Prasad G V Ramesh
Renal Transplant Program, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.
J Eval Clin Pract. 2015 Jun;21(3):455-60. doi: 10.1111/jep.12334. Epub 2015 Mar 10.
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.
类比推理是医学进步的核心，它要么具有创造性，要么具有保守性。根据霍夫曼等人的观点，保守类比将旧技术中的概念与新技术联系起来，重点在于保持理解和行为。然而，创造性类比为新技术带来了新的理解，将源领域中存在的相似性引入到之前毫无关联的目标领域，并引入了与类比本身内容完全不同的东西。我支持这样一种观点，即虽然保守类比因其基于熟悉度和经验而易于使用且更易被社会接受而有用，但它们只会带来医学上的渐进式进步。然而，创造性类比更令人兴奋且富有成效，因为它们在广泛分离的领域中产生了先前意想不到的关联，强调关系而非物理相似性，强调结构而非表面现象。我以肾脏移植和抗排斥药物研发为例，说明用于改善医疗实践的类比推理。抗排斥药物对高度致敏患者没有帮助，因为他们倾向于排斥大多数器官。我概述了保守类比推理如何导致抗排斥药物的研发，但创造性类比推理通过多米诺移植帮助了高度致敏和血型不匹配的患者，使他们获得了一个未对其致敏的肾脏。创造性类比推理比保守类比推理更有可能带来革命性的进步。虽然这些类比相互重叠，且创造性类比最终会变得保守，但通过结合保守和创造性类比推理，最有利于推动进步。
