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.

难怪病人被称为“患”者。现如今，一进入发达国家的医疗机构，人们闭着眼都知道要经历什么：医生的催促、没完没了的检查、一头雾水的术语、不断上涨的就医费用，最要命的是无尽的等待。还需要一些耐心，因为治病很复杂，是尽心费力的事。可是，患者的负面情绪不断膨胀。本周，美国三大巨头——亚马逊、伯克希尔-哈撒韦和摩根大通——宣布成立一家新企业，为自家员工提供更好、更便宜的医疗服务。如今，医疗系统的一个根本问题是病人缺乏医疗知识，也不懂疾病防控。获取医疗数据则能做到双管齐下。

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，患者可以自行安排合适的时间地点在线咨询。可以通过非处方测试来分析血液，对基因组进行排序，检查肠道中的细菌。然而，要彻底改变，还需要进行重要转换：从服务提供商转到患者，从医生转到数据，这种转变已在进行。人们可以借助于智能手机等技术监控自己的健康状况。填加缺失的关键性信息越有利于实现这种转变——可以查阅自己的医疗记录，向你信任的医疗网站提供个人信息。这样可以高效进行治疗，提供数据也有利于完善医疗算法。这不仅仅帮助自己治病，对其他病人也大有裨益。

The doctor will be you now

自行诊断

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.

医疗数据不太可能成为引发医疗革命的星星之火。不过，信息的流通可能在几个方面取得成果。一个有利于诊断。担心心脏出问题可以买到一种手环，内含医用监护仪，检测心律失常。从皮肤癌、脑震荡到帕金森氏症，手机应用都能测试，看看能否诊断出所有疾病。目前正在进行研究，要确定出不进行血液检测的情况下，能否通过汗液分析分子生物标志物。一些人认为，通过手机触屏速度的变化，可以判断出现了认知问题。

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.

第二个好处就是对复杂疾病进行管理。糖尿病应用可以通过监测血糖水平和食物摄入量，改变患者的控糖方式，减少失明和坏疽等慢性危害。创业企业Akili Interactive开发出一款游戏，能刺激某块脑组织，该部位与注意力缺陷多动障碍症有关联。该公司计划寻求监管机构批准此款游戏。

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.

病人也能提高他们的就医的效率。尽管医疗记录日益电子化，却仍有不足，很多记录都无法读取数据。这会导致治疗延误，甚至更糟。在美国，每年死于医疗事故的25万人当中，其中很多都是由治疗协调不佳导致的。患者有了数据，有了通用标准可实现共享，加之避免误诊的强烈动机，患者更有可能发现错误。1月24日，苹果公布了一项计划，要求医疗机构允许患者通过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.

患者自行负责数据有个最大的好处，那就是生成和聚合数据。谷歌母公司Alphabe旗下的一个部门在培训人工智能，识别癌变组织和视网膜损伤。智能手机和“可穿戴设备”能不断获得患者数据，人工智能也随之越来越智能。例如，未来的人工智能可以通过对描述症状，提供自动化的医疗诊断，发现潜在的抑郁症特征，或者识别出有没有心脏病隐患。数据汇总后，您还能很快找到其他相似疾病的病友，了解不同的治疗手段过后，病情有什么变化。

An Apple a day

灵丹妙药

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.

新技术大体如此，前景广阔但存在不足。推销的应用不见得有用。虽然监管机构要对存在隐患的应用进行管控，但病人还是掏腰包。不是所有人都想主动控制自身医疗；很多人希望由专业人士处理。没关系，感兴趣的人可以仔细研究数据，而不感兴趣的可以选择与可信赖的人自动共享数据。

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.

新技术往往让富人受益，有失公允。用人单位、政府和保险公司必须投资效益高的全民预防保健，这样就缓解对唯富人受益的担忧。例如，Alphabet最近成立Cityblock Health公司，该公司计划搜罗患者数据，为低收入城市居民提供更好的医疗服务，其中许多人都享受面向美国穷人的“医疗补助计划”。

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.

还有更难应对的风险。透明度变强，可能会鼓励身体好的人不买健康保了，也让患者无处遁形了。监管能减缓这样的变化速度——比如要求保险公司忽略基因数据——但阻止不了风险。安全是另一个问题。患者数据在云计算中分析的越多，或者跟不同企业分享的越多，黑客或滥用数据的潜在威胁就越大。在美国，几乎四分之一的数据泄露都是在医疗领域。如果医疗机构在安全问题上马马虎虎，就应该受到严厉惩罚，但侥幸认为不存在安全漏洞就太幼稚了。

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.

广泛提供数据利大于弊吗？有迹象表明确实如此。许多国家现在都在开放医疗记录，但很少有国家做到瑞典那样开放。它的目标是到2020年让所有公民都能通过电子方式查阅医疗记录；超过三分之一的瑞典人建立了账户。研究表明，通过这样的途径，患者对自己的疾病有更多了解，也更能成功治疗。在美国和加拿大进行的试验，不仅仅让病人积极乐观，而且医疗成本也变低，因为临床医生不用解答那么多问题。这是自然而然的结果，谁会比自己更关心自己的健康呢。放手去相信自我治疗吧。

译者：李圆敏

编辑：翻吧君

来源：经济学人（2018.02.01）

阅读·经济学人

翻吧·与你一起学翻译

微信号：translationtips

长按识别二维码关注翻吧