Turning the Tide on Physician Suicide

By Ami B. Bhatt, MD, FACC
June 14, 2018

Since the two very sudden public suicide deaths of Kate Spade and Anthony Bourdain, society has again recognized that we never know what is under the surface of another’s façade. As physicians, these tragic occurrences emphasize that our caregiving requires seeing the entirety of an individual’s many parts.

While we acknowledge that the façade is not fake—it is but one true representation of an individual, well-curated, like pages on Facebook or Instagram—no one mourns the corporate façade created for these individuals. We mourn the fact that despite feeling we know someone, we didn’t see it coming. This is that much harder when it is a loved one, and most frightening when you might see it in yourself.  Especially, if you are a physician. Continue reading “Turning the Tide on Physician Suicide”

Gun Violence as a Public Health Issue

By Ajay K. Singh, MBBS, FRCP, MBA
November 21, 2017

An interesting viewpoint about gun violence was recently advanced by Nicholas Kristof (with Bill Marsh) in the New York Times.

Kristoff argues that a blanket opposition to guns hasn’t worked and that an alternative approach of regulating guns should be considered. He advocates a “public health approach.”

The article cites some staggering facts:

  1. Guns per 100 people—for the US, 88.8; the next closest Switzerland at 44.7; Canada comes in at 30.8 and Japan 0.6.
  2. Murders per 100,000 people—the US 3.0; the next closest Italy at 0.7; Canada comes in at 0.5.
  3. Research on guns: from 1974 through 2012, the NIH funded just three research awards.

The Kristof article makes some sensible recommendations that seem to resonate with Americans. Here are three that caught my eye:

  1. Background Checks—93% of Americans surveyed agree and yet 1 in 5 guns are obtained without one. Nearly 90% of Americans agree that the mentally ill shouldn’t be buying guns.
  2. Safe storage—making sure guns are inaccessible to children and have trigger locks.
  3. Banning under-21-year-olds from purchasing guns—we don’t let them drink, but allowing a teenager to buy a semi-automatic gun seems sensible?

Other ideas that we could consider with a public health approach include taking a systems approach. How can the health system help reduce gun violence?

  • Could the primary care doctor ask patients about gun ownership, and perhaps even counsel them about safe gun use?
  • Does integrating educating patients about safe storage and making sure guns can’t be fired accidentally seem to make a lot of sense?
  • Could research be funded that predicts which individuals are prone to gun violence? Perhaps, high-risk individuals could be screened and then offered help by the health system?
  • Could sensible controls be built-in that, on the one hand preserve privacy, but at the same time regulate access to guns in people with mental illness? Should people with personality disorders or a history of psychotic illness be allowed to buy guns without undergoing some secondary screening? On a related note, merging databases that screen people as a part of a “background check” with databases that record diagnoses around mental health could be developed.

Whether gun violence abates in the US is a complicated question. At one level, solutions are a function of societal trends, politics, and the power of the gun lobby. Still, thinking about novel ways to frame an important problem isn’t a bad idea. Gun violence kills people, and as Kristof suggests, emphasizing and framing it as a public health issue makes sense. Has anything else worked?


Learn more about Health and Health Care Disparities from a panel of HMS experts.


Ajay Singh, MBBS, FRCP headshotDr. Ajay K. Singh is the Senior Associate Dean for Global and Continuing Education and Director, Master in Medical Sciences in Clinical Investigation (MMSCI) Program at Harvard Medical School. He is also Director, Continuing Medical Education, Department of Medicine and Renal Division at Brigham and Women’s Hospital in Boston.

Share your thoughts on solving America’s gun violence crises in the comment section below.

*OPINIONS EXPRESSED BY OUR AUTHORS ARE VALUABLE TO US AT LEAN FORWARD, BUT DO NOT REPRESENT OFFICIAL POSITIONS OR STATEMENTS FROM HARVARD MEDICAL SCHOOL.

Ending America’s Gun Violence

By Ajay K. Singh, MBBS, FRCP, MBA
November 7, 2017

…it is imperative, now more than ever, that we approach this public health concern in an evidence-based and apolitical manner so as to better understand the complex social, economic, and political factors associated with firearm-related injuries. – Faiz Gani

Gun violence is a leading cause of premature death in the US, killing approximately 30,000 people and causing about 60,000 injuries each year.

In the midst of writing an article about a blog post on gun violence by Faiz Gani, I heard breaking news about 26 people tragically killed in a Texas church.

Senator Chris Murphy (D-Conn) issued a statement after the Texas church mass shooting: “As my colleagues go to sleep tonight, they need to think about whether the political support of the gun industry is worth the blood that flows endlessly onto the floors of American churches, elementary schools, movie theaters, and city streets. Ask yourself—how can you claim that you respect human life while choosing fealty to weapons-makers over support for measures favored by the vast majority of your constituents.”

While the motive for the Texas mass shooting (or for that matter, the tragic mass shooting in Las Vegas) remains elusive, one factor that has been common among some earlier mass shootings is that the perpetrator(s) suffered from mental illness.

Besides the mental instability part of the problem, there is also the economic cost. The post by Faiz Gani in Health Affairs discusses the price of gun violence:

Thousands of individuals incur firearm-related injuries daily, leading to approximately 36,000 deaths each year from a firearm-related injury. The number of nonfatal injuries is estimated to be three times that number…we estimate that the annual financial burden associated with the ED and inpatient care for firearm-related injuries to be $2.8 billion in hospital charges. Taking into account the costs of rehabilitation, repeat admissions, and lost work, the CDC estimates that each year, approximately $46 billion are lost due to firearm-related injuries. This figure is comparable to the $49 billion spent to treat patients with chronic obstructive pulmonary disease, the third leading cause of death in the United States…it is imperative, now more than ever, that we approach this public health concern in an evidence-based and apolitical manner so as to better understand the complex social, economic, and political factors associated with firearm-related injuries.

Setting aside constitutional right issues around gun ownership and the huge and tragic human cost of gun violence, there is the economic cost. Isn’t it worth asking if better access to mental health services to perpetrator(s) would reduce the current rate and extent of mass shootings?

Gani’s post suggests that from a purely economic perspective, the government investing in more mental illness treatment (programs and facilities) might make the difference. Even if mental illness is not formally diagnosed, most of us would agree that this type of mindless, despicable violence has a component of mental instability.

Share your thoughts with Harvard Medical School in the comment section below.

Ajay Singh, MBBS, FRCP headshotDr. Ajay K. Singh is the Senior Associate Dean for Global and Continuing Education and Director, Master in Medical Sciences in Clinical Investigation (MMSCI) Program at Harvard Medical School. He is also Director, Continuing Medical Education, Department of Medicine and Renal Division at Brigham and Women’s Hospital in Boston.

*OPINIONS EXPRESSED BY OUR AUTHORS ARE VALUABLE TO US AT LEAN FORWARD, BUT DO NOT REPRESENT OFFICIAL POSITIONS OR STATEMENTS FROM HARVARD MEDICAL SCHOOL.