How do video games affect child health? By fueling violence, shrinking attention, promoting obesity and dulling interest in academic pursuits, if their critics are to be believed. But some physicians, psychiatrists and public health experts see a more positive side: They're betting electronic games can be adapted as tools to ease medical treatments, improve patient outcomes and boost fitness and knowledge for users young and old.
Government agencies including the National Institute on Drug Abuse, the Office of Naval Research and other branches of the Department of Defense are placing bets of their own, funding the development of health-related video games.
Some of those projects and others were on display recently at the second annual Games for Health conference at the University of Maryland School of Medicine in Baltimore. Between lectures, participants crowded into two windowless rooms for a first-hand look. In one, they could test themselves on the Kilowatt, an isometric exercise device in which players use body strength to interact with scenes on a video screen -- for instance, muscling a car around a race track. In another room, attendees donned a virtual-reality helmet for a simulated plunge into FreeDive, a fantasy underwater world meant to distract pediatric patients from pain or anxiety.
In an age where so much of life revolves around a computer, a cell phone or a personal digital assistant, advocates of so-called serious video games see their potential to reach many more Americans.
"The medium has matured to the point where enough people understand and use [electronic video games] that we can now put them to other uses than just entertainment," said Ian Bogost, a founder and partner in Persuasive Games, an Atlanta-based company that designs and builds video games geared to learning and social change.
So far the market for serious games is puny -- maybe $50 million, compared with the $7.3 billion spent annually worldwide on commercial games, said Ben Sawyer, co-founder and co-director of the Games for Health Project, funded by the Robert Wood Johnson Foundation. New applications like FreeDive, which is being developed for what is essentially a new market -- hospitals -- could change that.
The first hurdle for game designers: coming up with a concept that's not just beneficial but engaging. The next challenge: amassing proof that the games can help patients. That requires researchers to study the games -- as they are doing at places like the University of Maryland, Baltimore County, and the New Jersey Medical School in Newark.
While parents might fret at a child's immersion in Nintendo or Xbox or PlayStation, a game's almost hypnotic appeal can help distract a child about to receive anesthesia or have dialysis or chemotherapy. Terry Spearman, team leader for child life services at the Children's National Medical Center, said distraction -- through games, music, storytelling and relaxation methods -- is a well-documented technique for helping children manage anxiety and fear in the hospital.
Video games "sound like another, higher-level form of distraction," said Spearman. The game categories being developed include:
* simulated- and virtual-reality games being used to treat phobias and post-traumatic stress disorder;
* "exergames," which invite participants to exercise while playing; and
* learning games, which teach about a health condition or distract children from painful procedures.
One of the best-known exergames is Dance Dance Revolution -- in which users follow with their feet cascading arrows on a video screen. Players can free-form dance, compete or track calories expended, to a variety of music.
Sawyer predicts an upcoming Sony entry -- the EyeToy Kinetic -- will push the genre further into the mainstream. Developed with Nike and designed for the PlayStation 2, the Kinetic will let users kickbox or practice yoga, among other things, in simulated environments.
Among the specifics discussed at the meeting:
* Ben's Game. A few years ago, 8-year-old gamer and leukemia patient Ben Duskin of San Francisco wanted a game that would let him pretend to fight the cancer cells invading his body. The Greater Bay Area Make-A-Wish Foundation linked Ben with LucasArts, the game-developing arm of George Lucas's Star Wars sci-fi empire. Out of the connection came Ben's Game. To play it, kids can choose among pre-drawn characters -- a boy, girl, dog or alien, for instance -- or create their own on-screen surrogate.
They skateboard through a minefield of animated cancer cells, trying to guard their stores of "Health," "Ammo" (medicine) and "Attitude," while zapping disease cells and acquiring shields to protect against seven monsters, including Fire (fever), Cue Ball (hair loss), Snow (chills) and Vomit. When all seven shields have been acquired, fireworks and an animation celebrate the achievement.
Having Ben help with the design ensured that kids would want to play, said Eric Johnston, a senior software designer at LucasArts. Johnston said it was challenging to create a game where the main character did not "die" -- standard video game-speak for lose. Now 11 years old and living in Missouri City, Tex., Ben is in remission.
A free download of the game is available at www.makewish.org/ben. Since Ben's Game was introduced 18 months ago, the game has been downloaded 172,000 times, said Johnston.
* Use of a handheld video game to reduce kids' anxiety before anesthesia. Anuradha Patel, an anesthesiologist at the New Jersey Medical School, has been experimenting with giving children GameBoys or Nintendos to play on their way to the operating room. In a 78-patient study, Patel found that children who played with the games had markedly less anxiety -- a 71 percent drop from baseline -- than those who had their parents with them (29 percent decrease) or those who were accompanied by their parents and received a sedative (30 percent decrease). Previous studies have shown that children who have less anxiety before surgery recover more quickly and have fewer behavioral problems later.
* FreeDive. The program, in early-stage development by BreakAway Ltd. of Hunt Valley, Md., is designed to be shown on a conventional computer, with or without a virtual-reality helmet. With the helmet on, kids dive through a 3-D seascape while ambient music -- and the periodic sounds of breath through a scuba respirator -- is piped in through the earphones. Kids use a joystick to move around, searching for buried treasure. Lynnda Dahlquist, a psychologist at the University of Maryland, Baltimore County, is testing to see whether children who use the game are better able than others to ignore pain.
* A virtual reality program to help soldiers returning from Iraq and Afghanistan work through post-traumatic stress disorder (PTSD). The program, being developed by the U.S. Office of Naval Research, is in clinical testing. Controlled re-creations of traumatic events have been used for decades to help patients overcome stress reactions, said Commander Russell Shilling, a program officer in the Naval Warrior Applications Division at the Office of Naval Research.
A therapist will control the environment -- whether it's dark, light, raining or sunny, for instance -- while helping the patient slowly revisit the scene of the trauma. The program will eventually incorporate smells -- from rotting bodies to burning rubber, said Shilling. Therapists will be able to closely monitor patients' physiological responses to help gauge the program's impact.
Spencer Eth, a professor of psychiatry at New York Medical College, said data show that this type of re-exposure to traumatic events can work. But many stop therapy because "some patients become so distressed in their symptomatic response that they actually get worse," said Eth, who helped write the American Psychiatric Association's guidelines for treating PTSD.
Alicia Ault is a frequent contributor to Health. To comment on the story, e-mail firstname.lastname@example.org.