A revolution in health care is coming
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“病人”。如今，当人们进入富裕国家的医疗体系时，他们知道自己会得到什么:督促医生，没完没了的测试，莫名其妙的术语，不断上涨的成本，最重要的是，等待的时间长得多。因为医疗保健是复杂而繁琐的，所以我们总是需要一些坚忍。但是，沮丧情绪正在沸腾。本周，美国三大巨头——亚马逊公司、伯克希尔哈撒韦公司和摩根大通宣布成立了一家新公司，为员工提供更好、更廉价的医疗保健服务。今天的系统的一个根本问题是病人缺乏知识和控制。对数据的访问可以同时解决这两个方面。
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.
互联网已经使患者能够在合适的时间和地点寻求在线咨询。你可以通过非处方测试来分析你的血液，对你的基因组进行测序，并检查你肠道中的细菌。然而，激进的变革需要从提供者到病人，从医生到数据的巨大转变。这种转变正在发生的事情。智能手机等技术可以让人们监控自己的健康状况。当你把关键的缺失的材料加入到你自己的医疗记录中，并且很容易与你信任的人分享信息时，智能手机这种技术的可行性就会成倍增加。这让你可以减少自己治疗的效率低下，也可以提供数据来帮助训练医疗算法。你可以加强自己的医疗保健，也可以提高别人的医疗保健。
The doctor will be you now
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.
医疗数据似乎不像是点燃革命的火种。但是信息的流动很可能会以多种方式产生结果。一个是更好的诊断。一些担心自己心脏的人现在可以买一块含有医用级显示器的手环，可以检测出心率失常。应用程序正在努力研究是否能诊断出从皮肤癌、脑震荡到帕金森病等各种疾病。一项研究正在进行，以观察是否可以对分子生物标志物进行分析，而无需进行侵入性血液测试。一些人认为，一个人用手机触屏速度的改变，可能预示着认知问题的出现。
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.
第二个好处在于对复杂疾病的管理。糖尿病应用程序可以通过监测血糖水平和食物摄入来改变患者的治疗方式，从而有可能减少诸如失明和坏疽等长期危害。一家初创公司Akili Interactive计划为一款旨在刺激大脑涉及注意力缺陷多动障碍区域的视频游戏寻求监管批准。
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.
病人也可以提高他们的护理效率。尽管健康记录越来越电子化，但它们常常被困在孤岛上。许多数据包含机器无法读取的数据。这可能导致治疗的延迟，或者更糟。美国每年因医疗失误而导致的25万例死亡中，有许多都可以追溯到缺乏协调的医疗护理。通过他们的指尖上数据，共同的标准来实现共享，并有强烈的动机去做正确的事情，病人们更容易发现错误。1月24日，苹果公司制定了一项计划，要求各组织允许患者使用自己的智能手机下载自己的医疗记录。
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.
让病人负责的最后一个好处是他们的数据的生成和汇总。人工智能(AI)已经由谷歌母公司Alphabet旗下的一个子公司接受培训，以识别癌变组织和视网膜损伤。随着病人从智能手机和可穿戴设备的数据流中获得数据，他们将教AI做更多的事情。例如，未来的AI可以通过对你的症状的描述提供自动的医疗诊断，发现你患有抑郁症的行为特征，或者确认你是否有患心脏病的特殊风险。数据的聚合也会让你更容易找到患有类似疾病的人，并观察他们对各种疗法的反应。
An Apple a day
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.
正如所有的新技术一样，伴随承诺而来的是陷阱。广告员将推出不奏效的应用。但由于监管机构要求对给患者带来风险的应用程序进行监管，用户只会损失自己的一些钱。并不是每个人都想主动控制自己的医疗保健;很多人都希望专业人士管理一切。很好。数据可以被那些感兴趣的人仔细研究，而那些没有兴趣的人可以选择与受信任的提供者自动共享数据。
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.
新技术的好处往往不成比例地流向富人。雇主、政府和保险公司必须将高效成本的预防保健投资给所有人，才能减轻这些担忧。例如，Alphabet最近推出了一个名为Cityblock Health的公司，该公司计划对患者的数据进行调查，以更好地为低收入城市居民提供更好的医疗服务，其中许多人是由医疗补助计划覆盖的，这是一项面向美国穷人的保险计划。
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.
其他风险则更难处理。更大的透明度可能会鼓励健康的人不要买健康保险。它们甚至会使身体不好的人难于买医疗保险。规章制度可以减缓这一过程，通过要求保险公司忽略基因数据，但不能阻止它。安全是另一个担忧。在云计算中分析越多的患者数据，或者与不同的公司共享数据，潜在的黑客攻击或滥用的威胁就越大。在美国，几乎四分之一的数据泄露都发生在医疗保健上。如果卫生公司对安全问题草率处理，那么他们将面临严厉的惩罚，但如果认为这些违规行为永远不会发生，那就太天真了。
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.
使数据更广泛可用的好处是否超过了这种风险?有迹象表明会这样。许多国家现在都在开放他们的医疗记录，但是很少有国家能做到像瑞典那样。它的目标是到2020年让所有公民都能获得医疗记录;超过三分之一的瑞典人已经建立了账户。研究表明，有这种账号的病人对他们的疾病有更好的了解，而且他们的治疗更成功。在美国和加拿大进行的临床试验不仅使病人更快乐，而且降低了成本，因为临床医生减少了调查。这不足为奇。没有人比你对你的健康有更大的兴趣。相信“Doctor You”系统。
This article appeared in the Leaders section of the print edition under the headline "Doctor You"