Health data and privacy--Looking without looking

经济学人6月刊

The pandemic has sparked a new way to study sensitive medical records

ON MAY 7TH an article appeared on medRxiv, an online repository for medical research. It showed, for England at least, the degrees to which SARS-CoV-2, the virus that causes covid-19, discriminates in its deadliness between various groups of people. Men are more likely to die than women. The old and the socially deprived more likely than the young, well-off and well-connected. Those with uncontrolled diabetes or severe asthma, more likely than those without. And members of the country’s ethnic minorities more likely than those of its white majority.

medRxiv医学预印本：是由美国冷泉港实验室、BMJ和耶鲁大学联合运营的免费的、非营利性服务平台。所有医学研究论文初始版本都可以以预印本方式在该平台免费发布，从而能实现科研成果及时地传播，并获得及时的反馈用以改进研究，因此许多学者对其寄予了期望。

repository  n. /rɪˈpɒzətri/ 1.仓库；贮藏室；存放处 2. 学识渊博的人；智囊；知识宝典

discriminate v.   /dɪˈskrɪmɪneɪt/  1.~ (between A and B)~ A from B  区别；辨别；区分

2.[ V ] ~ (against sb)~ (in favour of sb) to treat one person or group worse/better than another in an unfair way 区别对待；歧视；偏袒

Deadliness /'dedlinis/ n. 致命；深仇大恨；不共戴天  asthma n.  /ˈæsmə/  气喘；哮喘

deprived adj.  /dɪˈpraɪvd/  贫穷的；贫困的；穷苦的

• a deprived childhood/background/area 贫穷的童年╱出身╱地区

• economically/emotionally/socially deprived 经济困难的；感情失落的；社会遗弃的

None of these, even the first (for men are more vulnerable than women to quite a wide range of infections), is exactly a surprise. Even the finding that current smokers actually have a lower risk of death from the illness than do non-smokers, though superficially arresting, is in line with the results of other studies that used different methods—though a possible protective effect on asthma patients of steroid inhalers looks worth following up. But the actual results of this study are not really the remarkable thing about it. That, according to its lead author Ben Goldacre, a clinician and data scientist at the University of Oxford, is the method of analysis by which they were obtained. Instead of extracting sensitive patient records from the databases of the company which manages them on behalf of general practitioners (GPs, Britain’s network of family doctors), the team behind the paper developed a suite of software that lets them run their massive analysis on the data in situ.

superficially /ˌsuːpəˈfɪʃəli; ˌsjuːpəˈfɪʃəli/ 表面的，浅薄的

Arresting adj. 醒目的；引人注意的  steroid n. /ˈsterɔɪd/类固醇；[有化] 甾族化合物 

inhaler n. /ɪnˈheɪlə(r)/. [临床] 吸入器；空气过滤器；吸入者

in situ adv. /ˌɪn ˈsɪtjuː/  in the original or correct place 在原位；在原地；在合适的地方

The research was carried out by studying the medical records of some 17m people on the books of GPs in England and the 5,683 covid-attributable deaths therein. GPs are the first port of call in England’s National Health Service (NHS) for any non-emergency matter, and thus hold the most complete records of patients’ health. Studying these at this scale and degree of detail, with individual records linked up to causes of death, has never been done before. Merely making plans to meddle with such primary-care data has been a cause of great national concern in Britain in the past. Dr Goldacre’s research was possible only because of the incentives created by the pandemic, and the ingenuity of the group of epidemiologists and data scientists he assembled, who call themselves the OpenSAFELY Collective.

attributable  adj. /əˈtrɪbjətəbl/  ~ to sb/sth probably caused by the thing mentioned 可归因于；可能由于 • Their illnesses are attributable to a poor diet. 他们的病可能是不良饮食所致。

there·in adv. 在那里，在其中（指提及的地点、物体、文件等）

Meddle with: 瞎弄；乱动  incentive  n. /ɪnˈsentɪv/ n. 动机；刺激 adj. 激励的；刺激的

In normal circumstances, merely obtaining permission to look at such a trove of sensitive health data would take months, perhaps years, of jumping through hoops held by ethics committees, computer-security checkers and so on. Running the analysis and getting it published might take months more. These are not, though, normal circumstances, and in fact it took OpenSAFELY a mere 42 days to go from idea to publication.

trove /trəʊv/==treasure trove （有价值或令人喜爱的）藏品；无主财宝，埋藏物；宝库

Three factors made this pace possible. The first is the existence of notices, signed by the country’s health minister, Matt Hancock, which give a wide range of people within the NHS broad licence to have access to and process health data in connection with fighting covid-19. These Control of Patient Information (COPI) notices make it much easier to get data wrangling done.

wrangle  /ˈræŋɡl/  ~ (with sb) (over sth)~ (between A and B) an argument that is complicated and continues over a long period of time （长时间的）争论，争吵

Numerous people close to the government’s digital efforts to fight the disease tell tales of COPI notices being waved in the faces of anyone who offers resistance to a particular data transfer. The OpenSAFELY team was acting on behalf of the NHS, and so had the power of the COPI notice behind its actions, speeding its way.

More important though, was the political heft arrayed under the OpenSAFELY banner. Academic expertise on electronic health records was provided by a team at the London School of Hygiene and Tropical Medicine, renowned for such work. The nitty gritty was covered by the Phoenix Partnership (TPP), a British company which stores, on behalf of GPs, the electronic health records of some 50m people. And Dr Goldacre himself is one of Britain’s foremost medical glitterati. He was once a columnist on a national newspaper and has nigh-on half a million followers on Twitter. His personal brand completed the picture, along with the data scientists and coders at his Evidence-Based Medicine DataLab in Oxford.

array n. 数组，阵列；排列，列阵；大批，一系列；衣服 vt. 排列，部署；打扮

renown n. /rɪˈnaʊn/  名誉；声望• He won renown as a fair judge. 他赢得了公平裁判的荣誉。• a pianist of some/international/great renown 具有一定╱国际╱相当知名度的钢琴家

glitterati n. /ˌɡlɪtəˈrɑːti/  (used in newspapers) fashionable, rich and famous people （报章用语）时髦人物，风云人物，知名人士

nigh adv. /naɪ/  1.~ on ( old-fashioned ) almost; nearly 几乎；差不多 •They've lived in that house for nigh on 30 years. 他们在那所房子里住了差不多30年了。 2.( old use ) ( literary ) near 靠近；近 •Winter was drawing nigh. 冬天快到了。

The most important component of OpenSAFELY’s success, though, was its approach to the records themselves. It did not try to copy them, or move them out of TPP’s data centre for processing. Instead, its coders wrote software which let them perform their analysis within that data centre. Even then, Dr Goldacre’s crew were not given free rein to poke around inside TPP’s systems. Instead they wrote a series of programs which let them interrogate the patient records through a secure connection. A log was also kept of all queries that the group ran on the records—thus the watchers were themselves watched.

crew /kruː/  

1.（轮船、飞机等上面的）全体工作人员 •crew members 全体机务人员

2.（轮船、飞机等上面不包括高级职员的）全体船员，全体乘务员 •the officers and crew 负责人员和全体乘务员

3. 技术人员团队；专业团队 •a film/camera crew 电影摄制组；摄制组 •an ambulance crew 救护车急救组

4.一群（或一帮、一伙）人 •The people she invited were a pretty motley crew (= a strange mix of types of people) . 她邀请的人相当混杂。

5.[ C+sing./pl.v. ] a team of people who row boats in races （赛船的）划船队员，划船队 •a member of the Cambridge crew 剑桥大学划船队的队员

6. 赛艇运动 •I'm thinking of going out for crew this semester (= joining the rowing team). 这学期我打算参加赛艇队。

Free rein n. 完全的行动自由     poke arround: 闲逛

inter·rogate v.   /ɪnˈterəɡeɪt/  

1.to ask sb a lot of questions over a long period of time, especially in an aggressive way 讯问；审问；盘问 •He was interrogated by the police for over 12 hours. 他被警察审问了12个多小时。

2.( technical 术语 ) to obtain information from a computer or other machine （在计算机或其他机器上）查询，询问