呼喚醫療領域的優步 Tech start ups turning healthcare on its head

American investors love drama. So it is no surprise that Theranos is causing a stir. Just two months ago this 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 testing techniques were not as novel as claimed, and the company has become a lightning rod for wider investor concerns about the sky-high valuations now seen in Silicon Valley.

美國投資者喜歡戲劇性。因此，Theranos引起騷動並不令人意外。就在兩個月前，這家血液診斷公司——10年前由斯坦福大學(Stanford)輟學生伊麗莎白霍爾梅斯(Elizabeth Holmes)創建——還受到投資者的青睞，估值高達90億美元。然而，如今該公司面臨指控：其檢測技術並不像該公司聲稱的那樣新穎，同時該公司成了投資者對如今硅谷天價估值的更廣泛擔憂的典型對象。

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 in different medical niches (Sage Bionetworks, We Are Curious and Patients Like Me are just a few). They could change how US healthcare is done, just as Uber has transformed our idea of what a “taxi” is.

但投資者不應因爲圍繞Theranos的喧囂而忽視了更大的問題：醫學診斷領域正在醞釀新趨勢。數十家其他初創企業正在各種醫學縫隙領域涌現（Sage Bionetworks、We Are Curious和Patients Like Me等等）。它們可能改變美國醫療服務的提供方式，就像優步(Uber)徹底改變了我們對“出租車”的看法一樣。

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

問題在於由誰控制醫學數據。過去幾十年，這被視爲美國文化的特徵：堅強的個人（即消費者）希望行使自己的權利。但在健康領域，他們似乎願意讓醫生控制自己的病歷並且保護隱私。

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

有3個因素看上去可能會改變這種格局。首先，醫學診斷成本大幅下滑，這令個人有更多機會進行醫學檢測，繞過醫生和傳統的醫療機構。Theranos等初創企業的血液檢測收費大大低於先前的價格；DNA測序現在的價格爲每個基因組1000美元，這令人震驚；2007年和2001年的價格分別爲1000萬美元和1億美元。

Second, consumers have grown increasingly comfortable with the idea of managing their health in cyber space. According to the Pew Research Center, more than a third of consumers already check health matters online. And the spread of Fitness gadgets such as Fitbit and Jawbone has helped reinforce this change, showing consumers what can be done with their smartphones alone.

其次，消費者對於在網上管理自己的健康越來越自在。根據皮尤研究中心(Pew Research Center)的數據，逾三分之一的消費者已在網上查看健康事宜。Fitbit和Jawbone等健康設備的普及也幫助加速了這種變化，它們向消費者展示了智能手機能做什麼。

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

第三，更廣泛地說，消費者對於數字化數據隱私的態度可能在發生變化。直到不久以前，體制內的醫療機構認爲，患者不願將太多數據放到網上，或者讓太多的人分享。但目前已經很明顯，消費者對於隱私的擔憂不及一些維權人士可能希望達到的程度。美國電信集團AT&T首席執行官蘭德爾斯蒂芬森(Randall Stephenson)表示，消費者爲了換取每月20美元的賬單折扣，願意放棄其移動手機使用數據的隱私限制（例如給營銷公司）。醫學診斷公司正在押注：如果消費者獲得某些“回報”（無論是服務費降低，還是希望數據被用於改進醫學研究），他們也願意分享自己的醫療數據。

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 being arranged according to how doctors are trained (making sharp distinctions between, say, surgeons and physicians), services may be shaped by the way consumers define their own health, typically focusing on specific ailments and body parts.

如果這種賭注押對了的話，它將帶來一些引人入勝的影響。首先，如果消費者（而非醫生）控制數據，醫療行業可能不得不顛覆其模式。醫學服務可能不會再按照醫生的專業來安排（例如明確分爲外科醫生和內科醫生），而是根據消費者定義自己健康的方式分類，一般是關注具體的疾病和身體部位。

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

更爲重要的是，如果消費者允許自己的信息被（部分匿名地）存放在中央數據庫，這可能讓美國醫學研究者邁出此前一直做不到的常識步伐：出於研究目的建立全員人口數據庫。此類數據庫已在冰島等國出現。但在美國，醫學數據處於割裂狀態，部分原因是隱私擔憂，還有一個原因是強大的商業利益阻礙了合作。然而，如果醫學診斷朝着消費者控制的趨勢發展，情況可能會發生改變；俄勒岡健康與科學大學(Oregon Health and Science University)主管布賴恩德魯克(Brian Druker)甚至認爲，到2020年，美國將建立其首個統一的癌症病歷數據庫。

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

這方面仍存在巨大障礙。首先，並非所有州都允許消費者獲取（更別提控制了）他們的數據。第二，只有在網絡能夠抵禦網絡攻擊的情況下，消費者纔會保持對數字化醫療數據的高度信任；鑑於最近發生的引人注目的黑客事件，這裏存在一個很大的問號。還有就是困擾Theranos的問題：很多消費者並不知道如何驗證“診斷”的質量。

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

但歷史表明，當美國消費者產生主體感(sense of agency)——以及用自己的錢包採取行動的機會——時，去中介化(disintermediation)出現的速度有時可能快得出奇。只需看看優步就知道啦。不管接下來霍爾梅斯會怎樣，Theranos題材背後的真正故事只是剛剛開始。