数据与医学：医疗保健革命即将到来 [英国媒体]

Data and medicine

数据与医学

A revolution in health care is coming

医疗保健革命即将到来

Welcome to Doctor You

欢迎来到人人是医生的时代



NO WONDER they are called “patients”. When people enter the health-care systems of rich countries today, they know what they will get: prodding doctors, endless tests, baffling jargon, rising costs and, above all, long waits. Some stoicism will always be needed, because health care is complex and diligence matters. But frustration is boiling over. This week three of the biggest names in American business—Amazon, Berkshire Hathaway and JPMorgan Chase—announced a new venture to provide better, cheaper health care for their employees. A fundamental problem with today’s system is that patients lack knowledge and control. Access to data can bestow both.

难怪他们被称为“患者”，当今人们参加发达国家的医疗保健制度时，明白会面对什么：脾气暴躁的医生、没完没了的检查、云里雾里的行话、高额费用、最主要是漫长的等待。一点儿斯多葛主义总是必要的，因为医疗保健是复杂费力的事情。然而，人们的沮丧情绪已经失控。本周，美国商界最为知名的三家企业——亚马逊、伯克希尔•哈撒韦、摩根大通宣布成立一家风险企业，为员工提供更加优质低廉的医疗保健服务。当今医疗保健体系的根本问题是患者缺乏知识和控制权。如果为患者提供数据，两个难题都能迎刃而解。

The internet already enables patients to seek online consultations when and where it suits them. You can take over-the-counter tests to analyse your blood, sequence your genome and check on the bacteria in your gut. Yet radical change demands a shift in emphasis, from providers to patients and from doctors to data. That shift is happening. Technologies such as the smartphone allow people to monitor their own health. The possibilities multiply when you add the crucial missing ingredients—access to your own medical records and the ability easily to share information with those you trust. That allows you to reduce inefficiencies in your own treatment and also to provide data to help train medical algorithms. You can enhance your own care and everyone else’s, too.

在时间和地点允许的情况下，如今患者可在网上进行医疗咨询，可通过市面检测来分析血液、进行基因测序、检查肠道细菌。然而，彻底的变革需要将重心从供应商转向患者、从医生转向数据。这样的变化已经发生，例如人们利用智能手机等技术监测健康。如果填补了缺口——获取自己的病例、方便地与信任的人分享信息，将极大扩展可能性。这将减少低效治疗，并提供数据帮助训练医学算法，你能够改善自己乃至所有人的治疗。

The doctor will be you now

现在你就是医生

Medical data may not seem like the type of kindling to spark a revolution. But the flow of information is likely to bear fruit in several ways. One is better diagnosis. Someone worried about their heart can now buy a watch strap containing a medical-grade monitor that will detect arrhythmias. Apps are vying to see if they can diagnose everything from skin cancer and concussion to Parkinson’s disease. Research is under way to see whether sweat can be analysed for molecular biomarkers without the need for an invasive blood test. Some think that changes in how quickly a person swipes a phone’s touchscreen might signal the onset of cognitive problems.

医疗数据也许算不上革命导火索，但信息流动有可能在多方面取得成果。首先是更好的诊断，如今担心自己心脏的人可购买一种手表，装有能监测心律失常的医疗级监测器。应用程序争相尝试诊断疾病，从皮肤癌、脑震荡、到帕金森病无所不包。科学家正在研究能否通过汗液来分析分子生物标记物，而无需侵袭性血检。有人认为，根据一个人滑动手机触摸屏的速度变化，可判断是否有认知问题。

A second benefit lies in the management of complex diseases. Diabetes apps can change the way patients cope, by monitoring blood-glucose levels and food intake, potentially reducing long-run harm such as blindness and gangrene. Akili Interactive, a startup, plans to seek regulatory approval for a video game designed to stimulate an area of the brain implicated in attention-deficit hyperactivity disorder.

第二个益处是管理复杂的疾病。糖尿病应用程序能改变患者应对疾病的方式，通过监测血糖水平和食物摄入量来减少致盲、坏疽等长期损害。创业公司Akili Interactive研发的一款视频游戏准备获得监管批准，它能刺激与“注意力缺乏多动症”有关的一个大脑区域。

Patients can also improve the efficiency of their care. Although health records are increasingly electronic, they are often still trapped in silos. Many contain data that machines cannot read. This can lead to delays in treatment, or worse. Many of the 250,000 deaths in America attributable to medical error each year can be traced to poorly co-ordinated care. With data at their fingertips, common standards to enable sharing and a strong incentive to get things right, patients are more likely to spot errors. On January 24th Apple laid out its plans to ask organisations to let patients use their smartphones to download their own medical records.

患者还能够提高医疗效率。虽然健康档案越来越电子化，但往往被束之高阁。其中许多数据无法被机器识别，导致治疗延误或更糟的结果。每年死于医疗差错的25万美国人中，许多是协同不到位的结果。如果为患者提供数据，出台数据分享的一般性标准，再加上纠错的强烈动力，患者更有可能发现错误。1月24日，苹果公司宣布计划，让相关组织允许患者利用智能手机下载自己的病例。

A final benefit of putting patients in charge stems from the generation and aggregation of their data. Artificial intelligence (AI) is already being trained by a unit of Alphabet, Google’s parent company, to identify cancerous tissues and retinal damage. As patients’ data stream from smartphones and “wearables”, they will teach AIs to do ever more. Future AIs could, for instance, provide automated medical diagnosis from a description of your symptoms, spot behavioural traits that suggest you are depressed or identify if you are at special risk of cardiac disease. The aggregation of data will also make it easier for you to find other people with similar diseases and to see how they responded to various treatments.

随着患者掌握控制权，数据的生成与整合带来最后一个益处。谷歌一家子公司Alphabet正在训练人工智能识别癌症组织和视网膜受损。患者通过智能手机和“可穿戴设备”提供数据，训练人工智能实现更多的事情。例如：未来的人工智能依靠症状描述来提供自动化医疗诊断，识别抑郁的行为特点，判断你是否有患心脏病的特殊风险。数据整合便于患者寻找病友，探讨对各种治疗的反应。

An Apple a day

每天一个苹果

As with all new technologies, pitfalls accompany the promise. Hucksters will launch apps that do not work. But with regulators demanding oversight of apps that present risks to patients, users will harm only their wallets. Not everyone will want to take active control of their own health care; plenty will want the professionals to manage everything. Fine. Data can be pored over by those who are interested, while those who are not can opt to share data automatically with trusted providers.

伴随所有新科技的到来，希望与隐患并存。小商贩会推出无效的App，但随着监管部门审查对患者有风险的App，用户最多遭受财产损失。并不是所有的人都想对自己的医疗保健拥有控制权，许多人希望由专业人士打理一切。没问题！感兴趣的人可以仔细研究医疗数据，不感兴趣的将数据自动分享给可信的供应商。

The benefits of new technologies often flow disproportionately to the rich. Those fears are mitigated by the incentives that employers, governments and insurers have to invest in cost-efficient preventive care for all. Alphabet has recently launched a firm called Cityblock Health, for example, which plans to trawl through patients’ data to provide better care for low-income city dwellers, many of them covered by Medicaid, an insurance programme for poorer Americans.

新科技的益处往往多被富人享受。为了减少这种担忧，需要激励雇主、政府、保险公司为所有的人投资有成本效益的预防性保健。例如：Alphabet公司创立的Cityblock Health公司准备查阅患者的数据，为城市低收入者提供更好的医疗保健。许多低收入者参加了美国政府向贫困者提供的医疗补助制度（Medicaid）。

Other risks are harder to deal with. Greater transparency may encourage the hale and hearty not to take out health insurance. They may even make it harder for the unwell to find cover. Regulations can slow that process—by requiring insurers to ignore genetic data, for example—but not stop it. Security is another worry. The more patient data are analysed in the cloud or shared with different firms, the greater the potential threat of hacking or misuse. Almost a quarter of all data breaches in America happen in health care. Health firms should face stringent penalties if they are slapdash about security, but it is naive to expect that breaches will never happen.

其他风险更难处理。提高透明度可能促使健壮的人不参加健康保险，患病的人更难参加保险。监管层可延缓但不能阻止这一进程，例如要求保险公司忽略基因数据。安全也令人担忧，云端分析的、企业分享的患者数据越多，被黑客入侵或滥用的潜在风险就越大。美国泄漏的数据中，约25%发生在医疗保健领域。如果保健企业对安全粗心大意，应当受到严厉处罚，但要想永远不发生数据泄露是不现实的。

Will the benefits of making data more widely available outweigh such risks? The signs are that they will. Plenty of countries are now opening up their medical records, but few have gone as far as Sweden. It aims to give all its citizens electronic access to their medical records by 2020; over a third of Swedes have already set up accounts. Studies show that patients with such access have a better understanding of their illnesses, and that their treatment is more successful. Trials in America and Canada have produced not just happier patients but lower costs, as clinicians fielded fewer inquiries. That should be no surprise. No one has a greater interest in your health than you do. 

为更多的人提供数据的益处是否大于风险？现有迹象是这样的。许多国家已开放病例，但与瑞典相差甚远。其目标是到2020年，为所有的公民提供电子病例，超过三分之一的瑞典人已经建立账户。研究表明获取病例的患者对自身的疾病有更好的理解，接受的治疗也更成功。美国、加拿大的试验表明，这样做不仅提高了患者的幸福感，也降低了成本，因为临床医生接到的问题少了。这也难怪，没人比你对自己的健康更感兴趣了。


scott0962Feb 5th, 23:41
One thing that would bring down the cost of physician care in the US would be tort reform to limit damages in case of malpractice lawsuits which would mean lower rates for the malpractice insurance purchased by American physicians. Trial lawyers of course are dead set against it and donate heavily to ensure Congressional Democrats don't allow any kind of meaningful tort reform that would jeopardize their lucrative fees.

美国降低医疗费的一个办法是通过侵权法改革来限制医疗事故诉讼造成的损失，以此降低美国医生购买医疗事故保险的费用。这必然遭致辩护律师的极力反对，他们会大力捐献资金，确保国会民主党议员否决任何形式的侵权法改革，因为这种改革会减少他们的丰厚收入。

simonelvladtepesFeb 5th, 20:17
'NO WONDER they are called “patients”' - no, they are called consumers. It's cute and entertaining to write about possible technological developments, but at some point, you should be able to grasp and describe the main issue: the corporatization of Medicine in the US. I now have to comply with algorithms developed by-? In a meeting last week I was told that 70% of my patient have to discharged within a specific time frame. The average length of stay was given a certain Holy Number. There are invisible corporate forces manipulating clinical decisions in more ways than I can describe, and they leave no fingerprints.

“难怪他们被称为患者”，不对，他们被称为消费者。作者探讨潜在的科技发展，很精明也很有趣，但在一定程度上，应抓住主要问题：美国医疗的企业化。我现在必须遵从某公司研发的算法。在上周会议上，我被告知70%的患者必须在规定期限内出院，他们为病人的平均住院时间规定了一个神圣数字。企业力量无形之中控制着临床决策，控制方式比我想象中还多，而且不露马脚。

fuSfLdqmytFeb 5th, 10:26
As a Medical Doctor and Specialist of 63 I can only recommend a few things: don't ever think that spending less you get anyway what you need, or, spending far more you always get the best. The first thing you must search is " good sense". Behind every machine there is a Doctor and his/her experience should become at your service with good sense. Business has always been there, in medical practice like everywhere else but quite rarely, a good doctor will also be a very wealthy one. I do not feel comfortable reading this article, it gives me the creeps.

作为一名63岁的专科医师，我只能给出几个建议：永远别以为花少钱能得到你想要的，也别以为花高价总能得到最好的，重要的是保持理智。每台机器都由一名医生操作，他们的经验应该理智的为您服务。与其他领域一样，医学也有商业性质，但在优秀的医生当中，非常富有的极少。这篇文章令我感到不适，细思极恐。

gwilsontFeb 2nd, 16:43
I know there's a lot of hype around this field but I remember back in the late 80s all the hype around AI and Expert Systems. It went no where in regards to complex and important problems. The apps that are out there now for health provide little value. We all know we should eat less, exercise more, sleep more and see our doctor for regular check ups. Even the device mentioned that tracks heart arrhythmias isn't all that precise.

我知道医学充斥着大量炒作，但回忆起80年代末有关人工智能和专家系统的所有炒作，这些东西根本无法解决复杂、重要的问题。如今的健康类App没啥价值，我们都知道应该少吃、多运动、多睡觉、定期检查身体。就连文中提到的监测心律不齐的设备也没那么精准。

Mikko HalonenFeb 2nd, 13:24
I doubt that there is a significant number of people who'll give up health insurance when they find out their risks are lower than average. Even if there were many who would think like that, usually health insurance is not optional.

假如人们发现自己的健康风险低于平均水平，我怀疑会有许多人放弃健康保险。但即便许多人有这种想法，健康保险也往往是必须的。