No development in U.S. healthcare over the last three decades has imperiled us more than the idea that we benefit from physician oversight of life events and circumstances that are not inherently medical. At its most intrusive, this process, called medicalization, creates a clinical conundrum out of the mere act of living and posits medical solutions for things (such as how to live a healthier lifestyle) that frequently benefit more from individual concentration and perseverance than professional intervention. We are thus bearing witness to tortuous reformation of what it means to be a physician in America: a formerly independent and autonomous profession is now our societal hall monitor.
Adam Goldstein, M.D., of North Carolina exemplifies the problem. His facile positioning of firearms as the new tobacco, coating the argument in a patina of medical benevolence, is testament to the profession’s creativity in dragging into its sphere things that do not belong there. There is, of course, no Constitutional right to smoke. But Dr. Goldstein doesn’t stop there. He wants national standards of licensure and professional behavior, especially regarding physicians and guns, akin to what is seen with commercial truckers. He also supports legal designation of all healthcare settings as “gun-free” zones, without a trace of irony about the fact that schools already occupy that space.
The conflation of smoking and firearms ownership is an almost laughable canard. I know of no reasonable claim that the firearms industry has been intentionally deceptive in its marketing, distribution, or sales, or encouraged gun buyers to engage in reckless behavior (which smoking is, by definition). This is quite a bit different from tobacco purveyors who willfully lied about the dangers of their products for decades, and, indeed, used physicians to deliver the lie and persuade potential smokers that all was medically hunky dory.
It is not so difficult to sense that the bottom line of anti-gunners is a grandiose tobacco-style financial punishment of the firearms industry for its alleged transgressions. If gun rights opponents want to use the legal system to pursue their goals, why not sue the family of Adam Lanza and the estate of Nancy Lanza, to create a theory of civil liability that puts the onus on gun owners to secure their firearms? If you live with someone you know, or ought to know, could use your guns wrongly, it is your obligation, not the gun maker’s, to secure them. Suing Bushmaster, the distributor, and the now-defunct retailer makes no more sense than suing the manufacturer and dealer of the car Margo Bronstein was driving in Redondo Beach, CA on December 17, 2014. She is suspected to have been under the influence of, among other things, prescription drugs.
As I have written elsewhere, the Affordable Care Act’s statutory language against gathering information about gun ownership is a subterfuge. The feds clearly want to doctors to inquire about and document in medical records information about gun ownership; absent that desire, there was no reason for an Executive Order clarifying that the prohibition really wasn’t one. Establishment medicine, as represented by groups such as the American Medical Association and the American Academy of Pediatrics, has firmly glommed on to the federal teat, which dispenses nearly forty cents of every healthcare dollar we spend, more if you count the forgone taxes on health insurance premiums and in-name-only not-for-profit health plans and hospital systems and other provider groups.
As physicians increasingly become employees, we can expect them to behave as such; they will ask about what their employers and their employers’ overseers want to them ask about, all under the guise of quality healthcare and helping to save us from ourselves. There is no request of the government that they will fail to heed because there is too much money, power, and influence in play to take seriously the notion that both policy positions and patient interactions ought to be framed by evidence and modesty.
The longer term play here is much more sinister. Doctors will be asked to promote safe guns even though there is no demand amongst gun owners for the technology and even less confidence in its utility. My cell phone periodically reboots without warning; will my safe gun reboot when I need it?
In keeping with the Executive Order, doctors will be asked to promote the idea that they are just trying to find people with mental illness who might be a danger to themselves or others. The U.S. Court of Appeals for the Sixth Circuit has just struck down as unconstitutional a federal law that bars gun ownership by anyone history of institutionalization for mental illness even if they are now deemed healthy.
A new paper in the American Journal of Public Health casts even more doubt on the idea that we can use mental health/illness as the government’s stalking horse to prevent gun deaths, which are in a 20-year-long decline. Discomfortingly, the authors speculate whether psychiatrists “could help society interrogate [emphasis added] what guns mean to everyday people, and why people feel they need guns or reject guns out of hand.” I, for one, am not assuaged by the proposal that we need a cultural interrogation on guns led by the psychiatry industry. How big a step is it from the idea that mental illness promotes gun violence (it doesn’t, according to the authors) to the conclusion that gun ownership is evidence of a mental disorder? If there is creeping encroachment on the concept of competence by the mental health professions, how will we challenge it?
It is bad enough that Obamacare enlists doctors in the feckless pursuit of Americans clinically. This policy meme, all by itself, foments overtreatment, overdiagnosis, overscreening, and just, pure outright medical harm, in a system that already wastes 30% of the resources put into it. Instead of engaging physicians to fix these issues, Obamacare welcomes them as the straws stirring a toxic drink of paternalism and unsustainable deference to people who have no legitimate intellectual or moral claim to the work they’re being asked to do.
The debate we need to have is this one: is it possible for a free society to try to prevent every potential tragic or adverse event? At what cost in commerce, individual freedom, professional autonomy, and respect for government? Was Churchill right…that we can pass so many laws and regulations that eventually everything is illegal and people lose all respect for the law? Have we reached the juncture where we will lose all respect for the medical profession because it is invited incessantly to intercede in so many facets of our lives, and it simply cannot restrain itself from carrying the government’s water?
Within the next decade, a very large number of Americans will join gun owners in the view that the healthcare industry, now explicitly an agent of the federal government, simply cannot be trusted with any information beyond what is necessary to solve an immediate clinical problem. I will not blame gun owners one bit if they look back smugly on today’s debate and say, “I told you so.”