Editor's note: This story includes graphic imagery and language.
A mocking tweet from the National Rifle Association has stirred many physicians to post on social media about their tragically frequent experiences treating patients in the aftermath of gun violence.
"Someone should tell self-important anti-gun doctors to stay in their lane," the NRA tweeted on Thursday. "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."
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. https://t.co/oCR3uiLtS7— NRA (@NRA) November 7, 2018
The NRA was criticizing the American College of Physicians' new position paper, in which the physicians' group outlines its public health approach to reducing deaths and injuries from firearms.
"We are not anti-gun: we are anti-bullet holes in our patients," Esther Choo, a doctor and professor of emergency medicine at Oregon Health & Science University, replied on Twitter. "Most upsetting, actually, is death and disability from gun violence that is unparalleled in the world."
We are not self-important: we are important to the care of others— Esther “STAY HOME” Choo, MD MPH (@choo_ek) November 8, 2018
We are not anti-gun: we are anti-bullet holes in our patients
We consult with everyone but extremists
Most upsetting, actually, is death and disability from gun violence that is unparalleled in the world https://t.co/E8qz3lewK7
The NRA posted its tweet just hours before a man shot and killed 12 people at a country music bar in Thousand Oaks, Calif.
"I would like to graciously extend the invitation to the author of this tweet and anyone else from the NRA to join me at the hospital the next time I care for a child who has been hurt or killed by a gun that wasn't safely stored or was an innocent bystander," tweeted Jeannie Moorjani, a pediatric doctor in Orlando, Fla.
More physicians weighed in, often using the hashtag #ThisIsOurLane.
"Do you have any idea how many bullets I pull out of corpses weekly? This isn't just my lane. It's my f****** highway," wrote forensic pathologist Judy Melinek, in a tweet that has gone viral.
Hey @NRA ! Wanna see my lane? Here’s the chair I sit in when I tell parents their kids are dead. How dare you tell me I can’t research evidence based solutions. #ThisISMyLane #ThisIsOurLane #thequietroom pic.twitter.com/y7tBAuje8O— Stephanie Bonne (@scrubbedin) November 9, 2018
The NRA's criticism of the physicians' position paper hinges in part on research studies cited by the ACP.
"The problem is that the ACP cites 'studies' that wouldn't qualify as 'evidence' in any other debate," the gun advocacy organization argued in an article posted at the NRA Institute for Legislative Action. "One cited study was focused on a single rural county in Iowa. Another was of 106 outpatients at a single clinic. The authors acknowledge evidence is limited but cite their own belief there is 'enough evidence' or simply argue the policy should be enacted anyway. Inconclusive evidence is not 'enough evidence.' Applying narrow findings to a larger population is not 'enough evidence.' "
The paper's co-author, ACP Senior Vice President of Governmental Affairs and Public Policy Robert Doherty, responded to the NRA's criticism in a series of tweets.
"All of our recommendations are supported by a comprehensive review of research on the causes of gun violence, & policies that could reduce it. Where the evidence is limited, we said so," he wrote. "All of our recommendations were reviewed and approved by ACP physician-members who serve on our health policy committee, several of whom are gun owners."
Doherty also noted that the paper calls for increased funding for research on gun violence.
For years, the NRA has lobbied to prevent the Centers for Disease Control and Prevention from conducting research on gun violence. A spending bill passed in March of this year notes that the CDC has the authority to do research on the "causes" of gun violence. But it doesn't change the 1996 law that mandates "none of the funds made available for injury prevention and control at the Centers for Disease Control and Prevention (CDC) may be used to advocate or promote gun control." The rule has had a chilling effect on gun research in the U.S. ever since.
Which makes the NRA's criticism about physicians not having adequate research particularly frustrating to doctors such as Melinek.
"We aren't against the second amendment," she told The Guardian. "What we are against is not researching, not putting effort into researching, and not putting the funding into researching what can be used to prevent gun violence and death, whether it's trigger locks, security, training or the idea of requiring insurance and having people have insurance in case their gun is used to kill someone else. We need to have the research and we need to have the data to back it up, and right now that's not happening."
"We need to do something, and telling doctors to stay in their own lane is not the way to do it," she told the newspaper. "We're the ones who have to deal with the consequences. We're the ones who have to testify in court about the wounds. We're the ones who have to talk to the family members. It breaks my heart, and it's just another day in America."
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A new hashtag that's been trending on Twitter is #ThisIsOurLane. It's been used by doctors around the country to respond to an NRA tweet criticizing a paper by the American College of Physicians that talks about gun violence as a public health issue. As NPR's Laurel Wamsley reports, doctors are speaking up about the public health crisis they see close-up.
LAUREL WAMSLEY, BYLINE: The NRA's tweet came just hours before the shooting in Thousand Oaks, Calif., last week. It said, quote, "someone should tell self-important anti-gun doctors to stay in their lanes." It linked to an NRA article criticizing a new paper from the American College of Physicians, in which the doctors group outlined its public health approach to reducing deaths and injuries from firearms.
The tweet hit a nerve for doctors, especially those who see the victims of gun violence every week. One of those was Dr. Judy Melinek, a forensic pathologist in San Francisco.
JUDY MELINEK: I was incensed. I was on my way into work. I was about to do another gunshot wound autopsy that morning. I had done one earlier that week.
WAMSLEY: She responded quickly with her own tweet, which said, minus a curse word for emphasis...
MELINEK: This isn't just my lane. This is my highway.
WAMSLEY: She's angry at the NRA for blocking attempts to research the causes of gun violence - research that she says could be used to prevent the deaths that she must investigate, sometimes at a crime scene, as family members of the dead watch her work. And, she says, doctors didn't pick this fight.
MELINEK: The NRA did. They're the ones who backed the Dickey Amendment that limits funding for gun research. And they're the ones who tried to pass legislation in Florida that, thank God, was overturned, restricting doctors' ability to speak to their patients about gun safety. And that's wrong. They're overstepping their bounds into medicine.
WAMSLEY: NPR reached out to the NRA for a comment for this story but did not hear back.
Cedric Dark is an emergency physician who works with the Baylor College of Medicine in Houston. And he's a gun-owner himself.
CEDRIC DARK: I own a 40-caliber handgun. I also own a 12-gauge shotgun, so I know a little bit about guns.
WAMSLEY: He says there are physicians who are NRA members who believe the NRA has gone too far.
DARK: We are not anti-gun. We're anti-bullet holes. We don't want our patients to have holes in them from guns, and there's ways that we can do that.
WAMSLEY: Among those things, Dark says, are background checks on every gun purchase and requiring a permit to purchase a gun, similar to getting a driver's license.
DARK: And then making sure that people that commit interpersonal violence or domestic violence don't have access to weapons because guns, in that situation, increase the risk of domestic violence escalating to murder by about five times.
WAMSLEY: Another policy some doctors want to see is a ban on assault weapons. Rani Dixit Schuchert, a trauma surgeon in Pittsburgh, is one of them. She and her colleagues have been treating some of the people who were shot at the Tree of Life synagogue a couple weeks ago.
She says that while mass shootings get a lot of attention, doctors see the everyday gun violence in America.
RANI DIXIT SCHUCHERT: My group of trauma surgeons are made up of both Democrats and Republicans. It's beyond politics. This is a public health crisis. And we want to do whatever it takes to save lives.
WAMSLEY: What she doesn't understand, she says, is why anyone would want to get in the way of that. Laurel Wamsley, NPR News.
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