Cyberpsychology, Behavior, and Social NetworkingVol. 25, No. 12 EditorialFree AccessThe MetaPharmacy: What Happens When Big Pharma Goes Virtual?Brenda K. WiederholdBrenda K. WiederholdBrenda K. Wiederhold, Editor-in-ChiefSearch for more papers by this authorPublished Online:6 Dec 2022https://doi.org/10.1089/cyber.2022.29262.editorialAboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail In June of 2022, at the start of migraine awareness month, the maker of migraine medication Nurtec launched an interactive Twitter campaign that invited users to “#relieveyourfeed” of migraine triggers.1 Viewers of the ad were able to swipe to identify their migraine triggers and then tap to “find relief” by customizing their Twitter settings. For example, if someone was particularly sensitive to light, they could tap to adjust the brightness of their screen. Or, if stress was a trigger, the user could select that section of the ad to find a page that enabled them to mute distressing words so they no longer appeared in their feed. This “Twitter Takeover” ad appeared on every feed in the United States as the first promoted post on June 7, 2022.The company behind Nurtec—Biohaven—is one of a number of drugmakers who have embraced online technologies to educate consumers about their products and the medical conditions that they treat. Biohaven's strategy to promote Nurtec has infiltrated social media with celebrity endorsements, Instagram posts, YouTube videos, and even TikTok clips.1 However, Biohaven, in its eagerness to hop online, is so far one of a few outliers.Although advanced technologies such as augmented reality (AR) and virtual reality (VR) have been widely utilized for things such as 3D modelling of compounds, procedural training, and physician and patient education for years, the pharmaceutical industry has proven relatively hesitant to enter the Metaverse. One by one though, companies are noticing the new generation of patients who find online communication familiar and comfortable. These consumers are already navigating the Metaverse, engaging virtually with their friends, colleagues, and even many of their healthcare professionals. As the public seeks more and more of its interaction online—including gathering medical information—the pharmaceutical industry will need to transform, exploiting the positive attributes of advanced technologies to improve its engagement strategies and to meet the needs of its consumers.Selling Pills vs. ContentAs pharmaceutical companies innovate to reach contemporary consumers, they might look to Hollywood to inform their efforts. Although the showbiz industry traditionally relied on movie theaters and prime-time television to reach their audiences, in recent years they have had to pivot to an on-demand experience that is focused on reaching consumers where they are. And while television was previously heavily brand centric, relying on customer loyalty to maintain viewership (e.g., NBC viewers would tune in for TGIF regardless of the lineup), because of the sheer volume and availability of movie and television content these days, services must now pay careful attention to exactly what content viewers are demanding, when and how customers would like to consume that content, and what will create a loyal viewership. They must work to engage their viewers and create an emotional connection that will bring their audience back for more.As consumers become more sophisticated and savvier, the pharmaceutical industry will need to follow in the footsteps of the entertainment industry in order to engage with an increasingly discerning public. They will need not only to move online, but, to also create experiential content designed to immerse their viewers in information that at times can be quite dry and technical. What better way to do this than utilizing the Metaverse?Imagining the MetaPharmacyIt is clear that the Metaverse and related advanced technologies are already bringing a new dimension to healthcare.2 Just as telehealth (spurred by the pandemic) has increasingly shifted the patient–healthcare provider relationship from in-person to hybrid, the next step will be to introduce tools such as AR and VR to transform how health-related information is delivered, and pharmaceutical companies could play a significant role in this transition. Attentive drugmakers will increase their direct-to-consumer interactions, targeting specific niche audiences with personalized, emotionally engaging content.One company at the bleeding edge of this movement is CVS. In March, the pharmacy filed a trademark with the U.S. Patent Trade Office for its logo and plans to open a CVS store in the Metaverse.3 The filing indicated plans to offer downloadable virtual items, including “prescription drugs, health, wellness, beauty and personal care products.” The company also intends to offer their in-person health services virtually, including nonemergency medical services, as well as nutrition and wellness counseling.Similarly, Teladoc Health and Amazon have partnered to release Teladoc on Alexa, a voice-activated general medical virtual care on certain Echo devices.3 This service is the first of its kind, offering U.S. customers the opportunity to connect with a medical care provider 24/7 from the comfort of their homes. Other companies such as Goodrx Holdings, Inc., Medtronic plc, and American Well Corp. are also currently creating digital products and services, with the aim of impacting the $1 trillion global pharmacy market.Who can blame them for wanting a piece of the Metaverse? The online space will be the ultimate location for patients, researchers, and doctors to meet, eliminating physical, language, and geographical barriers, creating a more globalized world. This global connection has the potential to reduce costs and increase efficiency and accessibility in the medical field.In addition, the technologies available within the Metaverse allow for the creation and delivery of immersive, emotional, personal experiences that will affect consumers far more than reading a pamphlet.4 VR and AR could allow users to enter the human body, exploring a three-dimensional world in which they can examine how a medication impacts the body and disease processes. Once a patient directly experiences how a medication will impact their own body, they may be more likely to accept and comply with a course of treatment.Moreover, pharmaceutical companies will be able to tailor their outreach within the Metaverse, providing personalized patients for both physicians and patients. For example, a drug developer who wants to illustrate the negative and the positive effects of a medication to a group of physicians could create a fully interactive patient model that doctors could explore in an immersive environment. In a patient-facing context, imagine that all patients diagnosed with type 2 diabetes are told to click on an informational Web site to learn about the condition before they see a provider in person. How much more effective would it be to create an immersive virtual world that teaches that information so that a patient could directly view their pancreas and understand its role in the disease? This type of immersive, emotionally relevant experience is a hallmark of the Metaverse, and pharmaceutical companies are taking note.Of course, messaging from big pharma has profound impacts on public health and the economy. Thus, it is essential that these messages are regulated and ethical. Several concerns arise when one considers the significant influence that experiences in the Metaverse can have on both doctors and patients, and certain important barriers must be overcome before the pharmaceutical industry can fully take advantage of the opportunities that the Metaverse provides.Perhaps the most obvious issue is related to misinformation and ethics. There is certainly some moral ambiguity when it comes to marketing pharmaceuticals, and this gray area only broadens when it comes to doing so online. Currently, there are few rules or regulations regarding pharmaceutical marketing on social media, let alone in the Metaverse.Another stumbling block relates to technology itself. Current VR headsets are miles better than the early, clunky, heavy hardware of the 1990s. Although the technology is advancing at a breakneck pace, further work is needed to create devices that reduce cybersickness and create a more inclusive virtual experience. There are also certain medical situations that do not lend themselves to virtual interactions. Specific evaluations, such as those for dermatological conditions, are still better done in person due to video quality issues. That said, as Metaverse technologies evolve (and they do so every day), these hurdles will become less noteworthy.Finally, data privacy in the Metaverse will be a key factor, especially in the medical field. Companies must protect proprietary information, and patients must be reasonably assured that their personal details will remain confidential.To reduce these issues, education and transparency are vital. Before entering the Metaverse, pharmaceutical employees, researchers, and medical professionals will need to sign appropriate agreements that assure nondisclosure and confidentiality. These agreements should spell out what information is private, how long this information should be kept secret, and what the consequences will be for breach of the agreement. In addition, all employees should be well trained in proper protocols before going online. Beyond this, creators and developers should evaluate ethical concerns, including patient consent and monitoring, and incorporate this information when developing medical applications. Education about expectations and clear communication about data sharing will be essential to create a successful pharmaceutical industry in the Metaverse.Currently, the Metaverse is, much like Hollywood in the early 20th century, the wild, wild west. And while the frontier is rife for exploration and innovation, before the pharmaceutical industry jumps into the fray, solid ethical foundations should exist to protect both companies and patients. While experience with in-person and telehealth interactions can guide this framework, in the end, a customized and considered approach will be required for a safe and healthy Metaverse.