“Real knowledge is to know the extent of one’s ignorance.”—Confucius (551 BC — 479 BC)
The modern corollary to the wisdom of Confucius would be Albert Einstein’s quote, “The more I learn, the more I realize how much I don’t know.” For me, one of the greatest attractions during my 30-plus years in the medical profession is the humbling impact this career has on personal perceptions of what I perceive to “know.” I find myself often paraphrasing both Confucius and Einstein to resident trainees with the quippy statement, “The more I learn the less I know.”
The idea that knowledge really only reveals the ever-growing extent of one’s personal ignorance of things is a vital component of being “expert” at any body of knowledge such as medicine. The humility that comes from this understanding is essential for the medical professional in order to avoid the trap of blind acceptance of traditional medical dogma, leading to practice stagnation. As an older physician, I am no longer surprised when I am forced to update what I thought I knew to be medical truth because of some newly discovered nasty fact. I have come to the realization that the only real postulate in medicine is: Anything I believe is medical fact will likely change, so I should stop being surprised.
Because I am grounded in the medical ethos I have just outlined, I was not at all taken aback by the recent news stories touting the discovery of a new human organ system known as the interstitium.1, 2 For those with even the vaguest understanding of human anatomy, the existence of fascia and the interstitium is no great revelation. What is fascinating is the greater appreciation of the complexity of this connective tissue system and understanding of the role this tissue might play in human homeostasis. Fascia has traditionally been thought of as a collagen-filled barrier surrounding muscles, nerves, and vessels. This way of thinking was supported by traditional methods for the histological examination of tissues which involves fixing the tissue to be examined with chemicals, thinly slicing them and then staining the slices for microscopic viewing. It was assumed that this process preserved micro-anatomical structure and was a reasonable facsimile of reality. In fact, this process tended to remove fluid from the tissue, collapsing the otherwise spongy interstitium. New methods of confocal laser microscopy (No, I do not know how this works. But, if it involves a laser, it must be cool.) and tissue staining are revealing in far greater detail the fluid-filled reality of this compartment that communicates throughout the body and may actually represent the largest organ system of the body.
What is the function of this new organ system? Theories abound to include a route for cancer metastasis, a possible role for immune function, a cushion for muscles and organs as they respond to movement and outside forces, a possible role in myofascial pain and an important fluid management system for the body, among other possibilities. The fact is, we really do not know its function, since we have only recently discovered the physical nature of this tissue space within the body. What I find particularly intriguing about this discovery is the role this organ might play in the clinical impact of certain integrative health modalities, such as massage or acupuncture. Are the therapeutic benefits of massage linked to the mechanical manipulation of this new organ? Do acupuncture needles impact on the body through interaction with the fascia and interstitial space? Is this new organ discovery actually the embodiment of the “meridians” theorized by the ancients to explain the interaction of acupuncture with the human body? This is all pure conjecture on my part. One of the advantages of editorialization is the ability to freely speculate, unfettered by facts.
In short, I find this new discovery fascinating and exciting. Imagine the medical walls that will be cracked and then broken down by this new knowledge. How many more unanswered questions will result from the exploration of this new space within the human body? What novel therapies and cures will result? What branches of medicine heretofore considered quackery will now be validated with this new discovery? Once again, it appears I have learned something and the edges of my ignorance have pushed out a bit further.
1Newfound ‘organ’ could be the biggest in your body. By Jacqueline Howard, CNN, Updated 10:10 AM ET, Sat March 31, 2018. https://www.cnn.com/2018/03/27/health/new-organ-interstitium-study/index.html accessed April 9, 2018.
2Benias PC, Wells RG, Sackey-Aboagye B, Klavan H, Reidy J, Buonocore D, Miranda M, Kornacki S, Wayne M, Carr-Locke DL, Theise ND. Structure and Distribution of an Unrecognized Interstitium in Human Tissues. Scientific reports. 2018 Mar 27;8(1):4947.
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