After the tragic shooting of 20 first graders and 6 adults at Sandy Hook Elementary School in Connecticut, both lawmakers and the President have promised action. Many Americans see gun violence as a political issue and offer their own opinions on the Second Amendment, albeit something only the Supreme Court can do. Certainly, politicians are needed to act on the issue of gun violence but let’s look at it from a medical perspective.
The United States ranks 11th in the world for gun-related deaths with 10.2 deaths per 100,000 people. Guns are the second leading cause of death for those aged 1-24.1 If an infectious disease was responsible for this carnage, health providers would be up in arms (pun intended). In fact, firearms reduce the average life expectancy in the U.S. by 103.6 days. The differences are staggering among ethnic subpopulations. Guns lower the life expectancy for African-American men by 361.5 days, nearly a year! In contrast, Caucasian women lost only 31.1 days. The cost of all of this is not anything to sneeze at either. About $100 billion is spent annually in the U.S. as a result of gun violence.2
So where have doctors been? Well, some professional medical associations, like the American Academy of Pediatrics, have previously come out with strong position statements addressing gun violence.3 Recently, in late December, over 50 medical organizations including the American Medical Association, the American Osteopathic Association and the American College of Emergency Physicians signed a letter to Congress asking for action to reduce the gun violence and increase mental health funding.4
But what does this have to do with podiatry?
Actually, the foot and leg are the most common body parts affected by a gunshot in three of the four categories studied by the Centers for Disease Control and Prevention (see photo above left).5 I am sure many of you have also managed lower extremity gunshot wounds, like this assault I treated at Broadlawns Medical Center in Des Moines, IA (see photo below right). Lower extremity gunshot wounds were a such common occurrence at this county hospital that Vincent Mandracchia, DPM, authored a comprehensive review that is a must read for any podiatrist treating them.6
Doctors played an instrumental role in making automobiles safer, reducing injuries in contact sports and lowering smoking rates. Injuries and deaths from gun violence are a public health crisis and doctors should be leading the discussion preventing these injuries. The American College of Physicians (ACP) published a letter to American doctors in the Annals of Internal Medicine, pleading with them to work for comprehensive reform of gun laws.7 They wrote, “Why does gun violence deserve physicians’ time and energy? Guns kill and maim.” The ACP quoted the AMA’s declaration of professional responsibility to, “Advocate for social, economic, educational, and political changes that ameliorate suffering and contribute to human well-being.”
Since the foot and leg are the most common anatomical regions affected by firearm-related trauma, podiatry should add its name to that list of concerned medical professions and make a commitment to advocate to promote lower extremity health by preventing gun-related injuries.
1. Palfrey JS, Palfrey S. Preventing gun deaths in children. N Engl J Med. 2013;368(5):401-403. http://www.nejm.org/doi/full/10.1056/NEJMp1215606  .
2. Available at http://knowledge.wharton.upenn.edu/article.cfm?articleid=1214  .
3. American Academy of Pediatrics. Firearm-related injuries affecting the pediatric population. Pediatrics 2000;105(4 Pt 1):888-895 http://pediatrics.aappublications.org/content/105/4/888.full  .
4. Available at https://www.aamc.org/download/325272/data/gunviolenceletter-houseofrepre...  .
5. Gotsch KE, Annest JL, Mercy JA, Ryan GW. Surveillance for fatal and nonfatal firearms-related injuries -- United States, 1993-1998. MMWR 2001;50:1-32
6. Mandracchia VJ, Buddecke DE, Statler TK, Nelson SC. Gunshot wounds to the lower extremity. A comprehensive review. Clin Podiatr Med Surg 1999;16(4):597-615
7. Available at http://www.modernhealthcare.com/Assets/pdf/CH847641228.PDF  .