Digital health 数字健康

Psyber boom

Dramatic growth in mental-health apps has created a risky industry 

第一段：

When carolina escudero was severely depressed, going to a therapist’s office became hard to face. So she joined BetterHelp, a popular therapy app. She paid $65 each week but spent most of her time waiting for her assigned counsellor to respond. She got two responses in a month. “It was like texting an acquaintance who has no idea how to deal with mental illness,” she says. BetterHelp says its service does not claim to operate around the clock, all its therapists have advanced degrees and “thousands of hours of hands-on clinical work”, and users are able easily to switch them if scheduling is hard.

当卡罗琳·埃斯库德罗严重抑郁时，她很难去治疗师的办公室治疗。所以她加入了BetterHelp，这是一个流行的治疗应用程序。她每周支付65美元，但大部分时间都在等待指定顾问的答复。她在一个月内收到了两次回复。她说：“这就像给一个不知道如何应对精神疾病的熟人发短信。”BetterHelp表示，它的服务并不是全天候的，它的所有治疗师都有高学历，并且有“数千小时的实践临床工作经验”，如果某位治疗师的时间冲突安排困难，用户可以很容易地切换到另一位治疗师。

第二段：

Helping people to deal with mental problems has rarely been more urgent. The incidence of depression and anxiety has soared in the pandemic—by more than 25% globally in 2020, according to the Lancet, a medical journal. That, combined with more people using online services, has led to a boom in mental-health apps. The American Psychological Association reckons 10,000-20,000 are available for download. That, combined with more people using online services, has led to a boom in mental-health apps. But evidence is mounting that privacy risks to users are being ignored. No one is checking if the apps work, either.

帮助人们解决心理问题从来没有像现在这样紧迫。据医学杂志《柳叶刀》报道，2020年，抑郁症和焦虑症的发病率在疫情期间飙升了25%以上。再加上越来越多的人使用在线服务，使心理健康app繁荣发展。美国心理协会估计有1万-2万个app可供下载。但越来越多的证据表明，用户的隐私风险正被忽视。也没有人检查这些应用程序是否有效。

第三段：

Mental-health-tech firms raised nearly $2bn in equity funding in 2020, according to CB Insights, a data firm. Their products tackle problems from general stress to serious bipolar disorder. Telehealth apps like BetterHelp or Talkspace connect users to licensed therapists. Also common are subscription-based meditation apps like Headspace. In October Headspace bought Ginger, a therapy app, for $3bn. Now that big companies are prioritising employees’ mental health, some apps are working with them to help entire workforces. Now that big companies are prioritising employees’ mental health, some apps are working with them to help entire workforces. One such app, Lyra, supports 2.2m employee users globally and is valued at $4.6bn.

数据公司CBInsights的数据显示，心理健康技术公司在2020年筹集了近20亿美元的股权融资。他们的产品解决了从一般压力到严重双相情感障碍（也称躁郁症，见文末补充资料）的问题。远程健康app（如：BetterHelp或Talkspace）将用户与持证的治疗师联系起来。同样常见的还有基于订阅的冥想应用程序，如Headspace。10月，Headspace以30亿美元收购了治疗应用程序Ginger。现在，大公司正在优先考虑员工的心理健康，一些应用程序正在与他们合作，帮助全体员工。其中一款应用程序Lyra支持全球220万员工用户，价值46亿美元。

第四段：

Underneath, though, a traumalurks in some corners of the industry. In October 2020 hackers who had breached Vastaamo, a popular Finnish startup, began blackmailing some of its users. Vastaamo required therapists to back up patient notes online but reportedly did not anonymise or encrypt them. Threatening to share details of extramarital affairs and, in some cases, thoughts about paedophilia, on the dark web, the hackers reportedly demanded bitcoin ransoms from some 30,000 patients. Vastaamo has filed for bankruptcy but left many Finns wary of telling doctors personal details, says Joni Siikavirta, a lawyer representing the company’s patients.

然而，繁荣的背后，在这个行业的某些角落里潜伏着一种创伤。2020年10月，黑客黑进了芬兰著名初创公司Vastaamo，黑客们开始勒索其部分用户。Vastaamo要求治疗师在线备份患者记录，但据报道没有匿名或加密。据报道，这些黑客威胁要在暗网（见文末补充资料）上分享婚外情的细节，在某些情况下还想分享恋童癖的想法，他们要求约3万名患者支付比特币赎金。代表公司病人的律师乔尼·西卡维塔说，Vastaamo已经申请破产，但这件事情让许多芬兰人不敢告诉医生个人细节。

第五段：

Other cases may arise. No universal standards for storing “emotional data” exist. John Torous of Harvard Medical School, who has reviewed 650 mental-health apps, describes their privacy policies as abysmal. Some share information with advertisers. “When I first joined BetterHelp, I started to see targeted ads with words that I had used on the app to describe my personal experiences,” reports one user. BetterHelp says it shares with marketing partners only device identifiers associated with “generic event names”, only for measurement and optimisation, and only if users agree. No private information, such as dialogue with therapists, is shared, it says.

可能会出现其他情况。没有存储“情感数据”的通用标准。哈佛医学院的约翰·托罗斯审查了650个心理健康应用程序，他形容这些应用程序的隐私政策糟糕透顶。有些人与广告商分享用户信息。据一位用户说：“当我第一次加入BetterHelp时，我开始看到的定向广告，上面有我在应用程序上用来描述我个人经历的词语。”BetterHelp表示，它只与营销合作伙伴共享与“通用事件名称”相关的设备标识符，仅用于测量和优化，并且只有在用户同意的情况下才会共享。该公司称，没有共享私人信息，例如与治疗师的对话。

第六段：

As for effectiveness, the apps’ methods are notoriously difficult to evaluate. Woebot, for instance, is a chatbot which uses artificial intelligence to reproduce the experience of cognitive behavioural therapy. The product is marketed as clinically validated based in part on a scientific study which concluded that humans can form meaningful bonds with bots. But the study was written by people with financial links to Woebot. Of its ten peer-reviewed reports to date, says Woebot, eight feature partnerships with a main investigator with no financial ties to it. Any co-authors with financial ties are disclosed, it says.

至于有效性，众所周知，应用程序的方法难以评估。例如，Woebot是一种聊天机器人，它利用人工智能生产认知行为治疗的经验。该产品以临床验证的形式上市，部分基于一项科学研究，该研究得出结论，人类可以与机器人形成有意义的联系。但这项研究是由与Woebot有利益关系的人撰写的。Woebot说，在迄今为止的十份同行评议报告中，有八份是与一名主要调查人员的合作关系，而该调查人员与公司没有任何财务利益关系。公司称，任何有财务利益关系的合著者都会被披露。

第七段：

Mental-health apps were designed to be used in addition to clinical care, not in lieu of them. With that in mind, the European Commission is reviewing the field. It is getting ready to promote a new standard that will apply to all health apps. A letter-based scale will rank safety, user friendliness and data security. Liz Ashall-Payne, founder of ORCHA, a British startup that has reviewed thousands of apps, including for the National Health Service, says that 68% did not meet the firm’s quality criteria. Time to head back to the couch?

设计心理健康应用程序的目的是将他们用于辅助临床治疗，而不是代替临床治疗。考虑到这一点，欧盟委员会正在审查这一领域。它正准备推广一项新标准，该标准将适用于所有健康应用程序。基于字母的量表将对安全性、用户友好性和数据安全性进行排名。英国初创公司ORCHA的创始人莉兹·阿沙尔·佩恩说，68%的应用程序不符合公司的质量标准。（ORCHA审查了数千个应用程序，包括英国国家医疗服务。）是时候回到沙发上去了？（回到原点）