( GUEST EDITORIALS J Science and Clinical Practice

John W. Madden, MO, FACS Director Tucson Hand Surgery, Ltd. Tucso1l, Arizona; Clinical Professor of Orthopaedics University of New Mexico Albuquerque

W hy devote an entire issue of a clinical jour­nal to a basic science topic? Even if

wound healing is the biologic basis of hand ther­apy, should we not devote our limited space and your limited time to more practical pursuits?

Science and clinical practice have had a short and complex relationship. Although there have al­ways been practitioners, biologic science came to our society less than 500 years ago with the publi­cation of the first anatomy text. Chemistry as a sci­ence is less than 200 years old. Bacteriology, less than 120 years old.

Certainly, medicine has profited by scientific thought, but what have we gained as a conse­quence of the application of science to the physical and occupational therapy clinics? We have the products of science (thermoplastics, computerized record keeping, jet printers, saran wrap, and such), but has science changed our practice in more fun­damental ways?

The vast majority of the things we do are em­piric. We have just begun to use the techniques of

Correspondence and reprint requests to John W. Madden, MD, Academy Medical Center, Suite 302, 310 North Wilmot Road, Tucson, AZ 85711.

applied science to question our empiric beliefs. Af­ter all, this journal devoted to applying scientific principals to clinical practice is only 11 years old! In this era of "mismanaged" care, when clinical de­cisions are being made by bureaucrats whose inter­est is almost always cost alone, we must prove that there is real benefit to what we do. Time is of the essence! If we fail to prove our dogma true (or not!), hand therapy will go the way of the mustard plaster.

So, why an issue devoted to basic science? Ap­plied research is really directed at reducing the em­piricism or increasing the theoretic component of a practical art. Basic science is concerned with devel­oping and improving our conceptual schemes (theories) and filling in the gaps in our systematic knowledge. Modem science is a tapestry woven with a warp and weft of conceptual schemes and decorated with the practical details that we use daily. Occasionally it is nice to step back and, rather than looking at the details, see the big picture. So, step back and enjoy the beauty of science before getting back to work proving that what you do does or does not work! Who knows, this issue may change the way you think about things.

Enjoy!

April-June 1998 73