枪支暴力作为公共卫生危机：放射科医生的前线观察与制度反思

Host: Nekai Walks is a new documentary from TVO that features the journey of sixteen-year-old Nekai Foster, who was the victim of a random shooting while playing basketball in the Jane and Finch community in Northwest Toronto. The film traces the fallout of his injury and looks at the systemic issues that make this type of violence all too common. Speaking to us now on this issue, Dr. David Koff. He is a Professor Emeritus at McMaster University, past Chief and Chair of the Department of Radiology, and a member of the Canadian Doctors for Protection from Guns. He joins us in Hamilton, Ontario. Dr. Koff, it's great to have you with us. Comment allez-vous aujourd'hui?

Dr. David Koff: Merci! It's a pleasure to be with you and I thank you very much for the invitation and I'd be really happy to share some thoughts with you.

Host: Excellent. JMM, after you.

Co-Host: Uh, thank you so much for joining us. Before we get started, could you give us a little background on why you got involved with this group?

Dr. David Koff: Well, we moved to North America and I've seen this horrendous mass shooting in the States and the only action plan which was coming out of that, and I saw that again and again and again, is thoughts and prayers. And, you know, being pretty practical, I, not that I don't believe that, but I don't think that thoughts and prayers is really very effective and there are certainly better ways to prevent these kinds of horrific incidents to happen, so that's then there was a shooting on the Danforth and then CDPG came out after that, and when I saw this group of doctors who were already kind of already exposed to through surgery and being surgeons, psychiatrists, and really exposed to this kind of things, getting together and trying to do something, I thought, "Well, maybe I should join and see how I can help with that," and I'm very happy I did and I believe we need, we need to more... have more visibility and people to understand more the problem that we're facing with that.

Co-Host: Let me follow up on that, Dr. Koff. As not just a doctor, but as a radiologist in particular, what does gun violence look like for you?

Dr. David Koff: So, for me, I had vested interest in forensic radiology and for a number of years, the coroner services where we had coroner services based in Hamilton and working at the Hamilton General Hospital, we used to have a lot of gun violence victims and a lot of shootings, and I must say I'm sorry for going into these kind of things, but we X-rayed our deceased patients in the bag and I could see the impact and effect of people taking their own lives with a big shotgun and all you see on the X-ray just the mandible and nothing left otherwise. It's horrible. It's a very, very stressful experience and I don't want people to do that. It's a one-way thing, so I've seen so many of those not even talking about the people wounded by high-velocity weaponries and heavy military-grade guns where the bones are shattered. You think, "Oh, they're just wounded," but when you see how the limbs look like, you think, "No way. It cannot happen." So, that's how I've been exposed. We don't have the coroner service anymore, but I've seen a lot of those.

Co-Host: In a quick follow-up, I know you're a professional, but how have you not suffered from PTSD or how do you keep your sanity in the face of seeing so much misery?

Dr. David Koff: Well, by taking action and that's one of the reasons why I joined the CDPG. If you think there is nothing I can do and there is no way we can act on that, then yes, you get PTSD. We get awfully depressed. You think it's just misery. But if you think there's something which can be done to reduce the amount of violence and shooting, then I think that gives you a purpose and it gives you a reason to fight and stay up.

Host: We normally think of gun control as a federal matter. You know in terms of federal criminal law, but of course, people live in cities and they live in provinces. and I'm wondering if you could explain to our audience what you see as the provincial role in gun control.

Dr. David Koff: Right. So, there are two aspects. As you say, people live remote areas, so most of this gun violence, as you say, I think it's 69% of deaths by guns is suicide. Mostly in the north where people are isolated. It's mostly men, elder, I wouldn't say all, but more than 50, um, and they take their lives. They suffer from mental issues, isolation, the feeling that there is no hope, no future, and they kill themselves. And killing with a gun is a one-way thing. You cannot just get back second thoughts and think, "Oh, why did I do that?" and call 911 and be saved, which is the case with most other ways of taking your life. So, that's probably more of the violence that we see and definitely the provincial role in that should be to provide more support, psychiatric help, access to services, education. I understand that the federal level is mostly legislation and trying to take away the guns, but the provincial level should emphasize on healthcare and gun prevention. That's really what we could do best I'm sure we can we can help people with that.

Host: You know, what's interesting. When media cover these stories, and in fact, when you gave an earlier answer, the first example you gave was the Danforth in Toronto, we do tend to focus on the urban areas where these things can take place. And yet, I think if you look at the statistics, it's actually in more rural and northern parts of Ontario that on a per capita basis, more of this takes place. Um, you know, how do we make a dent in this kind of phenomenon where guns in rural and northern areas are much more a part of the fabric of everyday life than they are in big cities?

Dr. David Koff: Right. So, the idea and the role of CDPG is not to take away guns from people. We're not here to prevent hunters and farmers to have guns. They need to have guns on their property. They need to be able to defend their cattle against predators, so the idea that, that's a common misunderstanding that people have been using a lot to try to discredit the CDPG. We're taking your freedom away. We are, we are, we have the right. We are law-abiding citizens. And this law-abiding thing, we've heard it so much that at some point it's just ridiculous. These law-abiding citizens who are taking their own lives because they don't see any way out. So, we won't take these guns away, but we want these people to make sure that they are stored in an appropriate way. They are locked in a cabinet. The ammunitions are not in the same location. So, if you put more steps to kind of limit the access to the gun, already, you can slow down the process, but mainly, we have to fight against isolation, you have to provide support, we have to detect mental issues and be sure that we can treat that before it ends up in a suicide or in violence. You know, the example I had because gun violence is a public health issue. It's for me, from my standpoint, it's nothing other than that and it has to be addressed the same way, but one of my neighbours, for instance, had an episode of absence driving went to see a doctor and his driver's license was taken away for the time of the investigation. He couldn't drive as long as he was not cleared and he had all the examination he needed, the MRI and everything. Uh. Same thing should apply to guns. You cannot let someone who has mental issues just manipulate heavy weaponry and be a risk for himself or for the community, so we have to make sure that we have ways to identify mental issues and treat them and not let people with mental issues to have access to guns, so that's probably one of the first things we can do is prevention and mental support.

Host: There was a private members' bill in 2022 that was introduced by then MPP Mitzie Hunter that would have amended the Safe and Healthy Communities Act to make gun violence a public health issue. It didn't make it into law, but your group supported the bill. Can you explain what that bill would have done and why you supported it?

Dr. David Koff: So, I think the role, I believe you mentioned here, um, Bill Number Nine and the idea was that the bill would have provided support for people who have been exposed to gun violence and it's mental health and really had support for that and it didn't go through because I don't know. I'm not a politician and I'm not too much involved in these kind of things, but I understand that it was some kind of confusion. If it was not already included in another bill, in Bill 60, and people at the end of the day said, "Well, we don't need that, this one," but I strongly believe that we need to include that and we need to have this kind of mental care covered by OHIP and made available to people, so someone needs to look a little bit what happened with this bill and we should resubmit and make sure that people who have access to the support they need.

Host: Dr. Koff, let me ask you one last question, which is to say, you know, there are two different avenues, I guess, that society can do down in order to make this situation better. You, in one of your previous answers, suggested people themselves can do a lot in terms of better gun safety, better understanding, better education, and then, of course, as you just described, there are also legislative solutions to this as well. Where do you think the accent should lie? More education or tougher laws?

Dr. David Koff: Well, for me, I think more education is probably the way to go. You know, it reminds me, we've seen that years and years ago, I was too young at the time, but when safety belts were made mandatory in the cars and people had been screaming, "You're taking away our freedom. We should be allowed not to wear the seatbelt and fined." But if you look at the number of lives which have been saved just by wearing the seatbelt and decreasing the amount of injuries and the cost for the society of not wearing a seatbelt, you'd think, "Well, there is common sense," and now the first thing you do when you sit in your car is to fasten your seatbelt. It's not even, you don't even think about it. We've seen the same thing with smoking, tobacco, and slowly lung cancer, but it's also this horrible lung disease which kills. You know COPD, emphysema, and things like that, and people die from that. And slowly, people got to understand, even if the tobacco lobby was extremely powerful, they started to understand that smoking can be dangerous and they have to take the measures to reduce the risk of dying from cancer and they did it. Look now what the situation, so of course, um, legislation has been very helpful by preventing and forbidding people to smoke in public areas and offices and restaurants and all that and we should pair both. But I believe that with dedication, we can already achieve a lot by getting people to understand that they have to be careful. The other thing is why do people need to have a weapon, military-grade weapons? There is no justification. Do I drive a tank on the 401? No. And I wouldn't be allowed to do that, so, you know, military weapons are for soldiers and for military. They don't have-- That should be removed from the streets and from homes. Um. So, I believe that probably having both. Strong dedication starting in school and at the youngest level to explain to young students that the risk and dangers of having access to guns and this was having strong regulations and laws. We need both at the end of the day, but for us, as doctors, we can help with education and prevention. Prevention is key.

Host: Parfait. Dr. David Koff, thank you so much for joining us today.

Dr. David Koff: Un grand plaisir, monsieur. Merci beaucoup.

Host: You're welcome. Merci.

Dr. David Koff: C'est moi qui vous remercie. Merci.

Host: Well, we're talking to Dr. Koff, of course, because of this documentary that we're playing on TVO right now and you can watch Nekai Walks. That's the name of the documentary and it's available on the TVO Docs YouTube channel and we will put a link in the description of the video, so you can check that out as well. Thanks so much for joining us.