What do you normally picture when you hear the word "gaming?" A teenager with her eyes glued to the TV for hours? A commuter playing Candy Crush on his smart phone?
Scientists and researchers may soon change these common perceptions. They are creating new games designed for very different purposes. Here are a few examples.
Level 1: NeuroRacer — Gaming as a treatment tool
Your Goal: To improve cognitive control in older adults
Adam Gazzaley, an associate professor of neurology, physiology and psychiatry at the University of California, San Francisco, says he created Neuroracer specifically to “target vulnerability in the brains of older adults in terms of cognitive control, which is the set of skills that allow us to interact in complicated environments.”
The game has two tasks that players have to juggle at the same time: they must try to keep a car on a winding road, using a joystick, while simultaneously responding quickly and accurately to signs that appear on the road.
“As you get better at each [task], the challenge increases," Gazzaley says. "The rewards in the game happen only when both skills get better — so you can’t ‘trade off.’ [This] forces your brain to figure out how to do these two challenges simultaneously, which is very hard for our brains to do.”
The findings have been exciting, Gazzaley says. Older adults played NeuroRacer for 12 hours over the course of a month, using EEG to record what happened in their brains before and after game play. The players improve substantially at the tasks involved in the game — in some cases, 60-year-old participants exceeded the skill level of 20-year-olds who had played the game a single time.
But Gazzaley’s team noticed something else: other cognitive skills not specifically trained by the game, such as memory for faces over short periods of time, also improved in some of the players. The EEG results showed a “robust increase” in activation of the prefrontal cortex — the part of the brain associated most closely with cognitive control — during the most challenging point in the game. The players who showed the greatest increase in prefrontal cortex activity also showed the most improvement in skills not being trained by the game.
Gazzaley says this is a strong indication that by "putting pressure on the brain," games may be able to elicit measurable cognitive improvements in several areas at once.
Don’t expect to find this game in the App Store, however. Gazzaley has different ambitions for NeuroRacer.
Gazzaley is the science advisor for a company called Akili Interactive Labs, which plans to develop a new version of NeuroRacer that can be “validated as a therapeutic tool,” he says. This will take some time. Bringing a game out of the laboratory into a clinical setting is a huge challenge. The new game will have to travel through the standard pathways to the FDA to see if it can become a “prescribable video game.”
“It could still be a couple of years,” Gazzaley says, “until well-controlled studies occur and get approved, and papers get produced, and the medical community starts accepting it and are willing to prescribe it right alongside traditional pharmaceuticals. That's a big change of culture and we have a lot more work to do until that happens.”
Level 2: Foldit and Nanocrafter — Gaming as a tool for scientific discovery
Your Goal: To use collective intelligence to solve complex problems
Zoran Popovic, a professor of computer science and engineering and the director of the Center for Game Science at the University of Washington, designed a game called Foldit to solve a specific problem: discover the shape of a particular protein biochemists wanted to use to create new disease-fighting drugs. Foldit's innovation was that it invited people from all over the world to actively participate in the scientific process.
Biochemists had been working on this problem for 13 years before they approached him, Popovic says. Within 10 days, Foldit players solved the problem. Two weeks later, the results were confirmed in the laboratory — the players had found the shape scientists had been looking for.
Popovic says this was possible because people are still much better at certain tasks than computers, especially when creativity is essential. Foldit worked so well, he says, because it harnessed the power of "collective intelligence" to solve a very hard problem.
"The biggest discovery of Foldit," Popovic says, "was that it is possible to create expertise on a rapid scale — and it's collective expertise. None of these discoveries were done by a single person. ... What's fascinating is that not only are people getting better, but they are self-organizing based on their particular propensities and strengths."
The way the game is structured, he says, information and strategies are transferred through mechanisms built into the game, such that new players become experts faster and faster. As the players increase their skills, they contribute their increased knowledge to the process of scientific discovery.
Now, Popovic has developed a new game, called Nanocrafter, which is designed for use in the field of synthetic biology. Nanocrafter is only about creativity, he says.
"The original Foldit," he says, "was solving a three-dimensional puzzle — trying to project what the shapes [of the proteins] should be. Nanocrafter is about protein design — people designing proteins that don't exist in nature."
Imagine, he says, taking DNA stuctures and pieces and working with them in an entirely new way. "Think of it like Legos, or a Tinkertoy set with motors that has a direct correlation with what you can actually do in a cell."
Only 50 to 100 people in the world are working in the field of synthetic biology, Popovic says, but it has huge implications for health in the long run. For him, it's becoming clear that this field is "not only a bigger 'sweet spot' for how people can outperform computers by a wide margin, but it is also a way to accelerate science on a large scale."
Level 3: Re-Mission — Gaming as a motivational tool
Your Goal: To increase treatment adherence in young cancer patients
“There are few things more challenging, that require resilience, than cancer," says Richard Tate, vice president of communications for HopeLab. “For young cancer patients in particular, it’s a challenge to engage them effectively in their own treatment.”
To address this persistent issue, a company called HopeLab created a video game called Re-Mission. Its goal is to increase young cancer patients' adherence to their prescribed treatments. Re-Mission puts the player inside the body of fictional cancer patients and arms them with weapons, like chemotherapy, antibiotics and the body 's natural defenses. “Your job is to destroy cancer and win,” says Tate.
Tate says HopeLab’s research and their work with hospitals and clinics around the world indicates that playing Re-Mission works: young people who play Re-Mission stick to their cancer medications and their antibiotics more consistently.
“There is a concept in psychology called self-efficacy,” Tate says. “[It is] the notion that you can do what it takes to fight your disease or to overcome a particular circumstance. Part of what we see the games doing is boosting that sense of self-efficacy — engaging young people and tapping into their own resilience to help them do what it takes to fight the disease.”
HopeLab’s researchers also discovered that Re-Mission led to real changes in the brain. Looking at fMRI data in patients, they found that playing the game lit up the brain’s motivational centers.
“It [isn’t] a passive viewing of information,” Tate explains. “We often lecture people or give them things to read. That's different from engaging them in an experience that allows them to make choices and to experience contingencies — both successes and failures — that then inform the way that they engage with the real-world.”
Level 4: Measuring success
Your Goal: To achieve results outside of the lab
Everyone involved with gaming agrees on one thing: If the games aren’t fun, no one will play them. Gazzaley says this is the biggest challenge facing researchers and practitioners working to incorporate gaming into medicine.
“We work very closely with game professionals, designers, artists, developers — the whole host of different skill sets that go into making a game fun, which is very hard to do,” Gazzaley says. “Then we balance their motivation, which is to create something that's fun and engaging and immersive, with the underlying goal of pushing on a process in the brain and keeping the science really clean. ... It takes a long time and takes a lot of testing, but it's possible — and it’s really gratifying when you wind up with something at the end that preserves all the scientific elements that you baked into it, but also ends up being a lot of fun.”
Tate agrees that it can be challenging to bring great scientific minds and creative game developers together to achieve one goal. Critical to Re-mission’s success, he says, was engaging young cancer patients in the development process.
“Ultimately,” he says, “when we got stuck — and we often did — the kids helped us decide. They helped us decide what was going to be fun and effective for them.”
For Popovic, the proof is in the pudding. It took two years, he says, to create Foldit, but the results have been astonishing: three papers published in the journal Nature and another in the Proceedings of the Academies of Science. Originally, Popovic says, other scientists said of Foldit, "Oh, what a cute idea." Now things have changed drastically. Every other day, he says, a scientist calls with an idea about how to take a scientific problem and "map" it onto a game.
Popovic says his lab has created a “completely new pathway toward scientific discovery” — leveraging the input and creativity of a wide population of people into the standard mechanism of scientific discovery.
So, how will all of this affect ordinary people's lives? Is it possible to conclude that video games will lead the way to better health outcomes and accelerate scientific progress? And what are people to make of all the websites and games already out there claiming such amazing health benefits?
“The field is really still in its infancy,” Gazzaley cautions. “It's appropriate to question things and to look at the difference between what is being claimed to be ‘based on science’ and what's actually been validated by scientific methods. They’re not the same thing. ... I think we’re at that stage now where we’re applying all the scientific tools and approaches to really validate what works and what doesn't work before we can make strong recommendations.”