Walter Greenleaf has been researching medical applications of virtual reality since 1984, and he believes that healthcare is going to be transformed by consumer VR & AR technologies. Walter says that VR is fitting into a number of different healthcare trends including the digitization of tools, moving from subjective assessments to objective measurements, moving towards patient-centered medical care, and moving away from a fee-for-service to a result-driven business model. These are all pointing towards the desire to collect more and more objective measurements, and VR technology has the capability to capture and present a lot of this data in entirely new ways.
I had a chance to catch up with Walter at the Silicon Valley Virtual Reality conference where he give me an overview of the medical applications of VR, and why he believes that VR is going to transform healthcare. There’s many different industry verticals within healthcare, and he believes that we are just at the very beginning of seeing how consumer VR could help improve many different dimensions of our health and potentially even help save lives.
LISTEN TO THE VOICES OF VR PODCAST
Here are the slides from one of Walter’s recent presentation on “How VR & AR Technologies will Transform Healthcare.”
Subscribe to the Voices of VR Podcast on iTunes
Donate to the Voices of VR Podcast Patreon
Music: Fatality & Summer Trip
Rough Transcript
[00:00:05.452] Kent Bye: The Voices of VR Podcast. My name is Kent Bye and welcome to The Voices of VR Podcast. Today, I talk to Walter Greenleaf, who is an expert in all the different medical applications of virtual reality. He's been looking at VR applications into medicine for over 30 years now, and he splits his time between doing academic research and teaching at Stanford, as well as advising businesses as they're building these different medical applications of VR. So I think Walter, out of anybody, has one of the best perspectives in terms of what is actually happening within virtual reality and all of its different various applications into medicine, as well as all the different trends that are happening within medicine that are opening the doors to all sorts of different applications of VR. And so He claims that medical applications and VR are actually going to be one of the most lucrative. And so we'll be discussing all the different reasons as to why he believes that in today's episode. But first, a quick word from our sponsor. Today's episode is brought to you by the Virtual World Society. The Virtual World Society was started by Tom Furness, and their goal is to become the Peace Corps of VR. They want to transform living rooms into classrooms, and so they're in the process of trying to recruit potential subscribers, as well as content creators who are interested in creating educational experiences that help solve the world's problems and help make the world a better place. So if you're interested, go to virtualworldsociety.org to sign up and get more information. So this interview happened at the Silicon Valley Virtual Reality Conference and Expo in April in San Jose. And I had run into Walter right as he was leaving the expo hall, and he had just had an opening in his schedule that had just opened up. And so I was able to grab a quick chat with him and talk about all the different future of VR and medicine. So with that, let's go ahead and dive right in.
[00:02:07.276] Walter Greenleaf: My name is Walter Greenleaf. I'm doing a bunch of things in VR. Historically, I got involved in medical applications of VR almost 30 years ago. And now I'm currently at the Virtual Human Interaction Lab at Stanford. I'm doing some projects involving looking at VR for interventions, stress management, also how we can use VR for assessments of cognitive function and mood disorders. That's at the university and outside the university I'm working with four startups that are doing medical applications of VR. So it's all focused within medicine.
[00:02:44.537] Kent Bye: So looking at virtual reality as an application in medicine, how do you paint the landscape of the different big applications of VR?
[00:02:52.919] Walter Greenleaf: Well, my bias is based on my background as a research scientist and a neuroscientist. So keeping that bias in mind, I think that of course entertainment and communication and social interaction are going to be big drivers for how VR rolls out and becomes an affordable price point and a great utility. That being said, I think VR is going to revolutionize how we do medical care. It's arriving at a time of inflection within the medical product community, the medical clinical services community, and it snaps right on top of some of the current trends that are going on. So I think because medicine is a big part of our economy, it's almost 20%, because there's some looming health care crises with an aging population, I think one of the deepest verticals for VR is going to be the medical world. So in terms of that landscape, I put, not in the short run, but in the long run, I think medicine is going to be one of the most successful vertical markets for virtual reality technology. Within medicine, there's probably 20 or 30 different verticals ranging from clinical care to clinical assessments to wellness and prevention and compliance management to rehabilitation. So it's a target-rich environment of where virtual reality can make a big difference.
[00:04:11.869] Kent Bye: You mentioned some of these trends in medicine and the overlap of VR kind of fitting into that. What are some of those trends?
[00:04:18.741] Walter Greenleaf: Right now medicine is going from an analog world to a digital world where things were originally very subjective and based on observation and written assessments to more of a data-driven world, evidence-based therapy. And medicine is pivoting more towards digital medicine. For example, almost every medical device that's used has been hooked up to the internet and to electronic medical records. So there's now ultrasound machines that can plug into your cell phone and can be used in a portable manner to do ultrasonic imaging. spirometers are hooked up to the internet. So medicine is going digital. Hand in hand with that, medicine is also shifting from something that is focused on the physician being the point of care to the patient being the center of care and the center of all the action. So that's a big shift. Also payment systems are changing. Instead of it being a fee-for-service type of business model, it's becoming more of a fee-for-result model. And because of that, we have to measure and objectively come up with good indexes of functional result, both in terms of patient satisfaction, direct health related issues, but also objective measurements of progress and success. And virtual environments are both a great platform for clinical care delivery in a telemedicine manner, but also for collecting those objective measurements that show progress.
[00:05:45.503] Kent Bye: Yeah, and I had a chance to do an interview with Michael Areto of VR Recover about rehabilitation, and one of the things that he said is that there's also a trend towards personalization in medicine, and maybe you could talk a bit about how you see the future of the personalization of medicine and what part that virtual reality has to play in that.
[00:06:03.100] Walter Greenleaf: Well, first of all, some of the big unaddressed problems in medicine right now involve behavioral medicine, psychiatry, psychology, and related fields. And as a result, if we're going to do personalized medicine in behavioral medicine, we need to have better ways of both changing behavior and measuring behavior. And virtual reality is a perfect way to do that. And the examples of how it's already been, and I should emphasize this, that there's been maybe 30 years worth of background research on how virtual environments can be used to affect clinical outcomes in everything ranging from post-traumatic stress disorder to rehabilitation, like what Mike's work is doing with VR Recover. to addictions, to autism, to cognitive aging, to helping with schizophrenia, helping with other serious mental illnesses, and then on the wellness side of things to help with stress and mood disorders. So there's a large spectrum of interventions that have had basic research, helping inform, and all this research has been done mostly at the academic research centers and it's about to spring out, now that the price is right, to the commercially available virtual reality systems.
[00:07:11.889] Kent Bye: Yeah, the thing that was really striking to me is that with these immersive virtual reality systems, that it's going to be able to capture all sorts of human movement and behaviors that we were never able to capture before. And yet we're still at that phase where we only have like White House track controllers, or we have leap motion, or we have a Kinect, and they seem like kind of like stopgaps. So what do you see the trend of as where we need to get to in order to actually capture all the data that would be useful and necessary for some of these future medical applications?
[00:07:42.892] Walter Greenleaf: You know, I think that things are actually pretty good, that the precision will get better, but it's not bad now, and it's certainly better than what we've been doing previously, which is using these handheld corneometers to measure range of motion or to subjectively measure something. So, it will only get better, and I think the tools that we have right now are actually pretty good, not just for capturing movement, but for capturing behavior in a virtual environment. We can challenge an individual, we can see what their attention span is, we can see what their resilience is to stress, we can measure how they perform executive function tasks and how their memory is and ability to do sequencing. So we can actually do some pretty good neuropsychological assessments in a standardized way in a virtual environment. that we really can't do with paper and pencil test. So from my viewpoint, the tools are only going to get better and it's not the sensor technology that's the getting step. I think it's coming up with the right applications to make use of that rich sensor data to come up with better diagnostics and better interventions.
[00:08:40.727] Kent Bye: Well, it seems like with the technology and being able to measure all these new things, it's going to enable new capabilities. So I'm curious if we look at like, what are all the different things that virtual reality technologies could measure? Is it like heart rate? Is it what they're looking at? But if you look at VR as an input system or being able to input things into the patient, like what are some of those things that we're going to be able to do that we couldn't do before without VR?
[00:09:06.838] Walter Greenleaf: Well, what's great about VR, especially for behavioral medicine, is that we can evoke through the experience an emotional state. And if you want to change someone's behavior, if you want to change the way their brain processes information, which you need to do for clinical psychology and psychiatry and behavioral health in general, you need to be able to change the environment to evoke an emotional state. You can't change a brain process unless you can evoke that brain process. So if I'm trying to teach someone how to deal with a fear and anxiety from a phobia or post-traumatic stress, I need to be able to, in a graduated, controlled way, evoke that fear. And I can do that in a virtual reality in a controlled manner. If I want to change how somebody reacts, if somebody has a mood disorder and I want to change how they react to things that are threatening in their environment, I can do that in a virtual environment in a reproducible, controlled way. If I want to help someone who has a social anxiety disorder, I can exaggerate some aspects of the world and slow down other parts of the world so that they can master social skills in that environment. So it's the flexibility of the virtual environment that gives us powerful tools to leverage mirror neurons in the brain, to leverage different cognitive processing in a way that we can help people change their reactions to stimuli and their basic cognitive processes to not only deal with clinical problems, but also on the health and wellness side if people want to be better at public speaking, for example, or want to be better at anger management, or want to be better at weight management. All these things that involve controlling our emotional response to things. Virtual environments are a great sandbox to teach skills.
[00:10:39.557] Kent Bye: What are mirror neurons and how are they related to VR and medicine?
[00:10:43.414] Walter Greenleaf: Well, right now, one of the great things about people is that we can read each other's minds. And we do that by looking at our facial expressions and our body language, and that conveys your emotional state I can perceive. And the way we do that is we have brain systems that are called mirror neurons that fire. If I see a state in you that I interpret as a certain mood or a certain emotion, similar emotional states get fired in my brain. And in a sense, I'm mirroring your emotional state, and I can recognize your emotional state. That's a very powerful thing to do, but we can leverage that to teach empathy in people. We can leverage that to help people see the world from somebody's other point of view. I can take you and put you in a virtual environment and I can have you look in the mirror and see someone who's 20 years older. And then I can say if you exercise, if you plan for retirement, if you don't use drugs, you know, whatever behavior you want to change in yourself, I can show you how your avatar looks healthier. And because of the mirror neurons, you're having a, this is a little complex, and I'm trying to be very brief about it, but you're basically using the fact that you have a fondness for yourself to shorten the feedback loop and see how your behavior affects yourself in the future. And one of the big problems we have right now is really seeing, it's one thing to eat well and exercise a lot, but we don't get immediate feedback on the benefit. But in virtual reality, I can show you the immediate benefit and leverage those mirror neurons. And they also help us have empathy not only for ourselves and our future self, but empathy for other people. So I can put you and show you from a third-person point of view or a first-person point of view what it's like to be a woman of color or what it's like to be someone who lives in a depressed socioeconomic environment or to be in a war zone. I can also teach you to have empathy for the environment by having you go out and swim around through part of the ocean that has ocean acidification because of carbon dioxide in the atmosphere and see how it's affecting the reef. I can show you what otherwise take 20 years. I can compress it down to a few minutes and give you the experience. All that changes your outlook and your emotions about something. So essentially I can change your behavior by giving you an experience that leverages the empathetic part of your brain.
[00:12:57.173] Kent Bye: Do you have any favorite stories that serve as an example of the power of VR as applied to medicine?
[00:13:04.132] Walter Greenleaf: Well, I can tell you right now, for example, we have, I think there's 60 or 70 virtual Iraq and virtual Afghanistan systems out there in use at VA hospital systems to treat combat PTSD. And it's a very effective intervention with a very difficult problem. But I also remember that in the early days when we often saw a lot of Vietnam vets coming into the VA hospital system who'd had Post-traumatic stress going back from the Vietnam War and who had sort of plateaued in their therapy by using a virtual Vietnam We could the therapist could help them address the stress and get great results Even though they had been stuck at one particular spot for a long point of time. I guess another example might be well, we've been able to help people who experience pain like for wound treatment and We use virtual reality as a distraction from the acute pain they're experiencing and we've been able to show that it reduces their need to use narcotics during that painful procedure by 30%. That's pretty important because reducing the risk of becoming addicted to narcotics is pretty important. Another example is how we've used virtual environments to help people who have had trouble with alcohol and substance abuse learn what we call refusal skills and situational confidence. The virtual environments are a great sandbox to, again, have people learn new skills.
[00:14:24.335] Kent Bye: Now, I know that you're helping advise the VR Recover. Are there any of the other startups that you can talk about what they're doing?
[00:14:32.025] Walter Greenleaf: Sure. I'm working with a company named Paratherapeutics that is combining apps and digital health care and soon to include virtual environments for what we call combination therapy. So instead of just giving someone a medication to change their brain biochemistry, we also combine it with a digital app to change their brain's experiences and their brain behavior. And combination therapy has been shown to be much more effective than prescriptions alone or cognitive behavioral therapy alone. Another company I'm working with is called Applied VR, and we're using VR as a pain distraction to help people who are going through both acute procedures, which are painful, and also uncomfortable procedures, to distract them from that pain. I'm working with a company called Cognitive Leap, which is taking many of the VR and behavioral healthcare interventions over to China. China has a big problem with anxiety and stress. They don't have a lot of clinicians. the ratio of psychologists to the whole population is not very favorable and we're using virtual environments to solve that problem by using technology.
[00:15:34.552] Kent Bye: And finally, what do you see as kind of the ultimate potential of virtual reality and what it might be able to enable?
[00:15:40.980] Walter Greenleaf: Oh, that's a big question. I think because, again, my bias is medicine, and I'll speak to that. I think because virtual environments are very powerful tools for addressing some very, very difficult problems in psychology, psychiatry, and behavioral medicine. I think the ultimate potential is to, we talked earlier about how medicine is going from a physician-centered to a more patient-centered process. I think that it's going to be virtual environments are going to be the technology that make that possible. The other thing they're going to do is they're going to be able to extend the reach of the clinician. There's a lot of underserved areas right now that either for economic reasons or for being in a remote or rural area can't get good health care. And virtual environments are a fantastic telemedicine platform.
[00:16:26.017] Kent Bye: Great. Anything else that's left unsaid that you'd like to say?
[00:16:28.956] Walter Greenleaf: No, just thank you very much for tracking this field. I think there's a lot of great things going on in virtual reality right now, but we need people like you who help us evangelize and get the word out. There's been a lot of things done in the past which I think have made virtual reality have an image in many people's mind as something that's a toy or something that's just for entertainment or just for gaming, and it's so much more than that. So thank you very much.
[00:16:52.751] Kent Bye: Awesome. Yeah, thank you. Okay, good. So that was Walter Greenleaf. He is an expert in the medical applications of virtual reality technology and also doing research and teaching at Stanford as well as advising a number of different VR startups. So there were a number of different things that were striking about this interview is that, you know, first of all, that there are a lot of different applications of VR into the medical field and that There are a number of different changes that he pointed out that make the medical industry really primed to have something like VR be introduced into the industry, moving from more subjective assessments from observation to more data-driven and evidence-based therapy, moving from the physician being the point of care to the patient being the center of medical care, and moving from a fee-for-service model to a results-driven model where they're needing a lot more objective measurements to happen. And so given that medicine accounts for about 20% of the GDP, then, you know, there's a lot of room for disruption for VR technologies to be introduced into the medical field. So another big striking thing for me was this whole concept of the mirror neurons of how there's kind of a neurological basis for what VR is able to do when it comes to empathy. You know, when you're able to actually feel like this sense of embodied presence with a digital avatar, then you start to have a lot more empathetic connection with them. And I think that there's going to be a lot of different applications for that, not only from within the medical applications, but just in entertainment. And one of the strengths of VR in general, as Chris Milk calls VR, the empathy machine, And I think the immersive qualities of VR starts to trigger those mirror neurons in ways that go beyond what happens in other media. Also, the whole applications of telemedicine will be really interesting to see where this develops first, because whether it'll be with people who are in remote locations, that kind of requires VR adoption to penetrate out into those areas, first of all. But also, what are the different types of medical applications that are going to be used within telemedicine? Is it going to be mental health counseling, or is it going to be something along the lines of diagnosis, or you know, which branches of medicine are going to be the first good fit for remote telemedicine applications. And finally, the big takeaway that I got from this interview is that the medical applications of VR are so vast and huge, and that all these ongoing changes that are already happening there are going to just make it more primed to have something like this disruptive technology of VR be introduced into the equation. So I think that the medical applications of VR are going to be pretty big and significant. And I already have at least two or three other interviews in the backlog that talk about some of the other applications of VR ranging from stroke rehabilitation as well as medical imaging. So with that, I just wanted to thank you for listening. And if you'd like to help out the Voices of VR podcast, then there's one of three things that you can do. You could either just tell your friends about it and just help spread the word about the podcast and what you get out of it. Leave a review on iTunes that'll help spread the podcast beyond your own immediate circle of influence, as well as consider becoming a contributor to my Patreon at patreon.com slash Voices of VR.
