Santa Rosa doctor no longer silent on gun issues

Dr. Mark Shapiro knows the endless wave of gun massacres is a political hot potato and a source of nightmares and a national character flaw. But to Shapiro, a hospitalist at Providence Health’s Santa Rosa Memorial Hospital, gun violence is first and foremost a public health crisis.

“It’s not debatable at this point,” the Santa Rosa native said. “When you’re confronted with things that are this harmful, and at this scope — as health care professionals, we not only feel like we have to try to resolve them. We want to. It’s a basic principle of medicine.”

Wednesday night, Shapiro texted a link to a story published less than a week earlier in the New England Journal of Medicine. It included a graph charting deaths among children and adolescents ages 1-19, from 1999 through 2020. The lines for various causes of death roll up and down a bit, but the order remains remarkably stable over time. Until 2020.

For the first time in the data set, motor vehicle crashes — once more than twice as likely to kill a young person as any other single source — were not the No. 1 cause of death for young people that year.

The new public enemy for Americans under 20 was firearm-related injury, which had increased by 13.5% between 2019 and 2020.

Shapiro has been all over social media in the wake of the shootings at Robb Elementary School in Uvalde, Texas, on Tuesday, drawing attention to HR 8 — the Bipartisan Background Checks Act — and reminding people how to contact their senators to help get it passed, among other messages.

It may be hard to believe for most of Shapiro’s nearly 25,000 Twitter followers, or the listeners who tune in to his probing “Explore the Space” podcast, but this activity represents a huge evolution in the doctor’s approach. For years, he bought into the idea that medical professionals aren’t supposed to speak out on controversial topics like guns.

That notion, Shapiro said, was baked into his education.

When he was pulling hospital shifts while attending medical school in Houston, he attended to plenty of gunshot victims in the emergency department.

“I saw the physical and emotional trauma done to the victims of gun violence – and to the members of the medical teams caring for them,” Shapiro said. “I was a small part of those teams, and this was a long time ago, and it’s still with me.”

The doctors and future doctors were trained to stop unchecked bleeding, extract bullets from bodies and sew up skin and organs.

“But it was all in isolation,” Shapiro said. “There was no ‘What are we seeing here?’ There was no ‘How do we talk to our patients about whether there are firearms in the home?’ or ‘Is there safe storage?’”

When Shapiro did his residency in San Diego, the same code applied: treat the wound, don’t frame the bigger picture.

It wasn’t just an unspoken rule, Shapiro noted. It was codified in the Dickey Amendment, part of a 1996 federal spending bill mandating that no Centers for Disease Control and Prevention funding be used “to advocate or promote gun control.”

For 20 years, the CDC interpreted the amendment to mean it couldn’t fund any research on gun violence.

Congress clarified the law in 2018 to allow such study — hence data such as that recent jarring graph in the New England Journal of Medicine — but the precedent was set. And Shapiro had learned to follow it.

A few years ago, though, he began to notice that more and more health care professionals, including physicians, were speaking frankly about gun violence and firearm safety legislation. It may have peaked on Nov. 7, 2018, when the National Rifle Association infamously tweeted that, “Someone should tell self-important anti-gun doctors stay in their lane.”

“Wanna see my lane?” read one representative reply from a New Jersey trauma surgeon named Stephanie Bonne, over the photo of a chair in the corner of a stark room. “Here’s the chair I sit in when I tell parents their kids are dead.”

It was a moment of epiphany for Shapiro. Ever since, he has claimed a lane of his own. He doesn’t explicitly introduce politics into his conversations with patients, he said. But he no longer shies away from contextualizing the epidemic of gun violence, or using his media platforms to raise awareness.

Shapiro once felt he couldn’t say anything meaningful about gun violence as a doctor. Now he is convinced he can’t stay silent.

“I get emotional on this,” Shapiro said. “Someday my son, whom I admire, will look at me and say, ‘Dad, what did you do to help?’”

And here Shapiro did indeed get emotional. His son is 5. The doctor took a few seconds to compose himself.

“The values we’re trying to instill in him, to be part of this rich community life — I want to be someone he can count on for help,” Shapiro continued. “Someday he will ask me, ‘Dad, what did you do?’ I need to have an answer.”

You can reach Phil Barber at 707-521-5263 or phil.barber@pressdemocrat.com. On Twitter @Skinny_Post.