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.

美国投资者喜欢戏剧性。因此，Theranos引起骚动并不令人意外。就在两个月前，这家血液诊断公司——10年前由斯坦福大学(Stanford)辍学生伊丽莎白霍尔梅斯(Elizabeth Holmes)创建——还受到投资者的青睐，估值高达90亿美元。然而，如今该公司面临指控：其检测技术并不像该公司声称的那样新颖，同时该公司成了投资者对如今硅谷天价估值的更广泛担忧的典型对象。

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.

但投资者不应因为围绕Theranos的喧嚣而忽视了更大的问题：医学诊断领域正在酝酿新趋势。数十家其他初创企业正在各种医学缝隙领域涌现（Sage Bionetworks、We Are Curious和Patients Like Me等等）。它们可能改变美国医疗服务的提供方式，就像优步(Uber)彻底改变了我们对“出租车”的看法一样。

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.

问题在于由谁控制医学数据。过去几十年，这被视为美国文化的特征：坚强的个人（即消费者）希望行使自己的权利。但在健康领域，他们似乎愿意让医生控制自己的病历并且保护隐私。

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个因素看上去可能会改变这种格局。首先，医学诊断成本大幅下滑，这令个人有更多机会进行医学检测，绕过医生和传统的医疗机构。Theranos等初创企业的血液检测收费大大低于先前的价格；DNA测序现在的价格为每个基因组1000美元，这令人震惊；2007年和2001年的价格分别为1000万美元和1亿美元。

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，消费者对于在网上管理自己的健康越来越自在。根据皮尤研究中心(Pew Research Center)的数据，逾三分之一的消费者已在网上查看健康事宜。Fitbit和Jawbone等健康设备的普及也帮助加速了这种变化，它们向消费者展示了智能手机能做什么。

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，更广泛地说，消费者对于数字化数据隐私的态度可能在发生变化。直到不久以前，体制内的医疗机构认为，患者不愿将太多数据放到网上，或者让太多的人分享。但目前已经很明显，消费者对于隐私的担忧不及一些维权人士可能希望达到的程度。美国电信集团AT&T首席执行官兰德尔斯蒂芬森(Randall Stephenson)表示，消费者为了换取每月20美元的账单折扣，愿意放弃其移动手机使用数据的隐私限制（例如给营销公司）。医学诊断公司正在押注：如果消费者获得某些“回报”（无论是服务费降低，还是希望数据被用于改进医学研究），他们也愿意分享自己的医疗数据。

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.

如果这种赌注押对了的话，它将带来一些引人入胜的影响。首先，如果消费者（而非医生）控制数据，医疗行业可能不得不颠覆其模式。医学服务可能不会再按照医生的专业来安排（例如明确分为外科医生和内科医生），而是根据消费者定义自己健康的方式分类，一般是关注具体的疾病和身体部位。

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.

更为重要的是，如果消费者允许自己的信息被（部分匿名地）存放在中央数据库，这可能让美国医学研究者迈出此前一直做不到的常识步伐：出于研究目的建立全员人口数据库。此类数据库已在冰岛等国出现。但在美国，医学数据处于割裂状态，部分原因是隐私担忧，还有一个原因是强大的商业利益阻碍了合作。然而，如果医学诊断朝着消费者控制的趋势发展，情况可能会发生改变；俄勒冈健康与科学大学(Oregon Health and Science University)主管布赖恩德鲁克(Brian Druker)甚至认为，到2020年，美国将建立其首个统一的癌症病历数据库。

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”.

这方面仍存在巨大障碍。首先，并非所有州都允许消费者获取（更别提控制了）他们的数据。第二，只有在网络能够抵御网络攻击的情况下，消费者才会保持对数字化医疗数据的高度信任；鉴于最近发生的引人注目的黑客事件，这里存在一个很大的问号。还有就是困扰Theranos的问题：很多消费者并不知道如何验证“诊断”的质量。

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.

但历史表明，当美国消费者产生主体感(sense of agency)——以及用自己的钱包采取行动的机会——时，去中介化(disintermediation)出现的速度有时可能快得出奇。只需看看优步就知道啦。不管接下来霍尔梅斯会怎样，Theranos题材背后的真正故事只是刚刚开始。