Intended for healthcare professionals

Observations Yankee Doodling

A modest proposal on gun control—and a real one

BMJ 2016; 352 doi: (Published 06 January 2016) Cite this as: BMJ 2016;352:i69
  1. Douglas Kamerow, senior scholar, Robert Graham Center for policy studies in primary care, professor of family medicine, Georgetown University, and associate editor, The BMJ
  1. dkamerow{at}

Regulate guns like we regulate abortions?

Gun violence has gotten out of hand here in the United States. It is not just last year’s high profile mass shootings in San Bernardino, Colorado Springs, Roseburg, Charleston, and Chattanooga. It is also the more than 3000 children (under 18) who were killed or injured here by guns in 2015.1

A smart legislator in the state of Missouri has come up with a good idea to protect the US from gun violence. Since much of the US has strict laws regulating (some would say restricting) abortions, presumably to protect the health of Americans, maybe we can learn something from them and apply the same principles to another perceived health risk—firearms.

Representative Stacey Newman, a Democrat from the suburbs of St Louis, introduced House Bill 1397 to the 98th Missouri General Assembly last year.2 In it, she matched the conditions under which Missourians can purchase firearms to those required to obtain an abortion.

Smart idea

Under Newman’s proposed law, at least 72 hours before you make your initial request to a firearm dealer to purchase a gun, you must consult with a licensed medical doctor. The doctor must discuss with you the indications, contraindications, and risk factors associated with the gun purchase. Then, if you choose to go ahead with the purchase, the doctor and you must sign a written statement that you are aware of all the physical, psychological, and situational factors relating to a gun purchase.

During the 72 hour waiting period you will be busy, because the law further requires that you watch a 30 minute video on fatal firearm injuries; visit an emergency trauma center in which gun violence victims are present; and meet with at least two families who have been victims of firearm violence and two clergy who have officiated at the funeral of a child killed by firearms.

After the 72 hour waiting period has elapsed you may then go to a licensed gun dealer who is located at least 125 miles from your house (which is the average distance Missourians must travel to obtain a legal abortion). The dealer must inform you of several items. These include the immediate and long term medical risks associated with firearms, illustrated with photographs of fatal firearm injuries; alternatives to purchasing a firearm, including non-violent conflict resolution; and a telephone number you can use to reach the dealer with any questions. Then you can buy the gun.

I am not making this up.

The bill, of course, has no chance of passage. And it seems that no national legislation is likely to be passed in the US by our gridlocked Congress, no matter how many people are killed and maimed by guns. One area, though, might be ripe for legislative change. Perhaps the Congress could agree to repeal its long time ban on research into gun violence, if it could be made clear that this would benefit gun owners as well as the general public.

Revoking research funding ban

About 20 years ago a small amount of research into the causes and prevention of gun violence was sponsored by the US Centers for Disease Control and Prevention (CDC) and the National Institutes of Health. Early studies aroused the ire of the all powerful National Rifle Association, leading to pressure on Congress and termination of funding for the research.3 Now, the former head of CDC’s injury research center and the former Congressman who led the battle against gun research are calling for the reinstitution of the program.4 In addition, a group of doctors have petitioned Congress to lift the ban on gun violence research.5 Maybe the time has come to at last treat gun violence with the same scientific objectivity that has been applied—with success—to motor vehicle crashes and other injuries.

As I write this, President Obama is preparing to announce his own executive initiative to bypass Congress’s unwillingness to regulate guns.6 He will reportedly focus on increasing the number of gun purchasers who would be subject to background checks, hoping that this will help keep guns out of the hands of criminals, terrorists, and mentally disturbed people. He will also increase staffing for the agency that performs these background checks, to make it speedier and more accurate, and he will make it easier for states to provide mental health information to the background check system.

The president may also order CDC and the National Institutes of Health to restart their gun research programs. This has been tried before and was thwarted by Congress, which ultimately provides the funding for the research agencies. It would be a shame if Obama’s unilateral actions on background checks, which are apparently within his legal authority, create a controversy that ensnarls needed legislation to restart gun research that might otherwise have a chance of bipartisan support and passage.


Cite this as: BMJ 2016;352:i69



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