¶ The Impact of Gun Policy Commentary
The National Rifle Association wrote this infamous tweet , which told doctors to stay in their lane . Their crucial mistake was trying to tell the American College of Physicians that they shouldn't talk about it . And then they referenced a report from the Rand Corporation , which is one of these famous DC think tanks .
Lo and behold , the NRA decided to only read the one line that supported their argument and then forgot the rest of the 400 page book that was out there . Supported their argument and then forgot the rest of the 400 page book that was out there .
So that's what I did , is I sat there and I read through that and decided to write the book using the same metric that the NRA used to tell doctors to stay in their lane , for us to say , oh wait , there are these gun policies that do work . Those of us that actually treat patients every day . We have a right to talk about it .
Not only do we have a right to talk about it , we actually understand how science works , and not just the politicking , and so this book is a response to that .
All right , y'all , we are here with Dr Cedric Dark , author of Under the Gun an ER doctor's cure for America's gun epidemic . Yo , I got a lot of notes from your book , man . This is a really great book .
The best way I can summarize this let me check my notes right here is basically you got a mix of personal experience , public health analysis , public suggestions to suggest or to address gun violence in the US . I got about like 10 points .
But for the sake of making this a really good conversation , my man , why let's start off with why did you decide to write this book ? Because you are board certified , you went to Morehouse , you work in Houston , you are ER doc . Let's talk about it . Why are you getting in this lane quote unquote you know where I'm going with this .
Why are you getting in this lane of gun ownership as an ER doc and where you at ?
Of gun ownership or the book writing . Which question do you want answered ?
Ooh , let's do because I'm very interested , I , you , you .
So for y'all who don't know Dr Cedric Dark , he's been in the Internet writing space for quite a long time with policy prescriptions which , in essence , dumbed down medical journals , so that senators and your congressman can really understand , you know the research that goes into what we do , so that when they make policies , when they make bills , they really understand
the science behind it in a way that they can understand Right .
So you've been doing this for close to a decade now , if not more Pretty much over at this point , getting close to like 20 years , because when I first started it , because when I first started it , the beginnings were like 2006 . We launched 2008 and , technically , are retired from it after 15 years .
So the website , even though we still keep it up , isn't being actively added to , but there are , I would say , spinoffs from it .
The Emergency Medicine Residents Association , emra they actually do a health policy journal club every month , which is something that we started under sort of a co-publishing platform that , even though I shut my website down , they continue to run .
Well , just to say that you ain't a novice at this , right . No , you ain't a novice at writing , so this book , right here . You've ain't a novice at writing , so this book , right here . You've been , and I appreciate you making time for us because you've been all over the media circuits promoting this book .
The question is why did you decide to write this book Under the Gun ? Yeah , give us the basis as to why you decided to write that book .
I had no desire to do so whatsoever . Gun policy is kind of like my second biggest interest . My first biggest interest is more like healthcare coverage , universal healthcare , that sort of thing .
But in 2018 , the National Rifle Association wrote this infamous tweet which told doctors to stay in their lane and , as you mentioned earlier , I've been doing this for 15 , going on 20 years talking about evidence-based policy . Their crucial mistake was trying to tell the American College of Physicians that they shouldn't talk about it .
And then they referenced a report from the Rand Corporation , which is one of these famous DC think tanks , that is , you know , if I had to put my own stamp on them , they're probably one of the most quantitatively rigorous think tanks out there in the health policy space , and use the evidence that RAND put out there in their Science of Gun Policy book to tell
the ACP that they were overstepping . Lo and behold , the NRA decided to only read the one line that supported their argument and then forgot the rest of the 400-page book that was out there .
So that's what I did , is I sat there and I read through that and decided to write the book , the premise of which , using the same metric that the NRA used to tell doctors to stay in their lane , for us to say oh wait , there are these gun policies that do work .
And you know , those of us that are physicians , those of us that have experience like I , worked on Capitol Hill- I've worked for Kaiser Family Foundation , or KFF as it's now called , and those of us that actually treat patients every day , we have a right to talk about it .
Not only do we have a right to talk about it , we actually understand how science works , and not just the politicking , and so this book is a response to that .
And it's been . From what I've seen , it's been very well received . I enjoyed this book , like I said , and it's been very well received . I enjoyed this book , like I said . I got a lot of notes from it . But I'm very interested as to not just in the book , but just even how you balance .
You are an admitted gun owner , right Number two , you are an ER doc , so you know what happens with guns , right , whether advertently or inadvertently . And then you've also had a close family member , a cousin , who passed away due to gun violence . Talk to us about that , how you handle that in the book . How do you handle all of that stuff ?
Because that's a lot of intersections , right ?
Yeah , I think that's one of the reasons why I was the person that had to write this , because I think if you take a normal person that's just focused on gun violence prevention , but they're maybe not a gun owner , a lot of the credibility that you might get otherwise goes out the window . Yeah , they don't have skin in the game , you know , I think .
Is there such thing as skin in the game ?
Of course there is . I hate that terminology sometimes , but that's more of a policy perspective than anything else . You know , having a family member die from a firearm , you know , is something that is not unique to me One out of five Americans had that happen in their family number one but I think it it gives us a lead in .
So when I'm approaching the reader , I can tell them that story , to personalize it a little bit .
But I think it does require , like all three of those things , being someone that sees gun violence in the workplace , someone that's experienced it , you know , in family setting , but then also somebody that's not anti-gun but , as my friend Esther Chu would say , it's anti-bullet hole .
Like realistically , that's what I'm here to do is to talk about how do we prevent bullet holes from going into people .
Now the way in which you put it out , like everything is common sense , right , it makes sense , right , like the ideas , the policies , in essence , essence , I think we , you've you found the way , or I think we all .
When you focus on the science and you focus on the end result as opposed to castigating the person , right , it's like saying someone is a racist . You can't really say someone's a racist . You can say , well , your behavior is racist , right , or the end product is racist , or it has some type of well , that's the end product . I get this point .
But talk to us about , in this book , some of the simple policy recommendations that you make . I think it's very interesting the way how you describe them .
Yeah , there's a bunch of them out there . I'm not going to list them all out . Whenever I do , I'll , of course , forget some of them .
I think number one , which , as you said , common sense , universal background checks , right , like , if I have a gun I want to sell it to you , I ought to run a background check on you to make sure that you're not some criminal , you know , abusing your spouse , that sort of thing .
But unfortunately , 22% of firearm transactions skip that whole background check process . 22% of firearm transactions skip that whole background check process . That's one thing that needs 22% , about one in five . So that's one thing that just needs to be fixed .
And again , if you look at the polling data , whether you're Republican , democrat , independent , pretty much everyone thinks that you should have a background check before you sell a gun to somebody else . Even gun owners think that . So that's one thing . Another thing is what we would call safe storage , and that can be a couple to somebody else .
Even gun owners think that . So that's one thing . Another thing is what we would call safe storage , and that can be a couple of different things . It could mean child access prevention .
It could mean that if you have a firearm that you know you're keeping it locked , preferably separate from ammunition , so that you don't have that risk of someone taking that firearm and harming themselves , whether it's intentionally or unintentionally .
So that's another policy that's out there , a policy that's been demonstrated to save people's lives , but it's something that is not universal across all 50 states . That's the crazy thing about the United States is that a lot of these policies are at the state level .
We don't necessarily have a lot of these things implemented federally , and so there's room for improvement . But it sets up from a scientific perspective , a natural experiment , so we can see well , in states that have policy A versus states that don't have policy A , what kind of impact is there .
There's other stuff included as well , including , like community violence prevention initiatives , hospital violence intervention programs , those sorts of things we talk about in the book .
So when you talk about that , you talk about like Dr Robert Gore's Kavi up in Brooklyn , New York .
Right , I talk about Rob's program . I talk about Kyle Fisher , who is on sort of a national organization called the Javi , which sort of helps to get all these programs started , coalesced , you know , provide them resources to get them off the ground .
So if you're at a hospital that doesn't have that , you want to try to get those going like that's a good resource for you to reach out to . So there's a bunch of things like that .
We even talk about what I like to call the mental health paradox , which is one of those things that we always think oh yeah , if we just screen people for mental health issues , then that's going to uh , cut back on like violent crime or whatever , which is like caught my ear , you know , because I think one candidate mentioned , you know , we just need more
mental health , and then the other vice presidential candidate corrected the record and was like people with mental health issues aren't necessarily more violent , they're actually more often victims .
I think that got lost , that got lost in the back and forth , that got lost in the back and forth . Can you explain that again , can you ? Can you describe that guy ?
Cause I cut you off actually while you were saying that oh yeah , yeah , no , I mean , I think the thing is that we assume , because what happens is , you know , there's a shooting that's popularized on television and we're like , oh man , that person must be like mentally ill or whatever .
Or you think like maybe they're schizophrenic or something like that , and that's not really the case . Um , you know , people with people with mental illness in this country , you know , are diagnosed all the time , right , depression , anxiety , all that kind of stuff . Whether or not it's a serious mental illness is completely separate issue .
And even when you you're talking about dealing with that , restricting firearms to people that have been involuntarily committed for something doesn't necessarily save people's lives .
¶ Gun Policy Recommendations and Challenges
Now , this is the interesting part , because when I first started this book back in 2019 , and I was reading that first iteration of the Science of Gun Policy from Rand it actually said , yes , it was . As I was reviewing the book , revising it , going through edits and getting it ready to print , that actually changed .
You know the scientific process , right , you add more and more studies into sort of a meta-analysis or systematic review . Yeah , things can change , and so I had to change the way I approach that . So now I approach it more a little agnostically , the reason why I call it a paradox ?
Because there is a mental health problem in this country as it pertains to guns , but it's really suicide which no one talks about . Like how many times do you hear on the news somebody you know died by firearm suicide ? Like never .
But we see it a lot . You know , within the ER and trauma surgery world we see that a lot .
Oh , we actually see it a whole lot less than we probably otherwise would , because firearms are so deadly , you know , if you think of it like a case fatality rate like 85 , 90 percent , most of the people that attempt it don't make it to the hospital because they're dead in the field . Don't make it to the hospital because they're dead in the field .
But that's really where , if we're thinking about mental health , we need to be focusing on that aspect of it instead of using mental health as a boogeyman and a distraction . And that's where I think where the politics sort of starts playing to . It is because people on one side want to use it as a distraction and then not fund mental health supports for people .
Right , we miraculously don't have more mental health beds in the system to get folks out the ER that need help , but we keep talking about it as a problem .
If people understood , if people understood the wait times . I think the hardest thing I've seen and I've seen this a lot is someone who has intent or has committed a certain act against themselves . Literally , the process of trying to get them into inpatient psych hospitals or just placement inpatient is one of the hardest things ever .
This is either no room or , let's say , the next day they change their mind or something like that , and because there's no room anticipated , they're like well , you go home , come back when you know it's just like , this is crazy . We see that a lot in these level one trauma centers right , like , can we get this person into inpatient ? No , can't .
I got a question for you , can't I got a question for you With the policy recommendations that you make have to be like a if you take one , you got to take it all , because I just feel like if everybody agrees on it , then why is it so hard to implement at least universal background checks ?
Why is it so hard to individually get like waiting periods and so forth ? Explain that to me .
I think there's a lot of weeds that get into that , right . So there are mental health checks , there are domestic violence checks out there , but there are loopholes in this , and this is one of the loopholes that law that was recently passed a couple of years ago , the Bipartisan Safer Communities Act tried to resolve one called the boyfriend loophole , right ?
So first of all , if you run a background check on somebody and they have a felony conviction for domestic violence felony just means greater than a year sentence then at that point you know they are eliminated from owning firearms , right ?
If , let's say , their sentence is 364 days or it becomes a misdemeanor , then that doesn't necessarily apply into that background check process .
Or if it's , let's say , a boyfriend that's not cohabitating , that doesn't have a child , it's not a spouse of that individual , then they're not really required to be reported as well , even though that's the same violent person , same violent act . And so there's a federal floor on some of this stuff . Then different states top it up , you know .
So some states do have background checks on every firearm transaction .
Some do have waiting periods , some require licenses , like you'd have to get a license maybe in hawaii or something , to then be able to go out and buy a firearm right , which which , if you're feeling suicidal , puts time and space between you to be able to go out and buy one , unlike if you you're in Texas .
If you want to go to the store , you can run over to one . Now , within the time it takes to process that federal background check , that FBI background check , which on average is two minutes , you can walk out the store with a gun .
You know , I mean , there was recently like a shooting at Lakewood church you know Joel Steen's church , you may have heard about that in the news . There's literally a store that sells guns walking distance from that church , right ? So in my mind I'm like I wonder if the person , just , you know , went to the store , bought the gun , walked over there .
You know that kind of thing .
That's the way I think , uh , but you know that there's , there's that floor you have from the federal , and then you have states that can can do things on their own on top of that , and that's where there's a lot of difference state to state , and that variation allows us to look at the policies and then see what happens with firearm mortality as a result of
it , and be able to determine their effectiveness as a result of it and be able to determine their effectiveness .
You ever get any pushback on like taking a stance , because I you know , I think the history of doctors at least is you kind of just treat the patients . You don't really kind of commentate on things . So I mean you could take it as far as even within your own specialty group , right ASEP . Like what's the lay of the land ?
Right , because you know we have I forget what the percentage is . Right , but you have so many physicians who are Democrat . You have so many physicians who are Republican . Like it's not . You know , we're not a monolith right . So in terms of , like , the reception of this book , how's it going , even within your specialty group ?
So and I don't know if you've read the part yet where I talk about one of my coworkers , paul Torrey . He's a life NRA , life member . You know , um , who literally thinks that the second amendment is what protects the rest of the amendments of the constitution . You know that's his viewpoint , um .
But then again , if you throw these policies in front of him , you know , making sure people got to be screened before they get guns and making sure that they haven't beat their spouse he can agree with that . And whenever I go talk anywhere I get the same reception .
¶ Understanding Gun Policy Perspectives
There's always a firearm owner , a hunter , somebody like that , a former military , that comes up to me either before or after the conversation and typically when we talk about it , they happen to be some of the people that want some of the most stringent restrictions because they understand what responsibility looks like for a gun owner , right , they understand that you
should have your firearm available to you , but you shouldn't have one if you don't have a right to have one if you're , you know , not of a certain age . You know age greater than 21 is one of those other policies , that's . It's a reasonable policy that can prevent loss of life . They often will believe you need to be trained .
You know you need to know that when you touch a gun , the first thing is you don't point it at anything you're not ready to destroy . You know they don't understand how someone can accidentally get shot , because you should never be pointing a gun at a target that you don't want to kill .
Right , and I think for those folks that actually were in the military and or um are hunters , they recognize this .
I was talking , I actually was talking this past weekend in north carolina and a hunter came up to me and was even further , I think , than I am in terms of restriction , because he's like , when I'm going hunting , what's the point of having a semi-automatic deer hunter ? It's like if you miss on the first shot , you just don't get that deer . Yeah .
Yeah . So I can say to say , you know , I that's kind of well , anyway , I'll let you keep going , I'll let you go .
No , I'm just , I'm just saying from that standpoint so the ones I actually get the most pushback A little upset that I'm not pushing harder on things like an assault weapons ban because , again , when we look at the data on that , the best data that we have says that an assault weapons ban we should be agnostic on .
Really , why Explain that ? Because I mean , that was the big thing back in the 90s the Bradley Bill and all that stuff and Brady Bill . We had Brady Bill Excuse me , the Brady Bill . I apologize , I'm sorry , it's OK , but we got like what Was that 10 years ?
15 years . It was 10 years of an assault weapons ban , I think from Bill Clinton . It expired in the Bush administration and , yes , we saw numbers go down . And this is where it's going to get a little nerdy here , because remember I was talking to you about natural experiments , right ? Remember I was talking to you about natural experiments , right ?
Yes , from one state to another state , right . From one state to another state difference . When you have a national assault weapons ban you don't have a different state to state , so you can't really do that same kind of study . So the strength of the study isn't as strong .
That's why the recommendation is kind of null , because you know you can't reject the null hypothesis , as it were , because the study type isn't great . It'd be different if you had assault weapons bans in some states , not in other states , and then you can look at the data to see how that plays out .
The other thing Told y'all he knows his stuff . Y'all , I'm telling you , I keep telling y'all .
This is also why I've taught journal club for years and years . You know which my residents hate me , because I always ask them about power calculations . You know , but you got to think of it that way too right In terms of statistical power , right ? How many people do you think die from assault weapons in this country , aka mass shootings in this country ?
Give me a guess , nii .
From mass shootings ? How many people die from mass ?
shootings yeah , per year .
I'd say in 100,000 .
Well , first of all , when we're talking like gunfire deaths , we're only talking 48,000 , only 48,000 people every year , right ?
Oh , really Okay yeah .
Out of that , 48,000 , the number of people that die in mass shootings is around 600 . Really Okay , there's more people that die from mass shootings is around 600 . Really okay , there's more people that die from police shootings than from mass shootings . We don't talk about that at all , right ?
okay , you don't hear but a mass shooting is what we would be what six people more dead , or something like usually let the stats like about four more people , um , I believe , shot at one time .
One incident doesn't necessarily have to kill all four of them . Right , and incident doesn't necessarily have to kill all four of them .
Right , and that doesn't necessarily have to be like something that you see on TV right , like that's Right .
It's literally a murder-suicide . And then you kill your two kids , right ? That's a mass shooting , right ? In essence ?
So that's not much Okay .
It's not much , but I mean it's not a lot . So you're talking about a small number , that you're trying to look for a difference between the assault weapons ban and then you don't really have good study or a good situation to say state A versus state B versus state C . In terms of that it's going to be hard to find a difference .
It's a lot easier to find a difference in things that are going to stop suicide , because suicide is the number one cause of firearm fatality in this country , usually two to one to homicide , and each one of those is in in at least above the 15 000 suicide , usually above the 20 000 range every year .
So we're talking those two things are relatively easy to research and study . The other stuff that we get all the news about harder to study and so that's why , like my perspective is very agnostic on it . You can decide to do whatever you want to do , and you had mentioned what our medical professionals , you know professional societies talk about .
Asap has an assault weapons ban called for in their firearm policy . So that goes further than where I stand , you know , because again , and you know me , I've been doing this for 15 to 20 years . It's all about evidence-based health policy . Right , that's what I'm focusing on is I'm sticking where the evidence is .
Now , should someone who's a physician , who's reading your book , um , is there a possibility that they can get a different message depending on where they reside or where they practice , Like a physician who works , who reads your book , who's from you know a populous city area Houston , Los Angeles , Atlanta , New York City versus a physician who works in the middle of
you know the Midwest , you know Pennsylvania , you know what I'm talking about , you know pencil tucky , you know what I'm talking about . Can there , can they get or glean two different messages or different messages from your book , depending on where they , where they practice at ?
I think so . I mean quite frankly , like this is how we approach any other kind of risk , risk prevention or risk reduction strategy , right ?
I mean you talk to your patients where your seat belt right , when they're leaving the trauma ICU or whatever , like you're discharging them home , like , wear your seatbelt , wear a helmet if you're riding a bike or motorcycle , that kind of thing . This is the same sort of situation .
Actually I tell them never get back on a motorcycle again . Actually .
Well , that's fair . That's fair . You know you can never I can't lie . I tell them , yeah , but again , like you can't command that of them , right , you can tell them what your recommendation is . You can tell them your personal history . You know what you've seen and everything .
You tell them you know the science says you're going to at least be more likely to survive it if you're inside of a car with a ceiling and walls than if you're thrown off of a two wheeled vehicle with nothing around you . Right , and that's the best sometimes we can do is give people the information .
So , yeah , everybody , I think , is going to approach it from their own perspective , and I think gun owners are going to approach it one way , non-gun owners are going to approach it another way . The main point is that we have a conversation .
Okay . So for a doc who's listening to this med students listening to this . Right now they read this book . What's the one , what's the easiest thing they can do right now to even start the conversation to say I want to do my part in trying to reduce gun violence . I want to do my part to you know , this is America's gun epidemic .
What can I do to change that ? What do you want ?
them to get from this . This is our lane . That's the main point . That's the last four words in the book . Essentially is we have a right to talk about this , just like we have a right to tell our patients to not get on a motorcycle again or to wear their seatbelt when they get in a car .
So we have those rights to do that as physicians and we shouldn't have a gag order put in front of us , much likeida tried to do to their pediatricians years ago and get overturned , because we do have free speech rights as physicians to say what we need to say to our patients to make them safe and healthy .
Now , if you happen to be a gun owner , that's also a physician . There's a second message . That second message is store your gun safely , because I think there is true , that's probably ducks .
Yeah , that's probably ducks who ? Yeah , yeah , they don't . They're not listening or at least practicing what you would think they would want to preach , which is like what you said you know not everybody . Yeah , well , I was one of them , you didn't lock your stuff up .
Nope , not until my kid turned four , got his remote control that we hold up on the mantle in front of the TV , pulled his little tiny chair out , slid it up there , got up on the mantle and , you know , got the remote .
When I saw that I was like I got to lock this thing up because my gun's like not even that high up , you know , in a drawer somewhere .
Now yours ? Yours is that , like you know , I've been exposed to guns , you know as a kid , and I like to shoot them . Or is it just for protection ?
Like what's your motivations ? So mine started out of the protective motivation . So we moved into Houston . Within a couple months of moving into , you know , the middle of the city , I actually got robbed or burglarized , I guess not robbed . I actually got robbed or burglarized , I guess not robbed .
Someone broke into the house and you know I showed up after shift , you know , found like the back door busted in and all that kind of stuff . The next day my wife went to the store bought some guns . She's the real Texan you know . So , oh , so she don't play .
Yeah , nah , nah , nah , nah , so , um , and so you know that that's why we started being gun owners . I would say , um , after that , like , once you get guns , they're , they're fun to go to the range and shoot . I mean , like you're , you're a surgeon , you know it's , and hand-eye coordination , all that stuff .
It's the destructive capability that's still kind of so . I had an experience where I was in Georgia when I was training at Morehouse .
And .
I did something that was near Columbus , georgia , so we went a little bit into Alabama and went to a gun range and it was I'll leave it to you like this the doctor had an AR-15 , had some other things . It was as exhilarating as it was scary .
Also , at the same time , you know , it was just like wow , like I'm , you know we're shooting at targets and stuff like that on a gun range safely , but you get this adrenaline rush . But then it's also like damn , like the destructive capability of this , you know , is just it's crazy .
Absolutely . Like you know , the first time I went shooting was in college . I took a course that was taught in Spelman . I went to Morehouse undergrad . You got a lot of cross-registers . I took this class called outdoor education . You know , we did like camping and hiking and all this other stuff and one of the things was going skeet shooting .
So that's where I learned to shoot a firearm . I feel like I didn't actually appreciate it until I had my own guns . And then , going to the range to shoot , we actually had one of our nurse practitioners teach us how to shoot , because he's former military and actually can source things that are even more professional than an AR-15 , right ?
So we actually shot an M4 rifle , which , again , it shoots like a breeze . And I agree with you , it's the exact same thing you're talking about , where it's exhilarating , but then at the same time you realize if it's this easy to shoot , you can see how easy it is to mow people down yeah , from a long distance as well , you know .
So again , I get the whole assault weapons ban thing . I don't think it would be wrong to do in that sense , but from the evidence-based perspective , that's why I'm saying I'll be agnostic on it .
¶ Celebrating a Book on Gun Epidemic
Well , there it is , guys . That's Dr Cedric Dark , author of Under the Gun an ER doctor's cure for America's gun epidemic . Guys , you can get this on Amazon right now . I got my preorder in , but it's available on Amazon . We'll put the links in the show notes . And , dr Cedric man , I'm proud of you , man . Guys , we go as far back as med school .
We didn't go to the same med school , but we know each other as far back as med school and I just want to say I'm really proud of , like , the strides that you've made and stuff , and you done made it . So I wish you all the luck in promoting this book .
I hope it reaches and gets out to as many people as possible and I hope that this is part of literally the solution to the gun epidemic that we have right now , because we definitely need a solution right now . So , dr Cedric Dark , thank you for coming on . Docs Outside the Box , man , we appreciate it bro .
Thank you so much , good seeing you , man .