Why does The Fulcrum feature regular columns on health care in America?
U.S. health care spending grew 9.7 percent in 2020, reaching $4.1 trillion — 19.7 percent of the gross domestic product. Over the long term this is clearly unsustainable. If The Fulcrum is going to fulfill our mission as a place for informed discussions on repairing our democracy, we need to foster conversations on this vital segment of the economy. Maximizing the quality and reducing the cost of American medicine not only will make people's lives better, but will also generate dollars needed to invest in education, eliminating poverty or other critical areas. This series on breaking the rules aims to achieve that goal and spotlights the essential role the government will need to play.
Pearl is a clinical professor of plastic surgery at the Stanford University School of Medicine and is on the faculty of the Stanford Graduate School of Business. He is a former CEO of The Permanente Medical Group.
In the aftermath of the latest school shooting – this one in a Texas elementary school, claiming the lives of 19 children and two teachers – President Biden asked the nation: “When in God’s name will we stand up to the gun lobby?”
There’s no telling when lawmakers will find the courage to stand up to the National Rifle Association and its supporters. Sensible gun-safety laws have long eluded Congress, paving the way for more than 3,600 mass shootings in the United States since 2014.
Shootings are now the leading cause of death among American children, making gun violence much more than a societal problem. It is a medical and ethical problem, as well – a chronic disease, growing in prevalence and severity, with no cure in sight.
If elected leaders won’t help, medical professionals – despite being overworked and increasingly burned out – can and must.
Things I learned while fishing bullets out of bodies
As a surgical resident, I spent long nights pulling bullet fragments out of legs, arms and chests.
I can tell you from experience that TV shows don’t portray gunshot wounds accurately. Bullets don’t pass through the body in a clean, linear path like an arrow. Once a bullet penetrates the skin, it spins and shatters, creating a wide path of destruction.
My responsibilities as a resident were to stop the bleeding, repair the organs, save a life.
For clinicians who treat gunshot victims, the technical aspects of care are fairly rote and routine, no different than removing dead intestines or bringing freshly oxygenated blood to a failing heart. The work isn’t easy, but the treatment plan is well-circumscribed: starting when the ambulance arrives and ending when the patient is discharged or dead.
Throughout my surgical career, I never considered talking to my patients about gun safety or making sure their firearms were stored in a locked cabinet, away from kids. I never even asked if they owned firearms or had ever thought about using one to harm another person. I doubt any of my attending physicians did, either.
Times have changed and so have the responsibilities of health care professionals.
The clinician’s lane is now a highway
In 2018, the American College of Physicians published a position paper in the “Annals of Internal Medicine” on gun violence, with suggested approaches for curbing deaths and injuries.
Among dozens of recommendations, the report included two major deviations from past positions. One solution urged doctors to discuss with patients the risks of having a gun in the home. Another encouraged physicians to advocate for gun-safety legislation.
In response to the report, which the gun lobby deemed a massive overreach, the NRA tweeted: “Someone should tell self-important anti-gun doctors to stay in their lane.”
That tweet was posted just hours before a man shot and killed 12 people at a country music bar in Thousand Oaks, Calif. Quickly, doctors replied on Twitter with personal accounts of traumatic gun-related injuries they treated, all under the hashtag #ThisIsOurLane.
One of the more emotionally charged responses came from a forensic pathologist named Judy Melinek who replied: “Do you have any idea how many bullets I pull out of corpses weekly? This isn’t just my lane. It’s my f**king highway.”
Doctors are trained to keep their feelings in check, not letting displays of emotion distort their objectivity or compromise a patient’s care. Perhaps that’s why the 2018 spat between doctors and the NRA felt so different – and so significant.
Hundreds of health care professionals reacted online with a kind of emotion and venom people had never seen before. The uproar on Twitter highlighted long-held tensions between gun-lobbying groups and researchers on the topic of gun violence as a public-health issue, signaling to many that the fight had only just begun.
A gun in the home
In 1996, under intense lobbying pressure from the NRA, Congress passed a law barring the Centers for Disease Control and Prevention from studying the public-health effects of gun violence. That legislative restriction, which still exists, came three years after a landmark CDC study undercut the NRA, finding that “a gun in a home does not make everyone safer.”
Ever since, researchers and the NRA have been embroiled in legislative disputes. In March 2019, an approved spending bill liberalized the restriction, somewhat, letting the CDC do research on the “causes” of gun violence. However, it stipulated that “none of the funds made available for injury prevention and control at the CDC may be used to advocate or promote gun control.”
The ACP position paper and all the doctors who’ve followed its recommendations were boldly choosing to step over the NRA’s preferred lane marker. In doing so, they’ve made families and communities safer. Now, in light of the latest mass shootings, doctors can and must do more to help. Here are three recommendations:
- Prevention. Talk to patients about ways to prevent gun-violence as you would in any other preventive-care conversation. Above all, urge parents to make sure kids can’t access and play with firearms.
- Mental health. Although we must be careful to avoid the illusory truth effect (the stigma-inducing assumption that gun violence is a “mental health problem”), we must be diligent in screening for suicidal and violent ideations in the doctor’s office; offering judgement-free assistance and vital resources.
- Influence. Doctors and nurses remain the world’s most trusted professionals. Now is the time to use that trust to demand strict gun-safety laws. Tell your representatives in Congress that you support background checks, assault rifle bans, 3D-printing bans and 48-hour delays for gun permits. Insist that Congress act now before thousands more die needlessly.
Guns kill 40,000 Americans each year — resulting in 10 times more gun-related deaths than the next four richest countries combined. By promoting gun safety to patients and politicians, alike, health care professionals can do their part to prevent the next horrific mass shooting.
Note: Portions of this article were excerpted, with the author’s permission, from the book “ Uncaring: How the Culture of Medicine Kills Doctors & Patients.”
U.S. Secretary of State Marco Rubio speaks with U.S. President Donald Trump during a Cabinet meeting in the Cabinet Room of the White House on May 27, 2026 in Washington, D.C. Trump met with his Cabinet days after saying a peace deal with Iran was“ largely negotiated” amid expectations around the re-opening the Strait of Hormuz.
The worst deal in the history of deals
As a former Republican, sometimes it’s fun to look back on the things we — I was part of a “we” at one time — criticized Democrats for, and not all that long ago.
Remember, if you will, when Republicans condemned former President Bill Clinton for pardoning his brother and his corrupt donor friend Marc Rich?
Or, remember when Republicans wagged their fingers at former President Barack Obama’s golf outings? Or his executive orders? Or his Syrian “red line”?
Or all the times Republicans went after former President Joe Biden’s gaffes?
While those criticisms may have been justified at the time, they look patently ridiculous next to our current president’s cartoonish and downright dangerous offenses.
Offenses like pardoning Jan. 6 insurrectionists — nearly 100 of whom have gone on to be arrested for, charged with, or convicted of crimes separate from the events of that day.
Or wreaking havoc on the global economy by instituting reckless tariffs on friends, neighbors, and enemies alike?
Or taking a proverbial sledge hammer to countless government agencies that have put every American in danger, whether on airplanes, in hospitals, at job sites, or in natural disasters.
That’s just a few, but nothing looks worse next to his predecessors than Donald Trump’s supposed Iran deal, at least as it’s outlined in the Memorandum of Understanding, the details of which Trump was loath to share.
And for good reason — they are shockingly bad and humiliating for the U.S.
I remember Obama’s Joint Comprehensive Plan of Action or JCPOA from 2015 very well. I, along with many Republicans as well as a cadre of foreign policy experts, criticized that deal for its obvious and problematic concessions to a very bad actor who we’ve long known could not be trusted. But trust was what we gave the Iranian regime, as well as sudden access to a boatload of cash — $100 billion, to be exact.
All of Obama’s provisions were temporary, which would allow Iran to restart enriching uranium upon their sunset; the deal didn’t address Iran’s ballistic missiles, or its funding of terrorist proxies like Hezbollah and Hamas; the supposed “anytime, anywhere” inspections came with a 24-day delay, if Iran so chose, giving them ample time to hide any suspect materials; and it didn’t require any congressional authority.
In short, I’d argue it wasn’t a great deal. But as bad as it was, it looks like the Magna Carta next to Trump’s.
Trump’s deal would give Iran immediate sanction relief and access to $300 billion, presumably to use to fund terror proxies; it doesn’t secure any upfront limits on uranium enrichment or missile development; it allows Iran to charge for safe passage through the Strait of Hormuz in the future; and it calls for Israel to stop its attacks on Hezbollah, another win for Iran.
Neither Americans nor the Middle East are safer than we were 100-plus days ago when Trump decided to pursue this folly. And in fact, our economy is weaker for it. But Iran is unquestionably stronger and more emboldened.
They’ve seen Trump’s weakness, unseriousness, and frighteningly limited appreciation for history. They’ve seen him retreat on most of his core threats to the regime, from bombing their cultural sites to ending a civilization overnight. And they’ve taken notice as he’s abandoned the promises that were supposedly central to his justification for war in the first place — regime change, liberating the Iranian people, and removing Iran’s nuclear materials.
What a waste of blood and treasure, not to mention American might and power, only so that our enemies can watch us limp desperately toward a conclusion that’s being described — by the right — as “unthinkable,” “appeasement,” and “the worst foreign policy blunder in decades.”
S.E. Cupp is the host of "S.E. Cupp Unfiltered" on CNN.