Health Care: Things Are Looking App
医疗保健：应用越来越有用
Mobile health apps are becoming more capable and potentially rather useful
移动健康应用功能日渐强大，而且可能相当有用
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.
伦敦萨维尔街(Savile Row)最出名的便是制作世界上最好的定制西服。但就在这同一条街道的一处安静街角，隐匿着一家通过智能手机应用为用户提供有针对性健康建议的公司。这款应用就是Your.MD，它利用人工智能来理解诸如“我头疼”等自然语句，并询问相关的后续问题。该应用代表了移动健康(又称为m-health)的新方式：它智能化、个性化，并在收集用户数据过程中变得越来越聪明。
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.
如今在苹果的iOS和谷歌的安卓这两个主要的智能手机操作系统上运行的健康相关应用约有16.5万个。咨询公司普华永道(PwC)预测，到2017年，这类应用的下载次数将达到17亿次。当然，应用经济高度分散。许多供应商依然很小，而且，大多数应用只有很少人使用，甚至没有人使用。
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.
尽管如此，成功的应用还是受到热捧。随着应用和可穿戴设备的功能越来越强、用处越来越大，以及智能手机继续雄霸天下，移动健康的发展前景一片光明。BCC研究(BCC Research)专注于基于技术的市场的分析，它预测，全球移动健康的收入将在2018年达到215亿美元，而欧洲将成为最大市场。
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.
到目前为止，大多数智能手机的健康应用都属于“健康”范畴。与Fitbit手环等便携式传感器一道，这些应用帮助人们管理和监控自己的锻炼、饮食与压力水平。诸如WebMD和iTriage等其他类型的应用把已经找到的在线医疗信息重新打包，并提供有关症状和治疗的信息。一些应用，如ZocDoc，让用户预约医生就诊。
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，移动健康越来越有望担负更多的医学重任。首先，用户用以同医生和治疗师直接沟通的应用不断增多。这些应用包括Teladoc、Doctor On Demand、Health Tap和Pingmd。自2014年底以来，美国连锁药店沃尔格林(Walgreens)提供了一款名为MDLive的应用，花费49美元即可在任何时间找医生诊断一次。很快，患者便可通过即时通讯应用与人工智能健康顾问聊天，就像Your.MD一样。其次，目前有一类新兴的应用，可以对有多种疾病的患者进行监测和诊断，在一些情况下，还能预测病情从而帮助避免突发急症。这些发展对护理质量有更深远的潜在影响。
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.
美国宾夕法尼亚州伯利恒市(Bethlehem)的Cerora公司发明了一款用来监控大脑健康的耳机以及相关的智能手机应用。这款耳机测量脑电波并跟踪眼球运动;其应用则利用智能手机内部的传感器来测试患者的平衡和反应时间。Cerora公司计划今年推出这款产品，前提是通过美国食品药品管理局(FDA)的审查。它可以帮助诊断脑震荡和其他神经退行性疾病。旧金山的CellScope公司提供了一款智能手机配件，让父母能够看到孩子的耳朵内部，拍摄照片或视频，并把它们发给医生。
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.
在每一个医疗保健系统中，总有一小部分患者，大多是慢性病患者，其治疗费用远高于其他病患。移动健康为他们提供了一种连续而长期的监控手段，并有可能改善心血管疾病、癫痫、哮喘和糖尿病等病症的治疗。
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.
医疗器械制造商美敦力糖尿病部门(Medtronic Diabetes)的胡曼·哈卡米(Hooman Hakami)表示，糖尿病患者经常要决定如何使用药物、选择饮食和进行活动;而且，大多数患者要好几个月才找医生诊断一次。美敦力联合IBM的人工智能系统沃森(Watson)，正在设计一款应用，在病人出现高血糖或低血糖水平之前3小时做出预测。这款应用通过穿戴在患者身上的美敦力胰岛素泵和血糖监测仪收集数据，并把这些数据与用户的饮食信息及活动跟踪器的数据相结合。其他与糖尿病相关的移动健康服务提供者还有Diabetes+Me，其应用已经证实能够改善患者的治疗效果并降低成本。瑞士制药巨头诺华(Novartis)正准备测试一种由谷歌开发的监测葡萄糖的隐形眼镜。
Apps on prescription
处方上的应用
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.
通过发现患者病情恶化的初期迹象，经由无线连接的持续监测也许会为患者避免许多痛苦。它也可能为医疗机构和保险公司免除多项高昂的住院费用。在考核对慢性阻塞性肺疾病患者远程支持的成本效益时，英国国民健康服务体系(National Health Service)发现，通过早期干预，一种与测量生命体征的传感器配对的电子片剂可能会带来更好的护理并极大地节省费用。一些移动健康产品可能证明非常有效，因而医生们开始把它们写进处方。
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.
到目前为止，大型制药公司加入移动健康革命的步调缓慢，但也有一些例外。辉瑞(Pfizer)的HemMobile和百特(Baxter)的Beat Bleeds帮助患者应对血友病。生产抗组胺药氯羟他定(Clarityn)的拜耳(Bayer)有一款花粉预报应用颇受欢迎。有多种哮喘药物的制药企业葛兰素史克(GSK)向患者提供一款名为MyAsthma的应用，帮助他们控制自己的病情。
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.
葛兰素史克正与Propeller Health公司联手，为前者的Ellipta哮喘吸入器研发定制的传感器，以便收集患者如何使用该产品的信息。葛兰素史克想知道患者是否遵照说明书规定的时间用药，以及这样做与药物的安全性、疗效和经济效益之间存在何种关联。
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.
所有的制药企业都受到来自监管机构和健康保险公司的压力，需要更加努力地证明其药物的价值，移动健康可能对此有很大帮助。在对提交审批的新药进行临床试验时，这些应用将派上用场，更准确地测量病情的发展，从而证明治疗的功效。在药物获批并且有或许成千上万的患者服用后，使用应用来监控他们的情况，这将对产品的长期功效构成重大检验。当然，如果这种审批后的测试表明其药物实际上没有达到预期效果或表现出不良的副作用，就可能为制药企业招致灾难。
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.
随着移动健康应用担任更重要的工作，它们将需要更加严格的监管。不准确对于计步器而言无伤大雅，但对于心率监测仪来说则是另一回事。去年8月，一款流行产品“即时血压”(Instant Blood Pressure)的准确性受到严重关切，它随之被苹果应用商店下架。2011年，一位开发者声称其AcneApp应用能借iPhone屏幕的光线来治疗青春痘，结果被罚款。
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，FDA完成了移动健康方面监管体系的制定工作，这表明它将调整方法，较少关注低风险的应用，例如那些仅仅提倡健康生活方式的应用;而仔细审查那些任何错误信息都可能造成危险的应用。这种明智的做法可能会被其他国家的监管机构所效仿。
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，其它的监管问题则更难回答。随着健康应用日益流行，对如何存储、使用和分享患者数据的担忧将变得愈加尖锐。《美国医学会杂志》(Journal of the American Medical Association)的一项新研究发现，许多健康应用可能在患者不知情的情况下就分享了他们的健康数据。在它调查的211个糖尿病应用中，五分之四没有隐私政策。
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.
自从iPhone问世以来，美国对于个人健康数据存储和传输的规则就一直没有改变过。因此，医生和医院可能不愿意接受健康应用，除非更新规则以明确他们可以这样做而不违反数据安全方面的严格准则。认真负责的移动健康应用供应商和治疗方(开处方者)可能会因为与滥用数据的流氓有关联而遭受污名。
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.
分散的而方兴未艾的移动健康市场似乎迟早会被整合，最有前途的创业公司或许会被值得信赖的健康品牌所收购，或者与这些品牌组成联盟。这将有助于它发挥巨大的潜力来帮助患者、医生、医疗保险公司以及研究人员。
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