Clinical

The talk of the town (in Anytown, USA) is "Evidence-Based Medicine". If you're in the health professions, I am sure you've become familiar with the phrase. The same holds for those in health insurance - and clinical research. "The evidence" is driving everything these days.

For the record - I am a true believer in the power of good clinical research. I do think that as clinicians we need to provide care based on true evidence-based medicine. We must hold ourselves to high standards of practice, and we must continue to challenge our thought processes and clinical reasoning skills - as uncomfortable a process as this may be. It involves reflection on our practice patterns and perhaps even challenging our belief systems - about our role in patient care or the methods we advocate.

When I was last in this neighborhood, we were discussing the amazing adaptability of the human machine. Incredible as it may sound, human physiology and anatomy will consistently adapt to the world - and if unable to do so, will give us warning signs (such as pain) and then show us that it is unable to do so - by way of injury. 

Lest we forget, the body aims for homeostasis - which is, implicitly, "balance". So at any given time, we are in homeostasis and thus always "in balance" relative to the demands on the system at that given point in time. Homeostasis is a wonderful thing. Our cellular mechanisms are constantly seeking homeostasis. We are always trying to find a balance - between stimulus and response, between training and recovery.

But here's the twist ...

To live on planet earth, humans are constantly adapting to the demands of their surroundings. As I am always saying (to anyone who will listen) - Form Follows Function. Our anatomical form evolves depending upon the functional demands that we face. Throughout the evolutionary process, the human form has changed to allow it to better adapt to the world around it.

Let's take a look at a few basic examples. An astronaut traveling to the moon adapts to the inherent decrease in gravitational force by having less muscle mass and a decrease in bone density. Why? There is no functional need for these - and thus the body adapts accordingly. On return to earth, there is a gradual return of bone density and muscle mass. Why? Because there is a functional demand placed on the body - and it adapts accordingly. Form follows function. Along the same lines, the average sedentary American, the "couch potato" if you will, has become very finely tuned anatomically to deal with the imposed demands of "couch-potato-dom" - a perfect slouch into the big puffy couch and very strong thumb musculature for the use of the TV remote!