Medicine was created to protect, preserve and extend human life. Over centuries we have come to understand the intricate systems of the human body and the effects of disease, aging and genetics. Progress, initially slow and fitful, now increases in incrementally larger and larger leaps as technology powers our ability to examine systems previously beyond our technical reach.

医学的创建是为了保护，保存和延长人类寿命。 几个世纪以来，我们已经了解了人体的复杂系统以及疾病，衰老和遗传学的影响。 随着技术推动我们检查以前超出技术范围的系统的能力的增强，最初缓慢而适度的进步现在越来越大。

Advances in computing have allowed us to map the human genome and global data networks allow for complex surgeries to be performed remotely. Medicine is simply another branch of science and embracing technology from allied scientific fields has formed an integral part of the natural progression of the discipline.

计算的进步使我们能够绘制人类基因组图谱，而全球数据网络则允许远程进行复杂的手术。 医学只是科学的另一个分支，而来自相关科学领域的拥抱技术已成为该学科自然发展的有机组成部分。

Medicine has benefited hugely from technology, possibly more than any other field and the impact on the end consumer — that would be us — has been nothing short of revolutionary. The relationship grows and strengthens by the day, but there is a price to pay for this “perfect marriage’.

医学从技术中受益匪浅，可能比其他任何领域都受益，而且对最终消费者(也就是我们)的影响无非是革命性的。 这种关系每天都在增长和加强，但是要为这种“完美的婚姻”付出代价。

标点均衡的破坏力 (The destructive force of punctuated equilibrium)

What does evolution have to do with modern medicine? Well, for one, it has provided scientific models that we now use across a swathe of different professions. There’s nothing to beat a few million years worth of evidence to prove a point and the past often holds the key to our futures, or, seen in a different light, allows us to postulate a reasonably accurate model of tomorrow.

进化与现代医学有什么关系？ 好吧，它提供了一个科学模型，我们现在可以在众多不同专业中使用这些模型。 没有什么可以超过数百万年的证据来证明这一点了，过去常常掌握着我们未来的关键，或者换个角度来看，过去使我们能够推测出一个合理准确的明天模型。

Darwin assumed we evolved slowly and in continuous incremental evolutionary shifts over time. Until the 1970’s, it was generally thought that these changes from generation to generation indicated that past species evolved gradually into other species over millions of years. This model of long term gradual change is usually referred to as gradualism or phyletic gradualism.

达尔文假设我们的发展缓慢，并且随着时间的推移不断以渐进的方式逐步发展。 直到1970年代，人们普遍认为，这些代代相传的变化表明，过去的物种在数百万年中逐渐演变为其他物种。 这种长期逐渐变化的模型通常称为渐进主义或系统渐进主义。

Then, in the 1970’s, this model was challenged by Stephen Gould, Niles Eldredge, and a few other leading paleontologists

然后，在1970年代，斯蒂芬·古尔德(Steven Gould)，尼尔斯·埃德雷奇(Niles Eldredge)和其他一些主要的古生物学家对这种模型提出了挑战。

They asserted that there is sufficient fossil evidence to show that some species remained essentially the same for millions of years and then underwent short periods of very rapid, major change. Gould suggested that a more accurate model in such species lines would be punctuated equilibrium.

他们断言，有足够的化石证据表明某些物种在数百万年内基本上保持不变，然后经历了非常Swift的重大变化的短期。 古尔德建议，在此类物种中更精确的模型应该是标点均衡。

It isn't a very friendly model in terms of peaceful change. Essentially these periods of rapid change are brought about by crises. In such stressful situations, populations would be expected to initially diminish and become isolated. Genetic drift would then potentially speed up the rate of evolution.

就和平变革而言，这不是一个非常友好的模式。 本质上，这些快速变化的时期是危机带来的。 在这种紧张的情况下，预计人口将最初减少并变得孤立。 遗传漂变可能会潜在地加快进化速度。

If by chance nature favored successful adaptations, the population would again increase in numbers as a radically changed species. Conversely, if it favored maladaptive variations, the population would decrease in numbers further and possibly even become extinct.

如果偶然的机会自然而然地支持成功的适应，那么作为一个彻底改变的物种，种群数量将再次增加。 相反，如果它支持适应不良的变异，那么种群数量将进一步减少，甚至有可能灭绝。

Medicine is currently experiencing its moment of punctuated equilibrium, and it isn't alone. However, unlike nature, its evolutionary path is still within its own grasp.

医学目前正在经历平衡的时刻，而且并不孤单。 但是，与自然不同，它的进化路径仍在自己的掌握之中。

The danger in this deviation from a standardized rate of growth is that medicine will be lured away from its core business, protecting, preserving and extending human life. We are all to well aware of the casualties involved in rapid evolution, it is a symbiotic process and arguably, the one cannot transpire without the other. Medicine has a responsibility to ensure that its patients do not number among the casualties.

偏离标准增长率的危险在于，药物将被引诱脱离其核心业务，从而保护，维护和延长人类寿命。 我们都非常了解快速发展所涉及的人员伤亡，这是一个共生的过程，可以说，一个人离不开另一个。 医学有责任确保其患者不在伤亡人数之列。

现在，医生数据将诊断您 (Doctor Data will now diagnose you)

One of the greatest advances in the past few months has of course come in the shape of remote medicine. Tele-health is the new buzzword. It’s been wheeled out in weeks, a knee jerk reaction to Covid-19 and although there are clear benefits to tele-medicine, its adaptation for use in densely populated environments and cities cannot be allowed to persist beyond the pandemic.

过去几个月中最大的进步之一当然是以远程医学的形式。 远程医疗是新的流行语。 它已在数周内被淘汰，对Covid-19的React非常猛烈，尽管远程医疗有明显的好处，但它不允许在人口稠密的环境和城市中使用，除非大流行。

Tele-medicine was created to assist doctors and patients in remote areas, beyond the reach of traditional medicine and diagnostic techniques.It was never designed to replace the benefits of physical interaction with an actual flesh and blood doctor. As a stop-gap measure to reduce exposure during the pandemic, it has however proved beneficial. The danger now is that we seek to continue its use beyond the pandemic.

远程医疗的创建是为了帮助偏远地区的医生和患者提供传统医学和诊断技术无法企及的服务，它从未设计过用实际的血肉医生取代身体互动的好处。 然而，作为减少大流行期间暴露的权宜之计，它已被证明是有益的。 现在的危险是，我们寻求在大流行之外继续使用它。

The importance of physical contact, one on one human interaction, cannot be stressed enough. It is a key part of effective medicine. Many believe that the psychological benefits derived from a physical consultation are as conducive to the healing process as the actual medication or treatment provided.

人与人之间一对一互动的身体接触的重要性不能得到足够的强调。 它是有效医学的关键部分。 许多人认为， 从物理咨询中获得的心理益处与所提供的实际药物或治疗一样，对康复过程也有帮助。

There is a large element of trust involved with the psychology at play. In simple terms we trust the doctor to tell us if we are going to survive whatever ails us. It’s a simple as “if I was going to die, the doctor would have told me, so I am good to go”. Interestingly and perhaps counter intuitively, an increased number of visits to a doctor is associated with a decreased life satisfaction.

心理学与信任有很大关系。 简单来说，我们相信医生会告诉我们我们是否要在任何疾病中生存。 这很简单，例如“如果我要死，医生会告诉我，所以我很好。” 有趣的是，也许直觉上与之相反， 看病次数的增加与生活满意度的降低有关 。

It isn't just the patient that benefits from this interaction.

从这种互动中受益的不仅仅是患者。

Doctors feed off this relationship in their own ways and the more patient focused a doctor is, the more important this one-on-one interaction becomes. Doctors currently isolated from their patients are experiencing their own form of social withdrawal. Sadly, in an industry that is driven by health, medicine cares little for its own and most are left on their own to deal with the emotional fallout of isolation.

医生以自己的方式养成这种关系，而医生对患者的关注越多，一对一的互动就越重要。 目前与患者隔离的医生正在经历自己的社交退缩形式。 令人遗憾的是，在一个以健康为驱动力的行业中，医学对自己的关心很少，而大多数却独自应对孤立的情感后果。

重新思考发展过程 (Rethinking the development process)

I am not anti-tech. Quite the opposite. I believe our global pursuit of deliverable healthcare for all is inseparably linked to the effective use of new technologies, but, as always, the devil lies in the detail, in how we set about embedding technology based solutions into the medical profession.

我不是反技术的。 恰恰相反。 我相信，我们在全球范围内为所有人提供可交付医疗保健的追求与有效使用新技术密不可分，但是，一如既往，魔鬼在于细节，在于我们如何着手将基于技术的解决方案嵌入医疗行业。

Patient centered care lies at the heart of medicine and technology needs to integrate this mantra into both concept and design.

以患者为中心的护理是医学的核心，因此需要将这一口头禅整合到概念和设计中。

The most effective new medical technologies are often delivered at the hand of innovative doctors. They invariably design products to fulfill a direct medical need that is of immediate and clear benefit to the patient. The profession is littered with examples of bespoke medical solutions created by doctors resolving a problem with new technology. They, better than anyone, understand the brief.

最有效的新医疗技术通常由创新的医生提供。 他们总是设计产品来满足直接医疗需求，这对患者有直接和明显的好处。 该行业散布着由医生创建的定制医疗解决方案示例，这些解决方案可以解决新技术的问题。 他们比任何人都了解摘要。

There is a swathe of new medical software and applications hitting the marketplace. Remote devices for pregnant women to perform sonars at home, DDx systems (AI based diagnostics) and apps for almost anything. As I write this, a press release has just been issued for a new breed of stethoscope.

市场上涌现出许多新的医疗软件和应用程序。 孕妇可在家中使用声纳的远程设备 ， DDx系统 (基于AI的诊断程序)和几乎所有应用程序。 在我撰写本文时，刚刚发布了一种新型听诊器的新闻稿。

Soon, that appendage dangling around the neck of almost every medical professional may become an historical artifact. Our world is changing and its with the speed of punctuated equilibrium.

不久，几乎每位医疗专业人员的脖子上挂着的附属物都可能成为历史文物。 我们的世界在不断变化，它的发展以平衡的速度发展。

The dangers of rapid change impact not just patients, but also doctors. Remote triage, remote consultations and remote medical diagnostic tools all disturb the status quo of the modern doctors financial business model. They impact a practice’s ability to generate traditional income and this is a key issue that needs to be addressed by any new technology that seeks widespread integration and acceptance by the medical community.

快速变化的危险不仅影响患者，还影响医生。 远程分类，远程咨询和远程医疗诊断工具都干扰了现代医生金融业务模型的现状。 它们会影响医疗机构产生传统收入的能力，这是一个关键问题，任何寻求医学界广泛整合和接受的新技术都需要解决。

What is needed is a set of clear and focused guidelines for the development of new technology. Guidelines, created by doctors, that will impact the development and planning of all future technologies and that can be applied to existing tech to see if the tools are up to muster. Guidelines that stress the final desired result and that stem from one simply question.

对于新技术的开发，需要一套清晰明确的指南。 由医生创建的准则将影响所有未来技术的开发和计划，并且可以应用于现有技术，以查看工具是否符合要求。 强调最终预期结果的准则仅源于一个简单的问题。

Does the product or service benefit the patient?

产品或服务是否有益于患者？

New products, new software and new treatment protocols all need to conform to this one simple parameter. They also need to ensure that their implementation leads to an increase in accessibility to healthcare across all spheres of society.

新产品，新软件和新处理协议都需要符合这一简单参数。 他们还需要确保其实施导致社会各个领域对医疗保健的可及性的增加。

Wealth should not determine Health and technology has to recognize the fundamental human right to basic healthcare..

财富不应该决定健康和技术必须承认基本医疗保健的基本人权。

Failure now to address existing inequalities in the delivery of health will merely serve to widen the gap between medicine, science and the people they serve, the patient. Deploying technologies that enforce and increase the gulf between the wealthy and the poor will erode the last vestiges of trust built up by medicine over generations.

现在无法解决卫生保健中存在的不平等现象，只会扩大医学，科学与他们所服务的人，患者之间的差距。 部署能够增强和增加富人和穷人之间鸿沟的技术，将侵蚀几代人建立的医学信任的最后痕迹。

That trust is crucial to the delivery of effective healthcare.

这种信任对于提供有效的医疗保健至关重要。

服务而不是塑造 (To serve, not to shape)

Perhaps the most daunting responsibility falling on the shoulder of modern medicine comes in the form of science and the God Delusion.Our ever evolving ability to affect not only our environment, but everything in it, has opened a proverbial Pandora’s box, a moral melting pot where ethics and pure intention are overwhelmed by power and profit.

现代医学肩负的最艰巨的责任可能来自科学和上帝妄想症。我们不断发展的影响环境的能力不仅影响我们的环境，而且影响环境中的一切，已经打开了一个众所周知的潘多拉魔盒，一个道德熔炉权力和利润压倒了道德和纯粹的意图。

Our ability to manipulate DNA causes both delight and revulsion. Delight at the potential of the eradication of genetic diseases and the development of new targeted DNA based antiviral treatments. Horror at the potential for abuse, global manipulation of our species and the surreptitious sterilization of millions.

我们操纵DNA的能力既令人愉悦又令人反感。 高兴地指出消除遗传疾病的潜力和基于DNA的新靶向抗病毒药物的发展。 担心潜在的滥用，对我们物种的全球操纵以及数百万人的秘密绝育。

The technology exists and medicine’s bedfellow drives it. Science could prove to be both our salvation and our undoing and whilst capitalist agendas underpin the science of new medicine, the dangers will persist. Medicine would do well to remember its original purpose. It is not to shape our societies, but to serve them. To ensure that no harm befalls them and to heal.

该技术已经存在，医学界的同胞对此进行了推动。 科学可能被证明既是我们的救赎，也是我们的消亡。尽管资本主义议程是新医学科学的基础，但危险将继续存在。 医学会很好地记住其最初的目的。 这不是塑造我们的社会，而是为他们服务。 确保没有伤害降临并to愈。

Separate humans from the process of medicine and you lose your humanity, possibly the most important ingredient in the process.Lose that, and you've lost the war. That process is already underway.

将人类从医学过程中分离出来，您就会失去人性，这可能是医学过程中最重要的组成部分，失去了人性，您就失去了战争。 该过程已经在进行中。

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