Digital Health: Doctor You
数字医疗：医生就是你
A digital revolution in health care is coming. Welcome it
医疗保健的数字革命就要来临。迎接它吧
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.
无怪乎英文里“患者”（patient）一词也有“耐心”之意。如今，当人们进入富裕国家的医疗体系时，他们知道自己会面对什么：不停催促的医生、无休止的检查、令人困惑的术语、不断上涨的费用，尤其还有漫长的等待。在这种情况下多少是需要忍耐的，因为医疗是一项复杂又细致的工作。然而人们已经开始忍无可忍。本周，美国三大商业巨头亚马逊、伯克希尔·哈撒韦公司和摩根大通宣布了一个新项目，要为员工提供更好、更便宜的医疗服务。现行系统的一个基本问题是病人缺乏知识和掌控。让他们自由获取数据可以解决这两点。
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.
有了互联网，患者已经能在自己方便的时间和地点在线问诊。你可以通过非处方检测来分析血液、做基因组测序、检查肠道细菌。但要彻底变革，需要将重心从医疗保健机构转向病人，从医生转向数据。这种转变正在发生。人们可以利用智能手机等技术来监控自己的健康状况。如果你能够填补其中缺失的关键部分，即访问自己的病历并能方便地和你信任的人分享信息，那么用技术手段监控健康的可能性还会成倍增加。这让你能够减少自我治疗中低效的情况，还能提供数据来训练医疗算法。你可以改善自己和其他所有人的医疗保健。
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.
医疗数据也许看起来并不像那种能点燃革命的导火索。但信息的流动可能会在多个方面产生效果。首先是更便捷的诊断。担心心脏问题的人现在能买到一种手环，里面装有可以检测心律失常的医用级监测器。各种应用正在争先恐后地研究如何诊断从皮肤癌、脑震荡到帕金森氏症的种种疾病。目前还有人在研究是否可以对汗液进行分子生物标记物分析，而不需要进行侵入性血液检测。有人认为，如果一个人滑动手机屏幕的速度有变，可能是出现认知问题的征兆。
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.
第二个好处体现在对复杂疾病的管理上。糖尿病应用可以监测血糖水平和食物摄入情况，从而改变患者管理该疾病的方式，这或许能减少如失明和坏疽等长期损害。名为Akili Interactive的创业公司计划让自己设计的一款电子游戏获得监管部门批准，以刺激与注意力缺陷多动障碍有关的大脑区域。
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.
患者还可以提高自己的治疗效率。尽管病例的电子化程度越来越高，但往往还是难以利用。许多病历包含机器无法读取的数据。这可能会延误治疗，甚至导致更糟的结果。美国每年因医疗事故死亡的人数达25万，其中许多是因为治疗协调不佳。假如病患自己的手机上就有数据，又有统一的标准来分享信息，加上他们有强大的动力来把事情做对，他们就更有可能发现错误。1月24日，苹果公司发布了一项计划，鼓励各大医疗机构允许患者使用智能手机下载自己的病历。
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.
让患者自己来负责医疗过程的最后一个好处来自于生成和聚合数据。谷歌的母公司Alphabet旗下某部门正在训练人工智能（AI）识别癌变组织和视网膜损伤。随着智能手机和可穿戴设备不断生成关于患者的各类数据，人工智能还可以学做更多事情。比如，未来的人工智能可以根据你的症状描述自动提供诊断，还可以识别表明你处于抑郁的行为特征，或是确定你是否格外有可能罹患心脏疾病。数据的聚合也让你更容易找到其他罹患类似疾病的人，了解他们对各种治疗的反应。
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.
和所有的新技术一样，陷阱总是与希望相伴而来。大吹大擂的商家会推出不管用的应用。但由于监管机构要求监控所有会给患者带来风险的应用，用户至多只会钱包受损。不是每个人都想主动控制自己的医疗保健——很多人希望由专业人士管理一切。没问题。感兴趣的人可以仔细研究数据，而那些不感兴趣的人则可以选择与可信赖的医疗机构自动共享数据。
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.
新技术带来的好处常常过多地流向富人。而雇主、政府和保险公司有动力为所有人投资经济适用的预防性保健，这就缓解了这方面的担忧。例如，Alphabet最近成立了一家名为城区健康（Cityblock Health）的公司，该公司计划通过研究患者数据为低收入城市居民提供更好的医疗服务，他们中许多人都参加了医疗补助计划（Medicaid），这是一项为贫困美国人提供的保险计划。
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.
其他风险则更难防范。更高的透明度可能会促使身体硬朗的人不参加医疗保险，甚至可能会让身体不好的人更难获得保险。监管可以延缓这一过程——比如要求保险公司忽略基因数据——但无法阻止它发生。安全是另一个担忧。在云端被分析或与不同公司共享的患者数据越多，被黑客攻击或滥用的风险就越大。在美国，几乎四分之一的数据泄露发生在医疗领域。如果医疗保健公司对安全敷衍了事，就应面临严厉的处罚，但指望永远不发生泄露就太天真了。
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. Trust in Doctor You.
广泛分享数据的好处是否大于这些风险？种种迹象表明的确如此。许多国家现在都在开放病历信息，但很少有国家能像瑞典那样彻底。该国的目标是在2020年前让所有公民都能访问自己的电子病历，超过三分之一的瑞典人已经开设了病历账户。研究表明，有这样渠道的患者更了解自己的疾病，治疗也更成功。美国和加拿大的一些试验不但让患者更满意，成本也下降了，因为临床医生的询诊减少了。这并不稀奇。没人比你自己更关心你的健康。相信你自己做医生的本事吧。
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