#ThisISOurLane: Doctor's Viral Tweet Puts Gun Controversy in Context

UPDATED 11/17 -- The following transcript has been edited for clarity and brevity.

Eric Topol, MD: Hello. I'm Eric Topol, editor-in-chief of Medscape. I'm really delighted to speak with Judy Melinek, who is a forensic pathologist in Northern California. She has a remarkable background: Harvard for college, UCLA for medical school, and she's been on the faculty at UCSF. She is now associated with UC Davis and the Alameda County Sheriff's department.

It's been a very interesting week, Judy.

Judy Melinek, MD: Tell me about it, yeah!

Topol: On October 30, the Annals of Internal Medicine publishes their public policy on guns^[1]—firearms—a very rational paper, every word of it. You are, of course, active on social media—Twitter—and you posted something. How did you get onto this?

Melinek: The Annals article was a position paper from the American College of Physicians with guidelines for internal medicine practitioners about gun safety. And it turned out that the National Rifle Association (NRA) had gotten ahold of this and had tweeted out something along the lines of "somebody should tell self-important doctors to stay in their lane when it comes to gun control."

There were multiple doctors and other healthcare professionals on social media who fought back, saying, "This is our lane." In fact, the hashtags #ThisIsOurLane and #ThisIsMyLane started trending on Twitter.

I had seen news coverage of this the day before but hadn't commented on it. Then, on Friday morning, I was going to work at the coroner's office and I had three cases, one of which was a gunshot case. It was my second case that week with gunshot wounds. The first one had been a homicide just a few days earlier, and I just lost it.

I know they say, "Don't tweet angry," but I tweeted angry. I wrote something along the lines of, "You know how many bullets I recover from cadavers weekly? This isn't just my lane, this is my eff-ing highway." Then I shut off my phone and went into the morgue, and 4 hours later when I came out, it had gone viral.

Topol: Did it ever! I've been on Twitter for 9 years and I've never seen something that had 700,000 responses!

Melinek: What was unbelievable to me was how generally positive it was. I got so many retweets and comments from people in medicine and in healthcare in general. I also got reactions from a lot of victims of gun violence—survivors—and they were all saying, "You go, girl!"

Topol: Did you have hostile responses?

Melinek: In general, I got mostly positive responses. Even the people who disagreed with me did so respectfully. There was only one veiled threat, which I reported to Twitter, and they took it down within 30 minutes.

I think the bottom line is that a lot of responsible gun owners and NRA members actually agree with doctors that we need to do something. You know, the NRA was developed initially as a gun safety organization and it was designed to train people how to use guns safely; at some point they kind of lost their vision. I think that, as responsible physicians and especially physicians who are gun owners and NRA members, we have a special responsibility to speak up and get the leadership moving in a direction where we can respect people's Second Amendment rights to own weapons but still keep our patients safe. That means that when people are having a mental health crisis or have exhibited suicidal or homicidal ideations, and they have easy access to weapons or are starting to build an armamentarium, that other people should be able to use the legal mechanisms such as extreme risk protection orders (ERPOs) to step in and keep them and other people safe.

If we see something that's dangerous for the pediatric population, like a toy that breaks apart or is a choking hazard, we report it to the Consumer Product Safety Commission and it gets recalled because it's a hazard.

Topol: No question. I want to applaud you and others who stood up. It's really important. I want to talk about activism among physicians, but before we do that, I want to drill down a little bit on the gun story. There are about 400 million guns in the United States,^[2] for about 325 million people. And we have had over 12,600 deaths this year already,^[3] 50,000 gun-related incidents,^[3] and over 300 mass shootings this year.^[3] We have a plurality of Americans wanting gun control.^[4] What's holding us back is, in part, the NRA. I mean, they lobby hard to basically not have any controls on guns. So this was a light [protest], taking on the NRA about their ridiculous tweet. But we don't really take them on enough, right?

Melinek: I think that we have a responsibility as physicians to step up and make a statement, as well as medical organizations—whether it's the American Medical Association or the American College of Physicians. And apparently the American College of Surgeons just came out with a statement as well, which was authored by 22 surgeons, and I believe 19 of them are gun owners themselves.^[5]

This is no different from speaking out about the dangers of alcohol in pregnancy or the dangers of certain toys. If we see something that's dangerous for the pediatric population, like a toy that breaks apart or is a choking hazard, we report it to the Consumer Product Safety Commission and it gets recalled because it's a hazard. We have a track record as physicians of speaking up on behalf of our patients when something is dangerous, especially when there are ways to make them safer. Trigger locks can make them safer. Limiting access, especially to people who have mental illness or who have violent tendencies, we have the capacity to step in and regulate this.

That's the other thing. High-velocity rifles are weapons of war. They cause a lot more tissue destruction than handguns. That's not to say you can't kill people with handguns. But the bottom line is that high-velocity rifle rounds cause a lot more tissue damage and they're less recoverable; they cause a lot more morbidity in the survivors. So we can pass legislation that's bipartisan that most of the country is going to be behind.

The only obstacle in our path right now is the NRA, and I'll be honest with you: I think that they will come to the table. I'm optimistic for two reasons. Reason number one is because they recognize that a big chunk of their own members understand the power of the weapons themselves and know that they're dangerous. I have spoken to law enforcement agents and to doctors who are responsible gun owners, and they all say, "What the NRA has done just goes too far." They're sometimes afraid to speak out because they're in a culture where guns are much more acceptable, and they are afraid that there is going to be political backlash or that some of their patients who are gun owners might disagree with them, and they don't want to put obstacles between them and their patients. But there are many responsible gun owners who are NRA members who want to see restrictions as well. So that's one reason why I think they're going to come to the table.

The second reason they will come to the table is if we put money into research and development for new state-of-the-art weapons—for example, ones that have trigger locks that can only be operated by the person who purchased it, so if it's stolen it doesn't work... I mean, why is it that I have a phone I can unlock with my fingerprint and nobody else can get into it, and if I lose it, it's got GPS to trace it, yet we don't have this technology in guns? If we could replace what's currently out there in the marketplace with state-of-the-art weapons, we'd be much safer.

Topol: Those are great ideas and I love your optimism. We need some optimism. But let me just add that if you look back at what's happened this year, from the Parkland shooting to the Pittsburgh synagogue, you see that it is relentless. And each time this happens, you hear these ridiculous statements about how we should have an armed person in the synagogue or on the roof or in the school or whatever. These are ridiculous and this is in part supported by the NRA.

Melinek: It is, and it's only when you come from a country where there are armed guards everywhere that you have a perception of what that's like. I was born in Israel; my family lives there. Clearly it's a very different environment in regard to existential threats from enemies. But you cannot go into a mall in Israel without getting your bag checked. You can't go any place where there's a public gathering without very heightened security carrying guns. Even there, terrorism happens and it can't be stopped just by people having guns. It maybe gets shut down a little bit faster, but the criminals and everybody else has guns, and then there's crossfire and other ways that people can get hurt.

I love Israel, but I don't want to live in a society like that. It's important to me to see the United States go on a different path. I would rather live in a society where we don't have to worry when we go to the movie theater. I would rather live in a society where my kids don't have active-shooter drills at their school. This is not how I want them raised. I want them to live in peace.

Topol: Right. And I think we are an outlier; there's no other country that has this magnitude of guns per population. Something has to be done.

Now, let's get into some related topics. You've been very active on Twitter, not just this week. What do you get out of it?

Melinek: My initial exposure to Twitter came when my husband and I published a book 4 years ago called Working Stiff: Two Years, 262 Bodies, and the Making of a Medical Examiner . It's a memoir about my forensic pathology training in New York City from 2001 to 2003. I kept a diary during my fellowship, and then at the end of it I handed it to my husband, TJ, who's a writer, and said, "Hey, you're the English major. Do something with this." When it was published, I had to learn how to respond to readers on social media. That's why I became comfortable using the platform.

It is also fantastic at spreading public health messages. Even that term "going viral" is an epidemiologic term. Now we have an opportunity when we have a public health message, whether it's "Get your flu shot" or, in this case, "Let's talk about gun safety." We can really spread it to millions of people in real time very, very quickly. That is a very powerful force. So I do encourage people to use Twitter. I completely understand those who are averse to social media because you are putting yourself out there publicly. And yes, there are people out there who are trolls. But I think that the good outweighs the bad in regard to spreading public health messages and getting information out to our patients in real time.

Topol: I totally agree with you. I think that you've shown the power of Twitter, certainly in recent days.

The other topic I wanted to get your views about is the fact that, over the years, physicians have been reluctant to be activists. We—and I say "we"—kind of lay down and play dead...

Melinek: No, we don't! [laughs] I'm actually going to contradict you. I know that individual physicians are afraid to get out there, and part of it has to do with the fact that we are steeped in a culture of privacy. When we are one-on-one with our patients, we develop a rapport. Everything we say is private; it's protected by law. So we develop that sense of intimacy and we don't want to violate that. That's definitely a component of the culture.

But when we come together as groups, physicians have actually been very active. If you look at how physicians came together and did the research and pressed for legislation regarding the auto industry many years ago, it was physicians who insisted that there be safety restraints in cars and that infants be put in car seats. Physicians also demanded that labels be put on cigarettes and that cigarettes shouldn't be used in indoor spaces and in hospitals.

I think that we have a history of activism when we get pushed and when we really see a public health crisis.

Topol: I agree. Maybe the best thing the NRA has ever done was to put out this tweet.

What I want to say is that we have had a lot of things done in the medical community where there was basically no reaction—for example, the whole electronic health record fiasco. There are so many things, Judy, that we have just lived through, where we didn't stand up for patients. You're bringing up some great examples where that did occur, but often it took decades, like with cigarettes and tobacco. Besides being busy, it's not really in the natural decorum of physicians. You don't really see many who are running for political office or who are in the public eye.

Melinek: Well, there are physicians who are politicians as well. And we have members of Congress who are former physicians. But you can't be running your practice and still be politically active simultaneously, just because of time restrictions. That said, you can have a megaphone basically at your fingertips with social media. That was what blew my mind about that tweet going viral. I thought I had a phone and it turned out to be a megaphone.

A lot of physicians have joined Twitter in particular because it's quick. The tweets are very small and you can be engaged when you're standing around doing nothing, using those periods of time when we used to just be bored. You can be a lot more engaged and you can reach out to millions of people very quickly.

Topol: That's what I wanted to underscore, and to me you are the exemplar. You reached millions of people, and then one thing led to another. You were on with Christiane Amanpour and others. It all started with a tweet. I think activism is so important, and you have shown the power of communication through this medium of Twitter—what it can lead to and all the good things. Obviously, many other physicians got engaged as well, but they didn't get the same response as you!

Melinek: I think being foul-mouthed sometimes helps... I'm embarrassed because my kids are teenagers and I'm telling them, "Don't use bad language" and then they see this. But at the same time, they're the ones doing active-shooter drills in their school, so they understand why I'm passionate about it and they understand why I spoke up.

Topol: Well, I can't thank you enough on behalf of the medical community and the Medscape community. I'm sure you're going to hear a lot from your fellow physicians. Thank you for representing us, because we don't have enough of that. And I hope that your optimism will play out like you say. That would be fantastic.

Melinek: I hope so, too. I do want to encourage people listening to this to be aware of the gun control debate in your state and even nationally. When Congress comes out with bills, please make your voice heard—call your congressmen, email them. Nowadays, you can go on their website; you can contact them and let them know that you're a physician, and if you're a gun owner, then let them know you're a gun owner. Let them know you're an NRA member so that they realize that they have your support, because this really isn't about restricting the Second Amendment. What this is about is making sure that dangerous people who are at risk for harming others or themselves don't have easy access.

Topol: Judy, you are a veritable gem. Thank you so much for taking the time to talk with us. You really are a born leader.

Melinek: Thanks very much. I appreciate it.