The purpose of medicine is twofold. First to prolong life, ie to prevent premature death from disease. The second is to relieve pain and suffering from disease. To many medical “experts” it also appears to include the alleviation of just about anything that can cause distress of any sort. War, murder, crime, poverty are among the myriad of mankind’s misfortunes that have been trivialized into diseases. Soon to be a medical problem is the anguish of a falling stock portfolio.
This approach to healing is taken in the piece in the New England Journal of Medicine – Guns, Fear, the Constitution, and the Public’s Health. Its by Garen J Wintermute, MD, MPH who is professor of public health and director of the Violence Prevention Center at UC Davis.
The article has nothing to do with medicine, at least as I have defined it above. It is an argument in favor of gun control laws. Dr Perlmute’s expertise on the subject seems to involve sneaking around gun shows looking for evidence of illicit sales of weapons. He’s obviously a true believer. He’s committed to a cause; as are all true believers, its merits are irrelevant. He believes. I’m not saying he is wrong, just that he’s not critical.
That guns kill people seems trite. That they should or should not be more or less regulated seems to me to be a political issue that should be debated in those organs created for that purpose and decided by courts and legislatures. That the piece appears in the NEJM says more about the current state of the medical press than it does about gun control.
The article presents a lot of dire sounding statistics that are either unreferenced or which cite a whole book – both are sloppy scientific practices which would never be tolerated in the “real” part of the journal; ie the part that contains the science. The editorial rush to territory not really medical is exemplified by the next article in the same issue of the NEJM; it’s by a lawyer. It discusses the implications the Supreme Court’s upcoming ruling on whether there is an individual right to bears arms given in the second amendment to the US Constitution. There is nothing objectionable in it. It seems to adequately and fairly cover the subject, but what’s it doing in a medical journal? It not as if medicine doesn’t have a full plate without rushing into politics.
Editing a medical journal or practicing medicine conveys no more standing on issues like gun control than that borne by any other citizen. Dr Perlmute, though it hasn’t prevented him from bursting into the medical press, seems to subliminally recognize the futility or inappropriateness of what he’s up to: “It’s unlikely that health care professionals will soon prevent a greater proportion of shooting victims from dying [Does he want to close trauma units? Stop research on gun shot wounds? Stop the spread of trauma units and emergency services?]; rather, we as a society must prevent shooting from occurring in the first place.” Then why doesn’t he run for office or write for the NY Times? Health care professionals of course can prevent people from dying from shootings. We can treat them. They have a disease. It’s called trauma. Dr Perlmute seems so obsessed with guns that he forgets he’s a doctor.
You may think it harmless and a little laughable when doctors puff themselves up with righteous self importance and medicalize anything they don’t like, but there’s more to it than pomposity. The urge to fix thing you don’t really understand more often breaks them. It’s the same impulse that leads to the pursuit of the ideal that worried Isaiah Berlin so much. Gun control is a serious issue and it deserves serious discussion. A medical journal is not the best place for it.