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Gaming for asthma control
Spotlight
Sowing the seeds of doubt Merchants of Doubt is a documentary film, based on a book of the same name by science historians Naomi Oreskes and Erik M Conway. The movie explores the ways in which corporations and industrial lobbies have used a handful of willing scientists and proven strategies to sow doubt and foster regulatory inertia, allowing them to continue to reap windfall profits while the government becomes bogged down in partisan feuds about scientific issues. The film’s primary example is the tobacco industry, which used a cast of compliant doctors and scientists, bought politicians, and willing dupes to disseminate confusion about the health effects of cigarette smoking long after the science was settled. The film-makers explore how disparate organisations, from chemical manufacturers to the fossil fuel industry, have used the same tactics to reduce the burden of government regulation and keep the profits flowing. On a production level, the film is somewhat scattershot and pedestrian, a series of talking-head interviews interspersed with stock footage and distracting and soon-to-be outdated graphics often standing in for an authorial voice. An overly cute framing device depicting a magician expounding on slight-of-hand sets the tone. The film wanders between several loosely structured vignettes, examining different people who have been directly affected by the spin techniques that the film explores, from scientists who have seen their work called into question, to journalists who have exposed corporate
malfeasance, to the people who go out on television to shill organisations’ views, whether for money or because of deep-seated ideological beliefs. At first, it seems like the people being interviewed will be the central thrust of the film, before it wanders on to another section without warning, and then another, with disappointingly little narrative coherence. Thus instead of a structured film, we are effectively left with several short profiles of people involved in one way or another with the loosely conceptualised idea of corporate spin. Director Robert Kenner (whose previous work includes 2008’s Food, Inc.) brings a haphazard earnestness to the film’s thesis, but he presents it in a way that makes no particular effort to reach out to anyone in the audience who doesn’t already buy into it from the start. Special opprobrium is saved for Fred Seitz and Fred Singer, two Ivy League physicists, who late on in their careers became climate change deniers. The film glosses over their motivations as “ideological commitments” and moves on without assessing further the reasons behind their stance. Kenner’s film explores an important subject, and is intermittently amusing and illuminating, but is unfortunately too scattered and ill-focused to convince anyone who isn’t already convinced. The kernels of several excellent films exist within Merchants of Doubt, but the execution of this one lets down that potential.
Merchants of Doubt Robert Kenner 2014, USA, 96 min For more about Merchants of Doubt see http://sonyclassics. com/merchantsofdoubt/
Aaron van Dorn
Features Gaming for asthma control Video games are one of the most popular pastimes among children in high-income countries and frequently fall under the scrutiny of the scientific establishment. Although many studies have been done to investigate the potential harms caused by their sedentary nature and so-called video-game addiction, others have focused on their potential educational benefits. As a medium that crosses gender, socio-economic, and cultural boundaries, video games are regarded by some medical experts as an ideal way to get children to take an interest in, and learn about, their own medical needs. Asthma, as one of the most common chronic diseases among children, has been the focus of several educational video games over the past 30 years. The first clinical investigation of an educational video game for children with asthma was done in 1986, a time when video games were a very different www.thelancet.com/respiratory Vol 3 July 2015
proposition from what they are today. David Rubin and colleagues assessed asthma-related outcomes in children with asthma who either played 40 min sessions of the specifically designed game, Asthma Command, or an unrelated computer game at six sessions during the course of a year. Children in the control group also received instructions on asthma management from a research assistant. The investigators reported that children who played Asthma Command showed improved knowledge of both the disease and how to manage it. Asthma Command was programmed on an Apple IIe home computer and featured a mixture of text and blocks of colour to portray the player, potential allergens, and the various locations children with asthma might find themselves. In the game, players had to “use their knowledge of asthma management to manoeuvre through obstacles and score points by avoiding allergens;
Published Online June 10, 2015 http://dx.doi.org/10.1016/ S2213-2600(15)00224-6 For Rubin and colleagues’ study see Pediatrics 1986; 77: 1–10 For more on Asthma Command see http://www.childtrends. org/?programs=asthmacommand For more on Quest for the Code see http://asthma.starlight.org/ For more on Lungtropolis see http://www.lungtropolis.com/ lungtropolis/accounts/login/ For more on Wellapets see http://www.wellapets.com/
519
Lifeguard Games
Spotlight
Wellapets teaches children how to use their inhaler by use of a touch-screen interface For more on studies into the effect of games see JAMA Pediatr 2013; 167: 574–80 For Huss and colleagues’ study see J Pediatr Health Care 2003; 17: 72–78 For Hieftje and colleagues’ systematic review see JAMA Pediatr. 2013 167: 574–80
520
appropriately using medications, the emergency room, and the physician’s office; and attending school”. Sadly, what the children playing the game made of it seems to be lost to history. Whereas Asthma Command was only available in the clinic in which it was being tested, the development of the CD-ROMs allowed games such as Air Academy: the Quest for Airtopia to be distributed to schools and clinics further afield. Children in inner-city areas can be at an increased risk of developing asthma and games such as Wee Willie Wheezie and Watch, Discover, Think, and Act were developed to teach them about the specific environmental triggers that they would be likely to face on a day-to-day basis. As childrens’ access to the internet increased, so too did researchers’ use of the medium for asthma education. Quest for the Code, developed by the Starlight Children’s Foundation and starring Oscar-winner actor Cuba Gooding Jr as the player’s guide and narrator, was originally developed as a CD-ROM game for use in schools. The game has now been made available online for free, enabling any parent or teacher to make use of it. Meanwhile, Lungtropolis: Attack of the Mucus Mob was created in association with the American Lung Association especially to be played online, with users able to create a profile to continue their progress at a later date. The game also has a linked website for parents, providing advice on various issues related to caring for a child with asthma. The makers of games about asthma have moved with the times, and now that more and more children have access to smartphones or tablet devices, educational apps about asthma have started to emerge. Wellapets is a virtual-pet game on the Android and iOS platforms designed to teach children about their asthma by caring
for a digital pet with the same disorder. Children look after a dragon that needs to use a maintenance inhaler twice a day to be able to breathe fire and battle smog monsters. Like others before it, the game gives instructions about avoiding triggers, remembering medication, and seeking help when needed. The touch interface is taken advantage of to show children how to assemble and use their inhaler, and the timer on the maintenance inhaler encourages them to remember their own treatment. Wellapets uses established mechanics from mainstream video games, such as experience points, minigames, and unlockable customisation options to encourage children to keep coming back to the game and caring for their pet. Although the developers, Lifeguard Games, designed the game on the basis of previous research, no investigators have yet taken the opportunity to study the effectiveness of the game since its release in March, 2014. It would be interesting to see what, if any, effect the game has on children, because it plays more like a conventional (ie, non-educational) game than many previous efforts, and it’s certainly one of the best looking games about asthma. Unfortunately for children outside of the USA, Wellapets can currently only be downloaded from the US app stores. Most research done on educational games about asthma has identified positive outcomes in children playing them, ranging from increased knowledge of asthma symptoms and control, to reductions in hospital admissions and use of oral steroids. However, the improved outcomes tend to differ between studies and games, and the quality of some studies has been somewhat questionable. Even studies with negative outcomes have their problems. In their analysis of children in inner cities who played Wee Willie Wheezie, Karen Huss and colleagues did not identify any significant positive outcomes, but also noted that this result could have been caused by the game’s excessive difficulty and the fact that play sessions were restricted to about 20 min. In a systematic review of research into electronic media interventions for the reduction of risk behaviours for illnesses in people younger than 18 years, Kimberly Hieftje and colleagues note that “few scientifically rigorous evaluations of electronic media for targeted behaviour change in this age group have been conducted”. Although existing research into the effect of these games is promising, more high-quality studies are needed to pin down exactly what it is about a game that determines whether children learn from it, and which outcomes should be the focus of new games. By understanding why a game works, as well as whether it works at all, developers can take the next step to deliver effective, and hopefully fun, new ways to help children to manage their asthma.
Sam Hinsley www.thelancet.com/respiratory Vol 3 July 2015
Sowing the seeds of doubt Merchants of Doubt is a documentary film, based on a book of the same name by science historians Naomi Oreskes and Erik M Conway. The movie explores the ways in which corporations and industrial lobbies have used a handful of willing scientists and proven strategies to sow doubt and foster regulatory inertia, allowing them to continue to reap windfall profits while the government becomes bogged down in partisan feuds about scientific issues. The film’s primary example is the tobacco industry, which used a cast of compliant doctors and scientists, bought politicians, and willing dupes to disseminate confusion about the health effects of cigarette smoking long after the science was settled. The film-makers explore how disparate organisations, from chemical manufacturers to the fossil fuel industry, have used the same tactics to reduce the burden of government regulation and keep the profits flowing. On a production level, the film is somewhat scattershot and pedestrian, a series of talking-head interviews interspersed with stock footage and distracting and soon-to-be outdated graphics often standing in for an authorial voice. An overly cute framing device depicting a magician expounding on slight-of-hand sets the tone. The film wanders between several loosely structured vignettes, examining different people who have been directly affected by the spin techniques that the film explores, from scientists who have seen their work called into question, to journalists who have exposed corporate
malfeasance, to the people who go out on television to shill organisations’ views, whether for money or because of deep-seated ideological beliefs. At first, it seems like the people being interviewed will be the central thrust of the film, before it wanders on to another section without warning, and then another, with disappointingly little narrative coherence. Thus instead of a structured film, we are effectively left with several short profiles of people involved in one way or another with the loosely conceptualised idea of corporate spin. Director Robert Kenner (whose previous work includes 2008’s Food, Inc.) brings a haphazard earnestness to the film’s thesis, but he presents it in a way that makes no particular effort to reach out to anyone in the audience who doesn’t already buy into it from the start. Special opprobrium is saved for Fred Seitz and Fred Singer, two Ivy League physicists, who late on in their careers became climate change deniers. The film glosses over their motivations as “ideological commitments” and moves on without assessing further the reasons behind their stance. Kenner’s film explores an important subject, and is intermittently amusing and illuminating, but is unfortunately too scattered and ill-focused to convince anyone who isn’t already convinced. The kernels of several excellent films exist within Merchants of Doubt, but the execution of this one lets down that potential.
Merchants of Doubt Robert Kenner 2014, USA, 96 min For more about Merchants of Doubt see http://sonyclassics. com/merchantsofdoubt/
Aaron van Dorn
Features Gaming for asthma control Video games are one of the most popular pastimes among children in high-income countries and frequently fall under the scrutiny of the scientific establishment. Although many studies have been done to investigate the potential harms caused by their sedentary nature and so-called video-game addiction, others have focused on their potential educational benefits. As a medium that crosses gender, socio-economic, and cultural boundaries, video games are regarded by some medical experts as an ideal way to get children to take an interest in, and learn about, their own medical needs. Asthma, as one of the most common chronic diseases among children, has been the focus of several educational video games over the past 30 years. The first clinical investigation of an educational video game for children with asthma was done in 1986, a time when video games were a very different www.thelancet.com/respiratory Vol 3 July 2015
proposition from what they are today. David Rubin and colleagues assessed asthma-related outcomes in children with asthma who either played 40 min sessions of the specifically designed game, Asthma Command, or an unrelated computer game at six sessions during the course of a year. Children in the control group also received instructions on asthma management from a research assistant. The investigators reported that children who played Asthma Command showed improved knowledge of both the disease and how to manage it. Asthma Command was programmed on an Apple IIe home computer and featured a mixture of text and blocks of colour to portray the player, potential allergens, and the various locations children with asthma might find themselves. In the game, players had to “use their knowledge of asthma management to manoeuvre through obstacles and score points by avoiding allergens;
Published Online June 10, 2015 http://dx.doi.org/10.1016/ S2213-2600(15)00224-6 For Rubin and colleagues’ study see Pediatrics 1986; 77: 1–10 For more on Asthma Command see http://www.childtrends. org/?programs=asthmacommand For more on Quest for the Code see http://asthma.starlight.org/ For more on Lungtropolis see http://www.lungtropolis.com/ lungtropolis/accounts/login/ For more on Wellapets see http://www.wellapets.com/
519
Lifeguard Games
Spotlight
Wellapets teaches children how to use their inhaler by use of a touch-screen interface For more on studies into the effect of games see JAMA Pediatr 2013; 167: 574–80 For Huss and colleagues’ study see J Pediatr Health Care 2003; 17: 72–78 For Hieftje and colleagues’ systematic review see JAMA Pediatr. 2013 167: 574–80
520
appropriately using medications, the emergency room, and the physician’s office; and attending school”. Sadly, what the children playing the game made of it seems to be lost to history. Whereas Asthma Command was only available in the clinic in which it was being tested, the development of the CD-ROMs allowed games such as Air Academy: the Quest for Airtopia to be distributed to schools and clinics further afield. Children in inner-city areas can be at an increased risk of developing asthma and games such as Wee Willie Wheezie and Watch, Discover, Think, and Act were developed to teach them about the specific environmental triggers that they would be likely to face on a day-to-day basis. As childrens’ access to the internet increased, so too did researchers’ use of the medium for asthma education. Quest for the Code, developed by the Starlight Children’s Foundation and starring Oscar-winner actor Cuba Gooding Jr as the player’s guide and narrator, was originally developed as a CD-ROM game for use in schools. The game has now been made available online for free, enabling any parent or teacher to make use of it. Meanwhile, Lungtropolis: Attack of the Mucus Mob was created in association with the American Lung Association especially to be played online, with users able to create a profile to continue their progress at a later date. The game also has a linked website for parents, providing advice on various issues related to caring for a child with asthma. The makers of games about asthma have moved with the times, and now that more and more children have access to smartphones or tablet devices, educational apps about asthma have started to emerge. Wellapets is a virtual-pet game on the Android and iOS platforms designed to teach children about their asthma by caring
for a digital pet with the same disorder. Children look after a dragon that needs to use a maintenance inhaler twice a day to be able to breathe fire and battle smog monsters. Like others before it, the game gives instructions about avoiding triggers, remembering medication, and seeking help when needed. The touch interface is taken advantage of to show children how to assemble and use their inhaler, and the timer on the maintenance inhaler encourages them to remember their own treatment. Wellapets uses established mechanics from mainstream video games, such as experience points, minigames, and unlockable customisation options to encourage children to keep coming back to the game and caring for their pet. Although the developers, Lifeguard Games, designed the game on the basis of previous research, no investigators have yet taken the opportunity to study the effectiveness of the game since its release in March, 2014. It would be interesting to see what, if any, effect the game has on children, because it plays more like a conventional (ie, non-educational) game than many previous efforts, and it’s certainly one of the best looking games about asthma. Unfortunately for children outside of the USA, Wellapets can currently only be downloaded from the US app stores. Most research done on educational games about asthma has identified positive outcomes in children playing them, ranging from increased knowledge of asthma symptoms and control, to reductions in hospital admissions and use of oral steroids. However, the improved outcomes tend to differ between studies and games, and the quality of some studies has been somewhat questionable. Even studies with negative outcomes have their problems. In their analysis of children in inner cities who played Wee Willie Wheezie, Karen Huss and colleagues did not identify any significant positive outcomes, but also noted that this result could have been caused by the game’s excessive difficulty and the fact that play sessions were restricted to about 20 min. In a systematic review of research into electronic media interventions for the reduction of risk behaviours for illnesses in people younger than 18 years, Kimberly Hieftje and colleagues note that “few scientifically rigorous evaluations of electronic media for targeted behaviour change in this age group have been conducted”. Although existing research into the effect of these games is promising, more high-quality studies are needed to pin down exactly what it is about a game that determines whether children learn from it, and which outcomes should be the focus of new games. By understanding why a game works, as well as whether it works at all, developers can take the next step to deliver effective, and hopefully fun, new ways to help children to manage their asthma.
Sam Hinsley www.thelancet.com/respiratory Vol 3 July 2015