Firearms, mental illness, dementia and the clinician

To the Editor: In their recent article in the Journal, Wand and colleagues suggest that the medical profession should play a more active role in the regulation of firearm licences held by older Australians.1 However, the authors underestimate the rate of firearm ownership in Australia by a factor of 1000 when they state that 3.9 per 100 000 people held a firearm license in 2001. In reality, about three-quarters of a million Australians held a firearm licence in 2001.2

While the reported vignettes seem compelling enough, the authors' recommendations need some scrutiny. Almost 15% of the population are aged over 65 years, yet these older people commit about 3% of the roughly 250 homicides per year. 3,4 Further, only about 15% of Australian homicides involve a gun.3 Hence, the potential number of lives saved by the measures they suggest can only be tiny.

In contrast, the downside of their recommendations might be significant. First, obligations on doctors to play a more active role in firearm ownership might deter some patients from seeking medical care. Second, even if people were not deterred from seeking health care, more active involvement by doctors in firearm regulation would come at the opportunity cost of ordinary medical care — care that could be focused on common and lethal medical conditions.

Firearm control in Australia has been singularly successful. While it may be the case that firearm regulations should be tightened, this is not really the responsibility of the medical profession, nor is it fair to focus on older Australians.