The Role of Metaphor in Design

What is Metaphor?

According to Wikipedia, metaphor is defined as:

“Metaphor can be a powerful tool for designers, in both the process of designing and within the products themselves…Metaphors provide cues to users how to understand products: to orient and personify.”

For example, you may not have realized that metaphor is embedded in the design of the digital applications you use everyday. I used to take these symbols for granted, but they are totally steeped in metaphor.

Metaphor helps us understand how the world operates.

And metaphors are used not just for digital products, but also for physical products. This is the metaphor embedded in a number of medical devices that deliver injectable medications:

A pen.

Insulin pens and regular syringes are an example of the effective use of metaphor

The needle is located where you would expect it, under the cap.

In contrast, Mylan's EpiPen is an example of a broken metaphor

What are the Effects of Metaphor on Health Outcomes?

One recent research study from England compared the outcomes of use of different epinephrine autoinjectors.

What is the extent of harm that has been caused by the broken metaphor of the EpiPen?

The graph below from a study by Simons et al shows the number of unintentional injections with Epinephrine Auto-Injectors by age reported to Poison Control Centers between the years of 1994 and 2007. (Note that for this analysis they searched specifically for the EpiPen product distribution code)

There were over 15,000 unintentional injections with the EpiPen reported.

Furthermore, in the same paper they describe a smaller number of unintentional injections reported by the Food and Drug Administration (n=105), and believe it or not, at least one third of those individuals who injected themselves were trained healthcare professionals. (That’s right, bad design even foils those who should know better!)

Have there been any changes to the design of the EpiPen to address the broken metaphor?

In the wake of #epigate, Mylan recently made claims that they made improvements to justify the dramatic price increases in the EpiPen, but the American Council on Science and Health recently debunked this claim:

Let’s compare older vs. the current version of the EpiPen to understand the evolution of the design.

(Some of these changes may have predated the acquisition in 2007).


The body of the pen became wider and less cylindrical.


The text on the label changed.


“Any time you see signs or labels added to a device, it is an indication of bad design.”

Instead of investing in research and development to fix the broken metaphor, Mylan is using a SIGN to prevent self-injury with the EpiPen.

This is the #sadstateofhealthcare we live with.

Joyce Lee, MD, MPH, Physician, Designer, Researcher. #learninghealthsystems; #design for #ai; and the maker movement

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