The Gamification of Health (Gamification Post #2)

Yesterday, I wrote a post discussing gamification – the idea of using games in new and even “serious” ways.   Healthcare is on everyone’s mind right now (see Nicole’s post below), especially here at Saint Louis University with our Center for Health Law Studies.  The prediction markets  — another type of game — are split on the outcome.  (Latest per Josh Blackman’s Fantasy SCOTUS: ACA Constitutional 42%, ACA Unconstitutional 57%).  And so, while we’re waiting, I thought I’d provide a little distraction by writing about the intersection of health care and gamification.

I recently finished a book by Ivan Beale entitled “Video Games for Health.”  Most of Beal’s book concentrates on an innovative game called “Re-Mission,” where the player’s avatar fights cancer cells in the body, and along the way receives advice about the importance of taking medication, getting enough rest, and lowering anxiety.  Preliminary results seem to support the idea that the game leads to positive health outcomes for kids and teens battling cancer in real life.  In the health insurance and employment context,  wellness plans are using gamification to motivate plan members to adopt healthier lifestyles.  For example, Mindbloom’s Life Tree allows users to earn seeds (points) for healthy behavior like walking, going to the gym, or getting a check-up.  A cute website and social networking integration provides users with additional motivation, as friends can see a member’s progress toward a healthier lifestyle.

As far as the legal issues, a recent article by Kristin Madison et al.  noted that the Affordable Care Act would allow for employers to provide additional financial incentives to employees who participate in wellness programs.  The article, however, also raised some legal and ethical concerns: will gamification and financial incentives discriminate against those who are ill, even when is not their fault?  Are some of these wellness factors class-based?  How do we feel about tying employment and work so closely together?  Do employees want employers to have their health-related information? Might employees feel coerced into these programs?  Regardless of the Supreme Court’s decision we have much to think about.

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4 Responses

  1. Josh S says:

    There is a recently developed iPhone app called Fitocracy. The game is a combination of a social media platform, weight loss and exercise tracker, and role playing game (RPG).

    The app allows you to enter different exercises you might do in the gym (such as pullups, pushups, running on the treadmill), and assigns a point value. For example, running on the treadmill for 15 minutes is worth 122 points. Each workout entry may be cross-posted to your other social media platforms such as Twitter and Facebook, allowing your friends to comment and (presumably) provide positive feedback. Reaching a certain amount of points allows you to progress to the next level.

    There are “Achievements” that can be unlocked, such as “Perform barbell bench press for at least 0.9x bodyweight.” There are also “Quests”, such as “Try out three different Shoulder exercises within 7 days.” Doing these activities will also give you bonus points.

    There are also other facets to the program, including the ability to join groups based on common exercise interests, add “Friends” and “Followers” like Facebook and Twitter, and even a leaderboard to see your ranking among all Fitocracy users.

    I’m just starting to use the App myself, but it looks to be an interesting way to combine the look and feel of social media, the benefits of an exercise tracker, and the gaming aspect of an RPG. It might be worth checking out further.

    Here is a review from the iTunes site:

    But it looks like an interesting topic…


  2. A.J. Sutter says:

    What constitutes a “positive health outcome”? Survival for some number of years, shrinking of tumors, or what? What percentages of those playing the game achieve these various outcomes? And to what extent are the outcomes attributable to playing the game rather than following the other advice dispensed or other treatments?

    Games are nothing new as visualization techniques to fight cancer. Meditation has been used for a long time as a way to fight both the physical and emotional effects of illness (as if those are always distinct). Though I can’t offer statistics about it, my own late brother, in his late 20s when first diagnosed, had been given a 3-month prognosis for a very virulent sarcoma, but survived for over 4 years without chemo or radiation, thanks to meditation and dietary changes. And that was 35 years ago. He was also able to get married and to be a calmer and sweeter guy than he’d been hitherto. Certainly a positive health outcome, albeit a finite one — as are they all.

    Maybe gamification is itself a symptom: sc., of the trend toward the ultra-utilitarianization of American society. All things are transformed into “points” — at least, when they aren’t being transformed into dollars.

  3. Frank Pasquale says:

    Great topic, and you’re the ideal person to cover this intersection of health and cyber law issues!

    I found this story on On the Media inspiring:

    I have yet to read Jane McGonigal’s Reality is Broken.

    The gamification trend is helpfully reconfiguring aspects of life into achievable “chunks” with direct reinforcement. I think the challenge will lie in discerning what aspects of life it is best suited to, and what it does some violence to. For example, Walker Percy probably would not have developed his world view (or written his ouevre) if he had gamified his recovery from tuberculosis. And to use a Percy image: I’m sure his “man on the train” would be playing Angry Birds nowadays. Peter Kramer’s “Listening to Prozac” and “Against Depression” are probably the best responses to the Calvinistic aspects of the Percy-an worldview.

    For the “dark side” of gamified health in the workplace, check out Gary Shteyngart’s Supersad True Love Story. I also think Scott Peppet’s “full disclosure future” suggests a possible “end game” there, though perhaps it will work as a self-preventing prophecy.

    In our field: I can imagine evidence law gamified well; admin law, not so much. Admin law best culminates in a “gestalt” that only comes after reading many cases. On the other hand, perhaps a series of small exercises (ala the Koch/Murphy Admin book before the Wine Trade Commission) is a very good way of inculcating the central skills there.

  4. Miriam A. Cherry says:

    Josh – Thanks for pointing me to that site, looks interesting, I will definitely check it out! AJ, If you go to the Re-Mission site that I linked to in the post, they have a section of their page that sets out their findings. A lot of it has to do with whether the kids are taking their meds, eating enough, etc. Also, AJ, I’m sorry you lost your brother so young – sounds like he made his time count. Frank, my next post (in progress) is about Jane McGonigal’s book and I’m contacting off-blog about some of your other thoughts/ideas…