From Physician to Politician

— Brian H. Williams discusses gun violence, bipartisan politics, and hitting the campaign trail

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    Emily Hutto is an Associate Video Producer & Editor for MedPage Today. She is based in Manhattan.

In this video, Jeremy Faust, MD, editor-in-chief of MedPage Today, and Brian H. Williams, MD, surgeon and former congressional health policy advisor, discuss their experiences with gun violence while working in the emergency department. Faust and Williams also talk bipartisan gun regulation efforts and Williams' own journey on the campaign trail running for a U.S. House seat in Texas.

Click here for part one of this conversation on Williams' new book, structural racism, and gun violence in the U.S.

The following is a transcript of their remarks:

Faust: You talk about, when you were at the [Air Force] Academy, the feeling of firing an assault rifle or assault weapon and how powerful that made you feel. I kind of wrote in the margins -- yeah, it's like a drug, right? People want that feeling. And for young men in this country -- of all races, by the way -- who feel like they don't have anything to aim for in their lives, or they are told one thing about the world and they're realizing that something different is true, that power must be intoxicating.

Do you worry that, even though we have gun rights in this country, that the combination of the problems this country faces and weapons of war in these young men's hands is a bigger problem than maybe even most people realize?

Williams: Yeah. I talk about my experience with an assault weapon to show that I understand the feeling that comes from holding that weapon and shooting it, but also from, as a trauma surgeon, having seen the devastation these weapons do to bodies, and also as a family member who has lost my family members to gun violence. So, I'm approaching this from many different angles.

To prevent gun violence, it's a lot to unpack, right? There is so much we need to deal with there. But from my experience, I'm focusing on if we want to talk about gun violence prevention, we have to talk about race. We have to talk about the racial disparities in gun homicides. We have to talk about who is viewed as the protectors and the patriots when it comes to gun ownership, and who is viewed as the criminals and the ones to fear when it comes to gun ownership.

There's so much wrapped up into that. But if we want to save lives from gun violence, we have to talk about race and what that means to gun culture every single time we have this discussion.

Faust: And laws are another way of enforcing or setting up healthcare. I mean, what we put in the law is what we accept.

And one of the things that really [came into] the public consciousness in the past 10 years as they grew are these stand-your-ground laws. These laws that -- I understand vaguely the idea behind them -- but as you say, there's a racial/racist component to who they help and who they hurt. Will you talk about that a little bit?

Williams: We have a lot of data now to look back on as far as stand-your-ground laws, which are technically called defensive gun laws. But what does that mean as far as who is harmed and who is protected?

We do know that if you're a white shooter shooting a Black victim, most often that is deemed as a justifiable homicide [rather] than when it's reversed to a Black shooter and a white person. In that case, the white shooter is protected.

We look back to the first stand-your-ground law -- we think about it being in Florida because I think we attach it to Trayvon Martin, but it actually came out of Utah and it was meant as a means for women that were suffering from domestic abusers to protect themselves from their abuser. And it's evolved into what we have now, which is essentially a means for the extrajudicial killing of Black people. But now it's evolved to the point that if you're a white man and you shoot and kill an unarmed person in public versus a woman who shoots her domestic abuser, the woman is more likely to go to jail than the man.

So it's really distorted how stand-your-ground laws have evolved to disadvantage people that probably need protection the most.

Faust: What can we do about these laws? I mean, we're a nation where basically democracy is supposed to rule. Is there a sentiment in the public about these laws, that they're a problem? Or is it one of these things where they are reflecting that population's perceived desires and what they think is in their best interest?

Williams: I really like, when we talk about gun violence, to step back and ask the question: what do we expect in a civil society? How do we want to feel safe and protect our citizens? And right now, with the permissive gun culture, we are leading to more and more needless death and suffering.

So we have to take a much broader view of gun violence. Stand-your-ground laws are one piece of that, right? What do we do about communities that are segregated by race that have high levels of gun violence? That would have to do with addressing the structural issues that lead to those sorts of situations. What do we do about gun trafficking that allows guns to go from states with more permissive laws to states with stricter laws?

There is so much to unpack here, but if we step back and say, "OK, we want to minimize needless death and suffering [from] gun violence," that is going to take a very prolonged approach. We have to take the long view and work on this. There's no one simple answer, but there has to be a commitment at the highest levels of government to make this happen.

Faust: This sort of leads to the part of your story where you're a trauma surgeon, you've been through all of this, and then you go to Washington D.C. to work in health policy, to work with senators and to learn about what's going on in the seat of this country's power. I would like to know, from your experience there, what you meant when you said that there was more bipartisanship than people realize?

Williams: Yes. I worked as a Robert Wood Johnson Foundation Health Policy fellow, so full-time in D.C. as a health policy staffer. I worked for Sen. Chris Murphy (D-Conn.), who led the effort on the Bipartisan Safer Communities Act, the gun safety bill from last year.

But what's happening behind the scenes -- not just on gun safety, I worked on a lot of healthcare issues, mental health reform, the opioid crisis, Medicare, Medicaid, I really got to roll up my sleeves and dig into that -- and away from the cameras, there are a lot of bipartisan efforts happening. If I went into a room to work on something and you didn't tell me ahead of time they were a Democrat or Republican, I wouldn't know. It's just, "Here's this bill, we need to hash it out, let's get it moving forward." But that's not what we get to see on TV a whole lot, unfortunately.

But it did leave me inspired, because Congress can do big things quickly when they need to. We saw that in the pandemic with those six big bills. They can do things. I just wish more people could have the experience I did and see that there are good people that are there trying to make the world a better place -- and they can go elsewhere and make a lot more money, probably -- but they're there because they believe in the work that they're doing. We just need more leaders like that to make that happen.

Faust: When you look at the disparities in this country in terms of healthcare outcomes, there are many ways to sift through that demography, but one way really is geographical in addition to race, ethnicity, and other demographics. But I have always struggled with this idea of why there are states in this country that refused free money from the government to expand Medicaid after the Affordable Care Act was passed? How do you process that piece of information as someone who's in healthcare as a physician and who's worked in D.C.?

Williams: In short, it's actually absurd that you would turn down free money to take care of your citizens. As a doctor, I just can't fathom that we continue to dichotomize healthcare to the haves and the have-nots. When we have an opportunity to take care of the have-nots, states refuse to expand Medicare, and it shows in their outcomes.

Here in Texas, we're ranked 49th in maternal mortality. We're at the bottom for a lot of healthcare outcomes that we could address by just expanding Medicaid.

That's just one example, but there's a bigger issue of how we as a country treat healthcare. Some will say that we have a healthcare business that delivers healthcare, but is not treating health. I probably messed up that line, but you get what I'm saying, right? The business side seems to have trumped promoting health.

We need to invest more in the health of communities and individuals and less in the business of healthcare.

Faust: Let's talk a little bit about D.C., and you're now running for Congress. You strike me as someone who'd be a very good congressman, but running for Congress is different than being a congressperson. What's it like to go from being a private citizen to being on the campaign trail? I know a lot of doctors think about, "Huh, should I get involved?" And you're really doing it. Tell us what that's like.

Williams: In short, I'm having a lot of fun, Jeremy. This is a stretch. It's new for me. But I'm having a lot of fun running for Congress on the campaign trail, meeting people in the community, learning what matters to them, so learning about a lot of issues that I normally wouldn't touch. I get briefings from experts on all sorts of things all the time. So as a student, this has just been a lot of fun for me to do.

But, I do think we need more doctors. You touched upon that. There're only 19 doctors in Congress, and if you think about that, they're making decisions about our profession and our patients without people that really have the frontline experience to know how these things affect what we do.

And during my time on the Hill, you could tell that they were grateful to have a doctor give them some frontline experience when they're doing the bills and things like that. They appreciated my presence.

Now, I wasn't an expert on getting laws passed, but they taught me the process, right? So now I understand this process of getting a bill, and I can see how the work that they're doing in D.C. impacts what you and I do every day on the front lines, and the dots are connected.

If we had more doctors -- more healthcare professionals in general -- that wanted to go into public service, we could do a lot for healthcare in this country.

Faust: Well, I think it's an important message. It's one that we all need to hear, physicians and healthcare providers across the spectrum: use the skillset to make a difference, get involved, go outside your comfort zone, which I know is something that you are doing and leading the way.

Good luck on the campaign trail and with the book. And thank you so much, Dr. Williams, for sharing your views today.

Williams: Jeremy, thank you very much. It's been a pleasure talking to you.