Two signs of the times: another mass shooting and more Twitter outrage. This time, though, the barbs over social media came from the medical community in response to a tweet from the National Rifle Association.

The piling-on began after the NRA tweeted on Wednesday a link to an article from its Institute of Legislative Action. The article, titled “Surprise: Physician Group Rehashes Same Tired Gun Control Policies,” was promoted with these words: “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.”

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. https://t.co/oCR3uiLtS7 — NRA (@NRA) November 7, 2018

The tweet went out hours before a gunman walked into the Borderline Bar & Grill in Thousand Oaks, California, and killed at least 12 people before turning his gun on himself.

The NRA’s tweet had more than 1,300 likes by mid-Thursday. But it also riled up people inside and outside the medical field, who replied by the thousands.

“Oh, was I supposed to consult the NRA when my elderly patient with dementia accidentally shot themself holstering a gun they legally owned?” @DrMFraggle asked. “Because I was under the impression I was to consult general surgery and social services. My bad. :/ Gun control: not just about young people.”

Oh, was I supposed to consult the NRA when my elderly patient with dementia accidentally shot themself holstering a gun they legally owned? Because I was under the impression I was to consult general surgery and social services. My bad. :/ Gun control: not just about young people — Dr M Fraggle (@DrMFraggle) November 8, 2018

“After treating countless patients with life altering spinal cord injuries and brain injuries secondary to gun shot wounds, I would have to say this is my lane,” @DanaBussing wrote.

After treating countless patients with life altering spinal cord injuries and brain injuries secondary to gun shot wounds, I would have to say this is my lane. — Dana Bussing (@DanaBussing) November 8, 2018

“Next time I have 16yo boy shot through the spine and liver, paralyzed and terrified, gasping for air, and have to pretend to reassure him that we will do our best as he only survives long enough to make it to the OR table, I’ll be sure to call you to come tell the family,” @tnicholsmd said.

Next time I have 16yo boy shot through the spine and liver, paralyzed and terrified, gasping for air, and have to pretend to reassure him that we will do our best as he only survives long enough to make it to the OR table, I’ll be sure to call you to come tell the family. — Taylor Nichols, MD (@tnicholsmd) November 8, 2018

“I helped save a gun violence victim in med school. Those are my hands holding pressure on his femoral artery so that he wouldn’t bleed to death. The bullet is right by my fingertips. This is me in #mylane, @NRA,” @nurielmoghavem tweeted, accompanied by an X-ray image of a patient’s torso.

“I’ve reviewed the literature,” @kyblot wrote, “and there are basically no studies on the therapeutic benefits of getting shot.”

i've reviewed the literature and there are basically no studies on the therapeutic benefits of getting shot — trump sucks, communism will win (@kyblot) November 8, 2018

What drove the NRA’s criticism: a recent article in Annals of Internal Medicine, a leading academic medical journal, coincidentally published in late October in the aftermath of the Pittsburgh synagogue shootings and the killing of two African-Americans in a Kentucky Kroger store.

In the article, the American College of Physicians shared new recommendations on how doctors can play a role in reducing gun violence across the country. The medical association has long maintained that firearm-related deaths and injuries should be treated as an urgent public health crisis.

The recommendations include urging doctors to more regularly ask whether patients have guns in their home and to counsel patients on gun safety.

The argument also comes at a time when organizations like Scrubs Addressing the Firearm Epidemic, known as SAFE, are coming together to demand an increase in federal funding for gun violence research while calling on lawmakers to implement “evidence-based policy” on guns.

A spokeswoman for the NRA dismissed the flood of comments.

“The so-called ‘uproar’ on twitter or what could [be] characterized as a normal exchange of emotions and uninformed opinions has nothing to do with the substance of the article being promoted in the tweet. It’s clear form the comments that they didn’t read the article,” Jennifer Baker wrote in an email. “It’s just another example of gun control advocates with the help of the mainstream media blaming law abiding gun owners for the criminal acts of deranged people and exploiting tragedy to push a gun control agenda that would not prevent these crimes. The gun control policies they advocate for are already the law in California and they did not prevent [last night’s] tragedy.”

Baker added that the focus on the NRA is misguided.

If medical organizations “would like to concentrate on a public health crisis,” she wrote, “they should focus on the mental health crisis that results in nearly 50,000 suicides per year, the medical community’s complicity in the opioid crisis that takes over 42,000 lives per year or the 250,000 deaths due to medical errors.”

Few NRA supporters appeared to get into the Twitter mix with the doctors, nurses and others.

But some stepped onto the field, like @wickedgrin1, who said, “This is a crime issue, not a public health issue. Doctors arrogantly deem anything they feel strongly about to be a public health issue, to be corrected by government interference in private lives. This is the opposite of what medicine should be, and there is not end to it.”

This is a crime issue, not a public health issue. Doctors arrogantly deem anything they feel strongly about to be a public health issue, to be corrected by government interference in private lives. This is the opposite of what medicine should be, and there is not end to it. — Wicked Grin (@wickedgrin1) November 8, 2018

And there won’t be an end to it until doctors are satisfied, said Bob Doherty, an official with the American College of Physicians.

“Here’s a link to the @AnnalsofIM paper we wrote that has the @NRA demanding that doctors not speak out on gun violence,” he tweeted. “Doctors will keep speaking out. Until the carnage ends. #GunViolence #GunSense”