Dying for Facts Part 3: The heart of the matter?

We live in an era of strident partisanship, with elections often decided by candidates’ attitudes towards morally and emotionally charged issues like gun control or abortion. Each presidential election seems to hinge on some set of irresolvable moral and cultural divisions, leaving the winner with at best a tenuous majority, while a firmly ensconced and angry minority plots their retribution. Tune into cable news for an hour just about any day and you will see a world divided over matters of fact. Does gay adoption harm children? Do school vouchers improve education? Does the minimum wage help low-wage workers? Each side in most of these debates appeals to their version of the facts in making their case. I am sure I am not alone in finding this discourse maddening.
But our disputes don’t always have to fester like this, in a puddle of factlessness. Because when people disagree, the right approach to facts-pursued honestly, objectively, and in genuine earnest-can resolve their disagreement. When I was a kid, arguing with my siblings at the dinner table, my parents would inevitably send us to the family room, where we kept our World Book Encyclopedia, so we could find out who was correct. Opinion didn’t win arguments in my household-facts alone were the key to success. (Of course, when the World Book failed to offer answers, we were left to utilize other, usually noisier, rhetorical weapons. But that’s a story for my memoir, not this blog.)
How is that we, as a society, can let decades pass without finding a neutral authority that will help us to figure out answers to so many important policy questions? What can we do when we are continually divided over matters of simple fact? For the beginning of an answer, I’m going to ask you to think about your heart.
The beating of your heart depends on the precise coordination of four chambers. The top two chambers, the atria, collect blood from the body and gently push this blood through to the lower, stronger chambers of the heart, the ventricles. In doing so, these two atria must coordinate their movement by sending out electrical impulses. The electricity starts up in the atria, causing those small chambers to push blood into the ventricles, by which point the electrical impulses have reached these larger muscles, spurring them on to eject the blood out into the rest of the body.
Should the electrical system in your heart go haywire, you could die from what us doctors call a cardiac arrhythmia, as happened to the beloved political journalist, Tim Russert. In his case, Russert’s doctors had already discovered that he had a narrowing of his coronary arteries, the blood vessels that supply the heart. But they had not suspected that he was at high risk for a fatal arrhythmia.
Fortunately, many people show warning signs of such arrythmias, giving doctors a chance to correct the situation before these electrical disturbances lead to disaster.
During my training at the Mayo clinic in the late 80s, I took care of many patients suffering from chronic arrhythmias. I remember monitoring their hearts with ECG recorders, watching the electrical tracings move up and down the screen. As a medical student, I had learned to recognize each of these squiggles-the spiky-looking QRS complex and the afterthought-like T waves. Some of my patients, back then, displayed scary irregularities on their heart monitors-a pulse of electricity would burst out from a rebellious location in their atria, jumping ahead of their natural pace makers. Electricity would pulse around their hearts in backwards and sideways directions. Some people would experience one or two of these premature beats every minute. Others would experience dozens of premature beats each minute, sometimes in rapid runs of four, five or six beats.
In general, people don’t die from these short bursts of electricity. But even early in my career, I was acutely aware that those six beat runs could devolve into sixty beat runs-the kind of sustained, rapid rhythms that often prove fatal.
But what could we doctors do to prevent such a tragedy? In the first few weeks of my cardiology rotation, I was being mentored by a senior cardiologist who explained that I should prescribe a powerful new anti-arrhythmic drug for my patients, a medicine like Encainide or Flecainide. These drugs, he told me, were specifically designed to prevent electrical disturbances in the heart.
So I dutifully prescribed these drugs, and was amazed-my patients’ arrhythmias invariably retreated in shame. I would watch their heart monitors, fascinated; thirty irregular heart beats per minute would become fifteen, then five, then almost none. I had seen the value of these drugs with my own eyes, and I was a believer.
But was I right to believe? And what does any of this have to do with political partisanship?
Stay tuned for Part 4.
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PeterUbel