Play This Video Game and Call Me in the Morning

http://www.kqed.org/.stream/anon/radio/science/2015/04/20150406science.mp3
I’m driving through a frozen world, where the roads are paved in ice. As I swerve left to avoid a mini iceberg, a red fish flashes at the top of my screen. I’m supposed to tap all the red fish that pop up, but not the green fish or the blue birds. And I have to do this without crashing the car.

“Doing one thing at a time is easy, but doing them both at the same time is where the magic happens!” says the omnipresent gamemeister– an unidentifiable animal with an unidentifiable accent wearing a white doctor’s coat.

The better I do at tagging the red fish and ignoring the green ones, the more excited the doctor on screen gets.

“A-mazing!” he says.

As I get better at the game, my brain is being trained to ignore distractions and stay focused in real life. Or at least that’s the hypothesis of the neuroscientists who designed the game.

The brain network that controls multitasking connects with networks that control memory and attention span. So by playing the game, some scientists believe you can improve cognitive skills, and by extension, relieve a range of symptoms associated with attention deficit disorder, and other conditions.

“We’ve been through eight or nine completed clinical trials, in all cognitive disorders: ADHD, autism, depression,” says Matt Omernick, the executive creative director at Akili, the start-up in Larkspur that is developing the game.

As consumers download mobile health games at booming rates, Omernick and his team are taking a very different approach to their Silicon Valley counterparts in bringing their game to market.

While most start-ups have opted to market and sell their mobile weight loss games and diabetes trackers directly to consumers, Akili has decided to pursue the long, expensive, risky path of clinical trials through the Food and Drug Administration. If successful, their game would be the first to be approved for medical use by the FDA.

“The first time those three letters were uttered in a group setting everyone’s like, ‘Oooh, that’s scary, do we want to do that?’” recalls Omernick.

If start-ups sidestep the FDA and sell directly to consumers, they can bring a game to market in six months. For Akili, it will take four years to get their game, Project Evo, through the agency.

But the start-up believes that will pay off. If the FDA gives its stamp of approval, doctors could prescribe the game. And that opens the door for insurance companies to pay for it.

“There will definitely come a time when games are part of the overall treatment plan,” says Willis Gee, Director of IT Strategy and Innovation at Cigna.

Health reform and the technology revolution have changed the competitive landscape for health insurance companies. Gee says they have to be more responsive to consumers.

“They tell us what they want,” he says, “and if we can’t satisfy that, they’ll go somewhere else.”

And what consumers want are games.

Gee says Cigna believes the explosive popularity in games could be harnessed to educate patients about medical issues and motive them to be more proactive about their health.

“If you think of an individual’s willingness to play Candy Crush or Angry Birds, they’re willing to do that,” he says. “It’s a very different approach, but it’s one that integrates into the lifestyle of individuals.”

Omernick and his team believe the clinical results of Project Evo could have a profound effect on the health care system. They’re hoping the trials show that the game is so effective at improving attention span and other cognitive skills, that it may reduce, or even replace, the pills that kids need to take for ADHD.

“We had to look at ourselves and ask, okay are we really going to try to change medicine, yes or no. And the answer was yes,” Omernick says. “And so you have to be as serious as you can about FDA approval and regulation across the board.”

Pharmaceutical companies are also keeping a close eye on the process. Pfizer is partnering with Akili on one of its clinical trials looking at Alzheimers diagnosis. Though the FDA approval process is grueling by gaming industry standards, it's a cakewalk compared to the time biotech companies invest in drug development. It takes most drugs ten years to get through the FDA process and could cost half a billion dollars.

“And it could fail at the last step,” says Adam Gazzaley, a neuroscientist at the University of California-San Francisco and the creator of the prototype that became Project Evo.

Gazzaley says he is cautiously optimistic about how Project Evo will fare in FDA clinical trials. Research on other video games for health has yielded mixed results – and inspired much internal debate among scientists. Some say the only thing these games make you better at is the game itself.

Gazzaley’s research is seen as an exception in scientific communities. He tested his prototype of Project Evo on older adults and found that they showed measurable improvement on standard cognitive tests for working memory and focus – and the effects lasted six months after they stopped playing the game. That research was published in Nature in 2013.

The clinical trials that Project Evo has undertaken to support its FDA application will determine if those results can be replicated for different age groups and to treat specific cognitive conditions.

The trials will also investigate if there are negative side effects of the game. It’s another concern raised by critics, that people sometimes get so hooked on games, they can’t stop playing them.

“It’s true,” Gazzaley says. “We built these games to be highly engaging and immersive and some people respond to that type of interactivity with an addictive response.”

Gazzaley says the scientists working on Project Evo are looking at ways to manage such negative side effects.

“The game locks out after a certain period of time. You play it for 20 minutes, and you can’t play it for another 24 hours,” he says.

Gazzaley is watching closely to see what happens with the clinical trials for Project Evo. If it is approved by the FDA, he has another four games in development that he hopes will be next.