Like many, I have followed the heartbreaking news out of Buffalo, New York, and Uvalde, Texas. One cannot scroll through gunviolencearchive.org without being overwhelmed. Mass shootings — many seemingly motivated by anger and hate, and newsworthy not merely because they’re committed using semi-automatic weapons — are now an epidemic.
One writer of a letter to the editor made a comment that stung me: We cannot do anything about the anger and hate. Presumably this writer speaks from a place of exasperation that they are not being heard and understood.
I witness frustration in friends and colleagues, and in patients I see as a family physician. What we offer one another is this: We can and must mourn. We must reach out to those we love and even to those we do not yet know.
Hate comes from fear, and to dispel that we must try to understand one another.
And to find solutions, we must also be objective. About 21,000 Americans died in 2021 from gun violence (excluding suicides). In 2019, about 1,600 Pennsylvanians died of gun-related violence. For comparison, about 1,000 Pennsylvanians died by motor vehicle accident that year.
While it is said by some that guns are not necessarily the issue, a 2017 systematic review identified 34 studies evaluating the effects of firearm laws on firearm-related homicides; it concluded that national and state laws mandating background checks and requiring a permit to purchase a firearm were associated with decreased mortality.
So, I implore and welcome legislative actions intended to promote public safety and common defense.
We should then consider what we are already doing that works better. One needs an initial physical to drive a car in Pennsylvania, and a yearly physical to drive a bus or commercial vehicle. Thus, completing an annual exam and filling out a form is a regular process to ensure that our buses are safe on public roads. Shouldn’t we hold those who are buying a gun or ammunition to the same standard as those who drive our children to school?
There is precedent. Some concealed carry laws and the Pennsylvania State Police Lethal Weapons Training Act mandate that those who serve in the public defense have a psychological exam before carrying a semi-automatic rifle. As a family physician in the Air Force, I became accustomed to completing these federal assessments, as well.
In both the civilian and the military spheres, psychological exams help to ensure that anyone carrying a weapon, loading payload or otherwise working with our country’s or state’s defense arsenal is stable and safe to perform their job. Not only does this keep co-workers and civilians safe, but it ensures appropriate treatment can be expedited when necessary. Shouldn’t we offer anyone, anywhere, who carries a weapon the same opportunity we give those who wear a uniform?
Gun violence is a public health problem and thus, health care access should be part of the answer. Thus, those who want or need to buy guns and ammunition — especially semi-automatic weapons and magazines — should face no barriers to screening assessment.
Assessments of individuals should be considered a public service, and thus facilitated as much as possible. Not only would this help effectively trigger red-flag concerns, but annual screenings would provide an early opportunity to identify those with mental health disorders who need assistance.
Finally, the performance of background checks is currently disincentivized; they are time-consuming and present the risk of losing business if potential problems are uncovered. Why not flip that script? Let’s acknowledge the trust we place in weapons distributors and deputize the role they play in our public safety.
One practical opportunity to balance this cost would be to eliminate exemptions to the federal Firearms and Ammunition Excise Tax; current exemptions of this sales tax include being a gun sales representative who sells fewer than 50 guns per year.
Aren’t we all willing, when we purchase weaponry for personal defense, to contribute to the common defense as well?
Health care services cannot eliminate anger and fear, but we can all try to listen and understand, and mental health services can address stress to help support our community. Thus patients must have access to mental health services. Certainly, any interventions to curb gun violence could be life-saving, which we can all agree would be priceless.
Dr. Corey Fogleman is a local family physician and the vice president of the Lancaster City Board of Health.