美国国家公共电台 NPR Electronic Health Records May Help Customize Medical Treatments

 

STEVE INSKEEP, HOST: 

Today in Your Health, we report on the consequence of a change at many doctor's offices. It's common that a doctor or nurse enters information on a computer instead of filling out paper forms about the patient. Those electronic medical records are much easier for researchers to explore. And it turns out that individual patients can benefit from what's learned. NPR's Richard Harris reports.

RICHARD HARRIS, BYLINE¹: Computerized medical records are all the buzz these days, but they're hardly new. Pioneers at the early HMO Kaiser Permanente were using electronic medical records as far back as the 1970s and saw them as a big part of the future of medicine.

TRACY LIEU: The part of it that they didn't envision that we're envisioning now is how proactive a role patients would be taking.

HARRIS: Dr. Tracy Lieu, who heads Kaiser's research division in Oakland, Calif., says patients don't just contribute information. They can learn from the experience of others, with patient privacy protected, of course.

LIEU: Patients are always saying, you know, don't just give me the averages. Tell me what happened to others who kind of look like me, who made the same treatment choices I did, and tell me not only did they live or die, but tell me what their quality of life was about.

HARRIS: Right now, she has a prototype of how this could work and uses pancreatic cancer as an example.

LIEU: We can put in pancreatic.

HARRIS: She pulls up data from all patients at Kaiser who have been treated for this cancer and then extracts specific information.

LIEU: And let's look at the survival curves for those patients.

HARRIS: Doctors will eventually be able to run a search like this and refine it to look only at people in certain age groups, cancer stages, treatment regimens, also information about their mental and emotional states, which comes from a short patient survey. That's pretty bare-bones information. Ideally, these medical records would provide a much fuller picture of a patient's emotional state. But Lieu says that would require more work for the patients.

LIEU: If you're a patient and someone says, gee², we'd like you to fill out this 30-item survey on a routine basis, you're going to say, why? What will this get me? How will it help my care?

HARRIS: That's one of the many problems researchers will have to solve in order to make these electronic medical records deeply useful in a world that straddles research and practical information. Another missing piece of the Kaiser records is they are shy on genetic⁴ information about patients. But the Geisinger Health System in Pennsylvania has sunk a lot of money and effort into adding gene³ scans to electronic medical records. They already have gene scans for 50,000 patients in their system. Dr. David Ledbetter, the chief scientific officer, says that number is growing fast.

DAVID LEDBETTER: Even though this is primarily a research project, we're identifying genomic variants⁶ that are actually important to people's health and health care today.

HARRIS: Geisinger patient Jody Christ volunteered to get the genetic screen done during one of her routine medical visits. Her doctor had been concerned about her high cholesterol⁷ and told her to work on getting in shape.

JODY CHRIST: So I started to ride a bike and 10 minutes in I would start to get a sensation down my left arm.

HARRIS: That made the 61-year-old from Elysburg, Pa., uneasy, so she stopped exercising. But last February, she got a call from the program that had run the genetic testing telling her she had a genetic variant⁵ that explained why she had persistently⁸ high cholesterol levels.

CHRIST: They suggested I make an appointment and come in to talk to them.

HARRIS: That led to a series of tests through the spring. Toward the end of April, Christ took a stress test, which suggested serious heart trouble.

CHRIST: April 29, they had me in for a catheter. And by May 5, I was having triple bypass surgery.

HARRIS: So how do you feel now?

CHRIST: Good, oh, real good, much, much different (laughter). I feel they saved my life.

HARRIS: Full on genetic testing like this is the exception since these tests typically cost a couple of thousand dollars. But Ledbetter says the prices are falling fast and this year could even be in the $300 range.

LEDBETTER: So we think as the cost comes down it will be possible to sequence all of the genes⁹ of individual patients, store that information in the electronic medical record. And it will guide and individualize and optimize¹⁰ patient care.

HARRIS: Doctors don't know how to interpret most of the genetic results, but there are a few genetic variants, like Jody Christ's cholesterol marker, that are clear indications of serious health problems. Ledbetter said, easy-to-interpret variants like that have shown up in 3.5 percent of the patients they studied.

LEDBETTER: Well, that 3.5 percent is going to grow. I don't know what the final number will be, but it'll be in the 5 to 10 percent range. And then our hope is that understanding the genetics of those single genes will also help us to understand the biology of more common forms of cancer, cardiovascular disease.

HARRIS: And he hopes even more genetically¹¹ complex diseases like obesity¹² and diabetes¹³. Geisinger's experiment, done in partnership¹⁴ with a company called Regeneron, is an important foray into the new world where genetic data merge¹⁵ with electronic medical records.

HARLAN KRUMHOLZ: The scientific community has been sort of waiting to see what was going to happen here.

HARRIS: Dr. Harlan Krumholz is a professor of medicine at Yale University. He's excited at the prospect¹⁶ of being able to look at physical symptoms and medical records and then look for genetic variations that could be responsible.

KRUMHOLZ: I think what we're also discovering is that the quality of data all around us is not necessarily research quality.

HARRIS: Think of something as basic as the language in these medical records.

KRUMHOLZ: Words like shock tend to mean different things to different people, and so I think it would be unfortunate if people felt that all of a sudden we have this remarkable¹⁷ treasure trove¹⁸. There's a long way to go to move from where we are today to where we need to be.

HARRIS: The potential is great, he says, both in terms of understanding disease and helping¹⁹ individual patients. In fact, that's the idea behind a massive federal effort called the Precision Medicine Initiative recently rebranded as All Of Us. But medicine is not yet at home in the world of big data.

KRUMHOLZ: Medicine's got to catch up. And medicine's got to understand how best to take advantage of all the information that's being generated every day.

HARRIS: These early experiences at Kaiser, Geisinger and elsewhere are helping find the path forward. Richard Harris, NPR News.

(SOUNDBITE OF SECEDE'S "FRIDAY FALL")

1 byline   

n.署名；v.署名

参考例句：

• His byline was absent as well.他的署名也不见了。
• We wish to thank the author of this article which carries no byline.我们要感谢这篇文章的那位没有署名的作者。

2 gee   

n.马；int.向右！前进！，惊讶时所发声音；v.向右转

参考例句：

• Their success last week will gee the team up.上星期的胜利将激励这支队伍继续前进。
• Gee,We're going to make a lot of money.哇！我们会赚好多钱啦！

3 gene   

n.遗传因子，基因

参考例句：

• A single gene may have many effects.单一基因可能具有很多种效应。
• The targeting of gene therapy has been paid close attention.其中基因治疗的靶向性是值得密切关注的问题之一。

4 genetic   

adj.遗传的，遗传学的

参考例句：

• It's very difficult to treat genetic diseases.遗传性疾病治疗起来很困难。
• Each daughter cell can receive a full complement of the genetic information.每个子细胞可以收到遗传信息的一个完全补偿物。

5 variant   

adj.不同的，变异的；n.变体，异体

参考例句：

• We give professional suggestions according to variant tanning stages for each customer.我们针对每位顾客不同的日晒阶段，提供强度适合的晒黑建议。
• In a variant of this approach,the tests are data- driven.这个方法的一个变种，是数据驱动的测试。

6 variants   

n.变体( variant的名词复数 )；变种；变型；（词等的）变体

参考例句：

• Those variants will be preserved in the'struggle for existence". 这些变异将在“生存竞争”中被保留下来。 来自辞典例句
• Like organisms, viruses have variants, generally called strains. 与其他生物一样，病毒也有变种，一般称之为株系。 来自辞典例句

7 cholesterol   

n.（U）胆固醇

参考例句：

• There is cholesterol in the cell of body.人体细胞里有胆固醇。
• They are determining the serum-protein and cholesterol levels.他们正在测定血清蛋白和胆固醇的浓度。

8 persistently   

ad.坚持地；固执地

参考例句：

• He persistently asserted his right to a share in the heritage. 他始终声称他有分享那笔遗产的权利。
• She persistently asserted her opinions. 她果断地说出了自己的意见。

9 genes   

n.基因( gene的名词复数 )

参考例句：

• You have good genes from your parents, so you should live a long time. 你从父母那儿获得优良的基因，所以能够活得很长。 来自《简明英汉词典》
• Differences will help to reveal the functions of the genes. 它们间的差异将会帮助我们揭开基因多种功能。 来自英汉非文学 - 生命科学 - 生物技术的世纪

10 optimize   

v.使优化 [=optimise]

参考例句：

• We should optimize the composition of the Standing Committees.优化人大常委会组成人员的结构。
• We should optimize our import mix and focus on bringing in advanced technology and key equipment.优化进口结构，着重引进先进技术和关键设备。

11 genetically   

adv.遗传上

参考例句：

• All the bees in the colony are genetically related. 同一群体的蜜蜂都有亲缘关系。
• Genetically modified foods have already arrived on American dinner tables. 经基因改造加工过的食物已端上了美国人的餐桌。 来自英汉非文学 - 生命科学 - 基因与食物

12 obesity   

n.肥胖，肥大

参考例句：

• One effect of overeating may be obesity.吃得过多能导致肥胖。
• Sugar and fat can more easily lead to obesity than some other foods.糖和脂肪比其他食物更容易导致肥胖。

13 diabetes   

n.糖尿病

参考例句：

• In case of diabetes, physicians advise against the use of sugar.对于糖尿病患者，医生告诫他们不要吃糖。
• Diabetes is caused by a fault in the insulin production of the body.糖尿病是由体內胰岛素分泌失调引起的。

14 partnership   

n.合作关系，伙伴关系

参考例句：

• The company has gone into partnership with Swiss Bank Corporation.这家公司已经和瑞士银行公司建立合作关系。
• Martin has taken him into general partnership in his company.马丁已让他成为公司的普通合伙人。

15 merge   

v.(使)结合，(使)合并，(使)合为一体

参考例句：

• I can merge my two small businesses into a large one.我可以将我的两家小商店合并为一家大商行。
• The directors have decided to merge the two small firms together.董事们已决定把这两家小商号归并起来。

16 prospect   

n.前景，前途；景色，视野

参考例句：

• This state of things holds out a cheerful prospect.事态呈现出可喜的前景。
• The prospect became more evident.前景变得更加明朗了。

17 remarkable   

adj.显著的，异常的，非凡的，值得注意的

参考例句：

• She has made remarkable headway in her writing skills.她在写作技巧方面有了长足进步。
• These cars are remarkable for the quietness of their engines.这些汽车因发动机没有噪音而不同凡响。

18 trove   

n.被发现的东西，收藏的东西

参考例句：

• He assembled a rich trove of Chinese porcelain.他收集了一批中国瓷器。
• The gallery is a treasure trove of medieval art.这个画廊是中世纪艺术的宝库。

19 helping   

n.食物的一份&adj.帮助人的，辅助的

参考例句：

• The poor children regularly pony up for a second helping of my hamburger. 那些可怜的孩子们总是要求我把我的汉堡包再给他们一份。
• By doing this, they may at times be helping to restore competition. 这样一来, 他在某些时候,有助于竞争的加强。