title: How the creative use of analogies can shape medical practice.
abstract: Analogical reasoning is central to medical progress, and is either creative or conservative. According to Hofmann et al., conservative analogy relates concepts from old technology to new technologies with emphasis on preservation of comprehension and conduct. Creative analogy however brings new understanding to new technology, brings similarities existing in the source domain to a target domain where they previously had no bearing, and imports something entirely different from the content of the analogy itself. I defend the claim that while conservative analogies are useful by virtue of being comfortable to use from familiarity and experience, and are more easily accepted by society, they only lead to incremental advances in medicine. However, creative analogies are more exciting and productive because they generate previously unexpected associations across widely separated domains, emphasize relations over physical similarities, and structure over superficiality. I use kidney transplantation and anti-rejection medication development as an exemplar of analogical reasoning used to improve medical practice. Anti-rejection medication has not helped highly sensitized patients because of their propensity to rejecting most organs. I outline how conservative analogical reasoning led to anti-rejection medication development, but creative analogical reasoning helped highly sensitized and blood type incompatible patients through domino transplants, by which they obtain a kidney to which they are not sensitized. Creative analogical reasoning is more likely than conservative analogical reasoning to lead to revolutionary progress. While these analogies overlap and creative analogies eventually become conservative, progress is best facilitated by combining conservative and creative analogical reasoning.
authors.affiliation: Renal Transplant Program, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.
authors.forename: G V Ramesh
authors.initials: GV
authors.lastname: Prasad
mesh_terms: D003405:Creativity; D049673:History, 20th Century; D006801:Humans; D007165:Immunosuppression Therapy / Q000266:history; D016030:Kidney Transplantation; D035703:Therapies, Investigational; D013850:Thinking
keywords: analogy; conservative; creative; domino; medical progress; transplantation