Plenty of people in and around healthcare can’t wait for the advent of the metaverse. They picture a day, just a few years off, when patients will be able to strap on a (perhaps slightly less dorky) VR headset and gesture their way to improved outcomes.

They believe the impact will be greatest within patient communities, the peer-to-peer networks that have revolutionized healthcare. Enhanced education tools will let patients take deep 3-D dives into one another’s cancer cells and share ultra-realistic test results. Instead of typing their support or voicing it in a video, their avatar will be able to hold other members’ hands, offering a virtual shoulder to cry on.

Those most bullish on patient and disease communities in the metaverse point out that these groups have been the backbone of the internet since the 1990s, when listservs and other online forums began shattering the isolation of millions of patients. They argue that these communities will handle the next phase of tech evolution just fine.

And maybe they will. But others are deeply leery of ways the metaverse could destabilize platforms and, in the process, unsettle these vital communities. They worry that some of the problems that have plagued communities — online bullies, less-than-selfless pharmaceutical companies and tech platforms indifferent to abuses — may only intensify as Web 3.0 nears fruition.

Here, we round up both sides of the meta-meets-patients debate, starting with six glittering possibilities.

Patient education will take a radical leap forward

“The undeniable upside of the metaverse is that it will dramatically facilitate the understanding of procedures and it will increase understanding of disease fundamentals,” explains Olivier Chateau, CEO of Health Union, which operates 38 patient communities. “For example, I could give you a technical description of Crohn’s disease. But a good digital animation in 3-D will provide a far more realistic picture.”

Better-informed patients can make better decisions, improving their care.

It will better engage underserved populations

Chateau says that underserved patient groups present the most metaverse-tastic opportunities, given how hungry these individuals are for new and disruptive approaches. That holds especially true for communities devoted to neurological conditions, such as Parkinson’s and Alzheimer’s diseases.

“There are so many unmet needs in these patients,” he stresses. “We have to continue to improve the way we provide support to these people so that they can have a better quality of life.”

Chateau, who spent years at GlaxoSmithKline before founding Health Union, believes that might require companies to shift their focus, away from drugs themselves and toward engagements and offers that will help them forge more genuine relationships.

“Often, what these patients struggle with isn’t about a drug they take. They need large ecosystems to help them deal with their challenges,” he adds.

Adriana Krasniansky, a researcher at digital health venture fund and advisory firm Rock Health, agrees. She points to products from Akili Interactive, which makes digital medications for individuals with cognitive issues, as a prime example.

“We’re seeing the potential for calming or energizing therapies, and there are products aimed at developmental disorders,” she explains. “Anecdotally, I’ve seen a good number of digital health companies come in with cognitive assessments or cognitive support tools, supporting things such as sundowner’s syndrome in Alzheimer’s patients.”

It will significantly reduce patient anxiety

Chateau recently experimented with a travel company’s VR experience that allowed him to “visit” a hotel room. He could lay in the bed, check out the ocean view and meander around the suite.

“Imagine how beneficial that might be in medicine, allowing patients to see what procedures and treatments might be like before their appointments?” he asks rhetorically.

To that end, he references his wife’s work as an ophthalmologist. “Eye surgery freaks people out. If providers could reassure people with hyper-realistic demonstrations of what the surgery will look like, it could radically alter the patient experience,” he adds.

That knowledge and those experiences would then make their way into peer-to-peer conversations, potentially lowering anxiety levels even more.

Those who struggle with physical spaces will move freely

While people who have difficulty navigating physical spaces are already vocal in online communities, the metaverse may offer an even deeper digital connection to others. “That may be especially true for people with mobility issues and many older adults,” Krasniansky notes.

But she also sees greater possibilities for individuals who struggle with intense anxiety around other people in the real world — individuals who may not even feel at ease in online communities as currently configured. “People with issues around emotional regulation, for example, may feel they are able to engage in communities safely and more comfortably,” she says.

It will further enhance the power of visualization

Following a neck injury that left her despondent and nearly immobile, patient advocate BabbleOnBrooke used livestreaming to connect with other patients. She often did so while lying on a massage table with an iPad suspended over her head.

“Something that helped me as I recovered was repeatedly visualizing myself before the accident,” she recalls.

Once dismissed as New Age silliness, that kind of motor imagery has become a bedrock component of many types of physical rehabilitation. Because the metaverse will make hyper-realistic imagery much more personal and accessible, BabbleOnBrooke believes that sort of visualization, aided by simulated realities, will have greater healing potential.

“I imagine we’ll have tools that will help patients see themselves being able to do something they can’t quite accomplish yet — to see the things they’re working toward,” she says.

Patient communities may even create communal imagery, helping them move beyond condition-specific goals.

So long, stigma

Patients with health problems still seen as stigmatizing have been enjoying freedom from judgment on the internet for decades. That includes those with mental health issues and substance use disorders, certain cancers, erectile dysfunction and sexually transmitted diseases such as HIV and HPV. The potential for improving treatments is vast, and could include exposure therapy, psychedelic-assisted therapy and meditation.

“The data doesn’t yet exist to show if immersive technology makes a group therapy session more valuable,” Krasniansky acknowledges. But she believes the metaverse will allow for “higher value connections.” And the more valuable the connections, the more helpful and supportive a community can become.

Taking these communities forward into the metaverse will likely make the support feel even better, enabling greater recovery and less shame, Chateau adds.

Then there are the seven menacing threats:

The metaverse will increase online addiction, isolating people and driving depression

You don’t need to be a sci-fi fan to understand the widespread discomfort with a potentially dystopian future. A recent study of more than 1,000 online adults conducted by customer service platform provider Tidio found that 77% believe the metaverse will be bad for society, 47% say it will cause addiction to simulated reality and 41% think it will worsen an already growing mental health crisis.

“There is the potential for a negative impact on mental health,” Chateau admits. “There’s a risk of isolation and feeling that your metaverse world can understand you but not your real world.”

Health disparities are already profound. The metaverse will make them worse.

As tempting as it is to view cyberspace as a great democratic equalizer, it’s anything but. Whether the $300 price tag on many VR headsets or the rising cost of broadband, digital access isn’t cheap. And, as BabbleOnBrooke notes, many members of patient communities have extensive medical bills.

That disparity extends to providers. Poorer hospitals and regional facilities often have fewer digital tools at their disposal, so they are less likely to push them out to patients in their local communities.

All of which is to say: There’s already a digital literacy gap, and it’s not just about who has a smartphone and who doesn’t.

“If someone feels overwhelmed by a telemedicine visit, I can only imagine that being told to use a VR headset is even more frustrating,” Krasniansky says. “It’s one thing to be able to afford access to the metaverse, but many people are in situations where they won’t even hear of it.”

Patients’ privacy will be even more at risk

Because so much may look and feel different in this brave new digital world, pharma and other marketers will need to work harder to protect patients. “They’ll need to be 100% transparent,” Chateau stresses. “Many people click ‘agree’ and don’t really know what they’ve agreed to. That will escalate as new experiences emerge.”

Twinning, defined as creating a digital representation of a real-world person or thing, is one of Krasniansky’s favorite examples. It may emerge as the coolest patient-education tool to date, enabling a provider or drug company to create 3-D images from patient records. Fastest out of the gate has been Q Bio, whose Gemini platform combines patient vitals, scans, medical history and genetic test results to build whole-patient simulations. Then there’s Twin Health, a maker of digital twins based on focused metabolism, which patients can use to plan lifestyle changes that might prevent or reverse metabolic disease.

Because these are such breakthrough approaches, patients are bound to share them in community spaces. But twinning also presents a privacy conundrum.

“That digital twin I created with your data — is that still your data, since a company created it?” Krasniansky asks.

Avatar bullies will be scarier than trolls

Patient bullying and shaming is all too real, whether within in-person support groups or on Instagram, Facebook or livestreaming apps. That’s why many health technologists fear that the metaverse might intensify these encounters, especially among vulnerable populations.

The New York Times recently reported that in VRChat, a popular VR game, a “violating incident” (harassment, assault, bullying and hate speech) happens every seven minutes. The more realistic the metaverse becomes, the more upsetting all that groping, stomping, punching and name-calling will feel.

In real life, disabled people are already far more likely to be victims of hate crimes. Online, even otherwise lovely people can quickly devolve into trolls. Add a little 3-D and the promise of complete anonymity? Yikes.

It will amplify the impact of health misinformation, especially among vulnerable patients

COVID-19 has provided a terrifying test case for the acceleration of the spread of health misinformation on social media, with platforms reluctant and/or unable to slow it.

Since the metaverse promises to be even more immersive, it potentially offers acres upon acres of fertile ground in which misinformation might take hold. And when inaccurate or misleading health information is dispensed by life-like avatars in friendly patient communities, well, how hard will it be to resist?

It will fuel contempt for brands

It seems likely that consumers will hate brands in the metaverse as much as they do in the real world. To that point, research firm Forrester says it detects plenty of consumer skepticism about the metaverse.

Only 34% of U.S. online adults are excited about what the metaverse will offer, while only 14% believe brands should deliver experiences there. Since 76% of the marketers Forrester polled are planning metaverse moves, the still-theoretical space could eventually be as full of annoying and unwanted ads as every other platform.

It will always fail the empathy test

One of the best things about Web 3.0, boosters say, is its potential to use data to make every experience more personal, responsive and rewarding. But to long-time members of patient communities, that’s an empty promise.

Humans have always provided and will always provide the best human-to-human support, Chateau notes. “Does Alexa understand what it feels like to have cancer come back when it had been in remission?” he asks.

Patient groups thrive because they address frailty and illness beyond shared experiences with medications, protocols and treatments. “How do you cope with the condition? How do you relate? These groups serve the emotional side.” Chateau continues.

On balance, BabbleOnBrooke believes the metaverse will ultimately make virtual patient communities stronger and more diverse. Every time technology presents a new solution, she points out, skeptics are quick to play up its potential drawbacks.

“Livestreaming saved my life when I was suicidally depressed. I needed that community,” she says.

Yes, she expects to encounter bumps and bullies. “But that’s been the case with any platform, and we keep moving forward,” she continues. “The good is going to outweigh the bad.”

Besides, she notes, had she listened to the tech-skeptical individuals in her life, her story might have had a different ending: “I don’t think I’d be here.”