Dr. Paul Friedman insists he wasn't distracted by the woman in the second row wearing a pair of wings and a rainbow bodysuit. And he didn't even seem to notice when a visitor teleported into the audience, scanned the crowd and vanished into thin air.
Friedman, a Mayo Clinic cardiologist, has given medical lectures worldwide. But last week he entered a new dimension, when he gave a presentation on the online fantasy world known as Second Life.
To most people, virtual reality and avatars are the stuff of games. But the Mayo Clinic is one of a growing number of real medical centers that have established outposts in this fictional universe to explore new ways to teach and practice medicine.
"There's a lot of really serious activity going on," said Leslie Beard, a researcher at the University of Toronto who has studied the use of Second Life in health care.
Among other things, organizations are using it to train medical students, conduct research, raise money and offer individual and group therapy.
"Virtual worlds," her 2009 study found, "have significant potential to improve health communication and patient experiences in the real world."
Second Life is perhaps the best known of the Internet's "virtual worlds," where people don alternate identities, interact with strangers and sometimes conduct real business, even in the most surreal settings.
Last year, Mayo Clinic hired a designer to create its own space, "Mayo Clinic Island," in this alternate universe, with a virtual hospital and giant outdoor "conference center." Since then, it has hosted several medical-based events on Second Life, including a seminar on Marfan syndrome and Friedman's lecture on abnormal heartbeats.
Friedman, a heart specialist who describes himself as a technology geek, said it's one way for someone "surrounded by wheat fields in southern Minnesota" to reach a bigger audience.
"The advantage [is], people who can't come to Rochester can hear the talk," he said. "They can hear it live, and ask questions."
Theoretically, any of the 15 million or so registered "residents" of Second Life could teleport to the island and listen in. And if they show up looking like clowns or vampires or giant cats, well, that's to be expected.
"That element of fantasy is a normal part of the culture," said Beard, of the Centre for Innovation in Complex Care in Toronto. "Strange clothing, strange hairdos -- things that you wouldn't see in the first world are the norm in Second Life."
Taking the leap
Brian Kaihoi is the man who persuaded Mayo to take the leap into Second Life. As a Web expert at Mayo's Center for Medical Innovation, he knew he'd run into some resistance.
You've got to be kidding, people told him; that's not for work -- it's a toy.
Now, of course, Mayo has a vast website and uses Twitter, YouTube, blogs and everything in between to spread its message. "Years ago, nobody imagined that you might have an e-consult over the Web, either," said Kaihoi. "That was a totally foreign concept."
In Second Life, which was created by Linden Lab in San Francisco, people use avatars -- essentially, cartoon figures that can walk, talk and even fly. Registration, at secondlife.com, is free.
To visit Mayo Clinic Island, for example, click on "teleport" and your avatar pops up in a tropical isle with the familiar "Mayo Clinic" logo. You can take a virtual tour of Mayo's famous Gonda building, complete with its Dale Chihuly glass sculptures and slow-moving revolving doors, and even shop at a virtual bookstore.
The difference between visiting this and a traditional website, Kaihoi explains, is that "the Web is a fundamentally solo experience." Second Life is more sociable -- you literally bump into the avatars of anyone else who happens to be visiting the same site at the same time. You also can chat with them by typing an Instant Message, or speaking through a microphone.
Already, dozens of universities are using Second Life to offer classes for credit, Kaihoi says, and government agencies are using it for training simulations.
At least 68 medical organizations are doing business in Second Life, the Toronto researchers found. One site, Virtual Hallucinations, allows visitors to simulate hallucinations, to get a better understanding of mental illness.
The experience can be so vivid that it carries a warning: "If you have a history of mental illness, particularly a psychotic disorder, you should not tour this facility."
At other sites, a visitor can perform a simulated autopsy or take a 3-D tour of testicles (at the popular Sexual Health Sim by the University of Plymouth in England).
"You really feel, to a certain extent, that you're there," said Dr. John Wiecha, an assistant dean at the Boston University School of Medicine, who also studies Second Life. "It makes you much more engaged with what's going on." This fall, he plans to use Second Life to teach inner-city patients about diabetes control, to see if it's more effective than face-to-face meetings.
The American Cancer Society, meanwhile, raised more than $222,000 in June with a virtual relay race on Second Life. People use their avatars to walk a virtual racetrack and raise pledges, just as they do in the real Relay for Life (only without the exercise).
Skeptics, however, have complained that these efforts are an exercise in elitism, and a distraction at best.
"Yes, the 3-D graphics are quite cool ... but the reality is small numbers of people are utilizing these sites," one critic wrote on a blog site about the CDC's use of Second Life.
Another wrote: "We have decided to ignore the millions of impoverished and medically underserved children in the U.S. who do not have high-speed Internet access."
Supporters admit there's concern about access, and say it's too early to know if there will be a real payoff. Last week, only about a dozen avatars showed up for Friedman's 20-minute talk. But he wasn't discouraged.
"I consider myself a novice in Second Life," he said, "but I could see how it really does overcome the barriers of distance and make things widely available."
Eventually, more patients are likely to turn to Second Life or other virtual worlds for information, says Jennifer Keelan, an assistant professor of public health who helped conduct the University of Toronto study. So it makes sense for the medical profession to get ready. "You have to be engaged in these platforms in order to be there when the people arrive."
Maura Lerner • 612-673-7384