Guns, the Supreme Court, and physicians’ voices [PODCAST]

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“When my patients asked me about losing weight, I would say, ‘Eat less and exercise more.’ I know that it is more complicated than that. There are psychological and socioeconomic factors. There is bariatric surgery and there are medications. But ‘eat less and exercise more’ is common sense, and every intervention should include ‘eat less and exercise more.’

Limiting guns is common sense too. If people do not have guns, they cannot kill and maim others with guns. They cannot kill teenagers playing basketball, children who happen to be on the street, or a 66-year-old man driving by. Fewer guns = fewer deaths. It is common sense.”

David Galinsky is a geriatrician.

He shares his story and discusses his KevinMD article, “It is time for the Supreme Court to help stem gun deaths.”

Reflect and earn 1.0 AMA PRA Category 1 CME for this episode.

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show we have David Galinsky. He is a geriatrician, and he wrote the KevinMD article “It is time for the Supreme Court to help stem gun deaths.” David, welcome to the show.

David Galinsky: Thank you so much, Kevin. A pleasure to be here.

Kevin Pho: So we’ll get into the article in a little bit, but first off, can you share your story and journey to where you are today?

David Galinsky: Sure. As you said, I’m an internal medicine doctor specializing in geriatric medicine. I had an outpatient practice and a hospital practice, and I also consulted in a psychiatric hospital on the geri-psych unit. Then I became medical director of my hospital’s step-down unit and medical director of skilled nursing facilities and retirement communities, and I did that up until seven years ago, when I retired from clinical practice. Then I became the medical director of the Pennsylvania Department of Aging. So I’ve talked to a lot of people and been involved with all sorts of things over the years, and I hope I’ve developed a little bit of common sense.

Kevin Pho: So as you reflect back on your career in geriatrics, tell me some of the challenges that geriatricians face practicing today.

David Galinsky: Well, one of the problems, and this gets back to what I was saying about having common sense, is that we have to solve problems all the time. I mean, first of all, all of our patients are sick. They’re all elderly, with multi-system disease, lots of medications, psychosocial problems, insurance problems, and living problems. And we have to do evidence-based medicine, and, you know, a lot of the evidence-based medicine doesn’t exactly apply to elderly people.

Not only that, but we have to deal with clinical guidelines. Now, I’ve actually been involved in writing some clinical guidelines, and I made sure that in the first paragraph we always said, “These guidelines are not meant to take away clinical judgment from the practitioner.” So, you know, when I would deal with a 98-year-old man who would walk into my office and say, “Do I still have to be on this statin drug?” well, what’s the clinical guideline for that one? Where’s the RCT that’s going to tell us whether my 98-year-old patient should still be taking a statin, when I know that he has a median life expectancy of just over two years? What makes sense? So there was a lot of common sense involved with that.

Kevin Pho: So let’s talk about the KevinMD article that you wrote. It’s titled “It is time for the Supreme Court to help stem gun deaths.” Now, for those who didn’t get a chance to read your article, can you just walk my audience through it and share the story of why you decided to write it?

David Galinsky: Sure. You know, every morning I would get up and I’d turn on the local news, and I was doing it to get the weather report and the traffic report. But increasingly, they would only start out with the latest deaths from gun violence, and these stories are really touching, and they’re heart-rending. Some teenage girl was sitting in her house at a birthday party, and there’s violence on the street, and she gets shot in the head. Or someone’s going to a football game, and there’s a fight, and someone gets shot. These things are terrible. And now, lately, we have people shooting policemen. These are terrible, terrible stories.

Now, you might say, as a geriatrician, did I ever see any of this gun violence, after all? No. One of my friends in the emergency room is just so saddened by the number of gunshot wounds being brought in to be taken care of. Or just recently, the trauma surgeon whom I know was reflecting on just how helpless she feels having to deal, in the operating room, with all of these gunshot wounds. So it caused me to want to know a little bit more about this.

So I started looking into the statistics of my local town. I’m in Philadelphia, and, you know, the number of gun deaths has gone up during the pandemic. There’s been a lot of stress out there, and gun deaths have gone up. It’s been over 300 a year, and now it’s over 500. So how did this come about?

So I started thinking about it and reading about it, and it came back to me that a lot of this has to do with the Second Amendment. And the Second Amendment is one sentence long. It’s one sentence, and it’s got two phrases in it. It says, “A well-regulated militia being necessary to the security of a free state, the right of the people to keep and bear arms shall not be infringed.” So there are two parts to that. There’s the part about a well-regulated militia, and there’s the part about not infringing the right to have guns.

So in 2008, the Supreme Court justices got a case from Washington, D.C. They wanted to ban handguns, and they also wanted to put in some safety measures for rifles. So they looked at the Second Amendment, and they focused on that second phrase: The government shall not infringe the right of citizens to bear arms. They weren’t looking at well-regulated militias. Now, what citizens of Washington, D.C., belong to a well-regulated militia? None of them. But I’m sorry, I get excited about this. They came down on the side of not infringing the right to bear arms.

Now, how did they get to that? Now, pardon me, this gets into legal theory, and I’m a doctor. I’m not a Supreme Court justice; I’m not even a lawyer. But they have an academic doctrine called original intent, and according to original intent, they figure out what the people who wrote that one sentence actually meant. Now, they’re smart people. They’ve read the Federalist Papers. They know it way better than I do. But they’re taking something that these men wrote 230 years ago, and they’re applying it to our current day.

Now, bear in mind, 230 years ago, doctors were doing bloodletting, and they were worrying about the miasmas that were coming in on the air to spread disease. These people 230 years ago were talking about flintlock rifles that could get off at most two shots a minute. They weren’t thinking about the people we’re dealing with today: someone who walks into a church and kills people, someone who goes to Las Vegas, gets a hotel room, and then sprays bullets into a crowd, or goes to Colorado and shoots up a theater. Or now we have people killing policemen. Things have just gotten out of hand.

Now, we physicians know that we want to do evidence-based medicine, and evidence-based medicine, which I was sort of making fun of before, we take seriously. If you do a randomized controlled trial, and the randomized controlled trial shows that what you were trying to do doesn’t work, you stop doing it. So these Supreme Court justices, who are reading the minds of these men from 230 years ago, have come out with a theory based on original intent that doesn’t work.

I want those Supreme Court justices to listen to the local news. They all live around Washington, D.C. Don’t they see that their decision to allow everyone to have handguns in Washington, D.C., has caused more killings? So I want them to take some personal responsibility, and that’s the reason why I wrote that article. I want that message to get out into the population. I think it is so important that doctors speak their mind, and that’s why I have to thank you, Kevin, for having the KevinMD website and the KevinMD podcast to help medical professionals have their say. So thank you so much.

Kevin Pho: So I can’t think of very many topics that are more heavily politicized than guns and gun control. Given the current makeup of the Supreme Court, a six-to-three conservative majority, do you envision any major changes when it comes to gun control in the near future?

David Galinsky: Well, here’s the problem: I don’t have a solution. I think we have to change people’s opinions, because I think the Supreme Court is stuck where they are for a while, unless we could convince any of them that this original intent doctrine just doesn’t work in this case. But maybe if we can get legislators to change their opinion and have some common-sense laws that would keep guns under control, maybe that will work.

You know, with the whole pandemic and vaccination situation, we have all these arguments that we’re coming out with based on science, and I think what we’ve missed is the social science part of it, where we try to change people’s opinions about things. And I think the best I can do personally is to get my opinions out there. So I don’t have a good solution for the Supreme Court, unless somehow the Supreme Court justices would listen to KevinMD and change their opinions, maybe.

Kevin Pho: You talked about the importance of physicians sharing their voices, sharing their stories, and being heard. Do you have an example, over your decades-long experience, where you shared your voice and shared your story and changed someone’s opinion and made a difference?

David Galinsky: You know, that’s a great question, Kevin. How many people did I tell to stop smoking? You know, that’s a tough one. How many people did I tell to get more exercise, and actually had them go out and exercise more? But you know, you have to keep doing it, because every once in a while you tell somebody to stop smoking and they do it. It actually works. People do listen to doctors some of the time, and we can’t be discouraged just because people don’t always do what we tell them to do. But we have to keep talking to them, and we have to do it in an empathetic way. We base it on science, but we know the science isn’t enough. We have to keep talking.

Kevin Pho: We’re talking to David Galinsky. He is a geriatrician, and he wrote the KevinMD article “It is time for the Supreme Court to help stem gun deaths.” David, what kind of tips do you have for physicians if they do want to speak up and share their voice? Because you’ve certainly been doing this for a while now. Any tips that you could share with other physicians who may be a little bit apprehensive or shy about sharing their voice?

David Galinsky: Well, I guess the first step is just do it, and the more you do it, the easier it gets. I was a terrible public speaker. I was so anxious that nobody ever really wanted to ever listen to me. But I started doing it, I got a little bit of coaching, and I ended up being an excellent public speaker. You know, pat myself on the back, but I do believe that’s true.

So what I would tell physicians is don’t worry; you should just do it, and there is great reward for that. I think one tip, of course, is to sit down and write out what you want to say and then actually practice saying it, and then just do it. Just talk about it, because if you have something you believe in, do it.

Kevin Pho: And my final question: What are some of your take-home messages that you want to leave with the KevinMD audience?

David Galinsky: Well, the first one is I want to talk to the Supreme Court justices. I want to change their minds. And the second take-home message is what we’ve just been talking about. I want all my medical colleagues to realize that just being in the exam room is not enough, that you really have to speak out in public. So once again, I want to thank you, Kevin, for giving doctors, and nurses too, I should have said, this forum for getting their thoughts out.

Kevin Pho: David, thank you so much for sharing your time and insight, and thanks again for being on the show.

David Galinsky: You’re welcome. Thank you.

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