This week, Ian Bogost and Gonzalo Frasca decided to close their seven year old serious games blog, Water Cooler Games.  In a nutshell, they believe that the idea of games for more than entertainment is no longer novel.  The blog sphere on this topic is saturated.

But a more important factor was at work in my decision to close the site. Since 2003, the widespread application of games to learning, news, politics, health, business, advertising, and other uses outside entertainment has become much more common. The very idea of our project was novel then, in a way that it is not now. Isn’t that what we wanted all along?

And it’s not just those in the serious game field talking about this topic.  Just a week prior an article in Health Affairs outlined the market state of health games. Currently, the health games market is valued at $6.6 billion, in comparison to the overall $42 billion video game market, according to PriceWaterhouseCoopers.  The video game business is estimated to grow an additional $26 billion in the next two years.

Will health games follow suit?  Carleen Hawn, co-founder and editor of Healthspottr.com in San Francisco believes health-related digital games have  an “immense” potential for growth in the digital game market, citing successes like Wii Fit, Robert Wood Johnson Foundation and Humana’s Horespower Challenge.

As the novelty wears off, what should we expect from the market?

If those in the field believe that serious games are starting to lose their novelty, how should we expect the market to react?  I’ve been asking myself the same question these last few weeks. The video game market continues to grow at a remarkably fast pace, but the health games market, although growing, has been slow.  If health games are really becoming a part of our everyday lives, to the point that they are no longer novel, where’s the money? Where’s the market?

Each week Gamasutra features an article from their member blogs.  Once in a while a member blog will write something on serious games or health games that really hits home.  This week’s Standout Member Blog is Raymond Ortgiesen’s Blog, views from a junior game design student at Champlain College in Burlington, Vermont.  His featured post is entitled “Some Thoughts About Serious Games.”  It’s a very thought-provoking article, and the comments are well worth taking a look at.  Here was my personal favorite quote from the article:

Frankly, it’s damned arrogant. The term [serious games] came about through a mixture of marketing on the part of the colleges and through a level of arrogance for developers who wanted to separate themselves from those other designers who make games just for fun. I truly believe that a large portion of it comes from a desire to say, “I make serious games, about how beating women is wrong.”  so that they can get a pat on the back from those ignorant of the power already inherent in mass market games.

Kudos to Raymond for such a bold and daring statement.  Also take note as you read the comments how Raymond tries to respond to everyone.  I greatly admire that in a blogger.

Will the real game developer please stand up?

Now,  serious health game developers, let’s hear what you have to say.  Some major things we need to ask ourselves:

• Is the term “serious game” really accurate?  Are we no different from conventional game designers?
• Has labeling our craft alienated us from the rest of the game industry?
• Are serious games “for the other guy” such as educators, doctors, etc?  Can we be mainstream?
• Are we trying to reinvent the wheel?  Could conventional video game titles be re-purposed to relay health messages?

But shouldn’t they be interactive?

I’m completely on board with Adam’s idea that games don’t necessarily have to be full of fun and non-biased.  Many health games are not fun, they’re educational and designed to change behavior.  We hope they will be fun, but they don’t always turn out that way.  The player knows this is not going to be Grand Theft Auto.  Furthermore, games shouldn’t be political?  Who came up with that idea?  There are plenty of social issue games out there from Fatworld to A Force More Powerful that clearly take a political stance and are clearly still games.

But what about interactivity?  Isn’t that what makes a video game different? Adam says, “What I’m against is the idea that, because interaction is the defining aspect of games, that games must always focus on interaction.”

Although all of the comments I read at the bottom of this article take Bishop’s side, I’m not completely sold on this last one.  I think to have a successful health game, you at least need a high level of interactivity.  What do you think?  Do you agree with Adam that a good health game doesn’t necessarily need to be interactive?

The devil is in the details.

As they indicated it on the Whosegame FAQ, “The first concept of the site is to provide playful self-made video content, providing the opportunity for creators (developer, artist and game designer) to showcase their talents in creating video games.”  The First concept?  You mean there is a second one?  Indeed, a closer look at the games submitted revealed that only one was dedicated to health. The purpose of this health game is to discover how new technologies bring innovative answers in the health sphere. Efficiency, comfort and cost cuts: enough to revolutionize health professionals and patients everyday life.  Surprisingly, it was created by the health division of Orange, the organizer of the contest.  Moreover, no details are given on the judging panel, its composition or how the winners were selected.  Curious, isn’t it?

Good boy!

In the Mission E-Health game, the main character is a puppy that tries to solve problems for the inhabitants of Jolyville using e-health. The first mission is to bring care trays to patients in the hospital.  Personally, I was never able to pass this level after several attempts. However, the other missions are listed in the help section like to help a young diabetic male manage his disease, to help disoriented people localize themselves, and to help a physician with an on-line appointment solution.

Just an Orange self-promo?

As this game was created by Orange Healthcare division, it shouldn’t surprise anyone when I tell you that these solutions are already marketed by Orange.  So, one could surmise that Orange has created the whosegame contest in order to create a buzz in order to promote its e-health solutions through the only one game dedicated to health in this contest.  By the way, this contest was also used as recruiting tool for the next serious game to come.  In my previous post I reported that the government has announced that it has budgeted about 50 millions Euro (about 70 million USD) to be spent on serious games and web 2.0.  How much you bet Orange Healthcare is preparing itself to gain its share?  The contest is open!

What about policy ?

An experiment was carried in 2006 at the Claude Bernard University of Lyon 1 to evaluate the effectiveness of MicroSim, a self-education software system of computer simulations for students to practice emergency medicine protocols and procedures. For almost 2 years, not much happened. Upon receipt of the May 2008 report on the numeric university, the French Ministry of Higher Education and Research, Ms. Valérie Pecresse, declared that she wished universities to be able to generate a bank of numeric documents, including serious games, on their own.

More recently in October  2008, Eric Besson proposed several actions in his government report “France Numerique 2012.”  Among these reports was a request that public training and education markets, particularly those concerning health and education, should be enriched by an approach based on serious gaming.

Consequently, Ms. Nathalie Kosciusko-Morizet, the French state secretary of Numerical Economy, recently declared on May 6, 2009 at the National Assembly that “she wants to use video games techniques for various domains like health.” As a matter of fact, about 50 millions Euro (about 70 million USD) should be spent via tenders for projects dedicated to serious games and web 2.0. The first projects should be selected by the end of this year.

No prevention, No salvation

With a growing body of the elder population, France has no choice but to reduce its health bill. Part of the goal could be achieved by reducing healthcare costs. However, this has led to ongoing and very unpopular reform. France’s health bill could also be lowered by emphasizing prevention at every age to delay the onset of disease. Consequently, a trend toward a responsible population acting for its health, also driven at the European level, is emerging like national health advertising campaigns on TV or other public actions like the Happy Night Club game to educate young people about the risks associated with the over-consumption of alcohol.

Did you say “Wii” or “oui”?

As a matter of fact, the Wii Fit is the most sold console in France and the Brain Development programs are amongst the top 20 best sellers.  But Nintendo should look in the rear-view mirror.

Just trailing the UK, France is expecting iPhone sales to reach 1 million by the end of the year. Taking into account the large availability of health and nutrition programs on iPhone, it might eat a significant part of the pie. Interestingly, as the new anti-obesity blue pill has started to be sold this month, a few days ago a European poll has shown that France accounts for the leanest population in Europe.

So where lies the paradox?

France has three of the best video game companies in the world of the video game industry. We have major private actors, a positive action from the government, and yet a small world market share. It will do, but we should do much better. Fortunately for the game industry, as the French people have to pay more and more by themselves and are facing less medical care reimbursement, they should find that games are a way to improve their health, and consequently for their purse.

About the author

Dr. Mohamed Selamnia is the founder of DCIS (Decisions and Innovation Consulting and Health) in Paris, where he devotes himself entirely to Helath 2.0 and national health events organization.  After his PhD in Physiology of Human Nutrition (Paris 7) in 1997, Mohamed conducted a postdoctoral fellowship for 18 months in basic oncology at Penn State University College of Medicine.  Back in France, he earned an MBA in Marketing BtoB at Paris-La Défense and started to work for a Business Consultant firm in Biotech. In 2001, he co-founded IMEDIAL in Gennevilliers, France where he has developed an expertise in pharmaceutical promotion and medical and participated in the development of several internal activity report software.  He has been the owner of DCIS since October of 2008.

The discipline and art of medicine has made a swinging 180 in the past few decades.  What used to be a patriarchy/matriarchy of “I am the medical professional, just do what I say” is now an Internet fueled “I am the patient, I’ve researched my options, and I need your professional advice.”  So the mindset of medical professionals is changing accordingly to “How do I connect with my patients within THEIR modus operandi?”
Healthcare Gaming is one of many new and exciting approaches that can affect attitude and desire for change that leads to a healthy life.  It incorporates a number of components that appeal to a wide age range and demographic cut of our population:

• It uses technologies such as cell phones (mini-computers with a misnomer!), laptops, even mp3 players that are an interwoven part of our lives.
• It’s fun and challenging and appeals to our competitive nature – an aspect that was previously sorely missing from patient education.
• It can involve solitary or group dynamic participation – allowing healthcare gamers to choose the environment in which they are most comfortable learning about their health.
• It optimizes social media and the connectedness that people often miss when they have a lifestyle or health challenge and feel that they are alone in it.

Building a new patient care strategy with health gaming.

In my entire career I never met a medical professional who wasn’t in the game to improve the patient’s health.   It’s true, healthcare is a business and economic drivers abound, but there still exists an underlying burn to see true improvement in the patient’s health – that’s the ultimate way to keep score for a medical professional.   When it comes to such a novel approach as health gaming, there may be skeptics, but there is no denying that these types of technologies and applications are an important part of their patients’ lives.  So to meet them on their own turf in the health arena is a sensible, though new, strategy.

Also important in this time of economic challenge are the opportunities that exist for new and existing companies to create applications that will revolutionize the healthcare industry, while fulfilling the altruistic goal of truly improving peoples’ lives.  Who doesn’t want to be a part of THAT?

Your challenge.

In future postings, we’ll take a look at some of the very innovative applications that are available or are in the planning stages.   The challenge to you?  Keep coming back to healthGAMERS, find out what’s new, and begin to imagine how it could change the way you practice medicine.

About Beth Frost-Johnson.

Beth is President of Frost-Johnson and Associates, a healthcare technology marketing and business development firm.   Her experience in  all sectors of healthcare – provider groups, multi-hospital system, payers, biomedical devices and healthcare IT, makes her a solid believer that patient-driven technology will be the greatest single strategy to improve our future health and healthcare.

Thumbnail image provided by: http://www.freedigitalphotos.net

We are honored to present our first guest contributor today, Dr. John La Puma, MD.  He is going to share some of his insight on the world of cooking games for weight loss.  A big thanks to Dr. La Puma for this article.  -Melanie L.

The top four.

When Dr. Mike Roizen and I taught nutrition and cooking to medical students at SUNY-Syracuse six years ago, we thought we needed to be there.

But people learn in all sorts of ways. Now Nintendo is out with four popular choices.

1. My Weight Loss Coach software. A simple stick-figure tool for someone starting out, this is more of an adult health app than a game. It coaches small, bite-size daily steps and reminders: skip the corn chips today. Put the salt shaker in the cabinet. There is a calorie counter and an iphone app.
2. Cooking Mama. Educational and slightly second-life-ish, Cooking Mama allows you to use the stylus as your ubi-tool (stir, chop, slice, dice, knead) for 70+ largely Japanese-style recipes. Cooking Mama has a bit of Gordon Ramsay, but only a little nicer. When you make a mistake cooking you’re not lambasted, though her eyes can flame. Recipe difficulty varies greatly; with little emphasis on calories.
3. Cooking Mama 2 can feed friends, and you can customize the kitchen, cookware and Mama’s clothes (nothing too racy, at all). Both Mama games have their adult fans, but cutesy graphics and the simple characters cater especially to preteens.
4. Personal Trainer: Cooking. Quirky and eclectically international, this is an interactive cookbook. You get detailed guidance for shopping and cooking 245+ recipes from lasagna to bulgogi on two small screens with WiFi. You can select dishes (using voice recognition and touch screens) according to calories per dish.

Hands-on is still the best way I know to teach healthy cooking. But if private weight loss coaching can work well by email, phone and fax, then this first phalanx of weight loss and cooking games is worth a look.

About Dr. La Puma.

John La Puma, MD is obsessed by games that can do good and still be as fun as World of Warcraft.  A practicing physician, professionally trained chef, and a New York Times best-selling author, he hosts “What’s Cooking with ChefMD? Sunday mornings on Lifetime TV’s “Health Corner”.  Visit him at www.drjohnlapuma.com.

We’re in the process of creating a health game about the food pyramid at the Playnomous office.  And it hasn’t been easy.  In my opinion, from a graphical standpoint, the latest edition of the USDA food pyramid (or MyPyramid) is nonsensical.  It uses a pyramid shape, but the new schematics work more like a pie chart since MyPyramid is all about percentages for individuals.  Frankly, I think they should have changed the shape and scratched the word “pyramid” altogether.

Food pyramid game or food pyramid lame?

However, sometimes you have to work with what you have, so we hope to soon release Food Pyramid Pile Up, pyramid and all.  At our last meeting the question was posed “How do other food pyramid games handle the new MyPyramid format?”  An excellent question and one I couldn’t answer right away.  I was well aware of MyPyramid Blast Off, an online game by the USDA which uses the analogy of fueling up a rocket ship to fueling up your body.  But what other games are out there?  After a few hours of searching, I didn’t come up with many.

• MyPyramid Game – a drag and drop category matching game by the Dairy Council of California
• MyPyramid Food Gallery and Quizzes – a basic tutorial and test of knowledge by Oklahoma State University
• Healthy Hurdles Nutrition Game – a meal balance board game by Learning Resources
• MyPyramid Pursuit Game - a pyramid completion board game by Learning ZoneXpress

All in all, I think MyPyramid, if that is indeed the format we’re going to stick with, needs some help.  There aren’t many health games out there that:

1. Do a good job of making MyPyramid easy to understand.
2. Aren’t just drag and drop category games.
3. Are actually fun to play.

Prove me wrong.

If you know of a stellar Food Pyramid or MyPyramid game that I missed, please add it to our list.  Prove me wrong! Good Food Pyramid games are wanted here on healthGAMERS!

I cannot believe we are to part eight of eight in our series!  It’s been quite a journey, but here is the last piece of the puzzle.  Great Game Tenet #8: a great health game needs to be intelligently designed.

Designed to do amazing things.

This is an excellent tenet to wrap things up because an intelligently designed health game must have it all: great art, great feedback, great content, great re-playability.  In other words, plan, plan, plan, plan, plan!  The game must flow or you’ve got nothing but a static set of health information that no one sees.  The content must match the gameplay.  This is harder to do than it sounds and is the subject of research being conducted by one of the Health Gamer authors, Dr. Cynthia Phelps.

Health games that do it well.

To name a health game that is “intelligently designed” without having personally witnessed the design process, one must look at the data.  Two sets of data to be specific:

1. Did the target audience actually play the game and enjoy it?
2. Did the target audience change their health behavior(s) during and/or after gameplay?

When looking at these two sets, no one beats the type-1 diabetes game Packy & Marlon for Super Nintendo created back in the mid-90s.  The goal of this game was to improve self-management among diabetic children and adolescents (age 8-16) by playing the part of a diabetic elephant that must save a diabetic summer camp.  The player must manage their character’s blood glucose, insulin use, and food selection in the game.  Did this game answer our two questions well?  You be the judge:

1. Participants played an average of 1.5 hours per week during their spare time for 6 months.
2. After a 6 month trial, the treatment group (those that played Packy & Marlon versus a traditional video game) had a 77% decrease in diabetes-related emergencies.  There was also a significant (that’s scientifically valid) improvement in daily diabetes self-management behaviors along with increased self-efficacy and communication with parents about diabetes.

Content matched gameplay for a fun and effective health game.  This is what every health game developer hopes for.  Furthermore, one of the Investigators of this game, Debra Lieberman, is now the Director of the Health Games Research Institute in Santa Barbara.  All in all, I’d put Packy & Marlon in the “success” category.

I’m sure there are many other health games out there that belong on this list as well.  Feel free to list yours.

Recommended readings.

• Brown, SJ, Lieberman, DA, Gemeny, BA, Fan, YC, Wilson, DM, and Pasta, DJ. (1997). Educational video game for juvenile diabetes: Results of a controlled trial. Medical Informatics 22(1), 77-89.

Continuing on with our series, today’s great game must is music to my ears.  You guessed it, Great Game Tenet #7: a great health game has great sound.  This isn’t just your run-of-the-mill sound effects.  Sound includes the sfxs, music, and voices.  All are crucial.

Sounds adds credibility and tone.

The obvious purpose of sound in a game is to activate your auditory senses, not just your visual.  This further immerses the player; it sucks them in.  In my opinion, sound can make or break a health game.  We’ve already talked about how important immediate feedback can be in a health game.  But what about the other sounds like music?  One might argue that music is unnecessary, but if it is used, music can set the tone for the entire game.  Is the game meant to be light-hearted or serious?  Dramatic or just educational?  Sound can also make or break your characters.  Does your character from China sound credible or stereotypical?  Does the character’s voice allow the player to identify with him/her or does it offend the player?  One must also consider general voice over.  This can be a necessity for an audience with a low reading level such as children.  Without voice over, your health message may not get across at all.

Health games that do it well.

Escape from Diab, a PC adventure game that was created to target obesity and decrease type 2 diabetes in children, is a perfect example of a pristine game full of sound.  With a custom soundtrack and professional voice talent, this NIH-funded creation goes above and beyond in the sound category.  The medical training game Pulse!! by BreakAway Ltd and Texas A&M Corpus does an amazing job of using sound to simulate the realities of a clinical emergency after a catastrophic event, such as combat or bioterrorism.  The goal of the game is to be lifelike.  Without sound, this would be a sub-par simulation.

Recommended readings.

• What Makes a Great Health Game Great – Part 6