Biomedicine on Display

I performed my fist knee operation today. Not in real life though but on my pc. Videogames inspired by medical practises or diseases has been discussed on this blog before but I don’t think that this particular game has been mentioned. In the game one takes on the role of a surgeon (or a surgeon’s assistant, I’m a bit in the dark on that one) and I must admit that I found the game to be surprisingly unpleasant.

I guess that working at a place like Medical Museion one gets hardened by telling stories of how the medieval surgeons performed their work or how the cholera epidemic infected people in the middle of the 19th century. Nevertheless this game, where one gets to perform surgery on a knee, really struck me. One thing is the images of the opened knee but I believe that it’s really the sound on the game that gets to me. Especially the sound of the saw going through the knee is really disturbing. Urg!

I must admit that I found it rather educational and apparently my patient survived. To be quite honest I’m not sure that it’s possible to actually ever fail. The game also reminded me of an article I read recently (”Inscribing surgery in digital culture” by Jan Eric Olsén, Årsskrift for Medicinsk Museion, vol. 3, 2006: 49), in which he links computer gaming and virtual surgery:

Future surgery may not require knowledge in handling the scalpel but rather familiarity with computers. It has also been suggested that surgeons who often play computer games sharpen their ability to coordinate the senses of vision and touch, when performing keyhole surgery (Satava ed 1998: 143-144)

That might be right, but I’m quite sure that the above-mentioned game does not train the necessary skills :) (For an online article about the link between surgery and computer gaming click here)

First of all, the title makes it sound worse than it really is. Actually this is just a little follow-up to Thomas’ and Adam’s posts about medical board- and computer games. This time though, the roles have been reversed. In Crazy Monkey Games‘ nifty (and free!) little game Pandemic 2, you take on the role of the disease rather than the doctor -and instead of curing the disease, your goal is to infect and kill the entire human population. How’s that for the ultimate in computer violence?

When you start a new game you’re given the choice of whether your disease will be a virus, bacteria or parasite, each of which has different pros and cons in the game. Then you’ll just have to think of a name for your disease and you’re all set to start infecting.

The game itself plays out on a little map, where the world is divided into some (rather broad) regions. Also on this map, are a lot of little ships and aeroplanes, cruising from airport to airport (and shipyard to shipyard), hopefully carrying a passenger infected with your disease. As the international community’s awareness of your disease inevitably grows, some countries may start shutting down their shipyards, airports and borders in order to contain your disease. Worst of all, they may begin researching a vaccine which -if successful- will prevent you from infecting any more humans.

An interesting thing about the gameplay is that you can’t actively do anything to spread your disease -that’s all up to the humans you’ve infected. Your only “real” participation in the game consists of helping your disease evolve, using “evolution points” that you accumulate through infecting people and as time passes. You spend these points on different traits and symptoms, that help your disease become more resistant, infect and ultimately kill. The system, although simple, is rather nifty and you get the feeling that your choices really matter. This is in part due to the visibility of your choices on the world map (for example, a waterborne disease that is also resistant to moisture will infect the water supplies of the infected regions) and partly because all the symptoms you choose for your disease are reflected on three sliders; “Lethality”, “Infectivity” and “Visibility”. Obviously, you want your disease to be very infectious and eventually lethal but not very visible, which leads to an interesting game of trade-offs.

As I’ve hinted at above, life as a disease is no cakewalk. When your visibility gets too high, the pesky humans start taking all sorts of countermeasures to prevent you from infecting more of them. If your disease is spread by rodents, they start exterminating them, if you’re all set to wipe them out by infesting their water supplies they start handing out bottled water and so on. Coupled with the above-mentioned shutting down of borders, airports and shipyards (be prepared for experiencing surges of irrational hatred against Madagascar once you start playing this game), you’ll quickly notice the evolutionary benefits of staying “below the radar”, so to speak. After all, once you’ve infected enough people you can always start to ramp up the Lethality factor with some “delicious” symptoms such as kidney failure and pulmonary edema. But of course the ingenuity of humanity should not be underestimated. If you don’t get them quickly enough they’ll eventually finish developing that dreaded vaccine. 

The game might not be extremely realistic (for example, it seems weird that it’s possible for a region to shut down all ingress perpetually) and all it’s elements might not be completely medically sound and “evolutionarily correct”, but I think it’s quite interesting to see a game that not only focuses on medicine (although in a reverse sort of way), but actually employs real concepts regarding the spread and evolution of diseases.

It might be slightly too morbid for some, but personally I find the game immensely enjoyable. I also think it’s quite interesting to to ponder what it is that make us transform the things we experience as threatening into entertainment -even to the point of identifying with it and make destroying mankind our goal. Even as a complete fiction that just seems pretty “heavy”. But I guess that’s one for the (other) philosophers or perhaps the psychologists.

At any rate, if you have time to kill you might consider trying out Pandemic 2, as it is very entertaining. But beware, it’s quite infectious!

Thomas wrote a post yesterday on medical board games, which got me reminiscing about medical computer games. There is a long history of medical computer games, particularly within the simulation genre. Most noteworthy is the now extinct Bullfrog Productions’ wickedly funny Theme Hospital, which was published in 1997 by Electronic Arts. The game is a darkly humorous simulation, in which the player has to build a hospital, manage staff and attract patients. A similar game is the recently published Hospital Tycoon, published in 2007 by Codemasters.

Another sub-genre of medical games emerged from Japan with the succes of Trauma Centre: Under the Knife, released for the Nintendo DS in 2005. The game is a roleplaying game set in 2018, and features the struggle against a man-made disease called GUILT (Gangliated Utrophin Immuno Latency Toxin), which is distributed by a terrorist organization. The protagonist is a young surgeon, who learns he is a descendant of Asclepius, no less. The gameplay consists of a series of increasingly difficult operations (you can see what the gameplay looks like here), which the player has to complete to advance the story. The game has since spawned a number of follow-ups and clones.

Another series of games that deserve a special mention is the Life and Death-series, which dates back to the early years of DOS-gaming. Check out what a digitalised interactive brain surgery looked like in 1990 here.

There are a number of other medical games, but my personal favorite medically themed game (well, sort of medically themed) is the fantastic Psychonauts from 2005, in which the player has to delve into the psyches of a group of kids to stop a villain from tampering with their minds. A truly original and brilliant game, by any standards.

I have no doubt that we will see more medically themed games in the future, and particularly games along the lines of the protein-folding game Foldit (which has been mentioned on this blog before). Everyone, including scientists, are increasingly realising the co-creative potential of the participatory web, and there will no doubt be a rush to explore this potential.

When I was a kid I loved to play board games of all kinds (and hated to lose). But I don’t think I ever encountered any medical games. Turns out there are quite a few of them, however, some of which are probably best described as educational games.

Operation (1965) is a battery-operated game for kids from age 6 and older. In Medical Monopoly (1979) you play a doctor running a hospital, and if you are skilled at diagnostics and spending your funds wisely on acquiring the right kinds of drugs, organs for transplants, etc., you’ll get more patients.

What’s peculiar about Medical Monopoly — a game which allegedly is used by some school districts in the US to teach health care — is that the winner is the player who first fills the hospital with patients. Common sense would give credit to the player who first empties the hospital. But maybe the game only reflects medical hospital profit system business as usual, in which case it’s a pretty realistic training ground for living in the US.

Then I just found out (thanks to Jessica for the tip) about yet another medical educational board game. Contrary to most games Pandemic isn’t competetive, but co-operative. The players are supposed to help each other control outbreaks of diseases around the world and search for cures against them. If you play badly and don’t co-operate well, the diseases will win!

Jessica believes Pandemic could be used for serious educational purposes because it “does a really nice job of challenging players to effectively distribute resources and minimize losses in an unpredictable milieu”:

Players end up debating various tactics and strategies several turns in advance: for example, is it better to dispatch your scientist to a relatively remote but heavily infected area to prevent an imminent outbreak, or have her stay close to a research station to effect a cure? It all depends, since the game has mechanisms built in to keep things unpredictable while mimicking how epidemics of infectious disease can rapidly build on themselves and spiral out of control. Just as in real life, you’ll lose pretty quickly if you try to treat every single infection – you have to choose your battles and concentrate on long-term damage management. Because of that, I found myself wondering whether the game would work in a high school or college course dealing with public health policy, and decided it might – except it’s almost too difficult! (But then, so is public health policy).

Maybe it’s not advanced enough for students at the public health programme here at the University of Copenhagen — but on the other hand designing a more advanced epidemiological board game would be an excellent topic for a Bachelor’s thesis in public health.

As Science Daily reports, researcher from the University of Washington have developed a computer game that turns protein folding into a competitive sport. The free game is called Foldit, and will, perhaps, one day lead to the first Nobel Prize won by a gamer.

The game targets a huge problem for protein research, namely the vast number of possible protein combinations. Even with all the collected computer power on the planet at the moment, it would take several centuries to work through all the protein combinations and shapes of the 100.000 proteins in the body, so the idea behind the game is that the players can develop an intution for how proteins connect and use it to target specific medical problems.

Involving the general public in a project like this instead of leaving it to trained researchers is because a lot of what goes into protein folding has nothing to do with scientific knowledge, but is rather based on an intuition for shapes. One of the protein researchers behind the game admits thats his 13-year old son is faster at folding proteins than he is, and the developers hope to discover people with a natural knack for ’seeing’ protein shapes through the game.

This game a startling example both of how scientific practices are changing, and how protein research requires a unique set of skills that have to do with intuition, spatial awareness and a sense of physical shapes.