????今天的醫(yī)療保健往往靠的還是“醫(yī)術(shù)”，而不是“醫(yī)學(xué)”。

????拿治療發(fā)燒為例。150年來(lái)，醫(yī)生一般都是開(kāi)布洛芬等退燒藥幫助退燒。但在2005年，邁阿密大學(xué)（the University of Miami）的研究人員對(duì)82名病?；颊哌M(jìn)行了一項(xiàng)研究。82名病人被隨機(jī)分成兩組，其中一組的病人在體溫超過(guò)攝氏38.5度時(shí)便服用退燒藥（即“標(biāo)準(zhǔn)療法”），另一組只有在體溫達(dá)到攝氏40度時(shí)才服用退燒藥。結(jié)果隨著試驗(yàn)的開(kāi)展，有7名接受標(biāo)準(zhǔn)療法的病人死亡了，而沒(méi)有服用退燒藥的那一組中，只有一名病人死亡。但就在這時(shí)，試驗(yàn)由于倫理問(wèn)題被終止了，因?yàn)檠芯繄F(tuán)隊(duì)認(rèn)為再讓更多病人接受標(biāo)準(zhǔn)療法是不道德的。

????像退燒這樣基本的病癥的治療都難以避免地帶有“醫(yī)術(shù)”的痕跡，而且這種情況持續(xù)了100多年都沒(méi)有改觀，我們不禁要問(wèn)：還有哪些療法是依托于傳統(tǒng)，而不是依托于科學(xué)？

????今天的診斷方式部分根據(jù)患者的病史，部分根據(jù)患者的癥狀（不過(guò)患者一般都不擅長(zhǎng)描述癥狀）。甚至大多數(shù)時(shí)候，醫(yī)生是根據(jù)醫(yī)藥廣告，以及多年前在醫(yī)學(xué)院學(xué)到的知識(shí)做出診斷。且不說(shuō)醫(yī)學(xué)院講授的內(nèi)容好多已經(jīng)過(guò)時(shí)，而且時(shí)間一久，醫(yī)生自己也忘了許多課本上的知識(shí)，何況光是從醫(yī)學(xué)院學(xué)來(lái)的知識(shí)也難免存在認(rèn)識(shí)偏差、經(jīng)驗(yàn)編差以及其它人為錯(cuò)誤。許多時(shí)候，三個(gè)醫(yī)生診斷同一個(gè)病癥，可能會(huì)得出三種不同的診斷和三種不同的療法。

????結(jié)果是患者不僅診療效果不理想，而且還花了大筆冤枉錢。約翰霍普金斯大學(xué)（Johns Hopkins?University）的一項(xiàng)研究發(fā)現(xiàn)，美國(guó)每年都有40,500余名患者因?yàn)檎`診而死亡，幾乎與死于乳腺癌的人數(shù)相當(dāng)。另一份研究則發(fā)現(xiàn)，有65%的誤診病例都與處理不當(dāng)、團(tuán)隊(duì)合作不協(xié)調(diào)、溝通不暢等所謂的“系統(tǒng)相關(guān)因素”有關(guān)。而75%的誤診病例都存在所謂的“認(rèn)識(shí)因素”，而其中最主要的原因，是由于醫(yī)生堅(jiān)持一開(kāi)始的錯(cuò)誤診斷，忽視了其它合理的可能。這種誤診也增加了醫(yī)療支出，每次誤診索賠的平均金額為30萬(wàn)美元。

????醫(yī)療診斷應(yīng)該更多運(yùn)用數(shù)據(jù)演繹的方法，減少“摸著石頭過(guò)河”的成分。而這個(gè)目標(biāo)離開(kāi)現(xiàn)代科技則很難實(shí)現(xiàn)，因?yàn)槿缃窨墒褂玫臄?shù)據(jù)和研究方法越來(lái)越多。新一代的醫(yī)療技術(shù)將用到更多、更復(fù)雜的生理模型，并且使用更多的傳感器數(shù)據(jù)，從而提供個(gè)性化的診療，這些數(shù)據(jù)可能不是光靠一個(gè)人類醫(yī)生就能理解得了的。每次診斷都將依托于成千上萬(wàn)個(gè)基線數(shù)據(jù)和多個(gè)組學(xué)數(shù)據(jù)點(diǎn)，以及更加全面的病史和患者行為等要素。

????日益完善的對(duì)話管理系統(tǒng)將有助于對(duì)病人進(jìn)行更為有效和更為全面的數(shù)據(jù)捕捉及探測(cè)。其中的關(guān)鍵就是數(shù)據(jù)科學(xué)。最終，它將有助于降低醫(yī)療成本，減少醫(yī)生的工作量，提高患者的醫(yī)療水平。

????Healthcare today is often really the "practice of medicine" rather than the "science of medicine."

????Take fever as an example. For 150 years, doctors have routinely prescribed antipyretics like ibuprofen to help reduce fever. But in 2005, researchers at the University of Miami, Florida, ran a?studyof 82 intensive care patients. The patients were randomly assigned to receive antipyretics either if their temperature rose beyond 101.3°F ("standard treatment") or only if their temperature reached 104°F. As the trial progressed, seven people getting the standard treatment died, while there was only one death in the group of patients allowed to have a higher fever. At this point, the trial was stopped because the team felt it would be unethical to allow any more patients to get the?standard treatment.

????So when something as basic as fever reduction is a hallmark of the "practice of medicine" and hasn't been challenged for 100+ years, we have to ask: What else might be practiced due to tradition rather than science?

????Today's diagnoses are partially informed by patients' medical histories and partially by symptoms (but patients are bad at communicating what's really going on). They are mostly informed by advertising and the doctor's half-remembered and potentially obsolete lessons from medical school (which are laden with cognitive biases, recency biases, and other human errors). Many times, if you ask three doctors to look at the same problem, you'll get three different diagnoses and three different treatment plans.

????The net effect is patient outcomes that are inferior to and more expensive than what they should be. A Johns Hopkins?study?found that as many as 40,500 patients die in an ICU in the U.S. each year due to misdiagnosis, rivaling the number of deaths from breast cancer. Yet another?studyfound that 'system-related factors', e.g. poor processes, teamwork, and communication, were involved in 65% of studied diagnostic error cases. 'Cognitive factors' were involved in 75%, with 'premature closure' (sticking with the initial diagnosis and ignoring reasonable alternatives) as the most common cause. These types of diagnostic errors also add to rising healthcare expenditures, costing?$300,000?per malpractice claim.

????Healthcare should become more about data-driven deduction and less about trial-and-error. That's hard to pull off without technology, because of the increasing amount of data and research available. Next-generation medicine will utilize more complex models of physiology, and more sensor data than a human MD could comprehend, to suggest personalized diagnosis. Thousands of baseline and multi-omic data points, more integrative history, and demeanor will inform each diagnosis.

????Ever-improving dialog manager systems will help make data capture and exploration from patients more accurate and comprehensive. Data science will be key to this. In the end, it will reduce costs, reduce physician workloads, and improve patient care.