呼喚醫療領域的優步

　　召喚醫療範疇的優步 Tech start-ups turning healthcare on its head

　　American investors love drama. So it is no surprisethat Theranos is causing a stir. Just two months agothis blood diagnostics company — created a decade ago by Stanford dropout Elizabeth Holmes— was an investor darling valued at $9bn. Now, however, it faces allegations that its testingtechniques were not as novel as claimed, and the company has become a lightning rod forwider investor concerns about the sky-high valuations now seen in Silicon Valley.

　　美國投資者愛好戲劇性。是以，Theranos引發紛擾其實不使人不測。就在兩個月前，這家血液診斷公司——10年前由斯坦福大學(Stanford)停學生伊麗莎白霍爾梅斯(Elizabeth Holmes)創立——還遭到投資者的青睞，估值高達90億美元。但是，現在該公司面對控告：其檢測技巧其實不像該公司宣稱的那樣新鮮，同時該公司成為了投資者對現在矽谷天價估值的更普遍擔心的典範工具。

　　But investors should not let the Theranos furore distract them from the bigger issue:something new is developing in medical diagnostics. Dozens of other start-ups are emerging indifferent medical niches (Sage Bionetworks, We Are Curious and Patients Like Me are just afew). They could change how US healthcare is done, just as Uber has transformed our idea ofwhat a “taxi” is.

　　但投資者不該由於環繞Theranos的喧嘩而疏忽了更大的題目：醫學診斷範疇正在醞釀新趨向。數十家其他始創企業正在各類醫學裂縫範疇出現(Sage Bionetworks、We Are Curious和Patients Like Me等等)。它們大概轉變美國醫療辦事的供給方法，就像優步(Uber)完全轉變了咱們對“出租車”的意見同樣。

　　At issue is the question of who controls medical data. In decades past, it was considered ahallmark of American culture that rugged individuals — that is, consumers — liked to exercisetheir rights. But in one area, health, they have appeared willing to let doctors control theirrecords and keep them private.

　　題目在於由誰掌握醫學數據。曩昔幾十年，這被視為美國文化的特點：頑強的小我(即花費者)願望利用本身的權力。但在康健範疇，他們仿佛樂意讓大夫掌握本身的病歷而且掩護隱私。

　　Three factors look likely to change this. First, the cost of medical diagnostics has tumbleddramatically, making it more accessible for individuals, and enabling them to circumventdoctors and traditional healthcare companies. Not only are start-ups such as Theranoscarrying out blood tests at a fraction of the earlier cost; it is startling that DNA sequencingnow costs about $1,000 per genome; in 2007 and 2001 the costs were $10m and $100mrespectively.

　　有3個身分看上去大概會轉變這類格式。起首，醫學診斷本錢大幅下滑，這令小我有更多機遇舉行醫學檢測，繞過大夫和傳統的醫療機構。Theranos等始創企業的血液檢測收費大大低於先前的價錢;DNA測序如今的價錢為每一個基因組1000美元，這使人震動;2007年和2001年的價錢分離為1000萬美元和1億美元。

　　Second, consumers have grown increasingly comfortable with the idea of managing their healthin cyber space. According to the Pew Research Center, more than a third of consumers alreadycheck health matters online. And the spread of fitness gadgets such as Fitbit and Jawbonehas helped reinforce this change, showing consumers what can be done with theirsmartphones alone.

　　其次，花費者對付在網上治理本身的康健愈來愈安閑。依據皮尤研討中間(Pew Research Center)的數據，逾三分之一的花費者已在網上檢察康健事件。Fitbit和Jawbone等康健裝備的遍及也贊助加快了這類變更，它們向花費者展現了智妙手性能做甚麽。

　　Third, consumer attitudes to the privacy of digital data more broadly may be changing. Untilrecently, it was assumed by the healthcare establishment that patients would resist puttingtoo much data online or sharing it too widely. But it is already clear consumers are lessconcerned about privacy than some activists might have hoped. Randall Stephenson, chiefexecutive of US telecoms group AT&T, says his consumers will drop privacy restrictionson use of their mobile phone data (with marketing companies, say) in exchange for a $20monthly discount on their bills. Medical diagnostic companies are betting consumers will bewilling to share their healthcare data, too, if they get something “back” — be it cheaperservices or the hope that the data are used to improve medical research.

　　第三，更普遍地說，花費者對付數字化數據隱私的立場大概在產生變更。直到不久曩昔，體系體例內的醫療機構以為，患者不肯將太多半據放到網上，大概讓太多的人分享。但今朝已很顯著，花費者對付隱私的擔心不及一些維權人士大概願望到達的水平。美國電信團體AT&T首席履行官蘭德爾斯蒂芬森(RandallStephenson)表現，花費者為了調換每個月20美元的賬單扣頭，樂意廢棄其挪動電話應用數據的隱私限定(比方給營銷公司)。醫學診斷公司正在押註：假如花費者得到某些“回報”(不管是辦事費下降，照樣願望數據被用於改良醫學研討)，他們也樂意分享本身的醫療數據。

　　If this bet is correct, it has fascinating implications. For one, if consumers — not doctors —control data, the medical industry might have to turn its model upside down. Instead of beingarranged according to how doctors are trained (making sharp distinctions between, say,surgeons and physicians), services may be shaped by the way consumers define their ownhealth, typically focusing on specific ailments and body parts.

　　假如這類賭註押對了的話，它將帶來一些令人著迷的影響。起首，假如花費者(而非大夫)掌握數據，醫療行業大概不能不推翻其模式。醫學辦事大概不會再依照大夫的專業來支配(比方明白分為外科大夫和內科大夫)，而是依據花費者界說本身康健的方法分類，通常為存眷詳細的疾病和身材部位。

　　More important still, if consumers allow their information to be placed (partly anonymously) oncentral databases, this might enable US medical researchers to take a commonsense step thathas eluded them: to create population-wide databases for research purposes. These alreadyexist in places such as Iceland. But in America medical data are fragmented, in part because ofprivacy concerns but also because powerful commercial interests have preventedcollaboration. If the trend towards consumer-controlled diagnostics accelerates, however,the dynamic could change; so much so that Brian Druker, director of the Oregon Health andScience University thinks that by 2020 America will have its first unified databank of cancerrecords.

　　更加主要的是，假如花費者許可本身的信息被(部門匿名地)寄存在中心數據庫，這大概讓美國醫學研討者邁出此前一向做不到的知識措施：出於研討目標樹立全員生齒數據庫。此類數據庫已在冰島等國湧現。但在美國，醫學數據位於分裂狀況，部門緣故原由是隱私擔心，另有一個緣故原由是壯大的貿易好處攔阻了互助。但是，假如醫學診斷朝著花費者掌握的趨向成長，情形大概會產生轉變;俄勒岡康健與科學大學(Oregon Health andScience University)主管布賴恩義魯克(Brian Druker)乃至以為，到2020年，美國將樹立其首個同一的癌癥病歷數據庫。

　　There are big obstacles to this. One is that not all states allow consumers access to, let alonecontrol of, their data. Another is that consumer trust in digital healthcare data will stay highonly if the networks are guarded against cyber attacks; that is a big if, given recent high-profilehacks. Then there is the problem plaguing Theranos — namely that many consumers do notknow how to validate the quality of their “diagnostics”.

　　這方面仍存在偉大停滯。起首，並不是全部州都許可花費者獲得(更別提掌握了)他們的數據。第二，只有在收集可以或許抵抗收集進擊的情形下，花費者才會堅持對數字化醫療數據的高度信賴;鑒於比來產生的惹人註目標黑客事宜，這裏存在一個很大的問號。另有便是困擾Theranos的題目：許多花費者其實不曉得若何驗證“診斷”的質量。

　　But history shows that when American consumers are given a sense of agency — and a chanceto act with their wallets — disintermediation can sometimes happen surprisingly fast. Just lookat Uber. Whatever happens next with Ms Holmes, the real story behind the Theranos story isstill an early stage.

　　但汗青註解，當美國花費者發生主體感(sense of agency)——和用本身的錢包采用行為的機遇——時，去中介化(disintermediation)湧現的速率偶然大概快得出奇。只需看看優步就曉得啦。無論接下來霍爾梅斯會如何，Theranos題材暗地裏的真正故事只是方才開端。