On the icy planet of Frigidus, a virtual world full of icy caves and treacherous waterfalls, your mission is to race around a track and catch the animals that come flying your way. This isn’t exactly easy: bumping into walls – navigating through your phone or tablet – can slow down your avatar, and there are other characters meant to distract you from your goal. Still, the idea is that through all of these challenges, Frigidus’ icy terrain can give you something that other video games don’t: medical treatment.
Frigidius is just one part of the EndeavorRx universe, a video game designed to treat ADHD in children between the ages of 8 and 12. deleted by the Food and Drug Administration in 2020, is designed to turn on the parts of the brain we use to focus our attention. Now the company that made it, Akili Interactive, hopes to expand its games for all sorts of other conditions, including depression and Covid brain fog. The goal is to create a new type of drug, using technology to deliver a treatment that doesn’t require personal supervision or risk serious side effects.
The idea of a prescription video game sounds far-fetched and potentially counterintuitive when you read the headlines warning of the rise of video game addiction. Still, games like EndeavorRx are attractive because they increase the possibility that an extremely fun activity could serve as a potential therapy. This approach promises to make it much more affordable to deliver treatments and suggests that we can transform the phones, tablets and computers we already own into medical devices simply by downloading an app. The challenge is that the impact of these games – which are still relatively new – is up for debate, even as companies like Akili go public and try to address more conditions. This means that these platforms are currently at risk promising and under-delivery.
EndeavorRx does have some scientific backing. After analyzing the Results of five clinical trials involving more than 600 children, the FDA found that the game “general improvement of attentionand appeared to relieve other ADHD symptoms as well. While EndeavorRx is not designed to replace a drug, it is only available to people who have a prescription. Patients with a prescription will be sent an access code with which they can download the game. The list price of the game is $450 per month for those who are covered by insurance, but those who do not have insurance pay a discounted, but still pricey, $99 per month. These are just some of the reasons Akili executives say EndeavorRx isn’t just another Mario Kart spin or souped-up version of the brain-training app Luminosity.
Despite all the “I’m not like other video games” energy, playing EndeavorRx feels familiar. You navigate the virtual galaxy as a cartoonish avatar, which you can dress up in a variety of outfits, including a rider costume and a Frozen-like ice queen dress. Within the wider EndeavorRx game, you can visit different worlds, where you can select different tasks that will challenge you to focus. Completing these tasks will earn you prized mystical creatures that you should collect, and the game gets harder or easier depending on how well you do. The hope is that between taking down targets and sliding through power zones, the technology can essentially train patients to stay focused.
“Under the hood are these really complex and beautiful sets of algorithms that create stimuli and closed feedback loops to activate a very specific part of the brain,” Matt Omernick, co-founder and chief creative officer of Akili, told Recode. “This underlying engine creates lasting effects in the brain, and the beautiful skin, whether the packaging or the barrel, is the style and look and feel of the video game.”
Although Akili’s product was the first of its kind to be approved by the FDA, it is far from the… first example of video games used in medicine. Veterans Have Used Video Games To Relieve Post Traumatic Symptoms stress disorderand therapists have increasingly turned to online gaming to work with people with depression, schizophrenia and anxiety, especially during the pandemic. Some experts believe that these games could do even more as virtual reality becomes more popular.
But proponents may be getting ahead of things. When the FDA approved EndeavorRx in 2020, the agency approved it through a process for marketing lower-risk medical devices. EndeavorRx isn’t all that popular yet either: fewer than 1,000 prescriptions were issued for the game in the second quarter of this year and only 3 percent were reimbursed by insurance companies. Some critics have expressed concern that the game only teaches kids how to get better at games, which is a gain that doesn’t really translate into everyday life. Attrition can also make these kinds of games less effective because August study that analyzed people using Akili, as well as other platforms.
“Say you want to expand it to 1 million ADHD kids,” explains P. Murali Doraiswamy, who co-authored the study and is director of the neurocognitive disorders program at Duke Medical School. “They have to be motivated to do it.”
These drawbacks have not held back Akili’s ambitions. The company is already working on a game for adults with depressionand recent research indicated that its platform could: helping people with lupus. Of course, the company hopes that developing games for all those circumstances can become a big business. Akili raised over $160 million after going public earlier this year through a SPAC or a special purpose company. Company recently partnered also with the children’s gaming platform Roblox – a sign that it likes to blur the line between medical and traditional video games.
“I’ve always found that the more engaging, the more fun the activity is, the more likely someone is to come along. Like a drug, the better it tastes, the more likely someone is to take it,” explains Josué Cardona, who heads a video game-focused nonprofit, Geek Therapy.
This is all part of a wider effort to rethink what video games are and what they can do. It is already clear that our virtual worlds will become more advanced as technologies such as 5G and the metaverse take off. Now there is a race to make them as useful as possible for our daily lives, whether that be to treat mental health problems, practice job interviews or learn a language.
EndeavorRx’s progress to date suggests this race continues, but we’re still in its infancy. For the time being, it is not yet clear how big the impact of this new approach to healthcare will be. Still, it seems fair to say that at least some of the help kids get from the company’s game is real, even if the planet Frigidus isn’t.
This story was first published in the Recode newsletter. Register here so you don’t miss the next one!