180203-Leaders-Doctor You你就是醫生

03-06

Doctor You 你就是醫生

A Digital revolution in health care is coming. Welcome it.一場醫療領域的數字革命正在拉開帷幕，做好準備迎接吧！

No wonder they are called"patients". When people enter the health-care system 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.

prod/prɑd/刺，戳，扎針
baffling/b?fl/讓人疑惑的
jargon/d?ɑrɡ?n/術語
stoicism/?sto??s?z?m/斯葛多哲學派，主要觀點認為理性決定世界的發展變化，人要接受自己在社會中的地位，恬淡寡慾，這樣才能幸福。斯多葛學派與懷疑主義、犬儒主義、伊壁鳩魯學派並稱為希臘化時期四大哲學流派。
boiling over boil-燒水，over-顛覆，少干，frunstration沮喪，沮喪已經燒乾-忍無可忍

難怪「病人」也有「耐心」的含義。今天，當發達國家的病人走進醫療系統之後，很清楚接下來會發生什麼：扎針的大夫，無休止的測試，讓人迷惑的術語，高漲的費用，尤其是漫長的等待。這種情況下多少是需要等待的，因為醫療本身就是一項複雜而細緻的工作。但人們已經對此忍無可忍。

This week three of the biggest names in American business--Amazon, Berkshire Hathaway and JPMorgan Chase--anounced a new venture to provide better, cheaper health care for their employees. A fundamental problem with todays system is that patients lack knowledge and control. Access to data can bestow both.（2）

Berkshire Hathaway伯克希爾·哈撒韋公司，巴菲特執掌的一家位於美國的多元化保險和投資公司。2017年世界500強排名第8位
JPMorgan Chase摩根大通，美國的一家銀行
bestow/b?sto/授予，放置

本周，美國三家大公司--亞馬遜、伯克希爾·哈撒韋和摩根大通，宣布一項為其員工提供服務更好、價格更低醫療服務的投資。現行系統的一個基本問題在於患者缺少醫療知識和掌控。引入數據可以解決這兩個點。

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 treatments and also to provide data to help train medical algorithms. You can enhance your own care and everyone elses, too.

genome/d?inom/基因組，染色體
gut/ɡ?t/膽量，本質的，內臟，簡單的
enhance/?nh?ns/提高，加強

互聯網使得病人可以在網上諮詢何時以及何地就醫的問題。你可以通過非處方檢測來分析血液，基因組測序以及檢查腸道里的細菌。但根本上的改變需要把重心從醫療提供方轉換到患者，以及從醫生轉換到數據。這樣的轉變正在發生。比如智能手機類的技術讓人們可以檢測自己的健康。如果你能夠填補其中確實的關鍵部分--接入自己的病例並把信息分享給你信任的人--那麼技術監控健康的可能性還會成倍增加。這不僅可以避免自我治療效率不足的問題，還可以用提供的數據來訓練醫療演算法。你可以改善自己和其他所有人的醫療狀況。

The doctor will be you now現在的醫生就是你

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 Parkinsons 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 phones touchcreen might signal the onset of cognitive problems.

strap/str?p/皮帶，捆綁，抽打
arrhythmia/?r?θm??/心律不齊
vying/va???/競賽的，爭相的
molecular/m?l?kj?l?/分子的
biomarkers /ba?o,mɑrk?/生物標記
onset/ɑns?t/開始，襲擊

表面上看，醫療數據好像不足以掀起一場革命。但是信息流卻可以在這幾個方面做出改變。一可以使診斷更精確。擔心心臟有問題的患者可以購買內置醫療等級監控儀器的腕帶來檢測心律不齊。用於診斷從皮膚癌、腦震蕩到帕金森等各類疾病的手機應用層出不窮。判斷能否把汗液作為分子生物標記，而不需要血液檢測的研究正在進行當中。有人認為，根據一個人滑動手機觸摸屏速度變化，可以判斷他是否有認知問題。

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.

glucose/ɡlukos/葡萄糖
gangrene/ɡ??ɡrin/ 壞疽
Akili Interactive醫療領域創業公司
hyperactivity/?ha?p?r?kt?v?ti/多動症

二可以用於複雜疾病的管理。糖尿病類應用可以改變患者應對疾病的方式，通過檢測血液中葡萄糖水平和攝入食物，來降低諸如失明和壞疽的長期危害。創業公司Akili Interactive研發的一款視頻遊戲正計劃獲得監管批准，它能刺激與「注意力缺乏多動症」相關的一個大腦區域。

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 dalays 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 fingers, 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.

silo穀倉，儲藏室
attributable/?tr?bj?t?bl/可歸於...的
lay out安排，展示

患者也可以改善自己的醫療效率。儘管病例正在不斷向電子化發展，但大多被束之高閣。病例中的很多數據機器根本無法讀取，導致治療延誤或更糟糕的結果。美國每年由於醫療事故的25k死亡人群中，有很多是由於協同不到位導致的。觸手可及的數據，引發分享的通用標準以及遵守流程的強烈意願，可以讓患者更容易地進行診斷。1月24號，蘋果公司宣布一項計劃，旨在呼籲組織機構讓患者使用智能手機下載病例。

A final benefit of putting patients in charge stems from the generation and aggregation of their data. Artificial intelligence is already being trained by a unit of Alphabet, Googles 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 if 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.

stems/st?m/軀幹，遏制
stem from 起源於
cancerous/k?ns?r?s/癌症的
retinal/r?t?n?l/視網膜的
cardiac/kɑrd??k/心臟病的

數據生成及整合使得患者可以掌控主動，這也帶來最後一個好處。谷歌的母公司Alphabet，已經著手研究通過人工智慧來診斷癌症組織和視網膜損害。隨著患者的數據流接入智能手機和「可穿戴設備」，這些會使得AI的用途更加廣泛。比如，未來AI可以從你癥狀的描述當中自動提供醫療診斷，識別抑鬱跡象或診斷你是否有心臟病危險。信息整合讓你很容易跟病友溝通，了解他們對各種治療方法的反應。

An Apple a day一天一個蘋果

As with all 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 may 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.

pitfalls/p?t,f?l/陷阱，誘惑
Hucksters/h?kst?/還價，自吹自擂的商販
pored over仔細閱讀，注視

技術帶來的不僅有希望，還有風險。無良公司會藉機上線無法使用的應用。但隨著對醫療應用監管的加強，用戶可能最多多花些醫藥費。也不是每個人都像主動監管自己的健康，希望讓專業人士處理的人大有人在。這不是問題。感興趣的人可以仔細研究醫療數據，不感興趣的人可以自動把信息分享給信任的供應商。

The benefits of new technologies often flow disproportionately to the rich. Those who 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.

mitigated/m?t?ɡet/緩和，減輕
insurer/?n??r?/承保人、保險公司
trawl/tr?l/脫網，排鉤【GRE】to search through a lot of documents, lists etc in order to find out information，可以理解為篩選

很多時候，富有階層總是能夠更多地收到新技術帶來的好處。富人，僱員、政府和保險公司會投資給低成本、惠及所有人的項目，這樣一來，對新技術有所擔憂的富人也可以略感寬慰。比如Alphabet公司最近成立了一家叫做Cityblock Health的公司，旨在通過篩選病人病例，從而達到給城市低收入人群提供更完善醫療的目的。對於這類人來說，很多人是由針對美國貧窮群體的保險公司Medicaitd來投保的。

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 unwell to find cover. Regulations can slow that proceess--by requiring insurers to ingore genetic data, for example--but not stop it. Securithy is another worry. The more patient data are analysed in the cloud or shared with different firms, the greater the potential threat if 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.

hale and hearty指身體健康，精神飽滿的老人
stringent/str?nd??nt/ 嚴格的
slapdash/sl?pd??/馬虎的，草率的，a.&ad.:Children ~ed their homework.孩子們馬馬虎虎地完成了作業。
take out （陸谷孫p2065）根據上下文能夠推測出是「投保」的意思，但是翻譯不能光憑感覺，要有依據才行。於是在陸老的字典里，查【take】條目，終於在看過幾十個釋義後，在頁面的底部找到了對應的釋義和例句：（通過申請）取得；（辦理）保險手續：Alex has taken out life insurance. 亞歷克斯已經辦好了人壽險。這跟本文的語境完全對應，這次這個意思算是完全記住，忘不了了。
unwell well有「身體好」、「健康」的含義，前面加上un否定前綴，表示的是「不健康」，也就是「病人」的意思。這裡的用法比較普遍。比如電影《生化危機》系列中，「喪屍」的英文就不是用的遊戲《Plants & Zombies》中的「Zombie"，而是用的「undead」，「不死之身」：下圖下部圈出部分↓↓↓

其他的風險就很難應對了。更加便捷地獲取醫療數據可能會使健康的老人降低投保意願，甚至患者也會受到影響。監管可能延緩進程，比如限制保險公司接觸基因數據，但並不會徹底遏制影響。安全性是另個一隱憂。上傳到雲端或者分享給其他公司的病例數據越多，遭到黑客襲擊或濫用的潛在風險就越大。在美國，醫療領域佔總數據泄露的比例接近25%。醫療公司如果對安全問題敷衍了事，將面臨嚴厲指控。但如果因此認為可以避免數據泄露就天真了。

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 Canada have produced not just happier patients but lower costs, as clinicians fielded fewer inquires. That should be no surprise. No one has a greater interest in your health than you do. Trust in Doctor You.

outweigh/a?twe/比...更有價值
fielded/fild/領域，這裡面應該是n.活用成了V.,因為在LDCE、陸谷孫和歐路詞典都沒有查到對應的動詞解釋，暫且當做「某個領域相關的問題」解釋
clinicians/kl?n???n/臨床醫生

擴大數據的使用範圍是否值得冒這些風險呢？事實表示是值得的。很多國家現在正在開放病歷，但沒有幾個國家可以在這方面跟瑞典相提並論。瑞典的目標是截止到2020年，讓所有公民接入到電子病歷；目前有超過1/3的瑞典人已經開立了賬戶。研究表明，接入電子病歷的患者更容易了解自己的病情。加拿大的患者承受的痛苦更輕，費用更低，臨床醫生面臨的巡診也更少。這很好理解。沒有人比你對自己的健康更感興趣。相信你作為醫生的本領吧。