Meta-morphosis: why doctors will need more patience to see the full potential of the metaverse

How do you talk to your doctor these days? Not so long ago, this question wouldn’t have even existed, as it was a given to simply book an appointment and head to the clinic. But the pandemic has made us increasingly comfortable with new ways of approaching healthcare – we are now self-testing, using online hubs and having all kinds of important conversations by video call. Of course, seeing your doctor in-person won’t end completely, but the medical world is changing.

Patient consultations are the traditional coalface of healthcare, but beyond them lies a world of actual and potential ways that the work of doctors, surgeons and clinical researchers may well transform. As we edge ever closer to a world of globally accessible spaces in the metaverse, decentralised data, augmented and virtual realities present opportunities for genuinely revolutionary change and are most definitely in the post, if not already at our doors.

Tristan Lawton is the Chief Clinical Officer at Canon Medical Research Europe, based in Edinburgh, which is a research and development centre that undertakes clinical research and uses it to realise cutting edge medical technologies. Together with Dr Ken Sutherland, the Company President, Tristan has been exploring the potential of metaverse technologies in a clinical context for some time and already sees some encouraging – and fascinating – developments. “As well as an increase in doctorless exams,” he says. “I believe the FDA [U.S. Food and Drug Administration] has also recently approved Virtual Reality for the treatment of chronic pain. I think this is quite interesting, as it moves people away from defaulting to drugs.”

However, to gain a sense of the true direction of travel for healthcare and the immense potential for change through the metaverse and its technologies, one needs to understand an unpleasant and fundamental truth about healthcare: “A lot of treatment analysis has been conducted in very skewed populations and largely based on white European men,” explains Dr Sutherland. “And that's a historic practice that we've got to shift, as it creates risk when treatments are rolled out to broader populations.” Dr Sutherland also makes the important point that treatments should not expect to be embraced where they have not received testing specific to the population. In this respect, opening clinical trials in a space that can be globally accessed does not just broaden the dataset, but lays the foundations for trust further down the line.

You might, however, be forgiven for drawing parallels with the world of crowdsourcing, as the idea of gathering volunteers in the metaverse to participate in a clinical trial certainly has more than a whiff of the Wikipedia model about it. But the costs ­– both financial and temporal – of taking trials from country to country have always limited this kind of exercise to only the most pressing diseases with the necessary funding (Covid 19 being the most recent example). Surely then, it can be nothing but positive to use the metaverse to draw the solution to the problem instead of vice versa. “Calls could be put out for certain demographics, for instance, or for specific kinds of clinical trials,” explains Tristan. Following the appropriate scrutiny, participants could have products or even drugs shipped directly to them, and results collected via virtual consultations, self-reporting or automatically through wearables. “Handheld ultrasounds exist and who's to say you can't do your own?” he speculates. “I believe there's even an ultrasound patch in development somewhere right now.”

Like all things metaverse, outcomes for medicine and healthcare are largely in the hands of the convergence of streams of progress, and that takes time. And while it is heartening to consider that the metaverse could be the trigger for a new world of diversity in clinical data, the reality is that a desire to contribute may directly be affected by economic forces. In short: nothing comes for free. “Everybody understands there's value in data but, at the moment, the person whose data it is has relatively little control over it. And I think that’s probably going to change,” says Tristan. In fact, there is an interesting theory under discussion in some corners of the internet that rapid advances in Artificial Intelligence will trigger the roll out of a Universal Basic Income, simply because it is assumed that it will automate people out of their jobs at a phenomenal scale. At the same time, it is speculated, Web 3.0 will drive the move to decentralise our data. That is, putting it back into the hands of individuals, using technologies such as the blockchain.

A potential outcome of such a meeting of circumstances might be that we, as individuals, become our own ‘side hustle’. We may find that we can sell our data for a “digital kickback”, as Tristan calls it, rather than freely handing it over, as we often do today. “You might have a certain trait that people are interested in investigating,” he explains. “And so, your uniqueness may be your future wealth. That's pure speculation, of course, but it’s certainly food for thought.” In the real world, we are also limited to being in one space at any given time. In the metaverse? Not so much. “Could a digital twin participate in clinical trials on our behalf?” asks Tristan. “Certainly. It’s the metaverse – they could even multiply.” Could our armies of selves be the future of true data diversity in metaverse-based clinical trials?

In a broader picture, access to data on a global scale for clinical studies would be a huge step towards a world where precision health becomes a reality, taking us from a reactive treatment approach to one where preventative and/or early detection interventions are possible. Of course, research and trials are just part of the picture, and any new knowledge and skills need to be introduced into an already vast library of clinical competencies through Continuous Professional Development. Education and training using Virtual Reality simulation technologies are quite commonplace across most industries today, but they are downright exciting in the medical field right now and this can only increase and improve. For example, Cambridge University have been trialling the use of Mixed Reality to train doctors in responding to emergency scenarios and deteriorating chronic conditions. According to their Faculty of Education, “Instructors will be able to share scenarios, change patient responses, introduce complications and record observations and discussions, while projecting the hologram via a mixed reality headset into any physical training environment.” Yes, you read that correctly – a hologram!

And while this all seems very dramatic and futuristic; the practical applications are quite straightforward. Tech-meets-common-sense, if you will. In an educational setting, VR is, as you might imagine, a safe way to learn new skills and try new approaches. But in live surgery, Augmented Reality overlays of medical images and data can also be a powerful aid. “These kinds of technologies remove distractions,” states Tristan. “Whether you're operating and it’s a very intricate surgery or concentrating on doing something from an educational perspective, being able to identify everything in the view, so you can focus and concentrate not only helps the clinician but also the patient.”

And from the patient perspective, the metaverse could represent a new kind of healthcare ecosystem where they can see quick results by consulting on common ailments in a trusted and automated way. To an extent, this is already happening, so patients are at least likely to be familiar with the concept. For example, the self-testing and treatment of Urinary Tract Infections through pharmacies has freed up a significant amount of time for doctors and this is a model that could easily transfer into the metaverse, using medical bots to assess symptoms, followed by automated shipping of self-testing kits and prescriptions. “If this prevents people waiting a few days for test results, then it can only be a good thing for doctors and patients,” says Tristan. “You’re just taking away the reproducible easily automated tests.”

But we cannot make assumptions about the global patient reach of healthcare in the metaverse, as this would ignore the current levels of global digital inequity. In November 2022, the UN Secretary General António Guterres’ made the point loud and clear at the G20, saying, “universal connectivity means reaching the 3 billion people who are offline, the majority of whom live in the Global South. We must close the digital divide by promoting digital literacy and giving access to the digital world to women and girls, migrants, rural and indigenous people.” Connecting and educating nearly half a world of people who live their lives completely offline is an undertaking that is intimidating in scale, and it simply cannot be predicted when – or if – it will happen.

However, what is known is the current situation for healthcare without the necessary digital infrastructure. Tristan tells of a group providing X-ray services to remote communities across Africa and who use expanding mobile phone networks to transmit data back to a central database. “When they go out into the community to do X-rays, they have to use 2.5G to send the data because the 3G doesn't work. It’s easy to talk about technology opening up endless opportunities, but is this just for the percentage of the world who are already online? And how do we give the people that can benefit most from it access to it?” And while the digital divide means that nearly 40% of the world may simply see no difference at all to their access to healthcare, it also means that these populations may also miss out on having their data included in important future clinical trials. And, as Dr Sutherland pointed out, these too are the people who will subsequently be less likely to engage with new treatments as a result. When you consider that the word ‘meta’ itself not only means ‘to transcend’ but ‘to transform’, it is a difficult pill to swallow that to achieve either at a truly global scale will take ‘trillions’.

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