Origin of the Nuclear Equation of State at the Quark Level

There is a measure of debate within the nuclear community concerning the relevance of quark degrees of freedom in understanding nuclear structure. We briefly outline some of the key issues and review the impressive progress made recently within the framework of the quark-meson coupling model. In particular, we explain in quite general terms how the modification of the internal structure of hadrons in-medium leads naturally to three- and four-body forces, or equivalently to density dependent effective interactions.