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Monday, March 11, 2013

A modest proposal to unfetter the Second Amendment

In my entire series of commentaries on guns and gun control--most since Newtown, but some prior--I have, for one thing, indulged the prevailing fantasy that this debate really has anything to do with the Second Amendment. I have pretended that I actually believe this isn't about big companies wanting to make as much money as possible by selling their wares. I'm sure those who truly believe the NRA fears imminent acts of tyranny by our government of jack-booted thugs against which they are the last line of defense, rather than losing the funding of the gun manufacturers that fill their war chest, have great admiration for the emperor's new clothes as well. They may also be shopping for bridges in Brooklyn.

But let's leave that alone. I have pretended I believe it thus far, and in for a penny, in for a pound. I will continue to pretend I believe it. It's about the Second Amendment! I do believe, I do.

And then, given that this is actually about our Constitutional rights, I have merely argued, reasonably and moderately, I thought, that the Second Amendment requires interpretation. I have suggested we were obligated to decide what people, and what arms. Not all arms, for all people, surely?

But I have been soundly thrashed for my pains. I have been told in no uncertain terms that I am an ignoramus. No, we do not need to decide which people, and no, we do not need to decide what arms. If the founders wanted our opinions, they would, apparently, have demanded them of us, presumably at gunpoint.

So, I surrender to the adamant friends of my gun-toting countrymen. I yield to the omniscient, future-forecasting prowess of the founders. I renounce my prior allegiance, and seek to join the ranks of the enlightened. I renounce the nonsense of thinking about actual consequences in the actual world.

I am now for a Second Amendment with no interpretation whatsoever. Let's fully, completely, and utterly unfetter the Second Amendment from the outlandish suggestions of the type of ignoramus I was until just now.

The Second Amendment, unfettered, makes no exclusion for incarcerated felons. It makes no exception for those convicted of violent crime. And so, neither should we.

Admittedly, it will prove inconvenient for the security personnel in our correctional facilities when they are obligated to indulge the Constitutional right of inmates to bear arms. But that's too bad. It's Constitutional, after all. A gun in every cell, I say. And by all means, make it a big gun, semi-automatic, high-velocity, with a large magazine. There is no mention in the Second Amendment of any reason not to do so.

The Second Amendment does not disparage armor-piercing bullets, so throw those in, too. Who the hell are we to add provisos and caveats to a Constitutional amendment?

There is no mental health test in the Second Amendment. So our psychiatric inpatients also should have their Constitutional Second Amendment right indulged. There is no indication in the Second Amendment that those upon whom commitment papers have been served are exempted. The unfettered Second Amendment does not exempt them, so neither should we.

There is no stipulation of age in the Second Amendment. Kids are people, too (more or less), and the Second Amendment says, simply and clearly: the people.

And so I raise my voice on behalf of the voiceless! There is no Constitutionally-safeguarded right to bear toys, or play with mobiles. Substituting those for guns is outrageous presumption on the part of parents everywhere.

Since we can't know whether or not neonates want loaded guns in their cribs, but they have a Constitutional right to do so, the only reasonable default is to presume they do. It is a violation of the spirit, if not the letter, of the Second Amendment to deny every 1-year-old the arms to which they are entitled. I damn well want a loaded gun in every crib!

And if you, like me, support a fully unfettered, unfiltered, uninterpreted, and unsullied application of the Second Amendment, then so should you.

If you happen not to want a loaded Bushmaster in every crib, in every cell, and on every psychiatric ward, then you seem to be suggesting the need to make decisions about what people, and perhaps what guns.

Frankly, that seems very slippery-slopish to me. What next? How far can it be between denying felons the arms to which they are entitled, and yielding all of our liberties to those jack-booted government thugs carrying out pogroms because we use the wrong brand of laundry detergent, or fail to watch Fox News? Truly, I see no daylight between those perils, and the many others that are sure to follow.

Denying the people, and I mean any people, their right to bear arms, and I mean any arms, seems dangerously unconstitutional to me.

If you remain so unenlightened as to disagree, I pity you. You are in the dark, as I was until half an hour ago. I won't go so far as to call you treasonous, but you know I'm thinking it.

But I will say this to you if you are the kind of ignoramus that wants to go off in the direction of interpreting the Constitution: in for a penny, in for a pound.

David L. Katz, MD, FACP, MPH, FACPM, is an internationally renowned authority on nutrition, weight management, and the prevention of chronic disease, and an internationally recognized leader in integrative medicine and patient-centered care. He is a board certified specialist in both Internal Medicine, and Preventive Medicine/Public Health, and Associate Professor (adjunct) in Public Health Practice at the Yale University School of Medicine. He is the Director and founder (1998) of Yale University's Prevention Research Center; Director and founder of the Integrative Medicine Center at Griffin Hospital (2000) in Derby, Conn.; founder and president of the non-profit Turn the Tide Foundation; and formerly the Director of Medical Studies in Public Health at the Yale School of Medicine for eight years. This post originally appeared on his blog at The Huffington Post.

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Blog log

Members of the American College of Physicians contribute posts from their own sites to ACP Internistand ACP Hospitalist. Contributors include:

Albert Fuchs, MD
Albert Fuchs, MD, FACP, graduated from the University of California, Los Angeles School of Medicine, where he also did his internal medicine training. Certified by the American Board of Internal Medicine, Dr. Fuchs spent three years as a full-time faculty member at UCLA School of Medicine before opening his private practice in Beverly Hills in 2000.

And Thus, It Begins
Amanda Xi, ACP Medical Student Member, is a first-year medical student at the OUWB School of Medicine, charter class of 2015, in Rochester, Mich., from which she which chronicles her journey through medical training from day 1 of medical school.

Auscultation
Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital.

Zackary Berger
Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews.

Controversies in Hospital Infection Prevention
Run by three ACP Fellows, this blog ponders vexing issues in infection prevention and control, inside and outside the hospital. Daniel J Diekema, MD, FACP, practices infectious diseases, clinical microbiology, and hospital epidemiology in Iowa City, Iowa, splitting time between seeing patients with infectious diseases, diagnosing infections in the microbiology laboratory, and trying to prevent infections in the hospital. Michael B. Edmond, MD, FACP, is a hospital epidemiologist in Richmond, Va., with a focus on understanding why infections occur in the hospital and ways to prevent these infections, and sees patients in the inpatient and outpatient settings. Eli N. Perencevich, MD, ACP Member, is an infectious disease physician and epidemiologist in Iowa City, Iowa, who studies methods to halt the spread of resistant bacteria in our hospitals (including novel ways to get everyone to wash their hands).

db's Medical Rants
Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.

Suneel Dhand, MD, ACP Member
Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care.

DrDialogue
Juliet K. Mavromatis, MD, FACP, provides a conversation about health topics for patients and health professionals.

Dr. Mintz' Blog
Matthew Mintz, MD, FACP, has practiced internal medicine for more than a decade and is an Associate Professor of Medicine at an academic medical center on the East Coast. His time is split between teaching medical students and residents, and caring for patients.

Everything Health
Toni Brayer, MD, FACP, blogs about the rapid changes in science, medicine, health and healing in the 21st century.

FutureDocs
Vineet Arora, MD, FACP, is Associate Program Director for the Internal Medicine Residency and Assistant Dean of Scholarship & Discovery at the Pritzker School of Medicine for the University of Chicago. Her education and research focus is on resident duty hours, patient handoffs, medical professionalism, and quality of hospital care. She is also an academic hospitalist.

Glass Hospital
John H. Schumann, MD, FACP, provides transparency on the workings of medical practice and the complexities of hospital care, illuminates the emotional and cognitive aspects of caregiving and decision-making from the perspective of an active primary care physician, and offers behind-the-scenes portraits of hospital sanctums and the people who inhabit them.

Gut Check
Ryan Madanick, MD, ACP Member, is a gastroenterologist at the University of North Carolina School of Medicine, and the Program Director for the GI & Hepatology Fellowship Program. He specializes in diseases of the esophagus, with a strong interest in the diagnosis and treatment of patients who have difficult-to-manage esophageal problems such as refractory GERD, heartburn, and chest pain.

I'm dok
Mike Aref, MD, PhD, FACP, is an academic hospitalist with an interest in basic and clinical science and education, with interests in noninvasive monitoring and diagnostic testing using novel bedside imaging modalities, diagnostic reasoning, medical informatics, new medical education modalities, pre-code/code management, palliative care, patient-physician communication, quality improvement, and quantitative biomedical imaging.

Informatics Professor
William Hersh, MD, FACP, Professor and Chair, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, posts his thoughts on various topics related to biomedical and health informatics.

David Katz, MD
David L. Katz, MD, MPH, FACP, is an internationally renowned authority on nutrition, weight management, and the prevention of chronic disease, and an internationally recognized leader in integrative medicine and patient-centered care.

Just Oncology
Richard Just, MD, ACP Member, has 36 years in clinical practice of hematology and medical oncology. His blog is a joint publication with Gregg Masters, MPH.

KevinMD
Kevin Pho, MD, ACP Member, offers one of the Web's definitive sites for influential health commentary.

MD Whistleblower
Michael Kirsch, MD, FACP, addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.

Medical Lessons
Elaine Schattner, MD, FACP, shares her ideas on education, ethics in medicine, health care news and culture. Her views on medicine are informed by her past experiences in caring for patients, as a researcher in cancer immunology, and as a patient who's had breast cancer.

Mired in MedEd
Alexander M. Djuricich, MD, FACP, is the Associate Dean for Continuing Medical Education (CME), and a Program Director in Medicine-Pediatrics at the Indiana University School of Medicine in Indianapolis, where he blogs about medical education.

More Musings
Rob Lamberts, MD, ACP Member, a med-peds and general practice internist, returns with "volume 2" of his personal musings about medicine, life, armadillos and Sasquatch at More Musings (of a Distractible Kind).

Prescriptions
David M. Sack, MD, FACP, practices general gastroenterology at a small community hospital in Connecticut. His blog is a series of musings on medicine, medical care, the health care system and medical ethics, in no particular order.

Reflections of a Grady Doctor
Kimberly Manning, MD, FACP, reflects on the personal side of being a doctor in a community hospital in Atlanta.

The Blog of Paul Sufka
Paul Sufka, MD, ACP Member, is a board certified rheumatologist in St. Paul, Minn. He was a chief resident in internal medicine with the University of Minnesota and then completed his fellowship training in rheumatology in June 2011 at the University of Minnesota Department of Rheumatology. His interests include the use of technology in medicine.

Technology in (Medical) Education
Neil Mehta, MBBS, MS, FACP, is interested in use of technology in education, social media and networking, practice management and evidence-based medicine tools, personal information and knowledge management.

Peter A. Lipson, MD
Peter A. Lipson, MD, ACP Member, is a practicing internist and teaching physician in Southeast Michigan. The blog, which has been around in various forms since 2007, offers musings on the intersection of science, medicine, and culture.

Why is American Health Care So Expensive?
Janice Boughton, MD, FACP, practiced internal medicine for 20 years before adopting a career in hospital and primary care medicine as a locum tenens physician. She lives in Idaho when not traveling.

World's Best Site
Daniel Ginsberg, MD, FACP, is an internal medicine physician who has avidly applied computers to medicine since 1986, when he first wrote medically oriented computer programs. He is in practice in Tacoma, Washington.

Other blogs of note:

American Journal of Medicine
Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.

Clinical Correlations
A collaborative medical blog started by Neil Shapiro, MD, ACP Member, associate program director at New York University Medical Center's internal medicine residency program. Faculty, residents and students contribute case studies, mystery quizzes, news, commentary and more.

Interact MD
Michael Benjamin, MD, ACP member, doesn't accept industry money so he can create an independent, clinician-reviewed space on the Internet for physicians to report and comment on the medical news of the day.

PLoS Blog
The Public Library of Science's open access materials include a blog.

White Coat Rants
One of the most popular anonymous blogs written by an emergency room physician.

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