To the Editor: The metaverse is a virtual environment merging physical and digital realities.1 Once the thing of movies, metaverses are tipped to be worth $800 billion by 2024.2 They have potential to revolutionise digital health care delivery, access, education, and patient outcomes.3 Artificial intelligence (AI)‐enabled health care, with metaverse enhancement, could create virtual hospitals,4 transform clinical workflows and accelerate the diagnosis and treatment of conditions relating to mental health,5 cardiology,6,7 ophthalmology,8 and oral health,9 for example.
AI‐enabled technology demonstrated potential during the pandemic by predicting the incidence of coronavirus disease 2019 (COVID‐19)10 and helping to identify sites for vaccine trials.11 Yet in the absence of strong national and global health governance and accountability mechanisms, digital health ecosystems create risk for medical confidentiality and privacy breaches12 resulting in data sharing13 and use/reuse by corporations or governments outside its intended purpose and the bounds of patient consent.14 For example, a National Health Service (NHS) Foundation Trust in the United Kingdom established patient data sharing with the international technology company DeepMind to develop machine learning‐based management tools,15 but British patient data moved to the United States when Google acquired DeepMind.14 Repurposing health‐related biometric and genomic data that cannot be altered is similarly concerning, and can result in racial profiling16 and privacy violations in the absence of appropriate legislation.
Metaverses also have potential to accelerate discriminatory practices. Bias may be embedded in data used to train AI models through lack of community representation or participation.17 Structural inequalities may be reflected in health care datasets, creating risk for discriminatory outcomes.18 For instance, racial bias in a health care therapy algorithm resulted in the discriminatory underestimation of health risk for millions of American citizens, precluding access to vital treatments.19
Prioritising protections for underserved populations and their right to access safe virtual health care is crucial,20 especially for Australians at the intersection of inequities driven by poverty, disability, gender, homelessness, Indigeneity, and for the 11% highly excluded from accessing digital technologies.21 We recommend that the Department of Health and the Australian Digital Health Agency partner with the Australian eSafety Commissioner's work examining metaverse deployment,2 to ensure the highest ethical standards are upheld as planning moves forward and regulatory frameworks are developed.
- 1. Lee LH, Braud T, Zhou P, et al. All one needs to know about metaverse: a complete survey on technological singularity, virtual ecosystem, and research agenda [website]. arXiv [cs.CY], 2021. http://arxiv.org/abs/2110.05352 (viewed Aug 2022).
- 2. eSafety Commissioner. Will the peril outweigh the promise of the Metaverse? [website]. https://www.esafety.gov.au/newsroom/blogs/will‐peril‐outweigh‐promise‐metaverse (viewed Aug 2022).
- 3. Chen D, Zhang R. Exploring research trends of emerging technologies in health metaverse: A bibliometric analysis. SSRN Journal 2022; https://doi.org/10.2139/ssrn.3998068.
- 4. Marr B. The amazing possibilities of healthcare in the metaverse. Forbes 2022; 23 Feb. https://www.forbes.com/sites/bernardmarr/2022/02/23/the‐amazing‐possibilities‐of‐healthcare‐in‐the‐metaverse/?sh=3127d1d19e5c (viewed Aug 2022).
- 5. Usmani SS, Sharath M, Mehendale M. Future of mental health in the metaverse. Gen Psych 2022; 35: e100825.
- 6. Mesko B. The promise of the metaverse in cardiovascular health. Eur Heart J 2022; 43: 2647‐2649.
- 7. Skalidis I, Muller O, Fournier S. CardioVerse: the cardiovascular medicine in the era of metaverse. Trends Cardiovasc Med 2022; https://doi.org/10.1016/j.tcm.2022.05.004 [Epub ahead of print].
- 8. Tan TF, Li Y, Lim JS, et al. Metaverse and virtual health care in ophthalmology: opportunities and challenges. Asia Pac J Ophthalmol (Phila) 2022; 11: 237‐246.
- 9. Albujeer A, Khoshnevisan M. Metaverse and oral health promotion. Br Dent J 2022; 232: 587.
- 10. McCormick J. How AI spotted and tracked the coronavirus outbreak. Wall Street Journal 2020; 6 Feb. https://www.wsj.com/articles/how‐ai‐spotted‐and‐tracked‐the‐coronavirus‐outbreak‐11580985001 (viewed Aug 2022).
- 11. Castellanos S. How AI played a role in Pfizer's COVID‐19 vaccine rollout. Wall Street Journal 2021; 1 Apr. https://www.wsj.com/articles/how‐ai‐played‐a‐role‐in‐pfizers‐covid‐19‐vaccine‐rollout‐11617313126 (viewed Aug 2022).
- 12. Murdoch B. Privacy and artificial intelligence: challenges for protecting health information in a new era. BMC Med Ethics 2021; 22: 122.
- 13. Oxford E. Hundreds of patient data breaches are left unpunished. BMJ 2022; 377: o1126.
- 14. Vincent J. Privacy advocates sound the alarm after Google grabs DeepMind UK health app. The Verge 2018; 14 Nov. https://www.theverge.com/2018/11/14/18094874/google‐deepmind‐health‐app‐privacy‐concerns‐uk‐nhs‐medical‐data (viewed Aug 2022).
- 15. Iacobucci G. Patient data were shared with Google on an “inappropriate legal basis,” says NHS data guardian. BMJ 2017; 357: j2439.
- 16. Hvistendahl M. Mass resignations at scientific journal over ethically fraught China genetics papers. The Intercept 2021; 5 Aug. https://theintercept.com/2021/08/04/dna‐profiling‐forensic‐genetics‐journal‐resignations‐china/ (viewed Aug 2022).
- 17. Ibrahim H, Liu X, Zariffa N, Morris AD, Denniston AK. Health data poverty: an assailable barrier to equitable digital health care. Lancet Digit Health 2021; 3: e260‐e265.
- 18. Leslie D, Mazumder A, Peppin A, et al. Does “AI” stand for augmenting inequality in the era of COVID‐19 healthcare? BMJ 2021; 372: n304.
- 19. Obermeyer Z, Powers B, Vogeli C, Mullainathan S. Dissecting racial bias in an algorithm used to manage the health of populations. Science 2019; 366: 447‐453.
- 20. Beaunoyer E, Dupéré S, Guitton MJ. COVID‐19 and digital inequalities: reciprocal impacts and mitigation strategies. Comput Human Behav 2020; 111: 106424.
- 21. Thomas J, Barraket J, Parkinson S, et al. Australian Digital Inclusion Index: 2021 [website]. Melbourne: RMIT, Swinburne University of Technology, and Telstra; 2021. https://doi.org/10.25916/phgw‐b725 (viewed Aug 2022).
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