Opinion

Doctors should do more than heal — they should be public health activists

Some people and organizations, like the NRA, believe that doctors should stick to treating the symptoms of public health issues — that is, mending patients once they're sick or injured — and leave it to others to worry about the cause. But that's a shortsighted approach to medicine.

Physicians can play a powerful role as healers of our communities

I've always felt disappointed with the medical profession in the United States for largely staying out of the battle against what is, by any definition, an American public health crisis: gun violence. (Shutterstock / Have a nice day P)

On November 7, the National Rifle Association (NRA) posted a tweet that managed to enrage doctors across the globe: "Someone should tell self-important anti-gun doctors to stay in their lane. Half of the articles in Annals of Internal Medicine are pushing for gun control. Most upsetting, however, the medical community seems to have consulted NO ONE but themselves."

As a veteran ER physician, I felt shock and dismay as I read this tweet. I suppose I shouldn't have been surprised, though. I've watched the gun debate rage in the United States for decades, with each mass shooting breaking records for carnage. And each time, the NRA response seems less concerned, less caring, often coming back to the empty refrain that "the only thing that stops a bad guy with a gun is a good guy with a gun."

Other than law enforcement, there are no "good guys with guns" in the communities where I practice, and yet in my 15 years in emergency medicine in Canada, I have yet to treat a victim of a school shooting.

I've always felt disappointed with the medical profession in the United States for largely staying out of the battle against what is, by any definition, an American public health crisis. Over 33,000 Americans were killed by firearms in 2016, and gun violence was the leading cause of death for American men aged 15-19.

Some people and organizations, like the NRA, believe that doctors should stick to treating the symptoms of public health issues — that is, mending patients once they're sick or injured — and leave it to others to worry about the cause. But that's a shortsighted approach to medicine. As Benjamin Franklin famously said, "an ounce of prevention is worth a pound of cure."

That in mind, I was pleased to see the American College of Physicians take a big step in publishing a position paper (the one that provoked that November NRA tweet) that noted that "firearm violence continues to be a public health crisis," and that the "medical profession has a special responsibility to speak out on prevention of firearm-related injuries and deaths, just as physicians have spoken out on other public health issues."

Ironically, the NRA's tweeted response, telling doctors to "stay in their lane," mobilized doctors in a way that the position paper never could. Their raw and angry responses, which virally exploded online under the hashtags #thisisourlane and #thisismylane, saw countless physicians post outraged messages, often accompanied by graphic images of blood stained scrubs and hospital gurneys – gruesome evidence of the daily job they face treating the catastrophic damage caused by bullets.

Many shared horrifying anecdotes, such as having to deliver a dead baby that saved its mother's life by stopping a bullet, or of hiding blood and brain matter on stretchers from grieving parents. 

Taking on political powerhouses 

The nation's physicians might be the one group that can successfully stand against such a powerful, connected and well-funded political lobby. Indeed, their past fight against the tobacco industry provides an interesting parallel.

In the same way that many of the politicians of today are reluctant to battle the gun lobby, so too were the politicians of the 1960s due to the significant political clout of Big Tobacco. However, the country's medical leadership faced no such political constraints, and the Surgeon General's landmark 1964 report on the health risks of smoking awakened the sleeping giant of American medicine, leading to the eventual collapse of the tobacco lobby's influence in American politics.

Since then, without limiting any individual's right to smoke, governments have enacted increasingly powerful changes to tobacco policy. These range from vocal anti-smoking public service announcements, to limits on advertising, to huge fees levied against tobacco companies for the costs of treating conditions caused by cigarette use. It is estimated these efforts have saved eight million lives in the United States alone.

This achievement — a testament to the powerful role physicians can play as healers of our communities, not just of bullet wounds — should serve as inspiration to the doctors of today. With an ever-growing list of public health crises, including antibiotic resistance, global warming, gun violence and so forth, coupled with an era of "fake news" and political polarization, the trusted voice of medical leadership is needed now, more than ever.

The NRA was right in a sense: doctors should stay in their lane. And this lane, paved by hard-fought policy change and toppled special interest groups, is exactly it.


This column is part of CBC's Opinion section. For more information about this section, please read our FAQ.

About the Author

Brett Belchetz

Dr. Brett Belchetz is a practicing emergency room physician in Toronto, and the CEO of Maple, a Canadian telemedicine company. He is also a senior fellow with The Fraser Institute, and a former management consultant with McKinsey & Company