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How urgent policy is made at the AMA HOD: the AMA takes a stand on gun violence.

Since joining the AMA as a first year medical student in 2010, I have had the opportunity attend both the annual meeting and interim meeting every year. Over those ten meetings, I have come to appreciate the certain ebb and flow with which the meetings are run. Positions and resolutions are usually proposed months in advance, with a rare few brought forward urgently. Usually these urgent items are shot down, and often not even considered because the House of Medicine does not agree that they are urgent and there has not been appropriate time to research possible positions. From time to time however, there are issues so timely that the AMA takes notice, and will move to quick action.

Hours after the opening ceremonies on June 11, 2016, 1,200 miles away in Orlando, a man, whose name I will not glorify in these pages, chose to take the lives of 49 people and injure 53 more. Those events stained the consciousness of the AMA's House of Delegates. In the pale light of the next morning we were aghast at what had transpired. Perhaps it is because we will be going to Orlando for the interim meeting in November, or perhaps it is because the LGBTQ community has such a noticeable and vibrant presence in the house of medicine, or maybe it was just because we tired of all the needless deaths, a few members decided that as the voice of the health community we had to speak about a crisis we barely understood, and one where the research was limited.

At the time of this editorial, there is currently an effective ban on study of Gun Violence by the Centers for Disease Control and Prevention (CDC). This is secondary to what is often referred to as the Dickey Amendment. The Dickey Amendment is a congressional rider passed in 1996. Specifically that rider prohibited the CDC from lobbying on behalf of gun control. The rider provides that none of the funds made available for injury prevention and control at the CDC may be used to advocate or promote gun control. (1) This ban on advocacy was turned into a de facto ban on research on gun violence secondary to: 1) re-allocation of funds previously made available for gun violence research to traumatic brain injury; and 2) a general sense that the re-allocation of funds to this effort would have significant political ramifications. (2-4) In 2013, President Barack Obama directed the CDC to research gun violence, and they did so with the caveat that their resources for such are very limited. (5)

The morning after the shooting at Pulse, the Orlando nightclub, a small contingent of prominent physicians in the House of Delegates sought to better understand the issue of gun violence. They recognized that the physicians' role in firearm control is one that is rather contentious, but the role the physician has as public health leader is not. Rather than enter into the quagmire of gun control, they thought better of it and rather wished to simply understand the burden of disease.

Initially, there was a large amount of trepidation, and the negations about bringing this topic to the floor were heated at the very least. As Sunday rolled on, more people joined the initiative. By Monday morning there was a groundswell of support; however as individuals joined there were those who wanted to broaden the issue to address firearm control. These efforts were quickly stopped. As co-sponsors continued to join, there was added pressure to bring the topic to the floor. Towards the end of the day Monday, a rumor sprang forward that the outgoing president of the American Medical Association, Dr. Steve Stack, was going to make a statement about the tragedy. There was a sense of urgency that the issue needed to be brought to the floor immediately, prior to his statement. The leaders of the coalition pushed back. They felt that bringing the issue too soon would backfire, and that it was more important to make the right policy than to be first. Dr. Stack did indeed make a statement that can be found in the references. (6) Perhaps in part secondary to the outgoing president's remarks, the resolution received unprecedented support with 55 member caucuses joined onto support what became known as AMA policy D-145.995, which reads:

Our AMA: (1) will immediately make a public statement that gun violence represents a public health crisis which requires a comprehensive public health response and solution; and (2) will actively lobby Congress to lift the gun violence research ban.

Since the meeting the position the AMA has taken has been well received, with both traditional and newer media outlets lauding the policy. We are still too close to the meeting to see any substantive change at the national level. The hope is that a change in the national conversation, and new efforts to understand the problem will lead to better prevention strategies. Inevitably our AMA, and our country will need motivated leaders, and most likely motivated physicians, to investigate and implement solutions to the violence and hatred that led to a tragedy like Pulse.

References

(1.) "Public Law 104-208." Ed. The 104th Congress. N.p., n.d. Web. 015 Aug. 2016.

(2.) Jamieson, Christine. "Gun Violence Research: History of the Federal Funding Freeze." http:// www.apa.org. N.p., Feb. 2013. Web. 16 Aug. 2016.

(3.) Frankel, Todd C. "Their 1996 Clash Shaped the Gun Debate for Years. Now They Want to Reshape It." The Washington Post, 30 Dec. 2015. Web. 15 Aug. 2016.

(4.) Fessenden, Marissa. "Why So Few Scientists Are Studying the Causes of Gun Violence" History, Travel, Arts, Science, People, Places. Smithsonian, 13 July 2015. Web. 15 Aug. 2016.

(5.) Schumaker, Erin. "Doctors Condemn The NRA-Fueled Ban On Gun Violence Research." Healthy Living. ngtnr Post, 7 Dec. 2015. Web. 15 Aug. 2016.

(6.) Stack, Steven. "AMA News Room." AMA President Responds to Orlando Mass Shooting Tragedy. American Medical Association, 13 June 2016. Web. 18 Aug. 2016.

by Daniel O'Brien, MD

PGY-2 Dept. of Otolaryngology Head and Neck Surgery Delegate from WV to the AMA-RFS Alternate Delegate from the RFS to the AMA-HOD
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Title Annotation:AMA Meeting: RESIDENT PERSPECTIVE
Author:O'Brien, Daniel
Publication:West Virginia Medical Journal
Date:Sep 1, 2016
Words:1028
Previous Article:American medical association meeting Chicago, June 11-15, 2016.
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