Games for Health 2005 conference, produced by the Serious Games
Initiative, was held last week on Sept. 22 and 23 in Baltimore,
Maryland. The conference's content focuses on serious games as used
specifically in health and health sciences, including games used for
training students in healthcare-related studies as well as games used
for treating patients.
Bogost, a researcher and professor and speaker at the event (the
session that he presented was titled Advergaming of Prescription
Medicine), attended several sessions, which he summarizes here.
Games for Health 2005, Day 1
J. Downs, senior program officer, Robert Wood Johnson Foundation, asked
in his talk, “Why did the [Robert Wood Johnson] Foundation invest in
video games?” Their “pioneer portfolio” looks for innovative projects
that might be influential five or 10 years hence. Robert Wood Johnson
research has shown that it takes 17 years for a new finding to make its
way into widespread practice, and we have to start now to accelerate
Bruce Jarrell, dean of the University of Maryland School of Medicine
welcomed attendees. He said research is the primary focus of the
medical school and mentioned that the process of teaching medicine is
done by lecture and apprenticeship. The electronic age in medicine is
limited: PowerPoint, web pages, and a few simple simulations are about
as in depth as it gets. The effect of the digital revolution has not
yet touched medical curricula in a meaningful way. The problem solving
in medical school needs to be improved.
spends his time with surgical residents and tries to dig into problems
with his students, helping them "repair the holes" in their knowledge.
This learning requires customization based on the students, a wide
range of common sense and technical knowledge, and an engaged,
interactive address of the students. In general, the practice of
medicine currently does not include techniques of this nature.
language processing and computational linguistics are one technical
obstacle that must be hurdled in order to change this situation.
Funding for improvements remains hard to find, and it needs to be
improved. Content is king at medical school, not just process.
The Future of Games for Health
Brain Training for the DS promotes cognitive learning.
Sawyer of the Serious Games Initiative, which organizes the Games for
Health conference, says there are two sides to games for health:
personal treatment and professional practice. The former includes
treatment, disease management, physical therapy, exer-gaming (or gaming
that promotes exercise), mental health treatment (VR/psychotherapy),
cognitive learning (Brain Training for the Nintendo DS is an
example), and other applications that people personally purchase. The
latter includes health messaging, modeling, simulation, and training.
future of games for health includes virtual reality medicine,
commercial games, and technology. Sawyer articulated a concept he
called the Personal Health Record, which takes personal information,
doctor visits, data recording from various devices, and produces output
that could be tied into or bound to games. One use for this is
recording and measurement information.
described a whitepaper the initiative is working on to help individuals
evangelize the use of games for health. They will also be taking the
initiative on the road, and launching a game contest for games for
health, akin to a kind of specific Independent Games Festival.
He then described the "plague" now afflicting World of Warcraft,
an infectious blood disease that has ravaged the game. Sawyer showed a
video of the epidemic at work, which created calls to "quarantine the
server." It is the first such "outbreak" on record in a game. So, now
we need "health for games" in addition to "games for health."
Sawyer also showed the Brain Training games and a slide from Nintendo president Satoru Iwata's Tokyo Game Show keynote that demonstrated how Brain Training has a very different sales pattern than other games. Most games have a big launch but a steep drop off shortly thereafter, but Brain Training has seen consistent sales over the first four months of sales. Brain Training is above the other DS games, including Nintendogs,
as a driver of DS hardware adoption. Brain Training's demographics are
very different as well, with at least 25 percent of players age 45 or
also showed a video of the new Revolution controller, demonstrating
that the method of play in these games also includes a health game: a
dental surgery game using the new controller. Finally, Sawyer argued
that there's no dividing line between commercial game innovation and
games for health, and health games can be healthy for the games
Ben's Game: Visualizing Cancer Treatment for Children
Johnston of Lucas Arts and now affiliated with the Make-a-Wish
Foundation, met Ben Duskin, a young boy who was diagnosed with leukemia
at age 5. At age 8, Duskin submitted a wish to Make-a-Wish to make a
game about fighting cancer.
In this session, Johnston showed Ben's Game in which the player controls a child on a board. The player's goal is to combat cancer by fighting cancer cells.
game took six months to make, with Johnston and Duskin working one
evening per week and Duskin also on weekends. The game has been
downloaded 172,000 times. Traffic on Make-a-Wish Foundation's web site
increased from 100 visitors to 60,000 visitors per day after the game
Game was hard to take on as a company, says Johnston, because of the
time required. The first step was to acquire funding, a step they
skipped. When Johnston made his first game, he accomplished it alone
and in only 10 weeks (Pipe Dream, a classic puzzle game). Since
then, the scale of gaming has increased considerably, so Johnston used
this new opportunity as an excuse to get back to his short, independent
approach. The project budget included a USB flash drive to allow Duskin
to take the game home after every meeting, and 16 liters of limeade.
Johnston was surprised and impressed by the child's involvement and
guidance, he said.
second step was to ask permission of LucasArts to make the game, which
Johnston says he also skipped. He just started making the game,
realizing that in the worst case, he could simply make it at home.
After getting some traction, LucasArts allowed him after-hours access
to the office, including the sound studio, which was a huge help in the
development process. The company's Legal and PR departments allowed the
game to be released for free; the company also facilitated a tour of
Skywalker Ranch and the archives for Duskin, places that Johnston has
never been himself.
question Johnston found himself bound to ask was: “How can we design a
game about cancer?” Clearly the player can't lose or die. The two
decided to focus on distraction and entertainment for kids undergoing
cancer treatment. Distraction is a big part of pediatric medicine, and
there's very little you can do in treatment.
Tuesday, Johnston and the young Duskin worked on the game (except one
week when Duskin was grounded). In the lecture, Johnston showed photos
of the two working on the game, demonstrating the child's detailed
involvement in the design as a primary driver. He shared his experience
watching Duskin play the game, which he cited as a tremendous help in
the iterative design process.
Ben's Game was made through the joint effort of 8-year-old leukemia-diagnosed Ben Duskin and Eric Johnston.
game's development started with the concept of a field of cells, but an
abstract and stylized game too. The field has mutating cells that grow,
similar to John Conway's game Life. Ben's Game uses a
shield (to protect against side effects), health, ammo, and attitude as
markers of the player's health level. But when attitude runs out, you
keep fighting, living beyond what the level says you can.
cells aren't very understandable, and kids don't see those; they see
the nasty side effects of treatment. So in the game, you fight monsters
which are manifestations of seven side effects: fire represents fever,
q-balls are hair loss, “ro-barf” is vomit, vampires represent bleeding,
the tornado stands of rashes, snow monster are colds, and the evil
chicken represents chicken pox. The game allows players to choose from
a number of playable characters or create their own.
Next-Generation Healthcare Learning Platform
speakers on this panel were Dr. Claudia Johnston of Texas A&M
Corpus Christi, Douglas Whatley of BreakAway Games, a serious game
developer, and Timothy Holt of Oregon State University.
Dr. Johnston first described Pulse,
a virtual learning space project in which a healthcare learning system
models dynamic changes in care environments. The idea is that an
immersive and persistent environment for responsive medical training
alongside high-fidelity graphics would make for a valuable adaptive
is conceived as a "virtual clinical learning lab," the panelists said,
that provides a persistent healthcare world with patient simulation.
Challenges include the technical and programmatic representation of
game will be used by the military healthcare team, the healthcare
delivery system (nursing and medicine, certification, and the like),
and higher education degree programs. Games allow rehearsals for life
and offer the promise of improved learning.
Substance Abuse Treatment with Game Technologies
Nemeth of the National Institute on Drug Abuse (NIDA), and Darion
Rapoza of Entertainment Science, spoke during this session. The gaming
community has a perception that the National Institute of Health (NIH)
doesn't have an interest in serious games because few grants seem to be
awarded. However, virtual reality was once in the same situation, and
now it's a major funding outlet for NIH and NIDA. Gaming will
eventually grow into a similar funding outlet. Small Business
Innovation Research (SBIR) solicitations are common and opportunities
will become more plentiful even in the near-term. Nemeth encouraged
people to talk to her to find the right NIDA or NIH contact for their
ideas to help make them fundable.
however, used her portion of the presentation to show and discuss a
game, which promises to offer more preventative intervention for drug
abuse than any other related materials could afford.
Created using the Unreal Engine, the game is an action/adventure role-playing game, akin to Deus Ex.
Action/adventure games typically have a high proportion of both male
and female players, and they are the best platform for the translation
of evidence-based approaches to drug intervention, according the
Feedback suggested that more advanced technology was needed to engage players. Rapoza showed an Unreal 3 screenshot and argued that this was the target to meet.
are an especially good medium for reaching the poor. According the a
study Nemeth cited, 100 percent of urban and rural poor people play
games daily, have internet access, and (as a projection) 100 percent of
the fathers of urban and rural poor would play games with their kids
once a week or more. Games are thus demographically appropriate for the
problem of drug addiction education, and video games are cost effective
compared to other preventative interventions.
developing the game, Rapoza mapped the effects of drug abuse—short- and
long-term memory loss, emotional problems, difficulties focusing and
problem solving, and so forth—and mapped them to gameplay attributes;
so in the game, the effects of drug abuse alter whether your player
identifies a person as a friend or foe, the conversation you have,
dialogue trees, impulsivity, aim, movement, and skill. Skill
enhancement is based on a hierarchy of achievements.
in the game come in the form of coffee and amphetamines, which players
can use to study for exams in the game and do better. Cravings are
represented as pop-ups during gameplay, and can be dismissed with
"auto" responders (that is, auto-smoke), which models the actual
addiction process. During severe addiction, the player may lose control
of the character, who will use the drugs without the player's
permission. Some players experimented with saving the game in a "pure"
drug free state , then experimenting with drugs, then going back to the
saved game, said Rapoza.
Video Games: Just What the Doctor Ordered
Anuradha Patel of the University of Medicine and Dentistry of New
Jersey (N.J. Medical School) discussed using existing games to treat
pre-operative anxiety in children. Most children experience anxiety
before surgical procedures, and they experience the most severe
distress when anesthesia is introduced. Research shows that children
tend to exhibit certain maladaptive behaviors after surgery, even up to
a year afterward: bad dreams, disobedience, separation anxiety,
tantrums, and bed-wetting. These behaviors would not have manifested
before the operation. The cumulative effect of these exposures is
preparation programs, including coping skills training, have
traditionally been used, but are time consuming, expensive, and not
necessarily successful (more information can lead to more anxiety).
Behavioral therapy such as distraction with toys, storytelling,
hypnosis, and so forth has also been used. Other researchers have tried
environmental modification. Medications also produce delayed recovery
and more agitation, and parents are concerned about "drugging" their
said Dr. Patel, can help focus attention. Games are known to increase
dopamine neurotransmission and absorption. In the study, Dr. Patel's
group used a Game Boy to active distraction. Because the device is
portable, the child can play it while anesthetics are administered.
on a Yale Prop Anxiety Scale (a standard measurement method in the
field), the group determined that the anxiety of children playing games
was lower than those with parents present but no additional anxiety
drugs, and parents present with the introduction of anxiety reducing
drugs. Seventy-one percent of the participants in the Game Boy group
had no change in anxiety during the study. Interestingly, parental
presence alone is associated with the most increase in anxiety.
Moreover, the study suggested a possible improvement in post-surgery
behavior, rather than an introduction of new negative behaviors.
Taking Games for Health Mobile
P. Schultz of Motorola presented this session, whose premise was that
games can provide players with a sense of mastery over their condition.
Schultz used the example of YuGiOh as evidence that kids can
learn large bodies of information about arcane topics, and this can be
applied to health instead of fantasy. Motorola tried to realize this by
extending existing internal products and initiatives. At the same time,
the company wanted to avoid using mobile technology as a nag, said
is an internal MMORPG built on Torque, started in October 2004, and
funded through 2005. The goal of the game is to help players manage an
acute lifestyle health condition like diabetes or heart disease. In the
game, the player receives token rewards for the acting in ways that
support his or her health condition. The purpose is to help kids (or
adults) understand and feel more confident managing their own
has a project called "seamless mobility," which involves the ability to
access what you want, when you want it, wherever you are. The new
iTunes phone is an example of this initiative. Other kinds of mobility
are content, experience, brands, information, social experience, device
independence, and demographics. So, specific content can be transmitted
based on the purposes of the game. Specific content from different
domains could then be delivered to the game world. These additional
materials could be pushed to a phone. The game world could also move
between devices (PC to mobile), and demographically, the parent and
child should both be able to engage the experience.
So far WellWorld
has incorporated branded content from LifeScan and the American Heart
Association. Motorola sees this as a viable method for distribution and
funding. The videos in the game are accessible through the game or on a
phone. In terms of demographics, parents want age-appropriate themes
and Motorola wants a "happy, shiny look." With respect to device
mobility, the phone clients are possible, but may have limited
justification for an MMORPG was based on research that showed social
support helps people engage in positive health behaviors, said Schultz.
Higher values of the social contract index are associated with
increased odds of health behaviors. Conceptual buy-in has been positive.
Free Dive is a scuba diving simulation used as a pain distraction tool for kids during uncomfortable treatments.
session was presented by Brian Morrison of the Believe in Tomorrow
Foundation and Lyn Dahlquist of the University of Maryland. FreeDive
is a scuba diving simulation (created by BreakAway Games) that
Dahlquist is using as a pain distraction tool for kids during
particularly uncomfortable treatments. The idea behind the game is to
distract kids from pain, which requires actual cognitive attention. In
Dahlquist's studies, pain tolerance increased more than two-fold among
kids in a controlled experiment using a hand submerged in ice as the