Reframing Gun Violence

In western movies, the ol' doc usually shows up toward the end, after the real men have shot it out at high noon. The doc is not a central character; he (always he) stays away from the action until it's over, then patches people up as best he can.

The results of a survey published in this issue suggest, however, that when it comes to gun violence, most internists and surgeons are no longer comfortable in a passive, peripheral role [1]. More specifically, most physicians who responded to the survey agree that gun violence is a public health problem. Most also agree that various actions, some involving regulation and legislation, some involving clinicians directly, can and should be taken to break the cycle of gun violence. Despite these perceptions, however, only a small proportion of the physicians surveyed say that they now actually counsel patients about preventing firearms-related injury and death. (Pediatricians, it should be noted, have been actively counseling families on gun violence for at least 6 years [2, 3].)

Gun violence isn't the only form of trouble that has made the transition from nonmedical cause to medical issue. Alcoholism, narcotic abuse, domestic violence, and use of tobacco were once considered the province of the courts, the church, or society at large, not medicine. But all have been reframed to a greater or lesser extent in medical, or at least public health, terms [4]. In many respects, even physical activity, food, and sex have been progressively “medicalized” in recent years.

Is this good? Some people don't think so. Social critic Ivan …