I had a chance yesterday to attend one day of the Games for Health conference, which covers one of the fastest-growing areas of mobile apps and an area of innovation that clinicians and policy-makers are embracing with growing enthusiasm.
The gamification of everyday life has become a theme of modern business, as well as public health and other groups interested in motivating people. Fun is now the ally, not the enemy, of intelligence, productivity, social engagement, and well-being. Here are a few existing or upcoming projects that illustrate what games are doing in health care:
A researcher developed a game for people with Attention Deficit Disorder that pops distractions up from time to time. If the player gives in to the distraction, the game ends. Over time, as the player gets better at ignoring distractions, they increase in order to test him further. The researcher claims that a few hours of this game eliminated the symptoms of ADD for several months afterward in many children, achieving more than drugs and other therapies.
A company is working with the Department of Defense on a game that encourages wounded soldiers to do their physical therapy. Normally, PT is an hour or more of boring, repetitive, painful exercise (I know, having undergone it). The game simply presents you with obstacles that you have to remove by performing one of the motions prescribed by the physical therapist. Thus, it keeps you engaged and randomizes the exercises to keep them fresh.
A web-based game asks you to wager game currency on whether an individual is likely to get a particular disease. The game presents you with increasing amounts of information about the relationships between genes and disease. The overall message of the game is that knowing your personal genome doesn’t offer much guidance on whether you’ll get the disease or how to avoid it.
A soccer ball is loaded with a device that measures how much it’s moving. From this, a hub can determine how much children are playing and track activity over time.
The last device, clever as it is, arouses depressing thoughts in me. When I was a kid (cue up appropriate background music here), nobody had to provide sensors or track our progress to persuade us to take a ball to an empty lot across the street for a game. But that particular lot is now covered with tract housing and the street is so busy that not even the most danger-immune wild child would try to cross it. Meanwhile, parents are afraid (sometimes for good reason and sometimes not) of letting kids wander unattended, and the lures of cable TV and social networks keep them on their couches. So I’m happy to see the digital incentives to increase exercise.
And although gaming hasn’t reached the mainstream of health care yet, it’s getting there. The Department of Health and Human Services has championed games, and major research centers in health care are developing programs for clinicians.
Getting to the conference at the Hyatt Harborside on the Boston waterfront was the first challenge, and after earning that badge, my next hurdle was avoiding the breakfast buffet. But as an attendee pointed out to me, being physically isolated helped keep people on site and talking to each other. Certainly, the location was spectacular, with lunch on the patio facing a view of the Boston skyline.
Personal control and empowerment in all areas of life were the theme of the day, and were expertly introduced in the opening keynote by well-known researcher Jane McGonigal. She started by reviewing the major regrets people express at the end of their lives. I don’t think that I’ll regret spending time listening to Jane McGonigal. Although she was pushing the use of her SuperBetter tool for personal growth, the basic principles are easy to follow independently. Pick a difficult but achievable goal that means a lot to you. Measure what you do each week. Enlist friends for support and positive thinking, etc. I’m doing it myself, and maybe next year I won’t eat the muffins.
Jane McGonigal’s keynote.
The government is here to help you
There’s a fine line between games that promote general health and games that have a special medical purpose. I would guess (as a lay person) that the latter category includes the game to combat ADD and the game to promote PT. And this category is subject to regulation by the FDA. We had a session by lawyer James M. Flaherty, Jr. on this seemingly dull topic, and I’m happy that a lot of people came and treated the subject respectfully. When we trust something with a medical matter, even a game, we need to trust that it will have the desired effect and not harm us.
Thus, if a game is tied to a particular medical device that the FDA is already regulating, the game is subject to the same regulation. That may require the manufacturer to go so far as to arrange a clinical trial and get approval from an Institutional Review Board. A game could also be subject to FDA regulation if the manufacturer claims a medical benefit. (On the other hand, a doctor is free to advise patients to use a game for some medical purpose without triggering FDA regulation.)
FDA regulations are undergoing major changes in this area. A year ago they release a Draft Guidance Document on Mobile Medical Applications, which may be worth consideration by gamers, and some documents on games are likely to follow. Recognizing that current registration procedures are cumbersome, Congress is well along the way to passing legislation that would reform the regulations and ask the FDA to hold discussions with people in the field–discussions that Flaherty urged us all to join. Game-makers also have to start thinking of experiments that can demonstrate the safety and effectiveness of their products.
Too healthy for your own good?
I brought away only a couple dystopic thoughts from Games for Health. One revolved around the privacy worries that accompany every activity modern people do online. Doctors and other professionals engaged in our care are regulated concerning whom the share our information with, and for what purposes. But game manufacturers and sites that offer to track us are not covered by rules like HIPAA. We should check their privacy policies before using them, and be aware that they have lots of incentives to mine the data and use it for marketing and other purposes.
The other, related, worry was about compelled participation. If your employer forces you to enroll in a program to lose weight, or your insurance company bases its premiums on your blood sugar levels, it’s a game-changer. One journalist recently compared self-tracking and Quantified Self to B.F. Skinner-like behaviorism, which struck me as absurd because in self-driven health movements the individual is making choices all along. The comparison takes on more relevance if an outsider is trying to control your behavior.
And if external rewards are tied to game-playing, incentives to cheat tail along. People will hack devices to report better results than they actually achieve, hire people to do things that they report themselves doing, etc. Certificates and encryption will have to be put in place. The landscape of health and gamification will be degraded.
Let’s reserve these concerns for policy-making, while keeping them in mind while designing games that people use voluntarily and enjoy.