Correspondence (July/August 2000)

Correspondence (July/August 2000)

Is There a Right to Health Care? An Opposing View

Dear Dr. Faria,

I would like to share my thoughts with you on the question of whether or not health care is or is not a "right." (Medical Sentinel 1999;4(4):125-127.

Everyone is entitled to access to health care. Simply because one does not have money does not take away this right. Medical care is a necessity, not a commodity. Since the cost of health care can be beyond the amount affordable by the overwhelming majority of people (especially in cases of most surgeries), the only way to guarantee that everyone has this right is through a wealth-redistribution scheme --- government or other --- where all members of society pay what they can and everyone benefits.

Although there are problems with universal health care in countries that have it, these problems are minor and are less severe than the problems we have in the U.S. In fact, most nations with such systems do not want to abandon them for U.S.-style, free market types.

It was written in one of your essays that health care is not a right because the physician is forced to offer his or her services to someone who cannot pay. This is not true; the doctor gets compensated. No one is "forced" to perform any service for free.

The free market does many things well. Unfortunately, guaranteeing universal health care is not one of them. It is curious that those who see the government as incapable of doing anything right have an unbreakable faith in the free market and large corporations to do no wrong.

I hope to soon be working to once again get a single-payer health care proposition on the ballot here in California. We may not get it soon, but we do hope to expose some very serious problems with the current free market system.

Anthony Curzi
via e-mail

As for health care in other (socialist) countries, the letter writer should check the more recent polls in Canada and Great Britain as well as entertain the collapse of those health care systems (Medical Sentinel 2000;5(3):78-79).

The second paragraph comes straight out of the Communist Manifesto by Karl Marx (1848).

The AAPS believes in true, individual compassion, i.e., charity, for the indigent, not government coercion. Of interest to us, should be Mr. Curzi's plans for further socialization of medicine. California AAPS are you listening? --- Ed.

Junk Science of Public Health and Gun Control

While the CDC and Arthur Kellermann, M.D. have been siginificantly slowed in their gun prohibitionist agenda (see Medical Sentinel 1997;2(2):46-53 and 1997;2(3):81-86, and the references cited therein), others have picked up the gun control agenda under the pretended theme of "finding solutions to the problem of guns and violence in America."

Guns and Suicide

So where the CDC and NCIPC have been slowed, the various schools of public health sprouting throughout the country via the public-private partnerships of academia and public health, on the one hand, and private foundations (e.g., the Robert Wood Johnson and Joyce Foundations) and the AMA on the other, have picked up the slack.

Among the personalities who have now emerged to take the place of Dr. Kellermann is Dr. Garin J. Wintemute at the University of California, Davis.

In an article in The New England Journal of Medicine (NEJM), Dr. Wintemute and associates blamed suicides on gun availability. I responded to their articles in a letter to the editor, which after passing "review" was accepted for publi-cation, only to be sacked at the last moment because of "space considerations."

I thought it would be of interest to the readers of the Medical Sentinel to publish this thinly veiled attempt at censorship impeding the free exchange of ideas necessary in the intellectual atmosphere of a free society. The following exchange ensued.

November 19, 1999
Dr. Marcia Angell
Editor, NEJM

Dear Dr. Angell,

Dr. Wintemute, et al's article ("Mortality Among Recent Purchasers of Handguns," N Engl J Med 1999;341(21):1583-9) is not the first to link rates of suicides to availability of handguns in the U.S. What these authors, like their predecessors,(1,2) failed to point out is people readily substitute for handguns (when these are not available), other universally available methods to commit suicide.(3,4)

Japan, Hungary and Denmark boast strict gun control laws and severely restrict the availability of firearms; yet, these countries have much higher rates of suicide than the U.S.(4,5) In these countries, other methods are used for suicide: Seppuku in Japan, drowning in the Danube in Hungary, inhalation of poisonous gases such as carbon monoxide, or hanging as in Denmark and Germany --- quite effectively --- almost as effectively as with firearms.(4)

Guns are not the cause of suicide, but only the vehicle severely depressed Americans tend to use to commit felos de se. As physicians, we should stop blaming firearms, sensationalizing statistics, and making politically motivated predictions, as when Dr. Wintemute erroneously predicted by the year 2004, firearms would surpass motor vehicle accidents as a leading cause of injury death --- a prediction he has reluctantly retracted.(6)

Regarding the risk of homicide with firearms among women, the authors should have pointed out women are being victimized by criminal predators, and purchasing a handgun may have actually been a response to perceived (and as it turned out for many of them real) threats because they were already at risk! It should have been of interest to find out from the study how many of the women who bought a handgun actually survived because of the protection afforded by the firearm. And, herein, lies another major flaw of this study --- the fact the authors failed to consider the protective benefits of firearms, and relied only on a body count.(7-9)

We know from Prof. Gary Kleck of Florida State University the defensive uses of firearms by citizens amount to between 1 to 2.5 million uses per year, dwarfing the offensive gun uses by criminals (statistics which have been substantiated by a 1997 Justice Department study).(10)

We need to honestly admit the real culprit behind rates of suicide is unrecognized or poorly treated depression. It's time we start taking responsibility as professionals for our relative inaction in properly combating depression. Rather than blaming guns, let's carefully analyze the mind of those pulling the trigger.

Miguel A. Faria, Jr., MD
Editor-in-Chief, Medical Sentinel of the Association of American Physicians and Surgeons (AAPS)

References

1. Kellermann AL, Rivara FP, Somes G, et al. Suicide in the home in relationship to gun ownership. N Engl J Med 1992;327:467-72.
2. Sloan JH, et al. Firearm regulations and rates of suicide: A comparison of two metropolitan areas. N Engl J Med 1990:322:369.
3. World Health Organization, World Health Statistics 1989. Geneva, Switzerland: World Health Organization, 1989.
4. Kleck G. Point Blank: Guns and Violence in America. Hawthorne, NY, Aldine De Gruyter, 1993.
5. Suter EA Guns in the medical literature - a failure of peer review. J Med Assoc Ga 1994;83(3):137-148.
6. Wintemute GJ. The future of firearm violence prevention. JAMA 1999;282(5).
7. Lott JR, Jr. More Guns, Less Crime - Understanding Crime and Gun Control Laws. Chicago, IL, University of Chicago Press, 1997.
8. Kleck G. Targeting Guns - Firearms and Their Control. New York, NY, Aldine De Gruyter, 1997.
9. Kates DB, Schaffer HE, Lattimer JK, Murray GB, Cassem EH. Bad Medicine: Doctors and Guns in Guns - Who Should Have Them? (Ed., Kopel DB), New York, NY, Prometheus Books, 1995, pp.233-308.
10. U.S. Department of Justice study (conducted in 1993 and published in 1997) cited in Guns and Safety. Medical Sentinel 1998;3(1):7.

February 2, 2000
Dear Dr. Faria,

Your letter to the editor regarding the Wintemute article of November 19 has been accepted for publication in edited form in a forthcoming issue of the Journal and sent to the authors for their comments...

Gregory D. Curfman, MD
Deputy Editor, NEJM

March 7, 2000
Dear Dr. Faria,

I regret that we will not be able to publish your letter to the editor in response to the article to Wintemute et al. Because of other space priorities, we are unable to print the letter. I am sorry that we must change our decision...

Gregory D. Curfman, MD
Deputy Editor, NEJM

March 14, 2000
Marcia Angell, MD
Editor, NEJM

Dear Dr. Angell,

When you ascended to the post of Interim Editor of The New England Journal of Medicine (NEJM) following the resignation of Dr. Jerome Kassirer, I applauded your promotion because, among other things, you had also courageously breached the wall of junk science being built around the issue of silicone implant litigation. Moreover, under Dr. Kassirer, when it came to the topic of public health and gun control, and to a lesser degree, Medical Savings Accounts (MSAs) and private medical care, NEJM took a decidedly liberal perspective, whereby only one point of view was promoted.

The other side was ignored or, let us say it, censored. More recently, the mainstream press has been critical of NEJM because it had violated its own policies on conflict of interest ethics. When on November 22, 1999, I sent a letter to the editor (addressed, incidentally, to you), responding to Dr. Wintemute et al's article, "Mortality Among the Recent Purchases of Handguns" in N Engl J Med 1999;341(21):1583-9, and after passing editorial review, was accepted for publication, I was particularly delighted and grateful for its acceptance in your esteemed journal (Correspondence #99-3859). I was delighted because as a Hispanic (and the NEJM has promoted diversity), it seems that NEJM was also now promoting diversity of intellectual views.

Unfortunately, my hopes came tumbling down. Yesterday, I received a letter from Gregory D. Curfman, M.D., Deputy Editor, NEJM. He stated: "I regret that we will not be able to publish your letter to the editor in response to the article by Wintemute et al. Because of other space priorities, we are unable to print the letter. I am sorry that we must change our decision."

...Given the content of my letter, I must assume that like the refrain says, "The more things change, the more they stay the same." Intellectual freedom and social progress can only thrive in an atmosphere where there is a free and open exchange of ideas and information --- not censorship. I hope you can use your moral authority to reverse this decision. I remain hopeful that you can decidedly end this resurgence of lack of professionalism and ethics --- and return of censorship...

Miguel A. Faria, Jr., MD
Editor-in-Chief, Medical Sentinel of the Association of American Physicians and Surgeons (AAPS)

March 27, 2000
Dear Dr. Faria,

Thank you for your letter to Dr. Angell dated March 14. Regarding the correspondence on the Wintemute article, when we finally assembled it all, it was clear that we did not have sufficient space to explore all of the topics raised by that article. The central issue of your letter, that "guns are not the cause of suicide," is an interesting point, but one that we could not commit the space to assess in depth. [Emphasis added.] Thank you again for your interest in The New England Journal of Medicine.

Gregory D. Curfman, MD
Deputy Editor, NEJM

Politics of Gun Control

Another letter which did not make it to the pages of the politically correct medical journals was one I wrote to the Western Journal of Medicine (WJM) in regards to an editorial subtitled, "Physicians are morally obligated to help prevent gun violence," published in the November/December 1999 issue.

The editorial was an unscientific diatribe promoting gun control typical of what is being increasingly published in the medical literature by the public health establishment.

December 28, 1999
Dear WJM Editor,

Space constraints prevent me from challenging every erroneous assertion made by Drs. M.A. Rodriguez and Eric Gorovitz in their exceedingly biased op/ed piece, "The politics and prevention of gun violence." Their paper reflects the typical but extreme prejudice of the public health (gun control) establishment that permeates the medical literature on gun violence.

They write "people killed by guns" as if inanimate objects kill people, when in fact, people kill people --- with guns, knives, hands, feet, etc. They spew forth gun statistics but neglect to mention the impact gun safety courses have had in reducing deaths from accidental shootings. For example, the National Safety Council states that since 1930 the annual number of fatal accidents has been cut in half, even though there are twice as many people and four times as many firearms today.

They mention suicide but do not even mention that depression, a most treatable ailment, not guns, is, in fact, the most common factor associated with suicide, and it could be reduced substantially with effective diagnosis and treatment.

The authors quote FBI statistics (1998) to state that "household firearms are most likely to be used against a family member," when, in fact, this statement, erroneous as it is, should be attributed instead to Kellermann, et al, who is then quoted in the next two sentences.

They write, "unlike the situation for every other product sold in America, neither the Consumer Product Safety Commission nor any other agency" has the authority to regulate (effectively eradicate) guns from the hands of law-abiding citizens, but they neglect to state the insurmountable obstacle of why: because, among other reasons, the individual right to gun ownership is protected by the Second Amendment to the U.S. Constitution. And one reason the FTC has "never challenged advertising claims made by the gun industry," may be because guns --- as astounding as it may seem to readers of the public health (but not those of the sociologic, legal, and criminologic) literatures --- are actually used more frequently by law-abiding citizens to deter crimes than they are used by criminals to commit crimes. Yes, the beneficial aspects of gun ownership by ordinary law-abiding citizens dwarf the criminal misuses of firearms."(1-3) Despite a surfeit of scientific and epidemiologic studies in the sociologic, legal, and criminologic literature discussing the benefits of firearm possession by law-abiding citizens, the truth is that the physicians have not been informed about this information by the medical journals because it has been effectively censored.

We now know from Professor Gary Kleck of Florida State University and Dr. Edgar Suter of Doctors for Integrity in Policy Research that the defensive uses of firearms by citizens amount to 2-2.5 million uses per year and dwarf the offensive gun uses by criminals. Between 25-75 lives are saved by a gun for every life lost to a gun. Medical costs saved by guns in the hands of law-abiding citizens are 15 times greater than costs incurred by criminal uses of firearms. Potential victims, with guns to protect themselves, and who know how to use them, are not only more likely to thwart a criminal attack but are also only half as likely to be injured in the process.(1,2,4,5)

Interestingly, a 1993 U.S. Department of Justice study made public in 1997 confirms these researchers' findings. President Clinton's Department of Justice study found that up to 1.5 million citizens use firearms annually to protect themselves and their property, and of those surveyed, 67.7 percent had effectively used a weapon to defend themselves against violent crime.(6)

The authors write that gun lawsuits "create indirect incentives for changes by shifting the costs of risky behavior or products from the consumer to the industry that produces the risk." What it really does is to shift individual responsibility from a person who should be held accountable to perceived deep pocket defendants (i.e., gun industry), creating yet another bonanza for the sue-for-profit litigation industry, and abrogating, by extra constitutional means, a formerly protected, individual constitutional right in the process. Gun litigation is contributing to the moral decadence afflicting our society by removing personal responsibility from the individual --- not to mention the moral sense of right and wrong.

And one more item --- if Drs. Rodriguez and Gorovitz are on the government payroll in public health, they do have a competing interest, that of promoting gun control and it should be reported as such by the WJM.

Miguel A. Faria, Jr., MD

References

1. Kleck G. Point Blank - Guns and Violence in America. New York, NY, Aldine De Gruyter, 1991.
2. Kleck G. Targeting Guns - Firearms and Their Control. New York, NY, Aldine De Gruyter, 1997.
3. Lott JR, Jr. More Guns, Less Crime - Understanding Crime and Gun Control Laws. Chicago, IL, University of Chicago Press, 1997.
4. Suter E. Guns in the medical literature - a failure of peer review. J Med Assoc Ga 1994;83(3):137-148.
5. Suter E, Waters WC, Murray GB, et al. Violence in America - effective solutions. J Med Assoc Ga 1995;84(6):253-264.
6. US Department of Justice 1993 study reported by The Washington Times, 9/07/97, http://www.usdoj.gov.

To the credit of WJM with its new editorial leadership, I must state, it has been the most open of all the mainstream medical journals to the exchange of views in the medical marketplace of ideas.