Dr. Meera S. Beharry is the guest editor of this issue of Pediatric Annals and she has done a terrific job of organizing topics rarely covered in pediatric literature—menstrual abnormalities. This group of excellent reviews should be saved as they will likely be referred to often. Coincidentally, this subject matter has nothing to do with the recent intemperate comments made by a particular candidate for president dominating the news cycle as I write this column.
Readers may recall that in the October 2014 issue1 I noted that the US Court of Appeals for the 11th Circuit had upheld a Florida law that bans health care providers from discussing the safe storage of firearms with patients and families. Sadly, this same court voided its previous ruling on July 28, 2015 in a 2-1 decision but then again upheld the Privacy of Firearms Owners Act.2 This law prevents doctors and nurses from discussing firearms and firearm safety, with violators subject to disciplinary action by the Florida Board of Medicine, essentially denying health care workers their First Amendment free speech rights. Enforcement of the law has been blocked by an injunction since the law was enacted in 2011 (at the instigation of Florida Governor Rick Scott), at least until the full 11th Circuit Court decides whether or not to rehear the case to invalidate the law. This case was brought by the American Academy of Pediatrics (AAP), the American Academy of Family Physicians, the American College of Physicians, and individual Florida pediatricians and other physicians.
I agree with the AAP’s current advice to Florida providers to continue the practice of counseling families about gun safety in the home while the injunction is in place, because that can save lives—an issue that the Florida legislature, Governor Scott, and at least two judges on the 11th Circuit Court don’t appear to care much about. This appears to be the first time that a US court has upheld a state’s effort to prevent patient counselling that is universally recommended by all relevant medical organizations.2 Where is the outrage?!
On August 7, 2015, the national news reported the fatal shooting of a 3-year-old boy in Detroit by an 11-year-old boy who found a hand gun in a bedroom closet.3 The nonprofit group Gun Violence Archive provides free online up-to-date public access to accurate information regarding gun-related violence in the US, gathered from more than 1,200 sources daily.4 The data are mind-numbing and worthy of publicizing: in 2014, 12,552 deaths and 23,010 injuries, 628 children ages 0 to 11 years killed or injured, and 2,373 children ages 12 to 17 years killed or injured—a total of 3,001 children. Through August 20, 2015, the numbers indicate: 8,264 deaths, 16,791 injuries, 472 children ages 0 to 11 years killed or injured, and 1,630 children ages 12 to 17 years killed or injured—a total of 2,102 children. On August 6, 2015 alone (a date I selected randomly), 21 gun deaths were recorded. What can be done to mitigate this crisis, one that disproportionately affects the poor and minorities?
A novel idea was recently proposed in an Op-Ed column in The New York Times5 written by Rev. David K. Brawley, Rev. Otis Moss III, Rev. David Benke, and Rabbi Joel Mosbacher, all members of the Metro Industrial Areas Foundation. They propose to persuade President Obama (who has been very frustrated by the lack of common sense amendments by Congress to the existing gun control laws) to use the purchasing power of the government as a tool. Because the US government is the nation’s top gun buyer, purchasing more than 25% of guns and ammunition sold legally in this country every year (in addition to more purchases by state and local law enforcement agencies), gun manufacturers depend on such taxpayer-funded purchases. Thus, the government has considerable leverage with the leading manufacturers whose guns also happen to be the leading brands used in crimes.
These clergymen suggest that gun manufacturers could be encouraged in contracts to protect the public by agreeing to distribute their guns exclusively through responsible dealers and eliminating the disreputable dealers who disproportionately sell the guns used in crimes. Furthermore, the manufacturers could be incentivized to develop “smart guns” that are less likely to be able to be used in accidental shootings. Clearly these companies will only move in these directions if their major customers push them to do so.
Four specific strategies by which the executive branch of the federal government could push companies to compete for safer gun development and more responsible distribution networks are suggested by the four clergy in the article5: (1) use upcoming contract talks between manufacturers and the Pentagon (which is selecting a provider for new standard handguns for the US Army) and with the FBI to begin a substantive discussion regarding the development of safer guns and more responsible civilian distribution networks; (2) work with manufacturers to develop new distribution models—for example, certification of reputable dealers; (3) resume governmental research on smart guns and provide financial support for such research; and (4) develop metrics to measure manufacturers’ performance—for example, the proportion of each manufacturer’s guns found at crime scenes compared to their respective total market share for guns. These measures might offer some hope for eventually limiting the numbers of guns floating around our society, many of which kill and injure our children.
This Month’s Stamps
The stamp item I’ve chosen for this column is a really unique souvenir sheet issued in 1978 by Mauritius, an island nation in the Indian Ocean, to celebrate the 50th anniversary of Sir Alexander Fleming’s discovery of penicillin. The top left stamp shows World War I soldiers dying of gram-positive infections, with a round microscopic field of bacilli (probably clostridium). At the top right is a microscope and the agar plate with staphylococcal growth inhibited by the growth of mold (Penicillium notatum) on the plate. The lower left stamp shows the microscopic appearance of P. notatum, and the lower right stamp shows Fleming, a child in the hospital receiving a penicillin injection, and the gross morphologic appearance of P. notatum on a culture plate. On the selvage to the left of the stamps, Fleming’s laboratory notes with a drawing of the original plate are reproduced.
A souvenir sheet issued in 1978 by Mauritius celebrating the 50th anniversary of Sir Alexander Fleming’s discovery of penicillin.