It’s the age-old mantra of parents who won’t let their kids have gaming consoles — too many video games hurt your brain!
But last summer, the Food and Drug Administration approved the first-ever prescription video game. It’s called EndeavorRX, and it’s meant to help treat attention deficit hyperactivity disorder in kids age 8 to 12. It’s not a standalone treatment — it’ll be prescribed along with other, more traditional medication. Without insurance, it costs about $100 a month.
A year later, developers are just starting to reach out to doctors and potential patients.
We spoke with Ian Bogost. He directs the film and media studies program at Washington University in St. Louis. We asked him, what’s a medicinal game even like? The following is an edited transcript of our conversation.
Ian Bogost: It’s kind of like any video game. You’ve got a little character riding a vehicle and you pilot it through obstacles in order to reach a goal.
Jed Kim: That’s interesting. So, it doesn’t feel like you’re taking your medicine.
Bogost: Yeah, and you know, that’s part of the appeal of games for any purpose — for education or for politics or for training or what have you — is maybe you won’t notice that you’re doing this thing you don’t want to do if it’s in video game form. But the creators of EndeavorRx claimed to have made technologies that are measuring and adapting to the player who would be an ADHD patient who had been prescribed the game that, according to them, make alterations, kind of customizing the experience to optimize the attention-treatment experience.
Kim: I remember playing like Math Blaster! when I was in school, which is educational, but not very fun. As a designer yourself, how well designed does EndeavorRx seem?
Bogost: I mean, it seems fine. It really is just a video game. One of the things I wonder about it is, after you get over the delight and surprise of the idea of a prescription video game or a game for ADHD treatment, how long does that interest last? This game is meant for kids, and there’s a lot of games out there that they have to choose from, and how long would this specific game hold attention? Would it kind of become like medicine, in a way, because “It’s time to play your video game!” “I don’t want to play that game again.” So that’s one of the things that we just have to wait and see how that plays out over time.
Kim: Well, if it’s gotten approval, can we assume that that means it works?
Bogost: Well, one thing about approval is that it does no harm, according to the FDA, and the company admits this fully, it’s not meant as a sole treatment for attention deficit hyperactivity disorder. So in other words, you might be using the video game alongside other treatments. And those treatments might include traditional pharmaceuticals, or they might include therapy. It’s one tool in the toolbox.
Kim: It’s still the only FDA-approved video game that’s out there. Are there other companies trying to enter this market?
Bogost: Yeah, and this is complicated because everybody wants to be the first at everything, and we have a very short memory in technology and in games. So it kind of depends on what you mean by approved. A number of years ago, the FDA did clear the Microsoft Kinect device — a particular implementation of that motion-capture device — as a tool through which certain kinds of physical therapy treatments could take place as a special kind of FDA clearance called a 510(k). And that had to do with the way that the device was cleared to operate in conjunction with software. A number of years ago, another set of games made by the commercial company Ubisoft sought FDA approval for amblyopia [treatment], and these were based on commercial games used in a different way. And there have been a number of clinical trials pursued, controlled studies, that might lead eventually to FDA approval. In fact, many years ago, there was even a Game Boy add-on device for blood-glucose tracking for children’s diabetes. It was more about the device than about the game, but there was a piece of software connected to it. So this is a first, but it’s a first in a kind of murkier context of firsts that, to me, shows that folks have been trying to do this for a long time.
Kim: Is there a lot of funding going into prescription games?
Bogost: There’s a lot of funding going into this specific game. They’ve raised well over $200 million over the course of the last 10 years. Certainly there’s a lot of money in medicine and biotech and pharmaceuticals, in general, but we don’t have a large market of pharmaceutical video games. This is really one. Given that it took so long to get this approval, we would have to see a big funnel of companies and products coming on the scene to imagine that that market might open up. I still think this is going to be a curiosity for the foreseeable future.
Kim: Where do you see the prescription video games market going? And where would you want it to go?
Bogost: I mean, I’m a big fan and have been a big advocate of the idea of using video games outside of entertainment for health and medicine as well as for learning and for training and for documentarian, or historical, purposes. There’s certainly always been a lot of potential for games to do more than just be entertainment. But, it’s been really hard to gain traction in those sectors. One of the big questions that I’ve seen people asking about this specific game is, like, does this just mean that kind of any video game might be a good treatment for ADHD? And that’s a great question. It’s certainly one of the things that we’ve seen in the health, games and education sectors for a long time — the kind of notion of promise and potential. Like, Pokemon requires you to be able to read at a level that’s higher than the average grade level of a player of that game. Or, maybe you can kind of learn how to learn from video games, which are very good at teaching you how to solve problems and be persistent. Those sorts of ideas, though, they don’t get cleared in general by the FDA for something like that, right? That’s the kind of thing that researchers might study, but it’s only a specific product that gets approved for prescription use or as a medical device. So to me personally, I think these clearances, these things that look official, like official approvals, they’re partly rhetorical, they’re partly used by the companies that make these games to raise funds or to demonstrate the potential of their market or the reliability of recurring revenue for a product like this. And then they are partly indicative of an appetite and a potential for games, in general, for more games that might be used for these purposes. That said, we’ve seen a lot of these trends come and go. I remember 20 years ago or so, everybody was getting a PlayStation so they could play Dance Dance Revolution for exercise. No one sought to really pursue formal studies of that, at least not at the time, but people liked it, and they felt like it worked, and then that fell away in the same way that, like, aerobics videos did in the 1980s.
Kim: It just feels so counterintuitive that playing a video game could help you mentally. Like, I’m so used to hearing adults when I was a kid saying, “They’re gonna rot your brain.” How much of a hurdle is this?
Bogost: Yeah, I think this story of EndeavorRx is particularly perfect in that way. Because it’s like, “What, there’s a game that treats ADHD? I thought video games cause ADHD,” or something like that. And I do think it’s worth noting that the ability to tell a story like this, like the one that we’re talking about now, is a part of the value that [EndeavorRx developer] Akili has built in this product. That it stands out from the crowd, not just for the medical claims that they’re advancing, but also because it feels good to feel like a game might be able to do good in this fashion, whether it actually does good over time or not. We should just keep our wits about us and understand that we’re also being sold products in the marketplace, not just treatments.
Related links: More insight from Jed Kim
This is going to be a bit of a rabbit hole. Still not too keen on letting your kid play video games? It might just be that you don’t see the potential upsides. Psychology Today makes a compelling case for why you need to be playing video games with your kids. On the one hand, you can better monitor the hate speech they may be getting subjected to while playing. You can also sneak in questions about their day in between killing zombies. Really, it’s just about being where they are. Plus, you can finally be that supercool parent you always knew you were!
If you do decide you’re going to give it a go and game with your young’un, depending on their age, you may very well be playing Minecraft or Roblox — in which case, we’ve got a link to an article titled “Why Video Games Make You Feel Sick (and What You Can Do About It).” It’s a few years old, but really anything to help you deal with the inevitable nausea from five minutes of “Bed Wars” is worth it.
Speaking of minigames, does your kid love creating experiences in Roblox? You might want to sit down with them and explain how they may be getting taken advantage of financially. Roblox lets users create and share minigames and promises the opportunity to make bundles of money doing it. That’s the promise. The reality is likely much different. You can watch a video all about it by People Make Games on YouTube. There’s also a Wired article about it, if video isn’t your thing. Because we are the olds.
Have fun gaming!
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