s report commissioned by the White House, but I think that this is an ideal time to begin the request and the conversation now. The 1964 report actually began with a request from the American Heart Association among other organizations to President John F. Kennedy in 1961. And so it took a number of years before that report was finally commissioned. I think this is a wonderful time now to begin the series of communications and requests to the White House to have a US Surgeon General’s report on firearm injuries to be conceptualized and finalized.
Host: And since the majority of Americans want smart gun control laws, do you see any progress in that direction and ultimately for this to happen, doesn’t Congress have to get serious about this?
Dr. Maa: I believe that there is strong support as reflected in California with the passage of Prop 63 in 2016 with bipartisan majorities both Democrats and Republicans urging commonsense firearm safety reform. You are correct that the next steps would be movement through Congress and it’s reassuring that Congresswoman Robin Kelly from Chicago has introduced House of Representatives bill 1114 which would require the US Surgeon General to report annually on firearm injuries to Congress. That bill has passed through committees in the House of Representatives but would then need to move to the United States Senate and ultimately to be signed by the White House. I believe this is an ideal time to begin this multiyear process and to continue and extend it and to build consensus towards that reality.
Host: And building consensus is what we need but any thoughtful discussion about gun control has to include this, how much of a factor is the NRA with their massive lobbying efforts to protect what they feel is a trampling of their Second Amendment rights when it comes to gun control?
Dr. Maa: The NRA is a very powerful and effective force for advocacy and lobbying both in Congress and in our state legislatures. They too have struggled with the COVID pandemic leading to the cancellation of their national convention this year and also a number of layoffs and staff furloughs. I believe that their power and influence in Congress is waning. And I believe that firearm safety advocates could actually learn from the very successful strategies that the NRA has utilized both in the courts and also legislatively and it is my hope that firearm safety advocates can apply those legislative strategies to adopt new laws which will protect the public health across America.
Host: So, it sounds like you feel we are slowly moving in the right direction.
Dr. Maa: I believe that our nation has taken important steps forward during the Trump administration. Interestingly, President Trump signed an executive order banning the sales of bump stocks and also eliminated the restrictions of the Dickey Amendment on Federal Funding of CDC research into firearm injuries. There actually has been movement in the direction of firearm safety during this White House administration and I believe that the COVID pandemic also highlights the important role that state, local and federal governments can play in protecting the public health and I believe that if we are able to commission a US Surgeon General’s report to better understand the challenges to identify new solutions when they are prepared and presented to Congress and to our state governments there might be the consensus to have them adopted into law. I think there is reason to be optimistic.
Host: So even with incremental progress to this point, it really sounds like we need this Surgeon General’s report to fully lay out the complex problem and issues of gun violence in America and really help us understand how we got to this point and then serve as a wake up call for our local, state and federal officials.
Dr. Maa: That’s absolutely correct. The New England Journal of Medicine article is actually inspired by a conversation with President Barack Obama who suggested that the relationship between firearm ownership and gun injuries might be as strong as the connection between smoking and lung cancer. Essentially, he was proposing that the firearm was the factor and I think if we commission a US Surgeon General’s report, undertake a global international comparison, dispel myths and come to a deeper understanding of the problem that we’ll be able to identify solutions that we currently cannot see as a nation. The US Surgeon General’s report on smoking and health in 1964 would lead to 40 subsequent reports that characterized the impact on children, on pregnant mothers, of secondhand smoke which really enabled our nation over the decades to better understand the health hazards associated with cigarette smoking. To commission a first US Surgeon General’s report, as a part of a path and process forward over the upcoming years, it will be essential to illuminate in the conversation about firearm safety in America.
Host: And part of that illumination comes with more understanding and seeing research and data on the effects of gun violence. Earlier you mentioned the Dickey Amendment which had restricted federal funding of firearm safety, apparently that is lifted now. Can you tell us more about that and the effects that will have?
Dr. Maa: The restrictions of using federal funding for CDC research have been lifted by President Trump. The CDC will be funding studies within academic medical centers into this important topic. I don’t believe there’s plan for the CDC to undertake it’s independent report at this time, but it may be a recommendation of a US Surgeon General’s report. The Surgeon General and the CDC would work in partnership, but we haven’t quite reached the point where a CDC report on firearm injuries has yet been commissioned.
Host: So, we’ve been talking a lot about the government up until this point. What are some of the other ways or ideas that may help with a solution to this problem?
Dr. Maa: I think there are many valuable lessons from tobacco control and one of the powerful tools we have within hospitals are smoking cessation services. Once we have a better understanding of the epidemiology and the contributing factors to firearm violence and especially repeat injury, I think we’ll be able to use a public health lens and to have firearm violence prevention services within hospitals to provide counseling and to prevent individuals who are at high risk from suffering repeat injury.
I think that looking around the world to some of the public health strategies that have been utilized by other nations to balance responsible firearm ownership and to reduce the burden of firearm mortality should be adopted in the United States. Another primary concern is the circulation and trafficking of illegal weapons into other nations. There’s only one site in Mexico where firearms can be legally purchased, and it’s estimated that several hundred firearms flow from the United States illegally across the border into Mexico each year. It’s estimated that several hundred firearms flow from the United States into Mexico each day and it is also believed that many of these firearms then flow further south into Latin America and to Central America. I believe that a transnational multinational partnership to understand the vector, the firearms that are being circulated across national borders similar to the COVID pandemic would enable us to address this as a public health challenge around the globe.
Host: A multinational coalition would certainly go a long way in helping solve this problem. And as we wrap up Dr. Maa, and thank you for your time, any final thoughts on firearm violence prevention?
Dr. Maa: My hope is that professional health organizations like the American Medical Association will issue a call to the White House for the commissioning of this type of report. That would be a very powerful voice and for our nation’s top doctor, the US Surgeon General to join in that effort would be a very powerful next step to having this report be fulfilled hopefully in the next three to five years. another alternative would be for a state Surgeon General to commission a report within their individual state as a foundation for a future national US Surgeon General’s report on this topic.
Host: And that is something to hope for. This has been a great discussion Dr. Maa. Thank you so much for your time. We appreciate it.
Dr. Maa: Thank you for your interest as well.
Host: That’s Dr. John Maa and for more information please visit www.mymarinhealth.org. And if you found this podcast helpful, please share it on your social channels and checkout the full podcast library for topics of interest to you. This is The Healing Podcast brought to you by MarinHealth. I’m Bill Klaproth. Thanks for listening.
Gun Violence Prevention: A Trauma Surgeon Weighs In
Bill Klaproth (Host): Americans are 25 times more likely to be victims of a gun related murder and 8 times more likely to die by firearms suicide than people in other developed countries according to a study by the World Health Organization. So, is a possible US Surgeon General’s report on firearm violence prevention, what’s needed to address this concern? Well let’s find out with Dr. John Maa, the Immediate Past Chief of the Division of General Surgery at MarinHealth Medical Center and the 2018 Past President of the San Francisco Marin Medical Society. He is also a trauma surgeon at MarinHealth.
This is The Healing Podcast from MarinHealth. I’m Bill Klaproth. Dr. Maa, thank you for your time. So, in an article that you wrote, that was published in the New England Journal of Medicine, you say the increases in the frequency and lethality of mass shootings in the United States and the approximately 90 gun deaths that occur each day, argue for efforts to reframe the national debate about firearms as a public health issue. Is that what it’s going to take to establish thoughtful gun control in the United States?
John Maa, MD (Guest): The New England Journal of Medicine article reflects my personal belief that reframing the conversation as a public health challenge will identify new solutions and lead to a deeper understanding of the problem and to allow our nation to move the needle forward in discussing this very important public health topic.
Host: So, in the past, a Surgeon General’s report has been used to influence a national discussion about a public health issue such as back in 1964 the Surgeon General’s report on smoking and health. What is the stumbling block? Why is there no Surgeon General’s report on gun violence?
Dr. Maa: I believe that one of the major challenges to a US Surgeon General’s report has been the politics on Capital Hill. After he left office, US Surgeon General C. Everett Koop, tried to issue standards for firearm ownership and maintenance of certification to own a weapon but he had left the office of the US Surgeon General at that time and the idea didn’t catch national attention. There are very powerful forces on Capital Hill that would oppose the concept of the US Surgeon General’s report. During his Senate confirmation hearing, then candidate Vivek Murphy was criticized for his social media postings about the topic of firearm injury prevention. I believe that it will take a multiyear effort to have a US Surgeon General’s report commissioned by the White House, but I think that this is an ideal time to begin the request and the conversation now. The 1964 report actually began with a request from the American Heart Association among other organizations to President John F. Kennedy in 1961. And so it took a number of years before that report was finally commissioned. I think this is a wonderful time now to begin the series of communications and requests to the White House to have a US Surgeon General’s report on firearm injuries to be conceptualized and finalized.
Host: And since the majority of Americans want smart gun control laws, do you see any progress in that direction and ultimately for this to happen, doesn’t Congress have to get serious about this?
Dr. Maa: I believe that there is strong support as reflected in California with the passage of Prop 63 in 2016 with bipartisan majorities both Democrats and Republicans urging commonsense firearm safety reform. You are correct that the next steps would be movement through Congress and it’s reassuring that Congresswoman Robin Kelly from Chicago has introduced House of Representatives bill 1114 which would require the US Surgeon General to report annually on firearm injuries to Congress. That bill has passed through committees in the House of Representatives but would then need to move to the United States Senate and ultimately to be signed by the White House. I believe this is an ideal time to begin this multiyear process and to continue and extend it and to build consensus towards that reality.
Host: And building consensus is what we need but any thoughtful discussion about gun control has to include this, how much of a factor is the NRA with their massive lobbying efforts to protect what they feel is a trampling of their Second Amendment rights when it comes to gun control?
Dr. Maa: The NRA is a very powerful and effective force for advocacy and lobbying both in Congress and in our state legislatures. They too have struggled with the COVID pandemic leading to the cancellation of their national convention this year and also a number of layoffs and staff furloughs. I believe that their power and influence in Congress is waning. And I believe that firearm safety advocates could actually learn from the very successful strategies that the NRA has utilized both in the courts and also legislatively and it is my hope that firearm safety advocates can apply those legislative strategies to adopt new laws which will protect the public health across America.
Host: So, it sounds like you feel we are slowly moving in the right direction.
Dr. Maa: I believe that our nation has taken important steps forward during the Trump administration. Interestingly, President Trump signed an executive order banning the sales of bump stocks and also eliminated the restrictions of the Dickey Amendment on Federal Funding of CDC research into firearm injuries. There actually has been movement in the direction of firearm safety during this White House administration and I believe that the COVID pandemic also highlights the important role that state, local and federal governments can play in protecting the public health and I believe that if we are able to commission a US Surgeon General’s report to better understand the challenges to identify new solutions when they are prepared and presented to Congress and to our state governments there might be the consensus to have them adopted into law. I think there is reason to be optimistic.
Host: So even with incremental progress to this point, it really sounds like we need this Surgeon General’s report to fully lay out the complex problem and issues of gun violence in America and really help us understand how we got to this point and then serve as a wake up call for our local, state and federal officials.
Dr. Maa: That’s absolutely correct. The New England Journal of Medicine article is actually inspired by a conversation with President Barack Obama who suggested that the relationship between firearm ownership and gun injuries might be as strong as the connection between smoking and lung cancer. Essentially, he was proposing that the firearm was the factor and I think if we commission a US Surgeon General’s report, undertake a global international comparison, dispel myths and come to a deeper understanding of the problem that we’ll be able to identify solutions that we currently cannot see as a nation. The US Surgeon General’s report on smoking and health in 1964 would lead to 40 subsequent reports that characterized the impact on children, on pregnant mothers, of secondhand smoke which really enabled our nation over the decades to better understand the health hazards associated with cigarette smoking. To commission a first US Surgeon General’s report, as a part of a path and process forward over the upcoming years, it will be essential to illuminate in the conversation about firearm safety in America.
Host: And part of that illumination comes with more understanding and seeing research and data on the effects of gun violence. Earlier you mentioned the Dickey Amendment which had restricted federal funding of firearm safety, apparently that is lifted now. Can you tell us more about that and the effects that will have?
Dr. Maa: The restrictions of using federal funding for CDC research have been lifted by President Trump. The CDC will be funding studies within academic medical centers into this important topic. I don’t believe there’s plan for the CDC to undertake it’s independent report at this time, but it may be a recommendation of a US Surgeon General’s report. The Surgeon General and the CDC would work in partnership, but we haven’t quite reached the point where a CDC report on firearm injuries has yet been commissioned.
Host: So, we’ve been talking a lot about the government up until this point. What are some of the other ways or ideas that may help with a solution to this problem?
Dr. Maa: I think there are many valuable lessons from tobacco control and one of the powerful tools we have within hospitals are smoking cessation services. Once we have a better understanding of the epidemiology and the contributing factors to firearm violence and especially repeat injury, I think we’ll be able to use a public health lens and to have firearm violence prevention services within hospitals to provide counseling and to prevent individuals who are at high risk from suffering repeat injury.
I think that looking around the world to some of the public health strategies that have been utilized by other nations to balance responsible firearm ownership and to reduce the burden of firearm mortality should be adopted in the United States. Another primary concern is the circulation and trafficking of illegal weapons into other nations. There’s only one site in Mexico where firearms can be legally purchased, and it’s estimated that several hundred firearms flow from the United States illegally across the border into Mexico each year. It’s estimated that several hundred firearms flow from the United States into Mexico each day and it is also believed that many of these firearms then flow further south into Latin America and to Central America. I believe that a transnational multinational partnership to understand the vector, the firearms that are being circulated across national borders similar to the COVID pandemic would enable us to address this as a public health challenge around the globe.
Host: A multinational coalition would certainly go a long way in helping solve this problem. And as we wrap up Dr. Maa, and thank you for your time, any final thoughts on firearm violence prevention?
Dr. Maa: My hope is that professional health organizations like the American Medical Association will issue a call to the White House for the commissioning of this type of report. That would be a very powerful voice and for our nation’s top doctor, the US Surgeon General to join in that effort would be a very powerful next step to having this report be fulfilled hopefully in the next three to five years. another alternative would be for a state Surgeon General to commission a report within their individual state as a foundation for a future national US Surgeon General’s report on this topic.
Host: And that is something to hope for. This has been a great discussion Dr. Maa. Thank you so much for your time. We appreciate it.
Dr. Maa: Thank you for your interest as well.
Host: That’s Dr. John Maa and for more information please visit www.mymarinhealth.org. And if you found this podcast helpful, please share it on your social channels and checkout the full podcast library for topics of interest to you. This is The Healing Podcast brought to you by MarinHealth. I’m Bill Klaproth. Thanks for listening.