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Gun Control

Someone should tell self-important anti-gun doctors to stay in their lane. Half of the articles in Annals of Internal Medicine are pushing for gun control. Most upsetting, however, the medical community seems to have consulted NO ONE but themselves.”
National Rifle Association tweet of 8 November 2018 

This tweet by the NRA from almost four years ago riled many American doctors involved in trauma care. It was made in response to the  American College of Physicians policy statement, Reducing Firearm Injuries and Deaths in the United States which deemed gun violence a "public health crisis" that "requires the nation's immediate attention."

It gave rise to the hashtag #ThisIsOurLane which sought amongst other things to end the 1996 Dicky amendment prohibiting the Centers for Disease Control and Prevention (CDC) from funding research into gun control. Similar research on automotive deaths and cigarette consumption had previously led to changes in public opinion, the law and ultimately reduced premature deaths. 

The Australian gun law reform that resulted from the Port Arthur Massacre of 1996 is frequently cited as a successful demonstration of what can be achieved. It has contributed to the three fold decline in gun deaths from the early nineties.

The MJA published the paper Gun violence in Australia, 2002–2016: a cohort study in September 2021. It identified two major trends for further public health attention, specifically that, “Self‐harm injuries and deaths were more frequent among older people, men, and people living outside major cities” and that “assault‐related injuries were more frequent among younger people, men, and people in major cities.”

Health professionals have a right and a duty to protect the public from gun related injuries. NSW health legislation imposes duties on health professionals to notify police if they have a patient with access to firearms and whose mental health deteriorates to the extent that they are at risk of suicide or assault with a deadly weapon. 

Medical practitioners have responsibilities to the public, and not just to the patient, that extend beyond the clinic and hospital. This is both an ethical and legal requirement. 


Vaccination

Dr Simon Holliday

It seems like a lifetime ago but in August 2021 Dr Simon Holiday, a GP and director of the  Taree Respiratory Clinic, spoke to his local paper the Manning River Times about the coming COVID-19 epidemic. He foreshadowed that Covid on the Mid North Coast was “not a risk, but a certainty”. While exasperated by some over-60s seeking a Pfizer vaccination, which was not authorised in that age group at the time, it was misinformation about vaccination that most concerned him. 

"People who have been getting their information from Sky News and some of the extremists in the Liberal/National parties, and getting their information from Facebook, unfortunately they're putting themselves in a terrible position.

"We're doing all we can to help those people get to a safe position but people have got to get their feet on the ground, get their head out of the internet, and stop listening to these people, who are evangelical, talking nonsense with conviction.

"There are a lot of people who are foolish, who believe bizarre things. We can't let those people indirectly cause death and illness in our community.

"Unfortunately, you can't vaccinate against foolishness," Dr Holliday said.

Vaccination at that time was the only therapeutic option Australia had for limiting the disease severity and spread, and anti-vaccination theories were being promulgated by Liberal MP, Craig Kelly and Nationals MP, George Christensen. 

Dr Holliday’s remarks were aimed at saving the lives of those prevaricating about having the vaccination. 

It was therefore with some surprise that two months later he was contacted by the NSW Health Care Complaints Commission (HCCC) saying it had upheld an anonymous complaint that he had made “judgmental and unprofessional comments about Liberals over 60”.

Part of the complaint read, "He is a doctor and his comments about Liberals over 60s is unprofessional and divisive," the complaint alleged.

"We live in a democracy not a dictatorship so regardless of doctor Hallidays (sic) medical profession he is not allowed to dictate and police the communities political choices."

The HCCC warned him to be “mindful about maintaining constructive and professional communication” and to “reflect on and improve your practice”.

The HCCC  did not request Dr Holliday to respond since it had sufficient information to make its findings and stated that no further action would be taken against him.

As the responses to the article describing the event in Australian Doctor magazine revealed, the profession was furious. The complainant had concatenated a number of allegations that were simply untrue and the complaint should have been dismissed at an early stage. 

Nearly all comments supported or praised Dr Holliday for his actions in stating the dangers that medical misinformation entailed and some found the comment “to reflect on and improve his practice” demeaning and patronising. 

In a follow up article, Dr Craig Lilienthal, a GP and medicolegal adviser, was appalled that the HCCC had departed from its usual practice of informing the complainee of the allegations and seeking a response before coming to a determination. In Dr Lillienthal’s words, Dr Holliday was “hung, drawn and quartered before he had even heard about the complaint.”

It would seem the HCCC has become somewhat activist in a modern cause of allowing all views on matters to be given weight. While medical knowledge may evolve over time, it is constrained by scientific method. If society accepts a scientific approach to medicine it is reasonable to criticise non-scientific views as “bizarre”, particularly when they put others at risk of death. 

The complainant misconstrued the facts, added some false allegations and took offence at his construction of the events. That is his right but there is no obligation by Dr Holliday to accede to it. It is not an offence to offend someone, let alone to criticise some fanciful fabrication of reality. 

One might, generously, ascribe the HCCC’s position as acting to prevent the profession being brought into disrepute. That’s as may be, but there is no justification for this in Dr Holliday’s case. I am sure Dr Holliday has indeed “reflected” on his practice, as have many in the profession now - and we find it exemplary.

The HCCC is advising us to “stay in our lane” but once again we have an ethical duty to do the best not only for our direct patients but also for society at large. 

The Health Care Complaints Commission might be advised to reflect on its own behaviour and in so doing decide that Dr Holliday is owed an apology.