I agree with Dr. Keen on the importance of defending the Constitution, but he seems to have confused the issues raised by my editorial with some others included in the ACP position paper [1]. My editorial had little to do with Constitutional issues, unless it be the First Amendment right of physicians to counsel their patients about safe gun use. Besides, a major reason Big Brother is legislating gun use is that so many people are now being killed and disabled with guns, all the more reason we need better nongovernmental ways to control gun-related damage.

Living in the center of a great U.S. city, I particularly appreciate Dr. Stevenson's concern with the extent to which firearm injuries are related to drugs and poverty. But the more than 20 000 suicides carried out each year with guns (not to mention accidental shootings and impulsive killings in domestic quarrels) have little to do with drugs and poverty. And although people intent on killing themselves can find ways to do so without using guns, suicide attempts with guns are less reversible than those using many other means. It is probably also true that one reason physicians don't talk with their patients about guns as much as they should is that most physicians know relatively little about guns. We can and should remedy that problem with better educational programs.

Dr. Mendell suggests that as physicians, we should give advice only when our patients ask for it because, in his view, actively offering advice when we haven't been asked for it treats our adult patients like children. Infantalizing patients is not good practice. But surely he can't be suggesting that we should therefore offer advice to patients on smoking cessation, or mammography, or vaccination only if patients bring up the topic? I see things the other way around: Holding back information is what we do with children because they are often not ready to handle it; giving important, correct information is what we do with adults, even when that information is potentially disturbing. Doing so respects both their right as adults to know (note that it is often a legal right these days, as well as a moral one) and their ability to make informed decisions for themselves. And counseling about guns does not necessarily imply counseling about gun ownership; the issue is gun safety.

In W.V. Bonds' view, the net contribution of guns to death and disability is a positive, protective one. Somehow, the fact that "only" about half of all homicides are carried out with guns seems reassuring. But are "only" 6000 potentially preventable homicides, or 20 000 suicide deaths, really acceptable? Hepatitis C kills "only" 8000 people per year, but we're willing to intervene actively to prevent these deaths.

Most of these correspondents, plus many of the others who wrote to us on the topic, seem to view gun use as a primarily political issue. A political issue it certainly is, but that seems to be a large part of the problem. As my editorial suggested, it may be time to move beyond political agendas. Surely, a human body doesn't care whether the cause of its death or disability is a bullet, a bacterium, or a blood clot. I therefore see no reason why bullets should be considered any less "medical" than bacteria and blood clots; why even a single medically preventable gun-related death should be any more acceptable to us, either as physicians or as citizens, than a single medically preventable death from typhoid, or coronary artery disease, or any other grievous assault on the human body.