Video Game Prescriptions

Rob Capriccioso
January 10, 2005

Nov. 5, 2009 Update: The Robert Wood Johnson Foundation awarded grants to nine research teams to study how video games may actually improve the health of people with chronic conditions. Here's the press release: Nine Leading Research Teams Selected to Study How Digital Games Improve Players' Health. We'll keep tracking the issue on SparkAction!

Ben Duskin, 10, and LucasArts engineer Eric Johnston created "Ben's Game" to help young cancer patients visualize their bodies

Like many 10-year-old boys, Ben Duskin likes sports and video games. The L.A. Lakers top his team list, and thanks to some encouragement from his arcade-loving mom, Pac-Man really gets his gamer's thumb going.

For half his young life, though, he's been quite different than most of his peers. At age five, Ben was diagnosed with lymphocytic leukemia, a rare, life-threatening condition that he continues to battle to this day. He and his family have had to get used to his hair loss and persistent nausea as a result of numerous strong treatments to try to kill the disease. He is currently recovering from a risky bone marrow transplant he received in December 2004.

Pac-Man to the Rescue

Early during Ben's treatment, his physician, Dr. Seymour Zoger of San Francisco Children's Hospital, told Ben that he should think of ways to visualize his body healing. Ben started imagining his medicine as Pac-Man, with the big yellow guy eating away at the cancer cells.

As most people who have picked up a joystick know, the same game gets boring after a while. That's one reason why Ben took his Pac-Man visualization process to a new level a couple of years back when he and his family contacted San Francisco's Greater Bay Area Make A Wish Foundation. Ben's wish was to create his own cancer-fighting video game.

Foundation organizers were excited to help, but they quickly realized that the process of creating a video game would be complex and could be very expensive.

After hearing about Ben's wish through a friend, Eric Johnston, a senior software engineer with LucasArts, called the foundation and said, "Let's just start."

Ben's Game

Ben and Johnston began meeting regularly on Tuesday nights. Over six months, they hatched out a plan and started developing a game. Ben had one non-negotiable requirement: the main character could not die.

"How do you make a game fun if the player isn't afraid of losing?" Johnston asked Ben one evening.

"You keep fighting—that's what you do for real and that is what you will do in the game," Ben responded.

One night, Ben showed Johnston his port, a device inserted into his sternum to inject chemotherapy medicine. "This is how the player gets into the game," said Ben, pointing to the port.

Download Ben's Game and for instructions, visit Make-A-Wish.

It was the first time the collaborators had discussed the idea that the player in the game would be the medicine. Soon, Ben decided that the monsters of the game should be the real-life side effects of cancer treatment, like vomit.

"Ben's Game" was released online for free in 2004. It has been downloaded thousands of times and has been translated into nine languages at the request of cancer patients around the world.

"He could have asked for anything, a bike, a stereo," reflects Patricia Wilson, the director of the foundation. "[B]ut he asked for something that would not only help him, but other children struggling with life-threatening diseases."


"Revenge of the Diabetics"

In the case of a new device called Glucoboy, a parent's realization of just how much his young son loved playing Gameboy led to the development of a new tool for managing childhood diabetes.

Paul Wessel's son, Luke, was diagnosed at age three with Type 1 diabetes. Type 1 diabetics stop producing insulin very early in life, and must rely primarily on injections to get the insulin they need. Very careful monitoring of blood chemistry is needed to make sure diabetics receive enough insulin—but not too much.

Wessel says that as Luke grew up, he would check his blood sugar less and less frequently. By age six, he was purposely losing his glucose meter, but always seemed to know where his Gameboy was.

Wessel thought that a glucose meter combined with a Gameboy would be something Luke could never forget. So, using private savings, he first produced a prototype and secured a patent for his idea. Then, he had to convince Nintendo executives in Japan that the device should be licensed by the company. The device is set to be commercially available this summer.

To use Glucoboy, kids must collect a personal blood sample on a blood sugar test strip and insert it into the machine. Once their blood sugar numbers appear on the device, they can slide the Glucoboy into the Gameboy and download their testing data.

A library of reward games is stored in the Glucoboy. New games are unlocked as a child uses the device to demonstrate that he or she is complying with a blood-sugar testing regimen set by doctors and parents. The process is password-protected to aid parents, as Wessel noted that his son tried to cheat many times to unlock games.

"I classify the stored games as 'Revenge of the Diabetics,'" says Wessel. "They're not available at Target or Wal-Mart." The idea is that Type 1 diabetics have something special that their friends without diabetes don't have.

"The glucose testing market has never made a device like this specifically for kids—so much focus is on Type 2 diabetes," says Wessel.

Wessel has clinically tested the device and found that not only did a majority of kids do a better job managing their diabetes, parents also reported an improved relationship with their children. "With Type 1 diabetes, the parent often takes on the undesirable role of being the constant blood sugar test reminder," explains Wessel. "A parent comes out like a very bad guy, just because he's concerned."


An Image Makeover

Hundreds of video games contain gun violence, crime, car crashes, and sexual antics. Based on 15 years in the industry, Johnston realizes video games have a bad reputation among many parents for good reason, but he says that new directions in health-focused gaming technology may pique the interest of even the harshest critics.

Research indicates that video games can sometimes have powerful results in terms of kids' ability to cope with illness. One of the latest findings comes from a December 2004 study by Dr. Anu Patel of the University Hospital in Newark, NJ. The study found that letting children play Gameboy games in the operating room before undergoing surgery can actually help them relax better than being with their parents or taking tranquilizers.

One gaming device—which has received support from NASA researchers—focuses on helping kids cope with Attention Deficit Hyperactivity Disorder. When players produce faster brain wave, the game controller works better, and they have better control of the characters on the screen. However, when kids use more lethargic brain waves, the controller does not respond as well. Sensors in a helmet monitor the types of brain waves being utilized.

The idea is that the child will pay closer attention to the kind of thinking that makes the game work best, and perhaps apply these skills in real life. The technology is currently available commercially from Unique Logic and Technology, an educational company made up of research technologists, educators, and engineers.

As these kinds of projects are developed, more financial support is becoming available. In December 2004, the Serious Games Initiative received a two-year grant of $250,000 from the Robert Wood Johnson Foundation to support a Games for Health Project. The Serious Games Initiative is a joint effort between Digitalmill, Inc., a game development organization, and the Woodrow Wilson International Center for Scholars.

Organizers of the project hope to promote best practices, community building, and conduct more research into how cutting-edge game design and development methodologies can aid in the creation of health tools.

Meanwhile, "Serious Video Game Summits" that have popped up around the country since 2003 with support from the Wilson Center are getting the health-focused gaming ball rolling even further. At one Washington, D.C. session last fall, Dr. Mark Wiederhold, co-founder of the Virtual Reality Medical Center in San Diego, CA, spoke of the need for more investment in developing video games with a therapeutic purpose.


On the Horizon

Wessel recently attended a "Serious Video Game Summit" in Madison, WI. "Lots of people have figured out that you can modify kids' behavior with video games," he observes. And he appreciates that researchers are starting to look at the vast possibilities in the health-focused video game arena. But he also offers a cautionary observation: "Most of these people are from academia. They have not learned how to translate their knowledge into a commercially viable entity."

All video games, health-focused or not, should be fun, according to Johnston. What makes them fun? "That's a big question," he responds. "Game design is a tricky art; there's no one recipe."

In the meantime, Wessel has registered a few new patents on what he thinks might be the fun and healthy video games of the near future. Plus, Wessel's son Luke, now 17, is really interested in cell phones, so a gluco-cell phone might not be too far down the road.

Johnston hopes that once Ben recovers from his recent bone marrow transplant, he'll decide to go into the healthy video game production business. According to the game developer, the 10-year-old is a big inspiration: "My wife accused me of trying to give video games a good name," he says. "But I just wanted to work with Ben."


Rob Capriccioso is a former staff writer for Connect for Kids/SparkAction.