ACEP doesn’t speak for me on this one

Reading the latest Annals of Emergency Medicine today, I came across this Policy Statement:

ACEP deplores the threat to public safety that results from the widespread availability of assault weapons and high capacity ammunition devices.  ACEP supports a comprehensive ban on all sales of assault weapons and high capacity magazines.

Where to start.  I deplore specialty societies that are ignorant of the constitution, and which haven’t learned from recent history.  We had an AW ban, and it was a farce.  Scawwy-looking guns were banned, while the same guns with different stocks were OK.  Also, nobody is crowing about the big changes in gun violence that resulted from its enactment (none attributable to the ban), or pointing out there’s been no change since its repeal.

ACEP should be ashamed of itself for this piece of liberal-pandering.  This is the kind of crap that drove me out of the AMA, and is an excellent way to drive EM docs out of ACEP.


  1. David Weber says:

    You’re darned right! The Second Amendment very clearly says it all: “A well regulated Militia, being necessary to the security of a free State, the right of the people to keep and bear Arms, shall not be infringed.” Not much wiggle-room in that language, no sir!

    Now, it’s true that I’m not actually a member of any militia, and in 3.3 years in the Navy I only once fired a .22-rigged-Colt .45 at a small arms range for about 20 minutes. (I had to pay for a night course years later to learn to put six Magnum rounds into one hole in the center of a paper target.) But by God, my rights are clearly being infringed insofar as I can’t get me a shoulder-mounted rocket-propelled grenade launcher and some depleted uranium ammo. Cuz they’re very effective against Humvees, and I hate those wannabe, yuppie gas-guzzlers and the clueless posers who drive them. A tactical nuke would be nice to own too, to defend my family compound when the slavering liberals come for us patriotic Americans. Start with the nukes and next thing you know they’ve infringed on our right to own assault weapons for plinking rabbits. Those big-city ER docs go all squishy after patching up, or failing to, a few hundred teenage drive-by victims. They need to read the Constitution!

  2. [Sarcasm] Just think about all the wonderful things we could accomplish in the name of “Public Health” if we were able to get rid of the pesky Constitution and the Bill of Rights! Why, we could compell people to have STD tests, we could break into peoples’ homes and take their drugs (bad, you know), and we’d get all those awful guns. And knives, especially the steak knives, like our enlightened Brit buddies recently recommended. Yep. life would sure be better if the Right People were in charge! [/sarcasm]

    I sleep very well knowing there are enough guns in circulation to keep the ‘slavering liberals’ from knocking on doors and disarming the law-abiding. I do indeed work in a ‘big-city ED’, and know that the vast majority of ‘drive-bys’ are done with pistols, because they’re easier to hide and throw away. I have indeed ‘patched-up’ kids shot with guns, and I don’t recall a SINGLE instance wherein one was shot with a rifle, let alone one of them eeeevil assult rifles. I don’t doubt those shootings happen, but a) I’ve never seen one, and b) they’re the vast exception, and not the rule.

    Yes, ACEP needs to ‘read-up’ on the Constitution, and needs to consider that its constituents might not be behind lefty, feel-good statements that are farcical on their face and erosive at their core.

  3. Richard says:

    I’m glad I live in a country where drive-bys are practically unheard of. You can have your ‘infallible’ constitution.

  4. The Constitution isn’t infallible, nothing is. However, to paraphrase Churchill, Democracy is the worst form of government, besides all the others tried, from time to time to time.

    And, if you’re going to look down on the US, please tell us which nirvana you are writing from.

  5. Richard says:


    From New Zealand (definitely not nirvana). I’m willing to give up the right to own a handgun for almost no gun crime.

    I was curious why you said they were ignorant of the Constituion? perhaps they just disagreed with it, like you said it is not infallible and has in fact been amended many times.

    oh and democracy != constitution ;).

  6. Richard, I’ll give you the benefit of the doubt and assume you’re not trolling. The statement “I’m willing to give up the right to own a handgun for almost no gun crime” assumes a priori that banning handguns reduces crime. In fact, there is very strong evidence that the concealed carry laws that have been enacted in the US over the last 10 years have substantially reduced crime. I suggest you read the book “More Guns, Less Crime” by John Lott. Furthermore gun-related crime has dramatically increased in the UK since handguns were banned in the late 90s. If you want to believe that your government has banned handguns because it makes you safer, go ahead, but the evidence says otherwise.

  7. Eric Sivula says:

    Richard, if rendering guns illegal is supposed to reduce gun crime, why has it had the opposite effect in Britain and Australia?

    You do realize that two guys with a decent selection of shop tools can build submachineguns and pistols all day long right? They have captured men in Australia and Britain doing just that, making firearms in their garage and selling them to criminals. Plus making guns illegal encourages smuggling, after 1996 the IRA made a killing buying cheap Soviet Bloc guns and smuggling them in Britain. The Chinese gangs do the same in Briatin and elsewhere.

    In conclusion, if you don’t want to have a gun, fine. But for you to suggest that everyone else is better off without one, grow up. How are women supposed to defend themselves from rapists and abusers, who are almost always larger and more physically capable? How are individuals to defend themselves from groups of thugs? A middle aged man was beaten to death by 4 teenagers in BRITAIN for telling them to sod off after they asked for a light for their illegal cigarettes. How did a handgun ban make him safer?

    More Americans are murdered with knives and bare hands than guns. Have you banned thumbs and cutlery in Oz yet?

  8. It is refreshing to see a highly educated person with some common sense. One statistic often missing is the number of crimes prevented when potential victims simply brandish a gun. This is not regularity documented and reported by police departments, nor is it always reported by the potential victims who protect themselves without having to use lethal force, and who then don’t always report it to the police. People should know how to use some basic tools – pliers, crescent wrench, screw driver, socket and open-ended wrenches, saw, hammer, axe, gun,propane torch, etc. It is a sad state of affairs when people think they should not defend themselves when their locked doors are smashed in and violent criminals enter their homes or cars. It is a form of social/political pathology.

  9. What to say that hasn’t been said here and other places. Well, it seems that many professionals seem to favor gun bans. For the children of course. And so many people are willing to believe and be led by them. All in the name of SECURITY. Which doesn’t really exist in this world. As I recall there were these people living in some projects in Detroit or somewhere, to whom Clinton appealed to give up their right to own guns for their own safety. Clinton, the same guy who allowed the Chinese access to the missle technology which now allows them to threaten to nuke us with. The point of this screed being, that giving up your guns won’t make you safe in this world. There are always others willing to do violence towards you for whatever reason real or imagined. Even with a gun are you truly safe? No, but criminals prefer to prey on those who are unarmed. Those who they consider weak. A survey done in various prisons show that the bad guys are more afraid of homeowner with a gun than an armed police officer. Why? Because the homeowner doesn’t have to read them their rights.A homeowner is more concerned about his own rights than the bad guy’s. And that’s the way it should be.

  10. David Weber says:

    As usually seems to happen, this discussion veered off from a ban on “assault weapons” to a ban on gun ownership. Personally, I in no way favor banning private ownership of firearms normally used for hunting, target shooting and, yes, self defense in extremis. One problem is that for every Lott (whose evidence base has been demolished by experts — and physicians are customarily very picky and demanding of evidence) there are studies that suggest gun owners and their families are at far greater risk of injury or death from the weapon (especially handguns) than perps. That’s been my personal, anecdotal experience and that of a lot of ER docs I know. But I’m not ready to make owning handguns illegal. (Too bad we can’t make stupidity illegal.) And, too, maybe a ban on assault weapons is pretty much beside the point and just a camel’s nose under the tent. I realize most of the kids shot down on inner city streets aren’t going to be protected by a ban on assault weapons. Better a ban on cheapie, crappy Saturday Night specials. And why not? If the laws can distinguish against my right to build and own a nice little nuclear IED and a beautiful over-and-under shotgun, why can’t it extend to cereal-box pistols and automatic weapons pretty much useless except for defending against rivals in marijuana patches or invading phalanxes of terrorists? (I guess by now we can write off the Soviets and the UN.) In any case, I would urge you to argue on the merits that the ASEP is making a largely symbolic proposal. But why throw in deprecating allusions to liberals — not all of whom by any means want to “ban guns?”

  11. David Weber says:

    Sorry, ACEP.

  12. David Weber says:

    And now that I’m on a roll, let me a add that a citizenry packing concealed weapons is hardly a well-regulated Militia. The Constitution is open to all sorts of interpretation, strict construction of “arms” in 18th century terms would limit us to muskets and cap-and-ball pistolets (and cannon, I suppose, for that matter) and that’s why we have legislatures and courts. Life is nuance.

  13. I’m really starting to think, hard, about forcing TypePad comment registration.

  14. You know; of all the GSW’s I have seen, there was only one I remember involving a child genuinely shot by accident. He was shot by a .22 rifle some adult in his family was playing with.
    I have seen a lot of GSW’s sustained during altercations, such as one young man was shot through the gut when he and his friends were approaching a lone individual they did not know in the wee hours of the morning allegedly to tell him how much they liked his truck.
    It has been my personal experience that of those who come to the ED with GSW’s most of them have been perpetrated by criminals with illegally owned or operated guns against unarmed victims. The next most prevalent group is the criminal who ran afoul of an armed victim. Gun control would only extend the former group’s

    Gun control is not about guns; it’s about control.

  15. One problem is that for every Lott (whose evidence base has been demolished by experts — and physicians are customarily very picky and demanding of evidence) there are studies that suggest gun owners and their families are at far greater risk of injury or death from the weapon (especially handguns) than perps.

    Weber, you’re full of shit.

    Lott’s evidence base has not even been questioned much less demolished. His conclusions based on highly technical statistical analysis have been called into question, and are probably not accurate. However the best his opponents could do (while still looking at the whole dataset) is refute his claim of “more guns less crime” and demonstrate that there was NO correlation between crime rates and handgun ownership–at least this was the state of the argument 18 months ago when I last looked.

    As to “there are studies that suggest gun owners and their families are at far greater risk of injury or death from the weapon (especially handguns) than perps”, those studies completely disprove your previous comment “physicians are customarily very picky and demanding of evidence”. Having worked around physicians for a number of years they are no more or less demanding of evidence than anyone else, as long as it fits their preconceptions. The study you (seem) refer to (An Analysis of Firearms-Related Deaths in the Home) has been debunked so many times it’s not even funny. Hell, Kellerman even put a caveit IN THE PAPER saying that the causality might be reversed.

  16. TheNewGuy says:

    It is exactly pandering like this that has helped keep me out of the AMA, and ACEP. It amazes me how the physicians that lead our professional societies fail to appreciate the membership hit in taking controversial positions on issues that have little or nothing to do with medicine. Such stands only serve to alienate people, particularly where having no position at all is far more appropriate. This should be a no-brainer for divisive issues that don’t have a direct effect on our practice.

    My experience mirrors GruntDoc’s. Even when I was working the urban level-1 trauma center, and the knife-and-gun club hospital on the “wrong side of the river,” I saw virtually NO “assault weapon” injuries… most were “saturday night special” sort of weapons… .32’s, .25’s and .22’s. I took note of such details, as I have an academic interest in ballistics and penetrating trauma, and am a published author in the field.

    Assault weapons bans may make political hay for some politicians, but such weapons are statistically a non-entity.

  17. David Weber says:

    Who the heck are the liberals anybody feels they have to pander to these days?

  18. TheNewGuy says:

    “Who the heck are the liberals anybody feels they have to pander to these days?”

    An excellent question, Mr. Weber… an excellent question indeed.

    These positions have been a part of ACEP and the AMA since the early/mid 90’s (the last time I considered joining). During that time frame the Clinton Assault Weapons ban was de rigueur, both in the medical community and the public health community… never mind that there was no data to support it.

    It’s long past time for professional societies to drop the hot-potato issue advocacy and start advocating for their respective professions… not for the current political issue du jour. Until they regain their focus on issues that are important in day-to-day practice, they will languish in their current state.

    Unfortunate, but unlikely to change.

  19. David Weber says:

    Actually, it seems to me — a non-physician — that many hot-potato issues are very pertinent to day-to-day practice, not least the issue of gun violence. Healthcare coverage, end-of-life care, sexuality, drug and alcohol control policies, abortion, smoking, highway speeds, motorcycle helmets, auto emission standards… all have health impacts and all push somebody’s hot button. I think it’s appropriate and brave of influential groups to address things that affect them. Of course, the stance the group takes ought to be subject to vigorous internal debate. And somebody’s ox is going to be gored, no matter what. The gorees can quit in disgust — or stay and keep pushing the rational arguments for their position.

  20. TheNewGuy says:

    As a physician, I have to say that I disagree… these are not medical decisions, these are political issues. We will deliver the care whether a motorcycle helmet is worn or not. We will deliver the care whether a GSW victim is a cop or a gang-banger.

    I attempted to change some things in the AMA early in my career. However, the folks I dealt with weren’t the slightest bit interested in debating the issues. What I received instead was a continuous regurgitation of ideological boilerplate.

    Those of us who won’t join our professional societies to avoid supporting positions that we find objectionable are simply voting with our feet. Many of us feel these issues are NOT important in daily practice, and positions taken by small professional societies are unlikely to change political realities. Rather, these positions smack of naked political favor-currying. I’m busy enough… and I have no time or patience to fight my own professional organization while they happily use my dues money to print up glossy fliers bragging about their support for landmine bans and “no nukes,” just in time for the next Greenpeace convention.

    Passionate advocates for divisive stands within an organization can cloak their advocacy in whatever sanctimony they like… but far from being appropriate and brave, it’s actually self-defeating and foolish, particularly if the stated goal is to forge a large organization to advocate for nuts-and-bolts EM issues. Instead of keeping the group together for large and important fights, such schisms divide and drive away members. That’s fine if you’re trying to build a small cadre of true believers… not so fine if you need numbers to swing greater political weight.

    The ONE thing we have in common is that we’re all ER docs; they might consider starting with that.

  21. Mr. Weber;
    I quite agree. People should need prescriptions for guns, and medicare should help pay for them.
    Now, if you will excuse me, I am going to self-medicate….


  22. Derrick says:

    While I respectfully disagree with gruntdoc’s position regarding an assault weapons ban, I agree with him that this is a political issue that ACEP has no business choosing a side on. With reduced Medicare reimbursements, ED overcrowding, poor access to follow up clinics, and the threat of bioterrorism, there are MANY issues which require a unified voice of Emergency Physicians. Choosing battles which divide and weaken this voice only serves to dilute the strength of ACEP.

  23. doc Russia: If you’d like a scrip for that, in order to make Mr. Weber happy, please feel free to drop me a line.

    I think you need something in 6.8 SPC, if I’m not mistaken; you strike me as being mildly allergic to 5.56…



  24. Well, it is refreshing to see Doctors engaging in this debate, since we are supposed to be a participatory democracy. The AMA’s position on assault rifles makes as much sense as say the Teamsters taking a position that physicians should be subject to mandatory, ultra-high liability settlements regardless of the nature of the liability. Unattractive suturing would pay as much as leaving a clamp in the abdominal cavity, since the AMA knows as much about assault rifles as the teamsters do about medical procedures. Democracy is a bitch. I suppose it is all in the definition of terms, but most people can’t afford to buy assault rifles. Common sense dictates that most folks will keep a $300.00 Taurus .38 in the home for the extremely remote possibility that some maniac could come busting in. Instead of spending say 1500.00 on an assault rifle, they will use the $1200.00 ‘saved’ for their kid’s college tuition. That type of common sense is what gets us through, generation to generation, not the pontificating by the AMA and Teamsters.

  25. David Weber says:

    Aw, gee, doc Russia. Thanks. I almost feel as if I’ve been pandered to. And there’s nothing cuter than a pander.

  26. Grunt Doc,

    Thanks! After my optho type doc who lives across the street from me echoed tripe about gun banning I had about given up on the med profession. It is one I never understood, it is the ultimate capitalist guild, yet it constantly panders to those who prefer statism. Never could break the code. Your comments renew my faith that there are some thinkers left in your profession. :)

  27. If the medical societies truly wished to support public policies that benefitted their clients, whether that is physicians or patients, I would not have an issue with it. However, they do not. Information that supports gun ownership is ignored, eg Lott, Kleck, the fact that homicide and crime rates go down in non-discriminatory LTC states, and the rise in crime following gun bans in Washington DC, Britain, Australia, etc. Evidence that corellates firearms with any increase in crime, homicide, suicide, global warming, stagflation, etc is touted.

    Based on my personal observations, it appears that the voting members are largely ignorant of firearms issues, but do not let their ignorance stand in the way of their taking a position. I was at a meeting of the ACP in Philadelphia, during which a presentation was made of a survey of physicians and surgeons regarding good measures to take to prevent gun violence. The top three were 1) register machine guns, 2) no sales to felons, and 3) no sales to mentally unstable people. The fact that these have been federal law for decades completely escaped the audience and the presenters.

    If I asked how to reduce automobile injuries, and the “experts” suggested requiring that all cars have seatbelts and safety glass, without noting that all cars already have these things, I would concude that the “experts” were ignorant and not worth listening to.

    The same applies here.


  1. symtym says:

    Profession Pandering

    Agree! It is a real shame that professional societies take great leeway with their memberships when they confuse the political agendas of a few with the professional aspirations of the many.