Since the National Rifle Association’s statement that physicians should “stay in [our] lane” and avoid talking about gun violence, many doctors have been stirred to speak up. Using the hashtag “#thisisourlane,” doctors have publicly shared photographs of blood-stained scrubs and shoes, documenting our first-hand encounters with the tragedy of gun violence.

We both spend part of our professional lives teaching other physicians and public health professionals about gun violence. One of our goals is to help doctors move beyond statistics and individual stories and toward a deeper understanding of the issues. Given that gun violence is the second leading cause of death of children and adolescents in the United States, accounting for 15% of all child deaths nationwide,1  pediatricians must join the public debate. Here, we discuss 3 concepts that help explain why we have the highest levels of gun violence among high-income countries2  and how we might begin fixing the problem. These 3 concepts can make pediatricians wanting to reduce gun violence more informed, effective advocates.

When people are exposed to a gun, or even the image of a gun, some appear to act more aggressively, which is a phenomenon known as “the weapons effect.” An early demonstration of this, in 1967, placed research subjects around 2 different tables: on one table was badminton equipment, and on the other table were guns. The subjects were told that the objects had been left over from another experiment and that they should be ignored. Then the subjects were told to deliver shocks to someone they found irritating. The group with guns delivered stronger shocks than the group with badminton.3 

Although we were initially skeptical of such findings, the scientific evidence has been growing. In a recent meta-analysis of 78 studies, authors concluded that the mere presence of weapons increases aggressive thoughts and hostile appraisals.4  The weapons effect flies in the face of gun rights activists’ assertion that an armed society is a polite society; indeed, an armed society may be more hostile, suspicious, and aggressive. Consider the death of Acen King, a 3-year-old who was killed when his grandmother was driving too closely behind the driver in front of them; that man, who had a gun on his lap, became angry and suspicious and fired into the car at a stop sign.5  This man was prone to violence as evidenced by previous felony convictions; the weapons effect reveals that the presence of a gun on his lap may have raised his baseline aggressive and suspicious thoughts over a critical threshold, with tragic results. When recounting such senseless stories of gun violence, one should ask the question out loud: what would have happened if no gun had been present at the scene?

Jeffrey B. was a well liked, happy 19-year-old young man who lived in rural Michigan. One day, his girlfriend ended their relationship. Within hours of the breakup, he grabbed a shotgun from his girlfriend’s house and shot himself. He died instantly, leaving his family devastated and bewildered as to why their happy son and brother would have ended his life. Jeffrey’s sister openly shares his story to illustrate the fact that guns represent easy access to a lethal method of suicide. She believes (and the data overwhelmingly support) that if Jeffrey had not had a gun within arm’s reach, he would be alive today.

The great suicide prevention success stories of the past century have had little to do with changing mental health and everything to do with reducing access to lethal means. In the 1950s, half of all suicides in the United Kingdom were poisonings from toxic gas in heaters and ovens. Sylvia Plath, who famously died by putting her head in the oven, was one such suicide. With the introduction of nontoxic domestic gas, suicides fell by one-third, accounted for by the decrease in gas suicides.6  Israel offers another example. The Israeli Defense Force noted that many adolescent (aged 18–21) soldiers were dying by firearm suicide, so in 2006, they changed their policy to prevent soldiers from taking their guns home with them on the weekends. The policy resulted in a 40% decrease in the suicide rate among adolescent soldiers due largely to a reduction in firearm suicides on weekends.7 

One of the first stories that one hears in public health school is that of John Snow, a London physician who in 1854 traced the origins of an ongoing cholera epidemic to a certain water pump on Broad Street. Dr Snow persuaded the local council to disable the Broad Street water pump, and the cholera epidemic quickly ended. Rather than trying to convince people to stop using the contaminated pump, he made a change to the environment. This is a simple illustration of the public health approach.

Consider smoking, a more recent example of significant public health progress. In 1965, 42% of US adults were smokers; currently, 17% of adults smoke.8  Convincing patients to quit smoking during one-on-one clinical interactions is worthwhile and modestly effective, but it is nowhere near as powerful as legislation, regulation, and widespread changes to cultural norms.

Litigation has also been one of the most powerful tools of tobacco control in the United States. For decades after the initial Surgeon General’s report, the tobacco industry celebrated the fact that they had never paid out a penny to its victims. In 1996, the industry started to settle lawsuits brought by states to recover Medicaid funds spent on tobacco-related illness. Since that time, tobacco companies have had to contend with a flood of lawsuits by states, health insurers, and individuals united in class actions. This vulnerability put the tobacco industry on the defensive and helped in myriad tobacco control victories. Even beyond the billions of dollars in damages that has been paid to victims, litigation has forced the industry to negotiate with tobacco control advocates, leading to public health concessions such as a ban on outdoor advertising and stronger warning labels. Of great importance, it has forced the industry to disclose documents detailing the nefarious measures they took to avoid responsibility for promoting an addictive and carcinogenic product.9 

The parallels to the firearm industry are strong. In 2005, Congress passed the Protection of Lawful Commerce in Arms Act, which protected the firearms industry from much civil liability. Reversing this act and making the gun industry vulnerable to lawsuits by the tens of thousands of people affected each year might lead to meaningful changes from the gun industry. For example, it might lead to a toning down of the messages of toxic masculinity employed in its advertising, spur the adoption of smart gun technology to ensure that guns can only be fired by their owners, and promote industry support for universal background checks, red flag laws, and safe storage around children.

Should we as pediatricians still try to influence people’s gun practices? Yes, of course. We should counsel on safe storage and encourage people to remove guns from the homes of suicidal or mentally unstable people. We should encourage “violence interruption” programs in which trained community workers provide mediation after gang-related shootings to prevent retaliatory violence. We should teach parents how to inquire about the presence of guns in the homes where their children go to play. But we should do so with the knowledge that a comprehensive public health approach offers the greatest opportunity to save the most lives.

There are several ways in which pediatricians can take direct action on this issue. Grassroots organizations that work to reduce gun violence welcome the addition of medical or scientific voices. By framing our patient’s stories in the context of the weapons effect or access to lethal methods of suicide, pediatricians can elevate the conversation at community panels, public speaking events, or meetings with legislators. Furthermore, the upcoming election year provides a chance to draw candidates’ attention to policies that embrace a public health approach, such as those proposed in the call to action endorsed by 8 health professional societies and the American Bar Association.10  Pediatricians can amplify such proposals through letters to the editor, opinion pieces, or personal conversations, speaking to the importance of measures that focus on environmental change on guns.

Doctors are finding their voice on gun violence more and more each day. By understanding the concepts of the weapons effect, access to lethal methods of suicide, and a public health approach, their voice can be even more eloquent and powerful.

Dr Dodson conceptualized the perspective piece and drafted the initial manuscript; Dr Hemenway provided expertise in the initial conceptualization of the piece and edited and extensively revised subsequent drafts of the manuscript; and both authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

FUNDING: No external funding.

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Competing Interests

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.