So yesterday, after having poked at Pharma Guy’s stance on gamification, I got called out pretty severely by John Mack. Reading between the lines, I feel like he called me out as some sort of gold-digging digital con artist, so that was fun. Maybe it’s a case of, “You’re nobody in this town until Pharmaguy makes fun of you.” Perhaps I should take it all as a weird compliment.
Ignoring the ad hominem attacks, I’d like to dive deeper into Mr. Mack’s argument against the likelihood of the FDA ever approving a game as a proper treatment, the likelihood of a doctor prescribing a game, and the likelihood of an insurer paying for any of it.
The truth is, there is no proven science that games can, in any way, treat a patient’s condition better than a drug. Mr. Mack drills that point home pretty hard, which is fine because it isn’t the point I’m making.
The point I was making is that just because something doesn’t work now, it doesn’t mean that it can’t work in the future. In fact, the entire pharmaceutical industry is predicated on the idea that this particular clump of atoms form an unusual molecule, which when applied to certain people, cause certain outcomes. At one point, penicillin was just mold that grew on bread. It didn’t cure anything until we applied some science to it and learned what it could do.
And, like games, the first time we tried penicillin, it didn’t work. We learned, through trial and error, applied via the scientific method, the best way to use it to stop infections. I wonder if there was a Mr. Mack in 1928, claiming that no one would ever eat the mold off of bread because no one had ever been cured by it before. Or that no one would pay for moldy bread bits.
This all gets even more interesting in light of Mr. Mack’s post today in which he is supportive of the idea that people play games in order to stave off the onset of Alzheimer’s disease. You’ll excuse me for being confused by his position. Regardless of what the FDA will or won’t do tomorrow (as my crystal ball is in the shop), pharma’s reason for being is to discover find whatever solutions to people’s health care issues they can, no matter how unlikely or unusual the source. They were skeptical of tree frog venom, once. Video games seem obvious in comparison.
Frankly, the day pharma can build a game that treats a disease (in a scientifically-provable manner) nearly as well as a brand, is the day pharma finally realizes how much money can be made from this. That’s when pharma takes gamification seriously and issues about the FDA will be figured out.
Also, since games probably won’t have much in the way of side effects, does the FDA really need to be called in to do anything more than verify that the game does what it says it does? Indeed, proving one’s claim hasn’t stopped, say, magnetic jewelry makers and vitamin salespeople from edging in on what should be solely pharma’s domain.
The real issue is that pharma, by playing ostrich, is letting tech get a huge head start. Kodak used to believe that no one would want digital pictures to much the same effect. Acting outside the traditional pharma section puts tech in a position to be a true disruptive agent. Ten years ago, no one thought a guy with a list named Craig would be able to put thousands of journalists out of work. So let’s not assume the protective force-field of the FDA will stop tech companies from trying to do to pharma what Craigslist did to classified ads.
So, in an honest attempt to learn where Mr. Mack stands on the issue of gamification, I will ask that he define his stance free of argumentative distraction like the FDA, insurance providers, and things not necessarily germane to the issue at hand. I think that would be very enlightening.
It’s hard to remember, but there was a time when the idea that disease came from unseen microscopic organism that moved from person to person (or from water well to person) was something akin to “magic.” Disease was a function of luck, karma, the god’s displeasure, or some secret failing of one’s own soul.
You know what changed all that? Science.
So, if I told you that there was a tool whose regular use lowered (and even eliminated) a patient’s symptoms, and I could back it up with a set of clinical studies, you’d have to assume that I had a viable product on my hands, right? That’s the rule that pharma follows for the pills, topical treatments and injectables right?
But last week, Pharma Guy decided to stomp all over the idea of gamification like it was irritating pest. A game that helps kids with ADHD train their brain to not need Ritalin? Laughable!
Now, I’m not picking a fight with John Mack (oh, wait. Yes I am), but he seemed to take actual joy in pointing at it and calling it names.
I’m not calling for pie-in-the-sky (mmm… pie) thinking that leads to rose-colored glasses (so hot this year), but in science. If I can prove that a divining rod is far more likely to predict water than a placebo, it may seem like mysticism, but science proves that there’s something there (not that I have any proof that divining rods are any more than drought-based snake oil). And it’s the same with all sorts of things that aren’t pills and topical treatments and injectables and whatnot. I can’t see how penicillin works, but science proves it does, so that’s that.
Why can’t we apply the same rational thinking to games?
It seems like Mr. Mack is focusing on the politics of funding, testing and reviewing a game like a drug, and I agree that it’s a long road to follow, but pharma follows the path where science leads. What if playing a game every day really lower or eliminate the need for taking Ritalin?
Let’s not forget that games probably won’t have a lot of side-effects like nausea, heart palpitations and addictions (like Ritalin does). And what kind of adverse events would a game cause? Yeah, that doesn’t seem like a path worth following, does it?
The best part is that pharma can and should be making money marketing these new kinds of treatments. If pharma doesn’t get on ball and start playing with these ideas, the tech world is going to beat us to it and shut us out of the market completely. We’ll be busy playing an outdated game while tech moves the playing field out from under our feet.
Now, I’m not saying that we shouldn’t apply a critical eye to games like we do any other brand, but declaring them dead before they’ve had a chance to prove themselves like any other brand is short-sighted and closed-minded.
Or maybe Pharma Guy thinks washing one’s hands before an operation is lunacy.
Pharma likes to put itself in a very specific frame: They are makers of our “Brussels sprouts.” No one wants to take their meds, or go to the doctor, or track their progress. These are chores we all simply have to do. And while Pharma is fully engaged in finding and designing new Brussels sprouts to make us healthy, they throw a sidelong glance at the idea of adherence. You can almost hear pharma say, “It’s good for you, so just take your meds while we get back to making new ones.” They leave it to the prescribers and pharmacists to scare patients into adherence. But adherence is key to pharma’s success in the long run. Low adherence reduces the likelihood or curing or treating the disease, which lowers patient’s interest in taking more meds. If we instantly hit 100% adherence, pharma sales would be way up and we’d hear less doom and gloom at industry conferences.
So let’s look at someone who’s gotten the idea of adherence right and see what we can learn. Fitocracyis a site designed to get people to take a different kind of medicine: Exercise. Excluding those handful of crazy people who consider exercise fun, most Americans look at time at the gym or on the treadmill as a chore even more dreadful than swallowing some pills. Yet somehow, Fitocracy has levered a number of different psychological and sociological tricks to get people to commit to getting more fit, and then doing the work required to get there. How successful is Fitocracy? In a world where startups are desperate for people’s attention, Fitocracy’s site is invite-only, and it took a little effort for me to get in. In a nutshell, Fitocracy gives you points for being physical. You get points when you work out, but you also get points when you shovel snow, or take the stairs instead of the elevator (granted, you get a lot more points for deadlifting half your body weight than you do taking the stairs, but it all adds up). There are pre-assigned quests and achievements you can complete (like when you log 10 items in a week, or try a barbell squat). And as you add workout data, you can level-up, like in a video game. And like a video game, each level gets a little harder to achieve, but by the time you’re working towards level 10, you’ve got weeks of workouts under your belt and you have the confidence you can complete the level without it being too easy. Aside from the game tricks, Fitocracy leverages the power of each person’s personal network. Just as you will gain weight when you hang out with over-eaters, and get funnier when you hang out with clever people, hanging out with people who work out encourages you to work out. Hanging out with people trying to lose weight helps you look at your choices in a new light. On the site, your social network gives you props for good workouts or when you’ve had a couple of good workouts in a row. Or when you lose a few pounds. Or when you set a record on the treadmill or barbell. You get positive reinforcement, right there on your screen every time you work out, along with points for giving your friends props, encouraging you to give as well as you get. No friends? Join one of the existing groups, like the Chicago group or the weight loss group to achieve your goals. You are collaborating together, and that induces even more adherence. This is social proofing: you don’t want to let your friends down, and they don’t want to let you down.
How can pharma steal some tricks? Well, if pharma wants to start using the ideas of persuasion, gamification and social proofing to increase adherence levels, it needs to start by getting out of its own way. Especially in terms of privacy. Yes, pharma succeeds because of federally mandated privacy laws, but as you can see from the thousands of patient forums, people are willing and interested in talking about their disease state so long as they get the choice to do it on their own. Pharma can play a part, and even encourage people to talk amongst each other without coming anywhere near violating privacy rules. They can build a site like Fitocracy devoted to diabetes or gastric distress or gout or depression, where patients get points for doing things that make them healthier (like taking their meds), or talking to other people with the same disease, or helping other people with their problems. Beyond the obvious health benefits to the patient and adherence benefits to Pharma, this community could serve as an active focus group, one that can help you understand patients and even leverage should you need to communicate with patients or the public at large. Pharma needs to become partners with their patients to solve a lot of each other’s nagging problems, and it seems Fitocracy has developed a pretty interesting template on which to model that solution. If you’re looking for Fitocracy invites to check it out, ask me on Twitter: @digital_pharma!
Blah blah blah gamification of health care and applications.
Blah blah blah excite the user, they don’t know they’re learning.
Blah blah blah radical new way to think about apps.
Okay, so here’s what you need to know: Games have been with us since the first moment we had four extra seconds to catch our breaths between chasing and being chased by large animals. Games are how our brains work. They are huge muscles that always seem to have more cognitive surplus that we can even comprehend (ever have a song get stuck in your head? That’s your brain bored and looking for things to do. Don’t believe me? Then stop thinking about that song. See? You aren’t in charge of your brain: it plays its own set of games) so they play games.
It’s not new.
Learning the alphabet by song is a kind of game. Learning to walk is a kind of game. Anything that involves learning without immediate danger is probably a game of some sort. So it’s not new.
What’s new is the fact that we’ve all collectively decided that games are the new way we’re gonna make fat people restrict their diet, diabetes patients track their glucose and IBS sufferers see that they have a real issue.
So what do you need to know?
Let’s start by understanding what makes a good game. Start with the best all-around game out there today: Portal 2. What makes it a great game? I’ll let the experts explain.
Everything you need to play is given to you just in time. Rules are simple, but the circumstances evolve. You can put yourself into the game and relate to the characters. Writing (plot, characters, dialog, pacing, setting) matters.
When all those things happen, call it a game, call it a story, call it good design, whatever. It works.
Here are the things to consider if you’re really invested in making your app a game: Competition, Play, Rewards, Status.
Is Mint a game? I like making sure my money is doing what I want. There’s no competition, except with myself.
FourSquare? It’s all there.
Does your app have those components, or is it over-burdened with corporate language and having to learn 100 rules at the get-go? Are you so worried about how someone might use it that you’ve built walls to make it more of a maze than a game?
Remember ten years ago when the watchword was design? Everyone thought they could slap on some “design” on everything and it would sell. Design is a function of a design culture. You can’t graft it on at the end. This is why game companies (generally) make better games than non-game companies. They live gaming.
Do you live gaming? Then take a second look before jumping in.