Last week, the National Rifle Association sent out an aggressive tweet in response to an article from the Annals of Internal Medicine that had called for evidence-based, Second Amendment–compliant gun control regulation. The tweet in question: “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.” Doctors immediately tweeted back with pictures of blood-drenched scrubs, heartbreaking stories of having to tell parents that their child had not survived a gun shot, reviews of the enormous numbers of gunshot wounds that even one emergency department doctor sees in a career. Eventually, one doctor’s profanity laced response yielded the birth of a new hashtag: #ThisIsMyLane (and #ThisIsOurLane), and back and forth it continued to go. In fact, it’s still going. Both sides are sure they are correct and sure that this argument is new.
But of course, it’s not a new argument. This kind of argument has happened before, over and over. In fact, it happens almost every time there’s a new public health intervention. And that means I think I know who’s going to win, eventually.
Let’s start with cars. Americans learned to drive in the 1920s and, like most new drivers, immediately learned to crash. As cars became more widespread, death tolls rose sharply. Newspaper articles would frequently describe the scenes of motor vehicle crashes as “carnage.” For about 40 years, automobiles themselves were never considered responsible for the safety of their passengers or drivers, as the automotive industry largely promoted a narrative that it was unsafe drivers—not the technology they drove—that was the problem. It was, essentially, “cars don’t kill people; people kill people.” Belting yourself or your children into a vehicle seemed madness: Where was the freedom? Where was the personal responsibility of the driver? Regulations like that were considered infantilizing and unnecessary. And so the U.S. failed to pass any effective legislation for decades, and people continued to die in large numbers in motor vehicles.
Until one day, the discussion changed. We no longer talked about car accidents, a phrasing that implied driver error. Instead we used a name more consistent with what they often were, the shattering of human bodies within high-velocity vehicles: a car crash. And legislation started to pass (most notably the National Traffic and Motor Vehicle Safety Act of 1966) mandating the creation of safety equipment within cars: seat belts, child-safety restraints, airbags. Now we have the world we live in today, where it takes me a full 10 minutes to get my kids into or out of the car. All this safety gear is a palpable restriction on my freedom (and, my children frequently argue, theirs as well); and yet, it would never occur to me to step on the gas until each kid (and adult) is immobilized into their seat.
Here’s what’s interesting: Public health doctors and policies cross this boundary into individual liberty all the time, and it almost always creates backlash. When that boundary is crossed, it’s not always the right wing that is fighting off the onslaught. For example, in the 1990s, when public health recommendations in both the U.S. and the U.K. recommended that all women of childbearing age take folic acid—regardless of their plans for pregnancy—the backlash arose as planned, only this time, it was from populations we would usually associate with the left.
Folic acid is a vitamin that can prevent serious birth defects, but for a forming embryo to benefit from its presence, the folic acid needs to be in a woman’s body extremely early in gestation. To work, this vitamin needs to be present even before a woman misses a period—before a woman can possibly know she’s pregnant. Thus, asking all women to take folic acid throughout their childbearing years makes a lot of sense, especially when we consider how many pregnancies in the U.S. are unplanned.
From another perspective, though, asking all women to take a pill for a significant portion of their life is an incredible overstep from public health officials. And indeed, the recommendation met with a lot of outrage from communities who felt that treating all women as potential vessels of life was both demeaning and objectifying. The pro-choice community worried that extending concern for fetal well-being into the pre-conceptual period would eventually translate into further limitations on abortion or other reproductive options for women. Additionally, the move increased focus on expectant women’s personal accountability for birth outcomes and served to intensify both anxieties during pregnancy and feelings of guilt for anyone who had a disabled baby. (Similar recommendations from the Centers for Disease Control and Prevention in 2016 against alcohol intake for all women of childbearing age have met with similar controversy: that these paternalistic recommendations extend too far into much of a woman’s life, infringing on her body and rights in the name of a theoretical and currently nonexistent future embryo.) But in the end, those recommendations stood, and they still stand today.
This is all to say that we’ve had the #NotYourLane fight before, and we’ll have it again; the argument happens with the right, and with the left, and sometimes with everyone in the middle. This fight doesn’t always result in public health legislation, though it often does. But even when it does, the path to policy can take decades. It’s a long, often ugly, often multiple-front fight. But today, we have seat belts, and airbags, and car seats, and can’t imagine not having them. We no longer want to remove them; we’re even grateful for them. Similarly, we have recommendations about pre-conceptual vitamin supplementation that nobody is planning to repeal.
Because it turns out that many parts of your life, and mine, are in the lane of public health. Our attempts to best regulate that have always led to controversy and backlash. But generally it eventually comes down to this. However much we love our individual freedom, at some point we love something else more: our lives, or our kids’ lives, or the ability to go to school, or a bar, or a concert, or a yoga class without assuming that every loud noise is a massacre in progress. With gun control, I think that point is coming soon. This gun control lane, it seems to me, will shortly be a public health highway.
Thanks to Deborah Levine, Ph.D., associate professor of health policy and management, Providence College, for help with background and history.