Health Care: The Wonder Drug

医疗保健：灵丹妙药

 

Digitising the health-care industry is a huge business opportunity

医疗保健行业的数字化是一大商机

 

When someone goes into cardiac arrest, survival depends on how quickly the heart can be restarted. Enter Amazon’s Echo, a voice-driven computer that answers to the name of Alexa, which can recite life-saving instructions about cardiopulmonary resuscitation, a skill taught to it by the American Heart Association. Alexa is accumulating other health-care skills, too, including acting as a companion for the elderly and answering questions about children’s illnesses. In the near future she will probably help doctors with grubby hands to take notes and to request scans, as well as remind patients to take their pills.

 

如果有人心脏骤停，他的生存几率取决于心跳恢复的速度。喊一声“Alexa”启动亚马逊的语音智能音箱Echo，她可以背诵出心肺复苏急救说明。这一急救技能是由美国心脏协会（ American Heart Association）教授的。Alexa还在积累其他保健技能，包括充当老年人的陪伴者，以及回答有关儿童疾病的问题。在不久的将来，她还可能会帮助在治疗时弄脏了手的医生记笔记和请求扫描，还能提醒病人按时服药。

 

Alexa is one manifestation of a drive to disrupt an industry that has so far largely failed to deliver on the potential of digital information. Health care is over-regulated and expensive to innovate in, and has a history of failing to implement ambitious IT projects. But the momentum towards a digital future is gathering pace. Investment into digital health care has soared.

 

Alexa是力图颠覆医疗行业的一大例证。该行业在很大程度上尚未充分发掘数字信息的潜力。医疗保健行业监管过度，创新成本高，而且一向未能成功实施宏伟的IT项目。不过，朝向数字化未来发展的势头正在加快，数字医疗保健领域的投资已经飙升。

 

One reason for that is the scale of potential cost-savings. Last year Americans spent an amount equivalent to about 18% of GDP on health care. That is an extreme, but other countries face rising cost pressures from health spending as populations age. Much of this expenditure is inefficient. Spending on administration varies sevenfold between rich countries. There are huge differences in the cost of medical procedures. In rich countries about one-fifth of spending on health care goes to waste, for example on wrong or unnecessary treatments. Eliminating a fraction of this sum is a huge opportunity.

 

出现这种变化的原因之一是数字化在节约成本方面的潜力。去年美国人在医疗保健上的花费大约相当于GDP的18%。这是个极端情况，但随着人口年龄增长，其他国家也都面临着医疗保健支出上涨的压力，而且大部分支出的使用效率都很低下。富裕国家在管理支出上相差很大，最高达七倍。医疗程序上的成本也存在巨大差异。在富裕国家，由于错误或不必要的治疗等原因，约五分之一的医疗保健支出都白白浪费了。减少一小部分的浪费就意味着巨大的机会。

 

Consumers seem readier to accept digital products than just a few years ago. The field includes mobile apps, telemedicine – health care provided using electronic communications – and predictive analytics (using statistical methods to sift data on outcomes for patients). Other areas are automated diagnoses and wearable sensors to measure things like blood pressure.

 

消费者似乎也比几年前更愿意接受数字医疗产品。该领域包括移动应用、利用电子通信手段提供的远程医疗保健，以及预测分析（使用统计方法为患者筛选结果数据）。其他应用领域包括自动诊断和用于测量血压等指标的可穿戴传感器。

 

If there is to be a health-care revolution, it will create winners and losers. Andy Richards, an investor in digital health, argues that three groups are fighting a war for control of the “health-care value chain”.

 

如果要来一场医疗保健革命，那么既会有赢家也会有输家。数字健康投资人安迪·理查兹（Andy Richards）认为，有三类企业正在为争夺“保健价值链”的掌控权而交战。

 

One group comprises “traditional innovators” – pharmaceutical firms, hospitals and medical-technology companies such as GE Healthcare, Siemens, Medtronic and Philips. A second category is made up of “incumbent players”, which include health insurers, pharmacy-benefit managers (which buy drugs in bulk), and as single-payer health-care systems such as Britain’s NHS. The third group are the technology “insurgents”, including Google, Apple, Amazon and a host of hungry entrepreneurs that are creating apps, predictive-diagnostics systems and new devices. These firms may well profit most handsomely from the shift to digital.

 

一类由“传统创新者”组成——制药公司、医院，以及医疗科技公司如GE医疗、西门子、美敦力和飞利浦。第二类由“现有玩家”组成，包括医疗保险公司、药品福利管理机构（批量采购药品）以及英国NHS等单一支付医保体系。第三类是科技“叛军”，包括谷歌、苹果、亚马逊和一大批野心勃勃的企业家。它们在不断地创造各类应用、预测诊断系统和新设备。在向数字化的转变中，这些企业很可能获利最多。

 

The threat to the traditional innovators is that as medical records are digitised and new kinds of patient data arrive from genomic sequencing, sensors and even from social media, insurers and governments can get much better insight into which treatments work. These buyers are increasingly demanding “value-based” reimbursement – meaning that if a drug or device doesn’t function well, it will not be bought.

 

传统创新者面临这样的威胁：由于医疗记录已经数字化，而基因组测序、传感器，甚至是社交媒体也给出了新型的患者数据，保险公司和政府因而能更好地了解哪些治疗方法是有效的。这些医疗保健产品的买家越来越多地要求“按价值”报销，即如果药物或设备的功效不佳，就不会再买了。

 

The big question is whether drug companies will be big losers, says Marc Sluijs, an adviser on investment in digital health. More data will not only identify those drugs that do not work. Digital health care will also give rise to new services that might involve taking no drugs at all.

 

数字健康投资顾问马克·斯卢易斯（Marc Sluijs）说，最大的问题在于制药公司是否会沦为大输家。更多的数据不仅可以帮助识别没有用的药，数字医疗保健还可能催生无需服用任何药物的新服务。

 

Diabetes is an obvious problem for the pharma business in this regard, says Dan Mahony, a partner at Polar Capital, an investment firm. Since evidence shows that exercise gives diabetics better control of their disease (and helps most pre-diabetics not to get sick at all), there is an opening for new services. UnitedHealthcare, a big American insurer, for example, has a prevention programme that connects pre-diabetics with special coaches at gyms.

 

投资公司Polar Capital的合伙人丹·马宏尼（Dan Mahony）说，就这一点而言，糖尿病便是制药企业所面临的一个显著的问题。证据表明，运动有助糖尿病患者更好地控制病情（还能帮助大多数前驱糖尿病人避免发病），新的服务因而出现，例如美国大型保险公司UnitedHealthcare就有一个预防项目，为前驱糖尿病患者与健身房里专门的教练牵线。

 

An app or a wearable device that persuades people to walk a certain distance every day would be far cheaper for insurers and governments to provide than years of visits to doctors, hospitals and drugs. Although Fitbits are frequently derided for ending up in the back of a drawer, people can be motivated to get off the sofa. Players of Pokémon Go have collectively walked nearly 9bn kilometres since the smartphone game was released last year.

 

相比连年看医生、跑医院和吃药的费用，那种鼓励人们每天行走一定距离的应用或可穿戴设备对于保险公司和政府来说要便宜得多。虽然经常有人嘲笑Fitbit运动手环最终都是被扔进抽屉，但这些程序或设备确实可以鼓励人们不再赖在沙发上。自去年智能手机游戏“精灵宝可梦Go”（Pokémon Go）发布以来，其玩家总共已经步行近90亿公里。

 

That is the backdrop to a new firm called Onduo, a joint venture that Google’s health-care venture, Verily Life Sciences, and Sanofi, a French drug firm, set up last year. Onduo will start by developing ways to help diabetics make better decisions about their use of drugs and their lifestyle habits. Later on, Onduo wants to help those who are at risk of diabetes not to develop it. The startup is a good hedge for Sanofi, which faces a slowdown in sales of its blockbuster insulin medication, Lantus, which lost patent protection in 2015.

 

这正是新公司Onduo成立的背景。这家合资公司由谷歌旗下医疗保健企业Verily 生命科学公司（Verily Life Sciences）和法国制药公司赛诺菲（Sanofi）于去年成立。Onduo首先将开发解决方案，帮助糖尿病患者在药物使用和生活习惯方面做出更好的决策。之后，Onduo想要帮助那些有糖尿病风险的人避免患病。这家创业公司为赛诺菲提供了很好的风险对冲，因为赛诺菲在2015年失去了热销胰岛素药来得时（Lantus）的专利保护，面临销售下滑。

 

This kind of thinking does not come easily to drug firms. Switzerland’s Novartis is one of the few to have acknowledged that digital innovation will mean selling products based on patient outcomes. But if pharma firms do not design solutions that put the patient, rather than drug sales, at the centre of their strategy, they risk losing relevance, says Mr Sluijs.

 

接受这种思维方式对制药公司来说并非易事，仅有瑞士诺华等少数公司认识到数字创新意味着产品销售将由疗效决定。然而，据斯卢易斯说，如果制药公司不设计解决方案来把患者而非药物销售放在战略中心，它们就可能变得不合时宜。

 

Large hospitals, some of which count as both incumbents and traditional innovators, will also be affected. The rise of telemedicine, predictive analytics and earlier diagnoses of illnesses are expected to reduce admissions, particularly of the emergency kind that are most lucrative in commercial systems. The sickest patients can be targeted by specialist services, such as Evolution Health, a firm in Texas that cares for 2m of the most-ill patients across 15 states. It claims to be able to reduce the use of emergency rooms by a fifth, and inpatient stays in hospitals by two-fifths.

 

大型医院（其中一些既算是现有玩家，也是传统创新者）也将受到影响。远程医疗、预测分析和疾病早期诊断的兴起预计将会减少就医人数，尤其是在私立医院中利润最大的急诊。重症患者可以成为专家服务的对象，例如得克萨斯州的Evolution Health公司为15个州的200万名重症患者提供服务。它声称能够将去急诊的次数减少五分之一，将住院人次减少五分之二。

 

Rapid medical and diagnostic innovation will disrupt all businesses that rely heavily on physical facilities and staff. A mobile ultrasound scanner made by Philips, called Lumify, means that a far larger number of patients can be seen by their own doctors. As for data-based diagnostics, one potential example of its power to change business models is Guardant Health, a startup that is analysing large quantities of medical data in order to develop a way of diagnosing cancer from blood tests. If the firm can devise an early test for breast cancer, demand for mammograms and the machines that take them would fall, along with the need for expensive drugs and spells in hospital.

 

医疗和诊断的快速创新将颠覆所有严重依赖实体医疗设施和员工的企业。飞利浦公司制造的移动超声波扫描仪Lumify让更多患者可以直接看家庭医生。基于数据的诊断将能改变商业模式，创业公司Guardant Health或许就是一个例子。该公司正在通过分析海量的医疗数据来开发一种通过验血诊断癌症的方法。如果公司能够开发出乳腺癌的早期检验方法，那么对乳房X光及X光机的需求将会下降，对昂贵药物和住院治疗的需求也会下降。

 

There is also good news for hospitals, however. Increasingly, machine-learning programs are able to make diagnoses from scans and from test results. An intriguing recent project has been to stream and analyse live health data and deliver alerts on an app that is carried around by doctors and nurses at the Royal Free Hospital in London. The app, which is the work of DeepMind, a British artificial-intelligence (AI) research firm owned by Google, identifies the patients at greatest risk of a sudden and fatal loss of kidney function. The Royal Free says that the app is already saving nurses’ time.

 

然而，对医院来说也有好消息。越来越多的机器学习程序能够根据扫描和检验结果做出诊断。最近在伦敦皇家自由医院（Royal Free Hospital）有一个有趣的项目：在一款应用上上传并分析实时健康数据，必要时向随身携带此应用的医生和护士发出警报。该应用由谷歌在英国的人工智能研究公司DeepMind开发，可识别哪些患者最有可能突然发生致命的急性肾功能丧失。伦敦皇家自由医院表示该应用已经开始节省护士的时间。

 

Naturally enough, the health-care entrepreneurs have the boldest visions. The point of care will move rapidly into the home, they say. People will monitor their heart conditions, detect concussions, monitor the progress of diseases and check up on moles or ear infections using apps, mobile phones and sensors. Last year the FDA approved 36 connected health apps and devices. A new app, called Natural Cycles, was recently approved in Europe for use as a contraceptive. Its failure rate for typical use was equivalent to that of popular contraceptive pills. A smartphone may eventually be able to predict the onset of Alzheimer’s, Parkinson’s or even the menopause (if the information is wanted).

 

自然，医疗保健企业家的愿景最为大胆。他们称治疗地点将迅速转入家庭。人们将可以通过应用、手机和传感器来监测心脏状况、检测脑震荡、追踪疾病发展以及检查痣或耳部感染。去年美国食品药品监督管理局（FDA）批准了36个医疗保健类联网应用和设备。一个用于避孕的新应用 Natural Cycles最近在欧洲获批，其典型使用失效率等同于常见避孕药。智能手机也许最终将能预测出阿尔茨海默病、帕金森病的发病时间，甚至更年期开始的时间（如果想要了解这一信息的话）。

 

In emerging economies, where regulations on health data are less onerous and where people often already expect to pay to see a doctor, there is faster growth and innovation. China, which is building 400 hospitals a year, saw its two largest VC investments in digital health care last year. One went into a Chinese medical-service app, Ping An Good Doctor, which raised $500m; a video-consultations app called Chunyu Yisheng raised $183m. India is another innovator. To take one example, LiveHealth, based in Pune, is an app that lets patients assemble all their health records in one place, see test results and communicate with doctors.

 

在新兴经济体中，对医疗数据的法规要求没那么繁多，而且通常人们已经有了看病要花钱的预期，因而数字医疗在那里有更快的增长和创新。中国每年建造400所医院，去年在数字医疗保健方面出现了两个最大的风投项目：一个是医疗服务应用“平安好医生”，融资5亿美元；另一个是叫做“春雨医生”的视频咨询应用，融资1.83亿美元。印度是另一个创新国度。举个例子，由总部位于普纳的公司开发的应用LiveHealth让患者可以集中所有的健康记录、查看检验结果并和医生沟通。

 

In the short term, the greatest disruption will come from a growing array of apps in many countries around the world that give consumers direct access to qualified GPs on their mobile phones. Overall, telemedicine is expected to grow rapidly. In America, GPs will conduct 5.4m video consultations a year by 2020, says IHS Markit, a research firm. Britain’s NHS is testing a medical AI from a London-based startup called Babylon which can field patients’ questions about their health. A paid service called Push Doctor offers an online appointment almost immediately for £20 ($24). The firm maximises the efficiency of its doctors by reducing the time they spend on administrative duties. They spend 93% of their time with patients compared with only 61% in Britain’s public sector. Babylon reckons that 85% of consultations do not need to be in person.

 

短期内，最大的颠覆将来自许多国家日益增加的各种应用，它们让患者可以在手机上直接与注册家庭医生交流。总体而言，远程医疗预计将快速增长。研究公司IHS Markit的数据显示，到2020年，美国的家庭医生每年将提供540万次视频咨询服务。英国的NHS正在测试伦敦创业医疗机构Babylon的一个人工智能医疗程序，它可以解答患者提出的健康问题。这个叫作Push Doctor的服务每次收费20英镑（24美元），可提供几乎实时的在线问诊。Babylon公司通过减少医生在行政工作上花费的时间，最大限度地提高了医生的效率，让他们能把93%的工作时间花在病人身上，而在英国的公立医院这个数字只有61%。Babylon认为85%的问诊都无需面对面进行。

 

In the longer term, the biggest upheaval may come from the large technology firms. Amazon and Google are not the only giants to be stalking health care. Apple has expressed a strong interest in it, though it is taking time to decide exactly what it wants to do. For several years it has provided a way of bringing together health data on its iPhone, and tools for health researchers to build apps. As personal-health records accumulate on its platform, from sensors such as Fitbits to medical-grade devices, it will encourage more app development.

 

长远来看，最大的颠覆可能来自大型科技公司。紧盯保健医疗行业的科技巨头不仅仅有亚马逊和谷歌，苹果也表达了浓厚的兴趣，不过它也并没急着决定到底要做什么。几年来，苹果一直让用户能在iPhone上汇集健康数据，并提供工具让医疗研究人员构建应用。随着来自Fitbit手环等传感器以及医疗级设备的个人健康记录在其平台上不断积累，苹果还将鼓励开发更多的应用。

 

An app using data from an iPhone or another smartphone might be able to warn users that a sedentary lifestyle will exacerbate a heart condition or that, based on social-media patterns, they are at risk of depression, for example. Apple and other tech firms may also be able to help patients take greater control of their existing health records. For now medical records mostly remain under the guard of those who provided the care, but this is expected to change. If patients do gain proper access to their own data, Apple is in a particularly strong position. Its platform is locked and fairly secure, and the apps that run on it are all screened by the firm.

 

利用来自iPhone或其他智能手机的数据，一款应用也许能够对用户面临的健康风险提出警告，例如久坐的生活方式会加重心脏病，或者其在社交媒体上的行为规律指向抑郁症风险。苹果和其他科技公司也可能会帮助患者更好地管控其现有的健康记录。现在的医疗记录大多由那些提供医疗服务的机构保存，但预计这将有所改变。如果患者真的可以恰当地获得自己的数据，苹果就会处于特别有利的地位，因为其平台是封闭式的，还算安全，平台上运行的应用也都经过了苹果的筛选。

 

None of this will materialise quickly. Regulated health-care systems will take time to deal with concerns over accuracy, security and privacy. In Britain the Royal Free is already under scrutiny over how it shared its patients’ data. That suggests a broader worry: that technology companies are too cavalier with their users’ data. Such firms typically use long agreements on data rights that are hard for individuals to understand. The medical world places importance on informed consent, so a clash of cultures seems unavoidable.

 

但这类前景无一会迅速实现。受监管的医疗保健系统需要时间来解决人们对准确性、安全性和隐私问题的担忧。在英国，皇家自由医院已经在就其分享患者数据的方式接受审查。从中可见一种更广泛的担忧：科技公司对用户的数据安全太过漫不经心。科技公司惯于使用个人用户难以理解的冗长的数据权利协议，但医学界重视知情同意，由此而来的文化冲突似乎不可避免。

 

Yet enormous change looks inevitable. Investors hope for billion-dollar health-tech “unicorns”. Payers eye equally sizeable savings. Amid such talk it is worth remembering that the biggest winners from digital health care will be the patients who receive better treatment, and those who avoid becoming patients at all.

 

然而巨变似乎同样不可避免。投资者希望出现市值超十亿美元的医疗技术“独角兽”公司。医疗费用的支付方也期待同样数额巨大的开支节省。在此类讨论中有一点值得记住：数字医疗的最大赢家将是获得更好治疗的患者以及躲过了疾病的人。

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