Health Care: Things Are Looking App
醫(yī)療保健：應用越來越有用
Mobile health apps are becoming more capable and potentially rather useful
移動健康應用功能日漸強大，而且可能相當有用
Savile Row in London is best known for producing some of the world’s finest bespoke suits. But tucked away in a quiet corner of the same street is a firm that gives tailored health advice through a smartphone app. Your.MD uses artificial intelligence to understand natural-language statements such as “I have a headache” and ask pertinent follow-up questions. The app typifies a new approach to mobile health (also known as m-health): it is intelligent, personalised and gets cleverer as it gleans data from its users.
倫敦薩維爾街(Savile Row)最出名的便是制作世界上最好的定制西服。但就在這同一條街道的一處安靜街角，隱匿著一家通過智能手機應用為用戶提供有針對性健康建議的公司。這款應用就是Your.MD，它利用人工智能來理解諸如“我頭疼”等自然語句，并詢問相關的后續(xù)問題。該應用代表了移動健康(又稱為m-health)的新方式：它智能化、個性化，并在收集用戶數(shù)據(jù)過程中變得越來越聰明。
There are now around 165,000 health-related apps which run on one or other of the two main smartphone operating systems, Apple’s IOS and Google’s Android. PwC, a consulting firm, forecasts that by 2017 such apps will have been downloaded 1.7 billion times. However, the app economy is highly fragmented. Many providers are still small, and most apps are rarely, if ever, used.
如今在蘋果的iOS和谷歌的安卓這兩個主要的智能手機操作系統(tǒng)上運行的健康相關應用約有16.5萬個。咨詢公司普華永道(PwC)預測，到2017年，這類應用的下載次數(shù)將達到17億次。當然，應用經(jīng)濟高度分散。許多供應商依然很小，而且，大多數(shù)應用只有很少人使用，甚至沒有人使用。
That said, the successful ones are highly popular. As apps and wearables become increasingly capable and useful, and smartphones continue their march of dominance, m-health has a promising future. BCC Research, which studies technology-based markets, forecasts that global revenues for m-health will reach $21.5 billion in 2018, with Europe the largest m-health market.
盡管如此，成功的應用還是受到熱捧。隨著應用和可穿戴設備的功能越來越強、用處越來越大，以及智能手機繼續(xù)雄霸天下，移動健康的發(fā)展前景一片光明。BCC研究(BCC Research)專注于基于技術的市場的分析，它預測，全球移動健康的收入將在2018年達到215億美元，而歐洲將成為最大市場。
So far, most smartphone health apps fall squarely into the category of “wellness”. Along with portable sensors such as the Fitbit wristband, such apps help people to manage and monitor their exercise, diet and stress levels. Other types of app, such as WebMD and iTriage, repackage medical information already found online, and offer information about symptoms and treatments. Some, such as ZocDoc, let users book consultations with doctors.
到目前為止，大多數(shù)智能手機的健康應用都屬于“健康”范疇。與Fitbit手環(huán)等便攜式傳感器一道，這些應用幫助人們管理和監(jiān)控自己的鍛煉、飲食與壓力水平。諸如WebMD和iTriage等其他類型的應用把已經(jīng)找到的在線醫(yī)療信息重新打包，并提供有關癥狀和治療的信息。一些應用，如ZocDoc，讓用戶預約醫(yī)生就診。
However, m-health increasingly promises to do more of the heavy lifting in medicine. First, there is a growing range of apps through which users can talk directly to doctors and therapists. These include Teladoc, Doctor On Demand, Health Tap and Pingmd. Since late 2014 Walgreens, an American pharmacy chain, has been offering an app called MDLive, which provides 24-hour access to a doctor for $49 a consultation. Patients will soon be able to chat with artificial-intelligence health advisers rather like Your.MD, but through messaging apps. Second, and with potentially more far-reaching effects on the quality of care, there is an emerging breed of apps that monitor and diagnose patients with a variety of ailments, in some cases predicting and thus helping to avert health crises.
然而，移動健康越來越有望擔負更多的醫(yī)學重任。首先，用戶用以同醫(yī)生和治療師直接溝通的應用不斷增多。這些應用包括Teladoc、Doctor On Demand、Health Tap和Pingmd。自2014年底以來，美國連鎖藥店沃爾格林(Walgreens)提供了一款名為MDLive的應用，花費49美元即可在任何時間找醫(yī)生診斷一次。很快，患者便可通過即時通訊應用與人工智能健康顧問聊天，就像Your.MD一樣。其次，目前有一類新興的應用，可以對有多種疾病的患者進行監(jiān)測和診斷，在一些情況下，還能預測病情從而幫助避免突發(fā)急癥。這些發(fā)展對護理質(zhì)量有更深遠的潛在影響。
Cerora, a firm from Bethlehem, Pennsylvania, has created a headset, with an associated smartphone app, which monitors brain health. The headset measures brainwaves and tracks eye movement; the app uses the smartphone’s internal sensors to test patients’ balance and reaction times. Cerora plans to launch the product this year, subject to review by America’s Food and Drug Administration (FDA); it could help diagnose concussion and other neurodegenerative diseases. Cellscope, of San Francisco, offers a smartphone attachment that lets parents see inside a child’s ear, take photos or video, and send them to a doctor.
美國賓夕法尼亞州伯利恒市(Bethlehem)的Cerora公司發(fā)明了一款用來監(jiān)控大腦健康的耳機以及相關的智能手機應用。這款耳機測量腦電波并跟蹤眼球運動;其應用則利用智能手機內(nèi)部的傳感器來測試患者的平衡和反應時間。Cerora公司計劃今年推出這款產(chǎn)品，前提是通過美國食品藥品管理局(FDA)的審查。它可以幫助診斷腦震蕩和其他神經(jīng)退行性疾病。舊金山的CellScope公司提供了一款智能手機配件，讓父母能夠看到孩子的耳朵內(nèi)部，拍攝照片或視頻，并把它們發(fā)給醫(yī)生。
A small number of patients, mostly the chronically sick, are disproportionately costly in any health-care system. M-health offers a continuous, long-term means of monitoring them, with the potential to improve the way conditions such as cardiovascular disease, epilepsy, asthma and diabetes are managed.
在每一個醫(yī)療保健系統(tǒng)中，總有一小部分患者，大多是慢性病患者，其治療費用遠高于其他病患。移動健康為他們提供了一種連續(xù)而長期的監(jiān)控手段，并有可能改善心血管疾病、癲癇、哮喘和糖尿病等病癥的治療。
Patients with diabetes constantly have to make decisions on medication, food and activity, says Hooman Hakami of Medtronic Diabetes, a maker of medical devices; and most will go for months between doctor’s appointments. Medtronic, allied with IBM’s Watson, an artificial-intelligence system, is creating an app to predict, three hours in advance, when a patient will experience high or low blood-sugar levels. It will gather data from Medtronic’s insulin pumps and glucose monitors, worn by the patient, and combine these with information on the user’s diet, and data from activity trackers. Among other providers of diabetes-related m-health services is Diabetes+Me, whose app is already showing that it can improve patient outcomes while reducing costs. Novartis, a Swiss drugs giant, is set to test a glucose-monitoring contact lens, developed by Google.
醫(yī)療器械制造商美敦力糖尿病部門(Medtronic Diabetes)的胡曼·哈卡米(Hooman Hakami)表示，糖尿病患者經(jīng)常要決定如何使用藥物、選擇飲食和進行活動;而且，大多數(shù)患者要好幾個月才找醫(yī)生診斷一次。美敦力聯(lián)合IBM的人工智能系統(tǒng)沃森(Watson)，正在設計一款應用，在病人出現(xiàn)高血糖或低血糖水平之前3小時做出預測。這款應用通過穿戴在患者身上的美敦力胰島素泵和血糖監(jiān)測儀收集數(shù)據(jù)，并把這些數(shù)據(jù)與用戶的飲食信息及活動跟蹤器的數(shù)據(jù)相結合。其他與糖尿病相關的移動健康服務提供者還有Diabetes+Me，其應用已經(jīng)證實能夠改善患者的治療效果并降低成本。瑞士制藥巨頭諾華(Novartis)正準備測試一種由谷歌開發(fā)的監(jiān)測葡萄糖的隱形眼鏡。
Apps on prescription
處方上的應用
Constant, wireless-linked monitoring may spare patients much suffering, by spotting incipient signs of their condition deteriorating. It may also spare health providers and insurers many expensive hospital admissions. When Britain’s National Health Service tested the cost-effectiveness of remote support for patients with chronic obstructive pulmonary disease, it found that an electronic tablet paired with sensors measuring vital signs could result in better care and enormous savings, by enabling early intervention. Some m-health products may prove so effective that doctors begin to provide them on prescription.
通過發(fā)現(xiàn)患者病情惡化的初期跡象，經(jīng)由無線連接的持續(xù)監(jiān)測也許會為患者避免許多痛苦。它也可能為醫(yī)療機構和保險公司免除多項高昂的住院費用。在考核對慢性阻塞性肺疾病患者遠程支持的成本效益時，英國國民健康服務體系(National Health Service)發(fā)現(xiàn)，通過早期干預，一種與測量生命體征的傳感器配對的電子片劑可能會帶來更好的護理并極大地節(jié)省費用。一些移動健康產(chǎn)品可能證明非常有效，因而醫(yī)生們開始把它們寫進處方。
So far, big drugmakers have been slow to join the m-health revolution, though there are some exceptions. HemMobile by Pfizer, and Beat Bleeds by Baxter, help patients to manage haemophilia. Bayer, the maker of Clarityn, an antihistamine drug, has a popular pollen-forecasting app. GSK, a drug firm with various asthma treatments, offers sufferers the MyAsthma app, to help them manage their condition.
到目前為止，大型制藥公司加入移動健康革命的步調(diào)緩慢，但也有一些例外。輝瑞(Pfizer)的HemMobile和百特(Baxter)的Beat Bleeds幫助患者應對血友病。生產(chǎn)抗組胺藥氯羥他定(Clarityn)的拜耳(Bayer)有一款花粉預報應用頗受歡迎。有多種哮喘藥物的制藥企業(yè)葛蘭素史克(GSK)向患者提供一款名為MyAsthma的應用，幫助他們控制自己的病情。
GSK, along with Propeller Health, is developing custom sensors for GSK’s Ellipta asthma inhaler, so that the pharma company can gather information on how patients use it. GSK wants to know how well patients comply with instructions on when to take it, and to see how compliance relates to the safety, efficacy and economic benefits of the drug.
葛蘭素史克正與Propeller Health公司聯(lián)手，為前者的Ellipta哮喘吸入器研發(fā)定制的傳感器，以便收集患者如何使用該產(chǎn)品的信息。葛蘭素史克想知道患者是否遵照說明書規(guī)定的時間用藥，以及這樣做與藥物的安全性、療效和經(jīng)濟效益之間存在何種關聯(lián)。
All pharmaceutical companies are under pressure from regulators and health insurers to do more to demonstrate the value of their medications, and m-health may be a big help with this. Clinical trials of a proposed new drug will be able to use apps to measure disease progression more accurately, and thus demonstrate the efficacy of the treatment. After a drug is approved and perhaps many thousands of patients are taking it, the use of apps to monitor their condition will constitute a huge trial of the product’s long-term benefits. However, it could spell disaster for drug firms if such post-approval testing shows that their medicines do not in practice deliver the expected benefits, or shows up undesirable side-effects.
所有的制藥企業(yè)都受到來自監(jiān)管機構和健康保險公司的壓力，需要更加努力地證明其藥物的價值，移動健康可能對此有很大幫助。在對提交審批的新藥進行臨床試驗時，這些應用將派上用場，更準確地測量病情的發(fā)展，從而證明治療的功效。在藥物獲批并且有或許成千上萬的患者服用后，使用應用來監(jiān)控他們的情況，這將對產(chǎn)品的長期功效構成重大檢驗。當然，如果這種審批后的測試表明其藥物實際上沒有達到預期效果或表現(xiàn)出不良的副作用，就可能為制藥企業(yè)招致災難。
As m-health apps take on more serious work, they will require more serious regulation. Inaccuracy is fairly harmless in a pedometer but less so in a heart-rate monitor. In August a popular product, Instant Blood Pressure, was removed from the Apple app store after serious concerns were raised over its accuracy. In 2011 a developer who claimed his AcneApp could treat pimples with light from an iPhone screen was fined.
隨著移動健康應用擔任更重要的工作，它們將需要更加嚴格的監(jiān)管。不準確對于計步器而言無傷大雅，但對于心率監(jiān)測儀來說則是另一回事。去年8月，一款流行產(chǎn)品“即時血壓”(Instant Blood Pressure)的準確性受到嚴重關切，它隨之被蘋果應用商店下架。2011年，一位開發(fā)者聲稱其AcneApp應用能借iPhone屏幕的光線來治療青春痘，結果被罰款。
Last year the FDA finished drawing up its regulatory regime for m-health, indicating that it will calibrate its approach, paying little attention to low-risk apps, such as ones that just promote a healthy lifestyle; and scrutinising those in areas where any misinformation could be dangerous. This sensible approach may be followed by regulators in other countries.
去年，F(xiàn)DA完成了移動健康方面監(jiān)管體系的制定工作，這表明它將調(diào)整方法，較少關注低風險的應用，例如那些僅僅提倡健康生活方式的應用;而仔細審查那些任何錯誤信息都可能造成危險的應用。這種明智的做法可能會被其他國家的監(jiān)管機構所效仿。
But other regulatory questions are harder to answer. As health apps become more popular, concerns about how patients’ data are stored, used and shared will become more pointed. A new study in the Journal of the American Medical Association finds that many health apps may be sharing patients’ health data without their knowledge. Four-fifths of 211 diabetes apps it examined did not have privacy policies.
但是，其它的監(jiān)管問題則更難回答。隨著健康應用日益流行，對如何存儲、使用和分享患者數(shù)據(jù)的擔憂將變得愈加尖銳。《美國醫(yī)學會雜志》(Journal of the American Medical Association)的一項新研究發(fā)現(xiàn)，許多健康應用可能在患者不知情的情況下就分享了他們的健康數(shù)據(jù)。在它調(diào)查的211個糖尿病應用中，五分之四沒有隱私政策。
America’s rules on the storage and transmission of personal-health data have not been changed since the advent of the iPhone. So doctors and hospitals may be reluctant to embrace health apps until the rules are updated to make it clear they can do so without breaching the stringent standards on data security. And conscientious providers and prescribers of m-health apps risk being tarred by association with any data-misusing rogues that emerge.
自從iPhone問世以來，美國對于個人健康數(shù)據(jù)存儲和傳輸?shù)囊?guī)則就一直沒有改變過。因此，醫(yī)生和醫(yī)院可能不愿意接受健康應用，除非更新規(guī)則以明確他們可以這樣做而不違反數(shù)據(jù)安全方面的嚴格準則。認真負責的移動健康應用供應商和治療方(開處方者)可能會因為與濫用數(shù)據(jù)的流氓有關聯(lián)而遭受污名。
The fragmented, nascent m-health market seems likely to consolidate in time, with its most promising startups perhaps being bought by, or entering alliances with, trusted health brands. That would help it to realise its substantial potential to help patients, doctors, health insurers and researchers alike.
分散的而方興未艾的移動健康市場似乎遲早會被整合，最有前途的創(chuàng)業(yè)公司或許會被值得信賴的健康品牌所收購，或者與這些品牌組成聯(lián)盟。這將有助于它發(fā)揮巨大的潛力來幫助患者、醫(yī)生、醫(yī)療保險公司以及研究人員。
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