See Dr. Corlin's inaugural address to the American Medical Association
My response to Dr. Corlin's speech, sent to the AMA
- My response, sent to the AMA
- Letter to the editor regarding gun politics in the doctor's office
- Refutation of specific aspects of Dr. Corlin's anti-Second Amendment tirade
- Physician, heal thyself (or at least the health care system), where medical mistakes kill three times as many people as firearm misuse. AMA, why are you diverting much-needed attention from this issue, where you can actually do some good?
I read your inaugural address at http://www.ama-assn.org/ama/pub/print/article/2542-4940.html
and I will be posting some commentary at my own Second Amendment web site. I am very disappointed to see the misapplication of the reputation and dignity of an old and respected organization like the AMA in the political arena. I think many of your members will walk away from the AMA in disgust. When they're finished doing so the AMA will be another gun control organization like the Physicians for Social Responsibility (PSR), not a medical professional society.Refutation of specific aspects of Dr. Corlin's anti-Second Amendment tiradeEveryone agrees that firearm misuse is unacceptable and that the only acceptable number of deaths from gun misuse is zero. How to achieve that is open for discussion. Emergency room doctors justifiably dislike having to treat gunshot injuries, but I doubt they enjoy using rape kits or treating unarmed crime victims who have been brutalized by violent thugs. Guns play a major role in preventing these incidents.
You grew up in a world without guns? How interesting. Unless you're very young, the Gun Control Act of 1968 didn't exist in your time and people
could buy guns through the mail. There was also a lot less violent crime back then.Your comment about guns being unregulated is misleading and inaccurate. I am sure that if I fired a gun at a paper target and the breech exploded due to a manufacturing defect the manufacturer would be liable. (If it exploded because the bore was obstructed due to my own carelessness that would be another matter.) Your inaugural address contains numerous inaccuracies and plenty of political dogma, and it does neither you nor the AMA any service.
Your address uses the racist term "Negrotown Saturday Night Special" (without the N word, of course). Yes, white supremacists coined this phrase because they didn't want Blacks to have affordable firearms for self-protection. "Negro" wasn't the word they used, by the way.
Your use of emotionally loaded phrases like "pocket rocket" shows total ignorance of the issues. "A palm-sized gun that is easy to conceal, has a large capacity for ammunition and comes in a high caliber." Your gun control allies enacted legislation to limit any handgun's ammunition supply. Federal laws also require that guns be a certain length (4.1 inches minimum, I'm not sure.) Furthermore, many states that issue concealed-carry permits REQUIRE the gun to be concealed, so the characteristic you cite helps gun owners comply with their states' gun laws. A high caliber is necessary for self-defense and is, in fact, less likely to kill the criminal aggressor. This is because one shot from a heavy caliber will stop him whereas the victim may have to shoot him several times with a smaller caliber to get him to stop. I think police firearm instructor Masaad Ayoob raises this point in "The Gravest Extreme" or "The Truth About Self-Protection." To put it a bit more bluntly, you do not know what you are talking about. "Pocket rocket" is simply inflammatory rhetoric from places like the dishonest Violence Policy Center (which openly states its intentions to deceive the public about so-called "assault weapons.") Your remarks have probably already done the AMA's image a lot of damage.
Your agenda also diverts much-needed efforts from the skyrocketing costs of medical care-- and the 90,000 or so deaths that come from medical errors. This is not a criticism of physicians, it's a criticism of the system in which they work. I am writing a book that discusses ways to reduce medical mistakes by using industrial quality systems like ISO 9000. If AMA focused its attention here we wouldn't have to worry about Medicare costs, and we might be able to get HMOs out of the business of practicing medicine without a license.
You cite slightly under 31,000 fatalities from gunfire (including suicide and homicide). My book will cite about 25,000 annual fatalities from physicians' poor handwriting. That's right, patients get the wrong medicines or doses because the pharmacists can't read the prescriptions. There is a VERY easy way to fix this, as specified by the ISO 9000 quality system standard: NO HANDWRITTEN INSTRUCTIONS- PERIOD. That's the rule for the factory in which I work. Documents and work instructions (a prescription is a "work instruction") must be controlled and legible. Instead of working with people like me to do something simple, inexpensive, and noncontroversial to save lives, Dr. Corlin, you have chosen to lead the AMA on a political crusade-- a Children's Crusade considering the damage it could do the AMA-- that will have no winners.
You say, "People have told me that this is a dangerous path to follow. That I am crazy to do it. That I am putting our organization in jeopardy. They say we’ll lose members. They say we’ll be the target of smear campaigns. They say that the most extremist of the gun supporters will seek to destroy us."
This is 100 percent correct, you are putting the AMA in jeopardy. There are plenty of members who will quit in disgust. And it won't take "extremists" to seek to destroy the AMA by legal, nonviolent, and socially acceptable means-- by showing, for example, that it is promoting gun control ideology and possibly junk science. This action would be quite justifiable if the AMA's prestige is misused on behalf of certain political agendas.
Doctors who feel as you do should join Handgun Control Incorporated or what's left of the Million Mom March (I heard that they're getting together). Doctors who support the Second Amendment can do so through the NRA. Keep politics out of the doctors' office.
The following is a letter to the editor about the Physicians for Social Responsibility. (I'm the author-- feel free to paraphrase and borrow. The body is 298 words).To the Editor;
Like PLO leaders who encourage teenagers to become "martyrs," the Physicians for Social Responsibility (PSR) have published an unsigned "Counseling Patients on Gun Violence Prevention: A Pocket Guide for Nurses and Physicians" on their Web site. It encourages physicians and
nurses to commit what might be unprofessional conduct by serving patients gun control dogma and junk science under color of medical advice. A pro-Second Amendment physicians' group (it doesn't present its political views as medical advice) uses the term "boundary crossing."I am not a lawyer and I cannot give anyone legal advice. It's easy, however, to envision a patient complaining to the state medical licensing board if a doctor asks the patient (or his her children) whether there are guns in the home, or says that a gun in the home is far more likely to kill someone you know than a violent intruder. The latter is true if you know people like drug dealers or rival gang members. Gun control groups want ordinary law-abiding people to think it applies to them.
Doctors and nurses, don't martyr your careers for PSR's ideology. If you do get in trouble and call them for help, I suspect that your calls will neither be answered nor returned. They'll hang you out to dry and leave you on your own.
Doctors Against Handgun Injury (DAHI— is anyone for handgun injury, except in self-defense against violent criminal aggressors?) has drawn several mainstream physician groups into its umbrella. This jeopardizes these groups' reputations and 501(c)(3) tax exemptions (if they get too heavily into politics). It could lead members into unprofessional conduct as described above. Medical practitioners can support gun control or the Second Amendment through groups like Handgun Control Incorporated or the NRA respectively while keeping political opinions out of the doctor's office.
[body: 298 words]
If you'd like me to share my material on quality management systems that might help AMA achieve some worthwhile goals, I'll be more than happy to
do so for free. I would rather see the AMA as a friend than a political enemy and, if we improve the system in which medical professionals work,
everyone will win.William A. Levinson
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| I began by telling you how I grew up in a world without guns. | I thought those substances were controlled even when he was young-- the only way he could have lived in a world without guns would have been to ingest some kind of mind-altering substance :-) One could even buy guns through the mail back then, it was before the Gun Control Act of 1968. |
| In 1993 and 1994, we resolved that the AMA would,
among other actions, “support scientific research and objective discussion
aimed at identifying causes of and solutions to the crime and violence
problem.”
Scientific research and objective discussion because we as physicians are -- first and foremost – scientists. We need to look at the science of the subject, the data, and –if you will – the micro-data, before we make a diagnosis. Not until then can we agree upon the prognosis or decide upon a course of treatment. |
Here is Dr. Corlin's "scientific research and objective
discussion," excerpted from later in his speech:
"In fact, one of the most popular handgun types today is the so-called 'pocket rocket': a palm-sized gun that is easy to conceal, has a large capacity for ammunition and comes in a high caliber." "Surely the Second Amendment does not remotely guarantee every person the constitutional right to have a Saturday night special or a machine gun." (allegedly quoting Supreme Court Justice Warren Burger) Dr. Corlin has already performed his "scientific research" and made his conclusions, as shown by the use of inflammatory rhetoric ("[Negrotown] Saturday Night Specials" and "Pocket Rockets") into his talk. |
| We will not advocate any changes at all based on urban legend, anecdote or hunch. We will only base our conclusions on evidence-based data and facts. It’s just good, common sense – the kind of solid epidemiology that has been brought to bear on other public health hazards – from Legionnaire’s Disease to food-borne illnesses to exposure to dioxin or DDT. | We can see from Dr. Corlin's rhetoric about "[Negrotown] Saturday Night Specials" and "Pocket Rockets" that he has already prescribed his snake oil cure ("common sense" gun laws like licensing, registration, and confiscation), now it's merely a matter of getting "data" to support his diagnosis. I sure hope reputable epidemiological journals don't publish this kind of material as fact. |
| The Chicago Tribune reported that the number of pocket rockets found
at crime scenes nationwide almost tripled from 1995 to 1997. It was a pocket
rocket in the hands of a self-proclaimed white supremacist that shot 5
children at the North Valley Jewish Community Center and killed a Filipino-American
postal worker outside of Los Angeles
in August of 1999. |
More use of inflammatory rhetoric-- sort of like a white supremacist who says he's going to run an objective and scientific study on the genetic equality (or inequality) of white and black people, while interjecting "N****r" into every other sentence. He has obviously made his conclusions, the "research" is just a formality. |
| We all know that violence of every kind is a pervasive threat to our society. And the greatest risk factor associated with that violence – is access to firearms. Because –there’s no doubt about it – guns make the violence more violent and deadlier. | As I said, he's already made his conclusions and prescribed his remedy, now he has to find "data" to support his conclusions and prescriptions. |
| Gun manufacturers are exempt by federal law from the standard health and safety regulations that are applied to all other consumer products manufactured and sold in the United States. | BULL****. Is he telling me that, if I point a gun at a paper target, squeeze the trigger, and have the breech explode in my face because of design or manufacturing defects, that I can't sue the manufacturer? (If it explodes due to a barrel obstruction caused by my own negligence, that may be another matter.) |
| In fact, one of the most popular handgun types today is the so-called 'pocket rocket': a palm-sized gun that is easy to conceal, has a large capacity for ammunition and comes in a high caliber. | This proves that he doesn't know what he is talking about. This
is the new President of the American Medical Association, Heaven help the
AMA.
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| People have told me that this is a dangerous path to follow. That I am crazy to do it. That I am putting our organization in jeopardy. They say we’ll lose members. They say we’ll be the target of smear campaigns. They say that the most extremist of the gun supporters will seek to destroy us. But I believe that this is a battle we cannot not take on. | Half a league, half a league,
Half a league onward, All in the valley of Death Rode the six hundred. "Forward, the Light Brigade! "Charge for the guns!" he said: Into the valley of Death Rode the six hundred. (Alfred Tennyson, The Charge of the Light Brigade, starring Dr. Richard F. Corlin as Lord Cardigan). The "guns" are primed and ready. Actually, there is a difference between this effort and the one at Balaclava; the Light Brigade reached the Russian guns and did considerable damage. This charge won't get halfway. |
Physician, heal thyself (or at least the health care system)
Dr. Corlin's anti-Second Amendment crusade diverts much-needed attention from the pressing matter of spiraling health care costs and the unlicensed practice of medicine by HMO administrators. The following material is COPYRIGHTED (by me) from a manuscript in progress and may be quoted only according to fair use guidelines.
Godfrey (2000) shows that there is an opportunity to cut health care costs by at least 30 percent: "Health care providers' cost of poor quality is estimated to be as high as 30-50 percent of the total paid for health care. For some companies the cost of employee health insurance is now higher than profits." There is no doubt that industrial quality control methods can reduce health care costs while improving patient care.The Institute of Medicine issued a report in November 1999 that said 44,000 to 98,000 hospital patients die every year from avoidable mistakes (Shapiro, 2000, 50). Crago (2000) cites the same estimate and adds Harvard School of Public Health adjunct professor Lucian Leape's estimate of 120,000 deaths a year from all medical mistakes. This is more than the United States' combined death rate for motor vehicle accidents, firearm misuse, falls, drowning, and fire.
The problem does not get as much attention as, for example, commercial aviation fatalities because the deaths occur one at a time. This is exactly what happens in many manufacturing establishments. Low-level scrap losses from random or common causes get little attention; everyone jumps on the assignable or special cause event because it stands out.
Crago cites Leape's observation that "health care's three-sigma to four-sigma quality is 'roughly equivalent to a jumbo jet crashing every day.'" This is not exaggeration as far as total loss of life goes. A daily plane crash with 329 fatalities would add up to about 120,000 deaths a year. Even one such crash gets nationwide attention. It also gets plenty of investigation into root causes and preventive measures to preclude recurrences; think TOPS-8D. Doctors, of course, bury their mistakes. From what we know of industrial quality management, the system in which the doctors work may well be the root cause of most of these losses.
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Citizens General Hospital in New Kensington, Pennsylvania, is actually using this [bar-coding] approach. A robot reads bar-coded prescriptions and retrieves the right medications for each patient. Each dose goes into a bar-coded bag. The nurse scans the bar codes on the patient's wrist band and the medication bag. This even avoids medication errors that result when confused elderly patients enter the wrong rooms and fall asleep there (Shapiro, 2000, 56).
The same article reveals practices that are accidents waiting to happen:
Shapiro (2000, 64) adds, "And some managers said that their colleagues still believe that many errors do come down to incompetent employees, not bad systems." If health care professionals studied industrial quality management they would realize that this perspective is absolutely wrong. Most mistakes result from defects in the quality management system. A key premise of poka-yoke is that people are not perfect. Any system that relies on human intervention to prevent errors is a set of mistakes waiting to happen. If parts can be assembled backward they will be, and if the wrong medication can be administered, it will be. It's only a question of how often.
- An intravenous solution with prophylactic antibiotics was known as "bug juice," and the pharmacist knew what went into it. The hospital finally realized that a new pharmacist might not know the ingredients of "bug juice," and it began to require precise names for this order.
- This one is a no-brainer under the ISO 9000 quality management system, which requires precise specifications for every operation that affects quality.
- Two chemotherapy agents came in lookalike vials. One was intravenous and the other was for spinal injection. It is easy to imagine injection of the former into a patient's spine resulting in paralysis or worse. The nurses suggested that the spinal drug be wrapped in red plastic.
- Bar codes on the vials would be even better because the system should not rely on having someone remember to wrap the vials in red plastic. Colorimetry might also be a good safeguard; even if the liquids look similar to the human eye, a colorimeter might be able to tell them apart.
- An anesthesiologist announces the name and dose of each drug she administers, along with the patient's weight. This "invites" (to use the article's word) other doctors and nurses in the operating room to double-check what she is doing.
- It's better than the old procedure, but inviting bystanders to verify what you are doing is not error-proof. The military communications practice of repeating back any verbal instruction or information is even better. If the anesthesiologist says, "I'm administering 100 milligrams of X," a specific assistant should check that against the patient's weight and repeat back, "I confirm 100 milligrams of X."
- Semi-legible prescriptions are legendary and unfortunately true. The hospital tried to educate the doctors about this by posting blowups of illegible prescriptions that the pharmacy had received.
- It would be more to the point to have the doctors type the prescriptions into a computer, which could not only relay the instructions to the pharmacy but also generate a bar-coded label for the dose.
- Handwritten prescriptions become even more frightening in the context of the ISO 9000 system. There is little difference between a handwritten prescription and a sticky-backed note in a factory work area— and the latter is anathema in any ISO 9000-conscious workplace. "Little sticky notes with work instructions stuck to documents or machinery won't cut it" (Bakker, 1996).
- An editorial says that doctors' bad handwriting causes as many as 25,000 deaths every year ("Message to physicians: Better read than dead," 2000). The solutions it cites focus on improving physicians' handwriting. As stated above this approach does not meet the standards of modern quality systems.
Crago, Michael G. 2000. "Patient Safety, Six Sigma, and ISO 9000 Quality Management." Quality Digest, November 2000.
Godfrey, Blanton. 2000. "Managing Key Suppliers." Quality Digest, September, 2000, p. 20.
"Message to physicians: Better read than dead." 2000. Wilkes-Barre Times Leader, 25 October 2000.
Shapiro, Joseph P. "Taking the mistakes out of medicine." U. S. News and World Report, 7/17/2000, 50-66[End of specifically copyrighted manuscript excerpt]
Doctors and nurses: This publication could be hazardous to your professional license because it advocates what could be construed as professional misconduct. It encourages you to promote gun control as "medical advice." Like anyone else, you are certainly free to promote gun control as a private citizen or join gun control organizations. You might not be free to push gun control under the color of medical advice. DSGL (see below) uses the term "boundary violations."