麻省理工技术评论：颠覆性创新与未来科技洞察

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"麻省理工技术评论 - 2012年01-02期" 这期的《麻省理工技术评论》涵盖了多个领域的创新和技术应用，包括商业影响、颠覆性创新以及麻省理工对科技未来权威见解的讨论。其中涉及到的具体文章包括： 1. **麻醉的神秘**（The Mystery of Anesthesia）：该文章可能深入探讨了麻醉这一医学领域的最新研究，可能涉及如何在手术中安全有效地使用麻醉药物，以及麻醉背后科学原理的新发现。 2. **数据拯救叛军**（Rescuing Rebels with Data）：这个主题可能关注的是如何利用数据分析来帮助那些处于困境中的人，比如战争地区的反抗者，可能是通过数据科学来提升他们的生存和行动能力。 3. **扔掉这款相机**（Throw This Camera）：这篇文章可能介绍了一种革命性的新型相机技术，鼓励读者抛弃传统观念，拥抱创新的摄影方式，可能是关于无反光镜相机、全景摄影或即时分享技术的进步。 4. **教人捕鱼，而非给予鱼**（Teaching a Man to Fish Is Humanly Possible）：这部分内容讲述了在灾难过后，如印度泰米尔纳德邦的海啸，如何通过职业教育帮助渔民转行，尤其是他们如何通过学习图形设计技能，实现收入的大幅增长，揭示了技能培训对于劳动力转型的重要性。此外，杂志还关注了美国制造业的困境及其对创新未来的影响，指出美国制造业的衰落不仅对经济构成威胁，也可能影响到技术创新的步伐。文章《Can We Build Tomorrow’s Breakthroughs?》可能探讨了如何重振美国制造业，以及这对全球科技创新的意义。另一篇《The Chinese Solar Machine》提到了中国太阳能公司在市场上的主导地位，可能分析了这些公司如何崛起，以及它们对全球太阳能产业和绿色能源发展的潜在影响。每一期的《麻省理工技术评论》都是对未来科技趋势的深度洞察，提供了对全球范围内科技进步、商业策略和创新实践的全面分析，是了解世界科技动态的重要参考资料。通过访问其网站www.technologyreview.com，读者可以获取更多相关信息和深入报道。

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CENTURY

HEALTHCARE:

From e-health to personalized medicine

photo courtesy of indra

The world of health-care information is moving online, as

governments around the world wrestle with how best

to manage and improve the health care of their citizens

efciently, effectively, and securely. And Spain is one of the

countries leading this effort.

Spain began its electronic health record (EHR) initiative in the region

of Andalusia, implementing EHRs for 8 million people. This effort

has since been expanded to other regions of the country, and the

regional health records are now being integrated at the federal level.

By 2010, more than 95 percent of primary health-care providers

across Spain had used the electronic records.

In 2005, the Spanish government began implementing electronic

prescriptions as well, and by 2010 more than 250 million prescrip-

tions were being submitted electronically to pharmacies, placing Spain

among the top nations in the world for utilization of these technolo-

gies. In the regions where these e-prescriptions are employed, visits to

primary care physicians have decreased by about 15 percent. “Years

ago, a chronic patient had to go to the pharmacy every week, and had

to go to the primary care doctor just to get that weekly prescription,”

says Pablo Rivero, director of international e-health development for

the Spanish Association of the Information and Communications

Technology Industry (AMETIC in Spanish). “Now, the patient can

simply go directly to the pharmacy.” This change has saved signi-

cant cost as well as time.

Managing health-care expenses is a key goal of the Madrid-based

consulting company everis; everis is one of the top two companies

in Spain in experience with EHR and personal health records, and its

solutions cover more than 20 million users. The company’s engineers

are now working to improve chronic disease management. “Chronic

patients consume about 50 percent of the global health budget,” says

everis business director Santiago Martín.

But the management of different diseases demands different plans,

so everis has developed solutions for a number of tasks. First, its

software segments a population by sufferers from each disease to be

managed, such as diabetes, cardiovascular disease, and lung diseases.

Then, for a given disease, the software classies the population fur-

ther, depending on the level of care required, and denes the care

needed and the technology solutions that can help meet those needs.

For instance, one diabetes patient may require only an interface that

allows her to upload her weight daily; this can be integrated with a

tablet or mobile phone. A more seriously ill patient may require addi-

tional technologies, such as advanced sensors for evaluating health

outcomes. Martín explains that this segmentation avoids the expense

of automatically installing a wide range of health-care technologies

in every patient’s house.

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Everis began implementing its telemedicine and chronic-care

solutions in Spain in 2011, and is working with public health admin-

istrations to determine the level of cost savings. Martín says thus

far the range of savings for chronic patients is 20 to 40 percent

over traditional care.

Indra is also investigating the management of long-term chronic

patients through a new center in Toledo, near Madrid. The com-

pany’s engineers are working with the local health-care agency to

dene the resources and services its patients need, along with the

most useful interfaces for the patient and health-care provider. A

pilot project involving some 80 thousand individuals will soon be

rolled out.

In Andalusia, the region is moving toward the beginning of the

next stage, implementing access to electronic health records on

mobile devices. The care providers in an ambulance, for example,

will be able to access a patient’s records via a tablet or mobile

phone, incorporate the information into the patient’s care, and

then update the record for the hospital.

According to Rivero, the key to Spain’s success has been the inte-

gration of clinicians into all levels of planning: “It’s most important

to involve health professionals from the very beginning. It’s not a

100 percent technological project; it’s a change in the process of

how health care is delivered.”

Madrid-based Oesia has developed specialized software for hos-

pitals and regional and federal health-care administrations, and is

moving into the realm of articial intelligence with a computer-

ized clinical guide. As the doctor types information about a par-

ticular patient’s condition, for instance, the guide may suggest that

a certain scan is not necessary, based on the experiences of other

patients. The doctor can then accept that decision, or override it

and explain why, leading the system to learn a new pattern.

Among other tasks, the software will be able to synthesize the

data from existing patient records, and point out why a particular

medication may conict with the patient’s other medications. “The

doctor still has the nal say,” says Arnaud Marivain, director of

the Oesia health business unit. “But in an emergency, or perhaps

if someone is tired, there can be mistakes. This will help ensure

the security of the patient.”

This product has been in development for the past year and

should be out by the end of 2012.

TRANSFERRING EXPERIENCE OVERSEAS

The Spanish government and Spanish companies are taking their

experience in e-health overseas, according to Rivero. “We believe

that international collaboration is key for e-health development, to

share information and best practices and to create a real network

of international collaborators,” he explains.

Madrid-based Indra proposed to develop and operate a com-

prehensive system for Bahrain’s entire national health-care system

network over the course of the next 11 years. The proposal was

accepted based on the company’s IT experience in the Spanish

health-care system. The rst step, says Diego García, Indra’s direc-

tor of health, will involve creating and sharing electronic records

and clinical and administrative management systems. The second

will include adding e-health functionalities such as telemedicine.

In addition, Indra is working with the European Space Agency

(ESA) on a telemedicine project in sub-Saharan Africa; the ESA

is involved in projects that expand the reach of the agency’s space

technology (such as satellite communication) here on Earth. The

feasibility study began in Senegal, focusing on basic needs such

as the tools for videoconferencing, including a satellite dish, a

modem, and electricity (using renew-

able energy such as wind or solar if

necessary). The prototype will allow

health-care providers to confer with

clinicians around the world, provide

a model for e-learning, and facilitate

EHRs. The results of the basic needs

study were presented in the fall of

2011, and the pilot program has begun in Senegal and Kenya.

GMV has also developed telemedicine for overseas communi-

ties, as part of a comprehensive platform for telemedicine that can

range from the most simple conguration—a face-to-face con-

sultation via webcam between a rural or homebound patient and

a distant doctor—to a complex system that allows data from any

type of device to be transmitted and reviewed. This project is the

latest for the engineering company, which has decades of experi-

ence in the aerospace sector; based on its experience with NASA

and the ESA, the company has applied its engineering expertise to

health care in products including medical simulations and EHRs.

GMV has set up a telemedicine platform at a soccer stadium in

Cartagena, Columbia, which is networked with ve hospitals; the

company is now expanding in Latin America and Africa.

Though the eventual goal is to offer such services in Spain (and

other developed countries) as well, particularly in intensive-care

units where there’s a dearth of specialists and a need for immediate

specialized care, Carlos Royo, director of business development,

expects this will take off rst in poor countries. “It’s a paradox,

but it’s actually cheaper and more efcient to jump to the best,

most advanced technology there,” Royo points out. It’s cheaper

than, for instance, building a new hospital, even as telemedicine

can afford patients a high level of care.

“In the past, I used to talk about the cost of telemedicine.

Now I talk about how quickly a government will receive a return

photo courtesy of indra

“We believe that international collaboration

is key for e-health development, to share

information and best practices and to create

a real network of international collaborators.”

Spain_health_mag.indd 2 12/2/2011 1:54:05 PM

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PHOTO COURTESY OF INDRA

on investment,” through savings in transportation costs and in

overall improved care for citizens, Royo continues.

PERSONALIZING MEDICAL CARE

The adoption of EHRs facilitates the move towards personalized

medicine, points out Indra’s García: “We believe that personal-

ized medicine will be used in the future—and what’s required is

IT.” Indra is participating in research projects that examine how

health records software could gather all relevant information,

including the patient’s genetic pro le, to tailor a particular diag-

nosis or treatment. The company has also initiated research into

personalized medicine, beginning with an oncology project that

analyzes samples and data from 1,000 patients suffering from

two types of cancer.

Part of the hope for personalized medicine is to ful ll the prom-

ise of matching the correct treatment to every patient. Not every

patient will respond to every option, so clinicians at times cycle

through a number of potential medications, or combinations of

medication, before hitting on one that works.

In response, Vivia Biotech has developed a technology that eval-

uates the most popular combinations of drugs to treat blood can-

cers (leukemias, lymphomas, and myelomas). “In blood cancer[s],

doctors always give a cocktail of drugs to treat a patient, but there’s

nothing on the market to predict how the patients will respond

to those four or  ve drugs,” says Juan Ballesteros, chief scienti c

of cer. “We’re the  rst to do that.”

The company’s technology, called ExviTech, consists of a plat-

form that can rapidly analyze thousands of biological samples (such

as blood samples in combination with medications) in 48 hours.

For blood cancers, Vivia Biotech has taken the 18 most popular

drug protocols already in use. The patient’s blood is treated with

each medication combination, which is then ranked by how many

tumor cells that protocol kills. Says Ballesteros, “Our hope is not

to cure the disease, but to reduce it to being chronic, by quickly

 nding the right drugs that kill the most tumor cells.”

The system is undergoing validation testing in Spain and the

United Kingdom. The results are positive, according to Balleste-

ros—though yet unpublished—and as a result one regional health-

care agency in Spain has agreed to initiate a pilot project for all

diagnosed blood cancers. Though a test might cost $1,000, the

savings it offers could leap to the tens of thousands by avoiding

unnecessary and expensive drugs. Its cost-effectiveness will also

be evaluated during the partnership with the health-care agency,

and Vivia Biotech expects the tests to be on the market in 2012.

Barcelona-based AB-Biotics has also developed a technology to

determine a given patient’s response to drugs, and has focused on

those used most widely to treat psychiatric and neurological diseases.

A DNA chip called Neurofarmagen analyzes the patient’s saliva

for genetic variations—published in the scienti c literature or

researched at the company’s laboratory—that indicate responses

to different drugs. “Some of the variations have to do with the

metabolism of the drug, or with the therapeutic target, or with the

patient’s own biochemistry that could affect the intake and process-

ing of that drug,” says CEO Miquel Angel Bonachera.

The company launched its  rst product, Neurofarmagen, in

2010; it is used for depression, schizophrenia, bipolar disorder,

and epilepsy. Further products include Neurofarmagen Epilepsy

and Neurofarmagen ADHD. Because of their success in Spain,

AB-Biotics is preparing a plan to sell these products abroad,  rst

targeting the U.S. market.

Advances in e-health and telemedicine will enable

higher quality and more cost-effective health care.

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REFINING BLOOD TYPES

Current tests de ne blood type as A/B/O and Rh positive or nega-

tive, but some racial groups share a variety of more obscure vari-

ants, explains Antonio Martinez, CEO of Bilbao-based Progenika.

African and Asians, for instance, might be negative for more rare

antigens. These do not cause a problem when someone needs a

single blood transfusion and receives antigen-mismatched blood;

chronic patients, however, will eventually develop antibodies and

suffer allergic reactions if the blood donor is not an exact match.

Most blood banks currently accept the fact that some patients will

live with these antigen-induced complications. Says Martinez, “We

want to avoid this problem by supplying patients with the perfectly

matched blood from the very beginning.”

So Progenika developed a DNA chip to identify whether a

patient or blood donor is positive or negative for these blood

types (their names include RHCE, Kell, Kidd, and Duffy). The

test identi es 23 single-nucleotide polymorphisms, or SNPs, and

labels them with  uorescent molecules. The DNA blood-typing

chip, available since 2008, has already been adopted in blood banks

across Europe.

For the U.S. market, Progenika identi ed SNPs related to sickle-

cell anemia. The company has already begun selling in the U.S., and

recently signed an agreement with Novartis to sell Progenika prod-

ucts in the U.S. The company is now utilizing the same technology

to identify markers for cancers, beginning with prostate cancer.

UNCOVERING TRACES OF DISEASE

Another hope of advanced personalized biotechnology is that new

techniques will employ genomic sequencing to detect early mark-

ers of a disease, or a patient’s genetic predisposition to a disease.

Madrid-based BlackBio developed a DNA biosequencing tech-

nology that improved the speed and accuracy of sequencing, then

moved into the realm of diagnostics. Instead of focusing on a

patient’s entire genome, BlackBio targeted a handful of SNPs that

indicate a patient’s likelihood of, for example, developing Type 2

diabetes. Says Gemma García, deputy general manager, “This is

quite an important approach for personalized medicine. If you

have a high genetic risk of diabetes, you can take preventive steps:

change your diet, exercise, try not to gain weight, get your blood

pressure under control.” The test is done using a simple oral swab.

BlackBio began validating the kit with a hospital in Madrid in Sep-

tember 2011.

In addition, BlackBio is teasing out the identi cation of a variety

of diseases. Sepsis, a whole-body infection, can be both fast acting

and deadly. Traditional microbiology to determine the source of

an infection can take from 48 hours to a week, but the diagnostic

kit developed by BlackBio can identify the bacterial source of an

infection in only eight hours.

Two Catalonia-based companies, Oryzon and Reig Jofré Labora-

tories, the former a specialist in biomarkers and early diagnosis and

the latter a larger, more traditional pharmaceutical company, have

teamed up to offer a minimally invasive test to predict the occur-

rence of endometrial cancer. This cancer, after breast cancer the

second most common among Spanish women, can appear at the

same time as menopause, and a woman’s irregular bleeding could

result from either state. “Ninety- ve percent of the time, the bleed-

ing is purely natural,” explains Ignasi Biosca, CEO of the Reig Jofré

Group. “But in  ve percent of the cases, the bleeding is related

to endometrial cancer. It’s important to catch that  ve percent.”

Current tests demand a multistep process and are both expen-

sive and invasive, involving sampling the uterine wall. And Carlos

Buesa, CEO of Oryzon, says that “clinicians wanted something

simple that could be done on the patient’s  rst visit,” without anes-

thesia. In response, the companies developed a test to evaluate

genes found in the mucus on the uterine lining. Following a swab

test, the technology can pick up the markers of  ve genes that are

over-expressed in the presence of endometrial cancer.

Oryzon and Reig-Jofré have conducted a clinical trial with 16

Spanish hospitals, comparing the swab test to actual results of the

current multistep diagnostics for tissue samples from 500 women.

The results, presented in September 2011, demonstrate 97% accu-

racy and compare favorably to current techniques, but these are

available in a dramatically shorter time frame and at a signi cantly

reduced cost.

Buesa says that Oryzon’s  rst product showcases the company’s

promise in diagnostic and personalized medicine, as the biomarker

discovery platform demonstrates. Buesa continues, “We want to

become a leader in molecular diagnostics, with specialization in

genomics, proteomics, and bioinformatics.”

PHOTO COURTESY OF PROGENIKA

Progenika’s blood-typing technology can distinguish

among more obscure variants to ensure that patients

receive perfectly matched blood.

Spain_health_mag.indd 4 12/2/2011 1:54:09 PM

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