一場關於健康方面的革命正在上演
A revolution in health care is coming
一場關於健康方面的革命正在上演
Data and medicine
Print edition Leaders
Feb 1st 2018
Welcome to Doctor You
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.
難怪他們被稱為「病人」。當今天人們進入富裕國家的醫療保健系統，他們知道他們將會得到什麼：尖銳的醫生，無盡的檢查，莫名其妙的行話，不斷上升的花費，最重要的是，長時間的等待。我們需要淡定，因為健康是最複雜和難以維持的東西。但是我們被一次次的失望不斷充斥著。本周，美國亞馬遜、伯克希爾哈撒韋和摩根大通三家最大的公司宣布了一項新的投資計劃，為員工提供更好、更廉價的醫療服務。而今醫療系統最根本的問題是患者對此缺乏知識和控制。如果可以實現對醫療數據的訪問，則兩者都可以輕鬆實現。
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.
現今的網路普及讓病人們可以選擇合適的時間和地點與醫生進行線上溝通。你也可以進行非處方的測試去檢測你的血液狀況，對你的基因組進行測序並檢查腸道內的細菌。但是如果要引髮根本性的改變，則需要從提供者到病人，從醫生到數據的轉變，而這種轉變正在發生。如今智能手機這樣的已經允許人們監督自己的健康。當你添加關鍵的缺失成分進入你自己的醫療記錄，並能輕鬆地與你信任的人分享信息時，這種可能性就會成倍增加。這樣不僅可以提高醫療的效率，也可以通過提供自己的醫療數據來訓練醫療演算法。你也可以加強對你和其他任何人的關注和照顧。
The doctor will be you now
你將會成為醫生
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.
醫療數據的革新看起開不像一場巨大的革命。但是信息的流動可能會以幾種方式開花結果。一，是更好的診斷，有人可能會擔憂他們的心臟的狀況，現在可以買一個手錶帶，裡面有一個可以檢測心律失常的醫用級監測器。應用程序正在爭相研究他們是否能診斷出從皮膚癌和腦震蕩到帕金森病的所有疾病。現在研究者們正在進行研究，看是否可以對汗液中的分子生物標誌物進行分析，這樣就不需要進行侵入性血液檢測。有人認為滑動手機屏幕的速度就可以檢測認知問題。
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 (see article).
第二個好處在於複雜疾病的管理。糖尿病應用可以通過監測血糖水平和食物攝入量來改變病人的治療方式，從而可能減少失明和壞疽等長期危害。Akili Interactive, a startup,，計劃獲得批准去設計一個視頻遊戲來模擬大腦引起注意力缺陷多動障礙的部分（見文章）。
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 (see article).
病人也可以提高他們的自身照顧自己的效率。雖然健康記錄越來越電子化，但是這些數據還時常被困在圍籠裡面。許多數據機器並不能讀取。這可能導致治療延誤，甚至更糟。美國每年250000例因醫療失誤而死亡的病例中，有許多可以歸咎於缺乏合適的護理。有了可被輕易讀取的數據，共享的標準和強大的激勵機制，病人可以更容易發現錯誤。1月24日，蘋果公司發布了一項計劃，要求機構允許患者使用他們的智能手機下載自己的醫療記錄（見文章）。
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.
最後一個好處是數據的生成和聚合。人工智慧（AI）已經被谷歌的母公司Alphabet訓練，以識別癌組織和視網膜損傷。患者數據流從智能手機和「可穿戴設備」可以教給AI更多。例如，未來的AIS可以從癥狀的描述中提供自動的醫療診斷，指出你是否有抑鬱的行為特徵，或者確定你是否有心臟病的特殊風險。數據的聚合也將使人們更容易找到和自己相似的病例，並且知道其他人如何對自己的病狀採取措施。
An Apple a day
蘋果一日
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.
擁有新技術，公司承諾有後門的APP不會出現。但是目前那些符合要求的程序也可能對患者產生風險，用戶有可能最後只是會損耗自己的錢包。並不是每個人都想積極的去控制自己的健康管理過程；有些人只是想要專家們對自己的健康進行管理。沒關係，數據會找出那些對自己健康管理感興趣的人，那些不感興趣的人可以選擇把數據分享給他們信任的人。
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.
新技術的好處常常不利於富人。僱主、政府和保險公司必須對所有人進行有成本效益的預防性護理，以減輕這些擔憂。Alphabt最近推出了一個名為「街區衛生」的計劃，例如，他們計劃把病人的數據和更好的健康管理提供給低收入城市的居民，他們中的許多人都被醫療補助計劃覆蓋，這是針對較貧窮美國人的保險計劃。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.
處理其他風險則更難。更大的透明度可以鼓勵健康的老年人不要拿出自己的健康保險。這可能使身體不適的人更難尋求健康保險的庇護。我們可以通過相關規定來減慢這個過程，但卻不能阻止它。安全則是另一個擔憂，在雲中分析的病人數據越多或與不同公司共享越多，黑客或誤用的潛在威脅就越大。在美國，幾乎四分之一的數據泄露發生在醫療保健中。健康管理公司應該如果他們草率處理這些數據泄露問題將面臨嚴厲的懲罰，但這是他們則天真的認為這不會發生。
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.
廣泛的使用健康數據到底好處多還是壞處多？跡象表明他們事實證明好處多。許多國家現在已經開放了他們的醫療記錄，但很少有人去過瑞典，但瑞典的目標是在2020年之前讓所有人可以訪問他們的醫療記錄，超過三分之一的瑞典人已經建立了賬戶。研究表明，患者能夠對自己的病情有一個更深入的了解，他們的治療也會更成功。在美國和加拿大的試驗不僅產生了更快樂的病人，而且因為臨床醫生減少了調查而降低了成本。這並不奇怪，沒有人比你更關心你自己的健康。相信你自己這個醫生。
This article appeared in the Leaders section of the print edition under the headline "Doctor You"
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