A wave of hate-filled gun violence has swept the United States in the past few days, and now a physicians' group is releasing new recommendations to reduce firearm injuries and deaths nationwide.
On Saturday morning, a man sprayed bullets into a Pittsburgh synagogue, killing 11 people who were attending services, law enforcement said. Federal prosecutors have filed hate crime charges against a suspect.
Another man is accused of shooting and killing two African-Americans on Wednesday at a grocery store in Kentucky in what is being investigated as a hate crime. The incident came moments after he tried to enter a predominantly black church nearby, police said.
Both of those shootings occurred within a 72-hour period.
On Monday, the American College of Physicians released new recommendations on how doctors can play a role in reducing gun violence across the country. The recommendations, published in the Annals of Internal Medicine on Monday, had been planned for release before the recent wave of violence.
Those recommendations urge doctors to more regularly ask whether patients have guns in their home and to counsel patients on gun safety.
The recent shootings emphasize "how important and poignant it is for there to be policies that can be really effective in keeping guns away from both those who are either a risk to themselves or to others," said Dr. Ana María López, president of the American College of Physicians.
"Firearm-related injuries and deaths really continue to be a part of what is harmful to patients and families," she said. "Gun violence remains an issue in our country, unfortunately, and if this paper can help move hearts and minds to action to prevent these tragedies from happening, that would be a great achievement."
Where physicians stand on gun policies
The American College of Physicians, a community of internal medicine specialists and subspecialists, says it's the largest medical specialty organization in the United States and has members in more than 145 countries worldwide.
The group has pressed Congress and state lawmakers for the adoption of policies to reduce firearm-related deaths and injuries for more than 20 years, according to the new paper.
The paper builds on and expands policies that the American College of Physicians approved in 2014, calling for a public health approach to preventing firearm injuries and deaths.
Now, some new or revised policy positions include the college supporting "appropriate regulation of the purchase of legal firearms to reduce firearms-related injuries and deaths" and child access prevention laws that hold firearm owners accountable for the safe storage of firearms.
The paper also noted how the group supports the enactment of extreme risk protection order laws, which allow families and law enforcement to petition a court to temporarily remove firearms from individuals who may be a risk to themselves or others.
Such laws -- variously known as ERPOs, gun violence restraining orders and "red-flag laws" -- are in effect in Connecticut, Indiana, California, Washington and, most recently, Oregon.
Also, the college favors the enactment of legislation to ban the manufacture, sale, transfer and ownership of rapid-killing semiautomatic firearms for civilian use that are designed to have increased rapid-killing capacity and large-capacity magazines, along with retaining the current ban on automatic weapons for civilian use.
"Although there is more to learn about the causes of firearm violence and the best methods to prevent it, the available data support the need for a multifaceted and comprehensive approach to reducing firearm violence that is consistent with the Second Amendment," the authors wrote.
The National Rifle Association has not responded to a request for comment on the paper.
Last year, after the deadly mass shooting at a concert in Las Vegas, the NRA issued a statement noting in part that it "believes that devices designed to allow semi-automatic rifles to function like fully-automatic rifles should be subject to additional regulations. In an increasingly dangerous world, the NRA remains focused on our mission: strengthening Americans' Second Amendment freedom to defend themselves, their families and their communities."
The new American College of Physicians position paper reinforced the importance of doctors speaking to their patients about gun safety, especially as it relates to mental health, domestic violence and children.
A separate research letter published in the medical journal JAMA Pediatrics on Monday said that charges associated with emergency department visits for gun-related injuries among children younger than 18 amount to an average of $270 million per year in the United States.
"We speak with our patients about, 'do you use a seat belt?' If they ride a bike or ride a motorbike, 'do you use a helmet?' So these are public health issues, and it's similar to ask patients if there's a gun in the home," López said.
Even doctors might misjudge gun death frequency
Anotherstudy published in Annals of Internal Medicine on Monday finds that many adults in the US -- including health care professionals -- misperceive the frequency of gun-related deaths.
That study involved surveying 3,811 respondents about the frequency of deaths in their state that were by firearm homicide, firearm suicide or other methods. The researchers compared survey responses with data on violent deaths from the US Centers for Disease Control and Prevention's web-based injury statistics query and reporting system.
The data showed that, between 2014 and 2015, more suicides than homicides occurred in every state, and suicide by firearm was the most frequent cause of violent death in 29 states.
Yet the researchers found that only 13.5% of the adults surveyed correctly identified the most frequent cause of violent death in their state. Additionally, only 20% of health care professionals answered correctly.
For violent deaths involving firearms specifically, 25.9% of respondents correctly identified the most frequent intent, the researchers found.
"Our findings suggest that correcting misperceptions about the relative frequency of firearm-related violent deaths may make persons more cognizant of the actuarial risks to themselves and their family, thus creating new opportunities for prevention," the researchers wrote.
'An enormous public health problem'
When talking to patients about guns, "the chief difficulties doctors face are the ones they bring themselves: They are not necessarily sufficiently informed about the topic or how to proceed with discussions of firearms," said Dr. Garen Wintemute, an emergency medicine physician and director of the Violence Prevention Research Program at the University of California, Davis, who was not involved in the study or the new position paper.
"Our group and others are developing resources to help," said Wintemute, who with his colleagues has developed educational handouts with firearm safety strategies for patients and health care providers.
"Patients are generally quite willing to have conversations with physicians about firearms, when the patients see the conversations as relevant and understand the position is well-informed. In this way, discussing firearms is no different from discussing other sensitive topics," he said. "I talk with patients about firearms almost every shift I work as an emergency physician."
As for the American College of Physicians' new paper, Wintemute said that it was "carefully thought through" and that the recommendations are in line with scientific evidence.
"It shows a continuing willingness on the part of the American College of Physicians to exercise leadership in an area where physicians have traditionally been less involved than they should be," he said.
The paper represented one of the ways to address America's gun violence problem by "focusing on the agent of injury, which is a firearm," said David Hemenway, professor of health policy and co-director of the Harvard Injury Control Research Center at the Harvard T.H. Chan School of Public Health, who was not involved in the position paper.
"The evidence is overwhelming that firearm violence in the United States -- firearms killing people, scaring people, injuring people -- is an enormous public health problem," he said.
A 2015 data visualization by Martin Grandjean, a researcher at the University of Lausanne in Switzerland, indicates that more Americans have died by guns in the United States since 1968, including suicide deaths, than by combat in all of the wars in American history.
"More Americans have been killed from guns in the United States since I graduated from college than have been killed on all the battlefields in all the wars in US history, including all the Americans in the Civil War and World War II and so forth," Hemenway said. "It's a problem."