Doctor Google will see you now

Alphabet is spending billions to become a force in health care

Can it finally shake up the stodgy multi-trillion-dollar industry?

谷歌医生现在要为你看病

Alphabet正花费数十亿美元成为医疗保健领域的一支力量

它能否最终撼动这个价值数万亿美元的呆板行业？

Rich countries pour heart-stopping amounts of money into health care. Advanced economies typically spend about 10% of gdp on keeping their citizens in good nick, a share that is rising as populations age. America's labyrinthine health-industrial complex consumes 17% of gdp, equivalent to $3.6trn a year. The American system's heft and inertia, perpetuated by the drugmakers, pharmacies, insurers, hospitals and others that benefit from it, have long protected it from disruption. Its size and stodginess also explain why it is being covetously eyed by big tech. Few other industries offer a potential market large enough to move the needle for the trillion-dollar technology titans.

富裕国家在医疗保健方面投入了令人震惊的资金。先进的经济体通常花费约10%的GDP用于保持其公民的良好状态，随着人口老龄化，这一比例正在上升。美国迷宫般的健康产业综合体消耗了17%的GDP，相当于每年36万亿美元。长期以来，美国医疗系统的庞大规模和惯性，由制药商、药店、保险公司、医院和其他从中受益的机构维持，保护其不受干扰。它的规模和顽固性也解释了为什么它正被大科技公司觊觎。很少有其他行业能提供足够大的潜在市场，让价值数万亿美元的科技巨头们为之心动。

In 2021 America's five tech behemoths collectively spent more than $3bn on speculative health-care bets —and may have invested more in undisclosed deals. Some of their earlier health-related investments are starting to pay off. Amazon runs an online pharmacy and its telemedicine services reach just about everywhere in America that its packages do, which is to say most of it. Apple's smartwatch keeps accruing new health features, most recently a drug-tracking one. Meta has scrapped its own smartwatch plans earlier this year but offers fitness-related fun through its Oculus virtual-reality goggles. Microsoft is expanding its list of health-related cloud-computing offerings (as is Amazon, through aws, its cloud unit).

2021年，美国的五家科技巨头共花费了30多亿美元用于投机性的医疗保健赌注--而且可能在未披露的交易中投资更多。他们早期的一些与健康有关的投资已经开始得到回报。亚马逊经营着一家网上药店，其远程医疗服务几乎覆盖了美国所有的包裹，也就是大部分地方。苹果公司的智能手表不断增加新的健康功能，最近的一项是药物跟踪功能。Meta公司今年早些时候取消了自己的智能手表计划，但通过其Oculus虚拟现实眼镜提供与健身有关的乐趣。微软正在扩大其与健康有关的云计算产品的清单（亚马逊也是如此，通过其云计算部门aws）。

Yet it is Alphabet, Google's corporate parent, whose health-care ambitions seem to be the most vaulting. Between 2019 and 2021 Alphabet's venture-capital arms, Google Ventures and Gradient Ventures, and its private-equity unit, CapitalG, made about 100 deals, a quarter of Alphabet's combined total, in life sciences and health care. So far this year it has injected $1.7bn into futuristic health ideas, according to cbInsights, a data provider, leaving its fellow tech giants, which spent around $100m all told, in the dust. Alphabet is the fifth-highest-ranking business in the Nature Index, which measures the impact of scientific papers, in the area of life sciences, behind four giant drugmakers and 20 spots ahead of Microsoft, the only other tech giant in the running. The company has hired former senior health regulators to help it navigate America's health-care bureaucracy.

然而，谷歌公司的母公司Alphabet的医疗保健野心似乎是最突出的。从2019年到2021年，Alphabet的风险投资部门Google Ventures和Gradient Ventures，以及其私募股权部门CapitalG，在生命科学和医疗保健领域进行了约100项交易，占Alphabet总交易额的四分之一。根据数据提供商cb Insights的数据，今年到目前为止，它已经为未来的健康理念注入了17亿美元，将其同行业的科技巨头甩在了后面，这些巨头总共花费了约1亿美元。在衡量科学论文影响力的自然指数中，Alphabet是生命科学领域排名第五的企业，仅次于四家巨型制药商，比唯一入选的科技巨头微软高出20位。该公司已经聘请了前高级卫生监管人员，以帮助它在美国的医疗保健官僚机构中航行。

Alphabet's approach to innovation—throw lots of money at lots of projects—has served it well in some other businesses beyond its core search engine. It has given rise to clever products, from Gmail and Google Docs to the Android mobile operating system and Google Maps, which support people's digital lives. Alphabet thinks that some of its health offerings will become as central to their physical existence. Is that an accurate prognosis?

Alphabet的创新方法--在很多项目上投入大量资金--在其核心搜索引擎之外的一些其他业务中也发挥了作用。从Gmail和Google Docs到安卓移动操作系统和谷歌地图，它已经催生了一些聪明的产品，支持人们的数字生活。Alphabet认为，它的一些健康产品将成为其实际存在的核心。这是一个准确的预言吗？

Techno-pharmacopoeia

Alphabet has dabbled in health since 2008, when Google introduced a service that allowed users to compile their health records in one place. That project was wound up in 2012, resurfaced in 2018 as Google Health, which included Google's other health ventures, and was again dismantled last year. Today Alphabet's health adventures can be divided into four broad categories. These are, in rough order of ambition: wearables, health records, health-related artificial intelligence (AI) and the ultimate challenge of extending human longevity.

自2008年以来，Alphabet一直在涉足健康领域，当时谷歌推出了一项服务，允许用户将其健康记录汇编在一个地方。该项目于2012年结束，在2018年作为谷歌健康重新出现，其中包括谷歌的其他健康企业，并在去年再次被解散。今天，Alphabet的健康冒险可以分为四大类。按照雄心壮志的粗略顺序，它们是：可穿戴设备、健康记录、与健康有关的人工智能（AI）和延长人类寿命的终极挑战。

Google launched itself into the wearables business in 2019 with a $2.1bn acquisition of Fitbit. The firm's popular fitness tracker has been counting steps and other exertions on around 100m wrists. It has come a long way since the Nintendo Wii motion-detecting game console that inspired Fitbit's founders. A new feature—a sensor which monitors changes in the heart rate for irregularities that can lead to strokes and heart failure—has just been been approved by America's Food and Drug Administraton (FDA). Google is also trying to boost the health-care potential of its other devices. To help it along, it has enlisted Bakul Patel, a former official tasked with creating the regulatory classification of “software as a medical device” at the fda.

谷歌在2019年以21亿美元的价格收购了Fitbit，启动了自己的可穿戴设备业务。该公司受欢迎的健身追踪器一直在约100米的手腕上计算步数和其他运动量。自启发Fitbit创始人的任天堂Wii运动检测游戏机以来，它已经走过了漫长的道路。一项新的功能--监测心率变化的传感器，可导致中风和心力衰竭的不规则现象--刚刚被美国食品和药物管理局（FDA）批准。谷歌也在努力提高其其他设备的保健潜力。为了帮助它，它请来了Bakul Patel，这位前官员在美国食品药品监督管理局负责创建 "软件作为医疗设备 "的监管分类。

The fda's stamp of approval for the Fitbit sensor is a big deal. It should make it easier to get a similar thumbs-up for Google's higher-end Pixel Watch, which uses a lot of the same technology and is due out this autumn, as well as other gadgets. For example, the camera on its Pixel phones can be used to detect respiration and heart rates by tracking the subtle colour difference brought about by the fact that blood with fresh oxygen in it is slightly brighter. Google's Nest smart-thermostat-turned-home-assistant can listen to snoring to assess your sleep. As significant, if not more, is that Google considered the regulatory go-ahead worth getting. It signals that the company intends its products to be more than fun consumer gadgets, actually able to influence the practice of medicine.

FDA对Fitbit传感器的批准是一件大事。它应该使谷歌的高端Pixel手表更容易获得类似的认可，该手表使用了大量相同的技术，并将于今年秋天推出，还有其他小工具。例如，其Pixel手机上的摄像头可以用来检测呼吸和心率，方法是追踪含有新鲜氧气的血液所带来的细微色差，使其略显明亮。谷歌的Nest智能恒温器变成了家庭助手，可以听打鼾声来评估你的睡眠。同样重要的是，如果不是更重要，那就是谷歌认为值得获得监管部门的批准。这表明该公司打算让其产品不仅仅是有趣的消费小工具，实际上能够影响医学实践。

Google is also giving health records another whirl. The new initiative, called Care Studio, is aimed at doctors rather than patients. Google's earlier efforts in this area were derailed in part by hospitals' sluggishness in digitising their patient records. That problem has mostly gone away but another has emerged, says Karen DeSalvo, Google's health chief—the inability of different providers' records to talk to each other. Dr DeSalvo has been vocal about the need for greater interoperability since her days in the Obama administration, where she was in charge of coordinating American health information technology. Until that happens, Care Studio is meant to act as both translator and repository (which is, naturally, searchable).

谷歌也在给健康记录进行另一次尝试。这项名为Care Studio的新举措针对的是医生而不是病人。谷歌早期在这一领域的努力，部分是由于医院在数字化病人记录方面的迟缓而脱轨。谷歌的健康主管Karen DeSalvo说，这个问题大部分已经消失了，但另一个问题却出现了--不同医疗机构的记录无法相互交流。DeSalvo博士在奥巴马政府负责协调美国卫生信息技术的工作时，就一直在大声疾呼需要提高互操作性的问题。在这之前，Care Studio旨在充当翻译和存储库（自然是可搜索的）。

Alphabet"s AI projects are also beginning to produce results. Starting in 2010 DeepMind, a British startup bought by Google in 2014, used data from Britain's National Health Service (NHS) to create diagnostic tools, in one case training an ai algorithm to detect retinal diseases. It made headlines last year with AlphaFold, a groundbreaking piece of software that can predict the structure of proteins, which is responsible for many of the complex molecules' characteristics. Alphabet has also launched another subsidiary, Isomorphic Labs, which will be run by DeepMind's boss and use machine learning to build on AlphaFold to accelerate (and cheapen) drug discovery.

Alphabet的A（项目也开始产生结果。从2010年开始，谷歌在2014年收购的一家英国初创公司DeepMind，利用英国国家卫生服务机构（NHS）的数据来创建诊断工具，其中一个案例是训练一个人工智能算法来检测视网膜疾病。去年，它以AlphaFold成为头条新闻，这是一款可以预测蛋白质结构的突破性软件，它是复杂分子的许多特征的原因。Alphabet还推出了另一个子公司Isomorphic Labs，该公司将由DeepMind的老板管理，并利用机器学习在AlphaFold的基础上加速（和廉价）药物发现。

The most out-there part of Alphabet's health portfolio is an effort to slow the ageing process—or stop it altogether. The idea is that ageing should be viewed not as an immutable aspect of life but as a condition that can be managed and treated, or a problem that can be solved with the right technology. To that end one of Alphabet's life-sciences subsidiaries, Calico, is looking into age-related diseases in partnership with AbbVie, a big drug firm that has chipped in $2.5bn and which last year extended the deal until 2030. Another Alphabet subsidiary, Verily, is working with L'Oréal, a French beauty giant, to better understand how ageing impacts the biology of the skin—and thus create better skincare.

Alphabet的健康投资组合中最离谱的部分是努力减缓衰老过程，或完全停止衰老。这个想法是，不应该把老龄化看作是生命中不可改变的一个方面，而应该看作是一种可以管理和治疗的状况，或者是一个可以用正确的技术来解决的问题。为此，Alphabet的生命科学子公司之一Calico正在与艾伯维（AbbVie）合作研究与年龄有关的疾病，艾伯维是一家大型制药公司，已经投入了25亿美元，并在去年将交易延长至2030年。Alphabet的另一个子公司Verily正在与法国美容巨头欧莱雅合作，以更好地了解衰老对皮肤生物学的影响，从而创造更好的护肤品。

Inspiring stuff, to be sure. But obstacles remain. Some are technical. The data DeepMind got from the nhs proved hard for ai to digest. DeepMind's ai assistant for doctors, called Streams, is being discontinued. Given the strides being made in machine learning, it may be only a matter of time before something like Streams is resuscitated. Other hurdles may be harder to overcome. Trustbusters are increasingly wary of letting through deals that might be seen as stifling nascent competitors. In Europe competition authorities have forbidden Fitbit (but not the Pixel watch) from favouring Google's own phones and operating system, or from using user data to sell advertising. Governments also fret about privacy breaches, which is even more sensitive than usual when it comes to medical information. Last month plaintiffs filed a class-action lawsuit against DeepMind for misuse of nhs patient data. DeepMind has not made a public statement on the case.

可以肯定的是，这是鼓舞人心的东西。但是障碍仍然存在。有些是技术性的。DeepMind从NHS获得的数据被证明很难被AI消化。DeepMind为医生提供的人工智能助手，即Streams，正在停止使用。鉴于在机器学习方面取得的进展，像Streams这样的东西恢复起来可能只是时间问题。其他障碍可能更难克服。信托机构对通过可能被视为扼杀新生竞争对手的交易越来越谨慎。在欧洲，竞争管理机构禁止Fitbit（但不包括Pixel手表）偏向于谷歌自己的手机和操作系统，或使用用户数据来销售广告。各国政府还担心隐私泄露，当涉及医疗信息时，这甚至比平时更敏感。上个月，原告对DeepMind滥用NHS病人数据提起集体诉讼。DeepMind没有就该案发表公开声明。

Last, good ideas are not the same things as a good business. The wearables market is highly competitive. So, increasingly, is the one for electronic health records. Google's reputation for technical brilliance has not exactly made Care Studio into an overnight success; the system is reportedly used by just 200 or so clinicians. Verily, which besides solving ageing also offers various diagnostics, signed $50m-worth of contracts for covid-19 testing during the pandemic, a tidy sum but chump change next to Alphabet's total annual revenues of nearly $260bn. DeepMind as a whole reportedly turned a profit for the first time in 2020 (seemingly from selling services back to the rest of Alphabet) but it gives away its flagship health product, AlphaFold, for nothing. Calico could be years away from generating real revenues, let alone profits.

最后，好的想法和好的企业不是一回事。可穿戴设备市场竞争激烈。电子健康记录市场的竞争也越来越激烈。谷歌在技术方面的声誉并没有使Care Studio一夜成名；据说只有200名左右的临床医生在使用该系统。Verily公司除了解决老龄化问题外，还提供各种诊断方法，在大流行期间签订了价值5000万美元的covid-19测试合同，这是一笔不小的数目，但与Alphabet近2600亿美元的年度总收入相比，这只是小钱。据报道，DeepMind作为一个整体，在2020年首次实现了盈利（似乎是将服务卖回给Alphabet的其他部门），但它将其旗舰健康产品AlphaFold白白送出。Calico要产生真正的收入可能还需要几年时间，更不用说利润了。

These are open-ended bets that a company of Alphabet's size can absorb. Still, in the next decade the task will be to show they can graduate from being experiments and vanity projects to being transformative for the firm—and for Americans' health.

这些都是开放式的赌注，像Alphabet这样规模的公司可以吸收。然而，在未来十年，任务将是证明它们能够从实验和虚荣项目中毕业，成为公司和美国人健康的变革者。