Arcade Redux

The overarching purpose of Arcade is to ignite the desire to learn and use health science.

In his magisterial medical history entitled The Great Influenza (2004), John Barry evokes the heroism of brilliant, bewildered and ambitious pathologists trying to identify an emerging crisis in public health that would soon kill around 50 million people worldwide:

And the excitement! Each time a student fixed a specimen on a slide and looked through a microscope, an entire universe opened to him! To some, discovering that universe, entering into it, beginning to manipulate it, was akin to creating it; they must have felt almost godlike.

Humaginarium isn’t a microscope; neither is it for clinicians (though some may choose to use it). Even so, that historic experience of hunting flu virus and its collaterals in 1918 is somewhat comparable to the living experience of trouncing disease in Humaginarium.

Our users are adults who have or risk developing chronic illness and coincidentally enjoy challenging video games. Our prototype application is for consumers who are affected by – or have reasons to be concerned about – metabolic disorder (even if they don’t know what that is and are oblivious to the risks it poses).

It’s important to state clearly and emphatically that users stand to benefit mightily from Humaginarium – but that’s not why they use it. They use it because it’s fun and beautiful and enriching and self-actualizing. “That’s entertainment!” Health and educational affordances are consequential and valuable aftereffects.

Our users stream Humaginarium to large and small screens. They may be in classrooms or clinics when they play, but probably not. More likely they’re at home or work or traveling – just hanging out. They’re keen to play rather than learn per se. However their learning experience is so surprising and engaging and useful that they really won’t dismiss it (as they tend to diss traditional health information and education); instead they’ll relish and likely share and build on it.

Our typical users take their first look (through a digital lens) at a biological universe that beggars the imagination; one riddled with fantastic menace like some seething terrorist underground; one they can safely explore and manipulate and maybe even master if they’re clever and fast and keep trying. Like those antique pathologists striving to rescue humanity from gruesome pain and suffering and sudden death, our users may experience the thrill of victory, the agony of defeat when saving themselves (or their family and community, or their generation) from Morgoth-like powers of organic malevolence. Moreover if I do what I intend with Humaginarium, players may indeed feel “almost godlike” because they themselves are creating the meaning of health and life inside a miracle known as “my body.”

Thanks to historian Barry, I know how pathologists discovered the one pestilential ring that ruled them all back in 1918. They did hard, frustrating, relentless science in labs, clinics and the field. How will users destroy a ring of their own in Humaginarium? They’ll start by getting situated in our Arcade.

The overarching purpose of Arcade is to ignite the desire to learn and use health science (to gain the power of health literacy). That’s the unrivaled albeit unconscious goal of all users from the moment they land on our home page. Without a desire to learn, users will experience our game simulations the way inert marbles experience a pinball machine. We don’t want that; it feels too much like industrial health care.

Imagine then an Arcade that dramatically opens on the first of many self-assembling choice architectures we have prepared: a prelude to the quest for wellness. The Arcade interface is desirable, intriguing, tempting and threatening; shimmering, sparkling, promising and ominous; spatial and fluid like gripping and evanescent dreams. Users gaze on this animated tableau for a few seconds and most likely utter “WTF?”

Their eyes are drawn to a stony portal they can see through to observe wonders, but can’t seem to pass. The portal is a metaphorical cut in a border wall between the real world (where we must live) and a hyperreal world (that we long to live for): a world full of promise and pleasure and despair.

To penetrate the portal each individual must make a magic key that becomes a private and powerful identity and credit card in Humaginarium. Like DNA, that key is unique to each player. It cannot be shared or exchanged though it can be edited. The key is a personal credential for playing and learning in Humaginarium. It works forever and grows in power over time, but it may be forfeited under penalty for unworthy behavior. The key is endowed with tangible and symbolic assets that are useful in play and beyond, on both sides of the border wall.

To make a key, each user dips into three wholesome mini games about biological birth, growth and death. These are visual puzzles that users manipulate in order to become deeply situated and immersed in Humaginarium while generating clues to unlocking the portal. All three pose the question “how”: how is the ideal body born; how does it grow; and how does it die. Content is presented in elementary symbolic rhetorics, not in words. Together the solutions inform a mental model of homeostasis (physiological wellness) that is important for future struggles in Humaginarium. For now the mental model is a grail; it triggers an urgent desire to learn.

Once through the portal, users leave the Arcade behind and enter an agonizing labyrinth – a framework for quest. In the first instance of Humaginarium (our MVP), there is one modular and multilevel game named Diabetes Agonistes. Eventually there will be hundreds. Before proceeding though, users must discover a little about the problems that lie ahead, as they provision for adventure.

I’ll describe that provisioning in my next post.

Scientific entertainment. Variation on Les Deux Baigneuses (1884), by William-Adolphe Bouguereau. Pictured with a micrograph of menstrual hormones.

Arcade

Abandon all hope, ye who enter here, and resolve to fight.

The first component of our model unit is the landing page: an architecture in the Cloud where consumers meet our brand, create a Humaginarium identity and shop our stuff. A few months ago I cluelessly dubbed this the “platform.” A misnomer! Platform means many things but none describes our landing page. The correct word is arcade.

I pause now because I don’t want to be confused with arcade video games, a classic genre that’s big in sports, gambling and amusement. We don’t make arcade games. On the other hand gamers don’t own the notional concept of arcade; they borrowed it from architecture and it’s much bigger than them.

A traditional arcade is an agora under a roof. A place to shop, discover new things, meet people, catch up on the news, have fun. It’s a precursor of the modern shopping mall. Arcades are also engines of culture; places where communities gather and make meaning together. That’s also a reasonable description of Humaginarium: a place where folks make meaning.

Our arcade is a digital environment loaded with things to view and do. When consumers first land there, they gaze upon the front gates of a labyrinth. A fantastic labyrinth that could have been designed by Jorge Luis Borges if he played video games. They stare in amazement and wonder, Why enter this perilous realm? Why not turn right around and find something normal to play? We don’t tell them why; we let them figure it out themselves by messing with curious knobs and handles. Our arcade is a cabinet of curiosities from a world where science and fantasy have fused and formed a strange new dimension.

In the center of the arcade there is a room for viewing video shorts. How short? Depends on the topic, but anywhere from 10 to 30 seconds. The videos are not eye candy, though they’re incredibly beautiful; some funny, others scary, still other puzzling and a little irritating. The videos are interrelated clue dispensers. Consumers who want to try the labyrinth can’t just enter it; can’t buy a ticket even if they want to pay; can’t use a key even if they have one; can’t make an offer or a trade or sign a waiver. Instead they must find clues in the arcade to crack the code and prove their mettle. They must earn the privilege of entering Humaginarium or forever be stuck outside, peering through display windows at magical intimate things that they can’t touch until they get past the gates.

Why would restless consumers “waste time” collecting and configuring clues like this? Some won’t of course, but many will because it doesn’t feel like wasting time. It feels exhilarating! One, because it’s fun; a lot of fun. Two, because it’s intriguing; like a teleport to somewhere desirable and momentous – and free for those who can turn the lock. Three, because it’s useful; promising a weird kind of entertainment that makes people smarter, more capable, more centered, more in control of their most painful and costly challenges. It bestows a gift of unshackled imagination and the freedom to explore the human body as if they were its creator.

Our arcade is a string of amusements that inspire and motivate. The inspiration is a mental model of perfect wellness. The model presents the formation of the body at birth, its disintegration at death, and its healthy progression through life known as homeostasis: an ideal state that’s impossible for any person to ignore and nearly impossible to attain. Worthy not just of study but of quest! The arcade motivates folks to break into a hall of horrors: a labyrinth where chronic illness is waiting to outsmart, outfox, outmaneuver, outlast any would-be hero who dares to enter. Abandon all hope, ye who enter there, and resolve to fight.

Humaginarium is made for heroes who are not endowed with superpowers. Just regular folks who have, or risk getting, a miserable chronic illness that lasts a lifetime in the real world. In the real world these folks may hope and endure and suffer. In Humaginarium they can choose to fight and control or overcome. Truly that’s a fantasy, but for many of the people landing in our arcade, it’s one of the greatest unreal stories ever told and it’s all about real life.

Coming next: a use case that describes what consumers may experience in our arcade.

Worth

Worth doesn’t show up in a value proposition; it’s under the radar.

My recent investigation of pre-money valuation yields a number: $3 million. That is the current hypothetical value of Humaginarium: pre-grant, pre-investment, pre-product and pre-revenue.

Like any good hypothesis, this one’s just a reasonable guess. It’s based on the parameters of four valuation methods: Berkus, Risk Factor Summation, Scorecard, and Economic. I also took into account the informed opinions of skeptical or auspicious advisors; and factored in the lasting value of cash and intangible assets given to, or generated by, Humaginarium as it bootstraps.

So what’s next after this valuation exercise? There are five steps related to valuation in the foreseeable future:

  1. Ask federal agencies for SBIR seed funding
  2. Ask select companies for dedicated industry knowhow
  3. Ask other companies for transactional corporate sponsorship
  4. Ask select foundations for program-related investments
  5. Ask investors for private equity

I estimate that these five asks may increase early-stage valuation (pre-revenue) to just under $10 million – an amount that seems sufficient to develop, test and launch awesome MVPs that generate serious revenue.

Yet not all of Humaginarium’s value can be measured in dollars and cents. The company exists not to make money, after all, but to promote health literacy and empower self-care. I believe it’ll make a lot of money because our business idea is meaningful and strikingly, uniquely commercial. But it doesn’t exist just to make money. For that reason, I want for a word that connotes value the way I think about it. That word may be “worth.”

The dictionary defines worth and value almost as synonyms, and often that’s how they’re used. But not by me. I associate value with benefit. Whether you’re a consumer or investor, the value of Humaginarium is the benefit you may get from it. Such benefits may be aesthetic, behavioral, educational, financial or some combination of these gimmes. A notable example: adults with a chronic illness have fun while learning stuff that improves their lifestyle and lowers their spend on medicine. That’s four concurrent, measurable benefits. Another example: investors own a monumentally creative solution while working with a brilliant team on the cutting edge of several advanced technologies as they head for an exit of 20x their original stake. That’s four concurrent, tangible benefits. According to my projections, Humaginarium is valuable.

Still, the way I think about it, value is not enough. Humaginarium also has to be worthy. This is nuanced, please bear with me. I associate worth with merit. Unlike value, merit isn’t what people take out of Humaginarium, but what they plow into it. Whether they’re a founder, employee, advisor, investor or business partner. merit is the quality and excellence they impart to the venture. This principle even applies to consumers who are often cutthroat when it comes to spending their hard-earned dough. They want more than their money’s worth! So I unlocked the front gates by welcoming consumers into Humaginarium for free; not just into the foyer but free to roam the whole house. The attention they give, the devotion they consequently pay to their own marvelous bodies, the merit they enact when they radiate the insights of Humaginarium, that’s what I mean by worth.

Worth doesn’t show up in a customer value proposition; it’s under the radar of value. Worth shows up in the pride that Humaginarium makes people feel, the honor it bestows on them, the belief that what they’re doing – researching, making, investing, selling, using – really matters in real life and in the brave fantasies of an unshackled imagination.

Specific Aims

When consumers are ready to transfer knowledge from the fantasy world of play to the real world of health.

I recently received a green light from the National Science Foundation to apply for Phase 1 SBIR. The invitation was prompted by my “Project Pitch,” a compact description of R&D that Phase 1 has the potential to support. My proposal calls for a series of experiments, conducted over a several months, that may confirm the technical feasibility of scientific, educational and commercial goals set for the video game component of Humaginarium.

The video game is one of four components of my model unit. Maybe the most exciting and creative, but not the most powerful and impactful. Why? Because the video game is for learning huge things while having intense fun, but that’s as far as it goes. A video game by itself cannot make learning stick. If all I do is make incredible video games for health, that may not move the needle; it may not produce tangible and valuable outcomes.

The job of moving the needle is performed by a different component of Humaginarium. I call this the Diagnostic (versus Game). The Diagnostic is where consumers go AFTER having fun and learning the science of chronic illness. They go there to figure out what to do with incipient health literacy that emerged in the game. They participate in the Diagnostic when they’re ready to transfer knowledge from the fantasy world of play to the real world of health; i.e the human body and the experience of life that the body makes possible.

The Diagnostic is the subject of my “Specific Aims” document: a single-page précis that describes what Humaginarium would do with a Phase 1 SBIR from the National Institutes of Health. NSF requests a Project Pitch whereas NIH requests Specific Aims in order to prequalify applications for funding. Since grant writing takes weeks or months, and grant reviewing takes additional weeks or months, both agencies want to discourage laborious submissions that are just not a good fit for their SBIR mandates. I sent my Specific Aims to program officers at NIDDK (National Institute of Diabetes and Digestive and Kidney Diseases) because my R&D concerns mitigation of metabolic syndrome and diabetes mellitus type 2: morbid conditions in the NIDDK wheelhouse.

Actually I sent my Specific Aims twice. The first submission, a couple of weeks ago, was like throwing a stone into a pond and not seeing ripples form. Eventually the eerie stillness made me wonder, so I opened my file and read my text. OMG it was bad! Bad meaning incoherent, meandering, dotted with idiotic rhetorical flourishes, doomed to failure (in my opinion). I couldn’t fathom why I wrote it that way; couldn’t imagine why I sent it after writing; and couldn’t guess why it wasn’t immediately spurned by the agency as DOA. I hated it.

The writing was bad, but the ideas lurking behind the words were pretty good (in my opinion). So I started over; rewrote my Specific Aims as quickly as possible (fearing that NIDDK would acknowledge my first draft before I replaced it), and submitted the second draft with a cover note of mea culpa and fuhgeddaboudit and I’m not the a-hole that I seem to be.

I may not grab the brass ring with my second draft, but at least I won’t be embarrassed by it. “The tangible yield of my Phase 1 experiments will include cloud-based, self-administered qualification and prioritization mechanics for setting health goals, conducting intimate risk-assessment, contextualizing a personal choice architecture for change, modeling behavior changes to predict impact, and reinforcing medical and lifestyle resolutions.” In a nutshell that is the Diagnostic. It doesn’t already exist anywhere; it’s a linchpin for making health education stick; and if NIH lets me propose it for Phase 1 R&D, it may practically guarantee that the individual outcomes I promise with Humaginarium will be delivered en masse.

Literacy

Caring for a human body requires diligence, a force that is powered by health literacy.

My website says “Humaginarium is a systematic and evidence-based way to increase health literacy.” Let’s slow that down for a closer look.

For me at least, all literacy is a situated competency. There are no universal definitions and standards. Instead literacy is a personal, differentiated and evolving attribute. Yet somehow it always encompasses the same four generative acts: recognizing information, understanding it, relating it, and using it. If folks can reliably do these four things appropriate to their circumstances, they’re literate though maybe – probably – in dissimilar ways.

Recognizing information is knowing what something is. We naturally recognize information when encountering the source of it. Understanding is discovering and pondering the meaning of information. For example understanding why Ingres spent decades painting The Source (shown at the bottom of this post) in his unique way; and understanding why it is perfectly beautiful like that. Relating is assigning context to information so that it fits functionally or imaginatively into one’s world view. I related (and distorted) The Source by inserting a concocted cellular view of water, in order to reveal dangerous bacteria supposedly living in it. Using is working with information. My job with Ingres was to bridge an aesthetic divide between art and science. I tried to embody “scientific entertainment” – and also have fun (respectfully) with a great work of art.

Since I haven’t mentioned reading so far, I’ll pause now for a confession. I trained and practiced as a professor of English. Before technology barged into my life I taught college students how to learn from the literature and history they read. This was my vocation: increasing literacy by means of text. To this day I enjoy and learn more from reading than anything else I do, yet I don’t feel that literacy is fundamentally about scanning text. Reading is only one way to recognize information, often not the best way, and certainly not the way that Humaginarium promotes health literacy.

My notion of health literacy aligns with the four-part model of recognize, understand, relate, and use. Health literacy is all of that, only situated in health. Sounds pretty straightforward, but it isn’t.

First there’s the wrinkle of “health.” By that I mean the condition of a human body, the physical thing one calls “my life.” Health is neither illness nor wellness, diagnosis nor treatment, scheduling nor adhering. Health is the sum total of a human body and health literacy is a person’s ability to recognize, understand, relate, and use information concerning the body.

Next there’s the wrinkle of information. Information about the human body is extremely hard to take in because most of it is hidden in layered systems so complex and mysterious that they’re nothing less than magical. I’m using that term literally. Our living bodies are miraculous no matter what condition they’re in. They’re just very hard to make sense of.

There are more wrinkles with understanding, relating and using information about the body. Few regular folks ever even consider most of that information; they can’t understand the scientific and medical rhetoric used to express it, and they have little or no idea how to use it. Let’s be candid: for most folks, using information about the body is limited to consumption, procreation and labor – and most of that can be done well enough without health literacy.

Then why bother with it? Well, I think health literacy enhances acceptance of what the human body is, how it works, what it needs and why it’s in each person’s practical self-interest to care – with gobs of curiosity and courage. Caring for a human body requires diligence, a force that is powered by health literacy.

As health literacy increases, so does medical efficacy and the capacity for self-care. Those are two horsemen of a long-awaited apocalypse that may bring a failing health care industry to its knobby knees and replace it with the best health care possible. The kind that every individual with a chronic illness, regardless of educational or socioeconomic situation, constructs for themselves. Those are the folks who may benefit most from Humaginarium.

Scientific Entertainment. Variation on The Source (1856) by Jean-Auguste-Dominique Ingres. Pictured with Vibrio vulnificus, a type of waterborne, flesh-eating bacteria.

Pre-Money

Pre-money valuations are often guesswork loosely based on creative analytics.

Humaginarium is pre-money in a cardinal sense of the term: no financing, no outside investment, no revenue. We’re clean as a whistle! Nonetheless we’re an economic entity with latent equities: stakeholder contributions of facilities, services, material, time, and cash. These significant contributions are measurable and have practical value. Surprisingly then, though we’re unfunded we’re not poor. We have operating and capital budgets, expenses, cash flow, an elegant brand, and a business model though we’ve yet to write a profit and loss statement. This may sound like a classic tech startup holed up in a garage, except we occupy several garages.

Our financial situation is going to change soon, so I’m working on our first pre-money valuation. Not all startups do this, but I feel it’s worthwhile. A pre-money valuation assigns a total net value to our present and near-future company so that I can rationally price shares in Humaginarium. Shares of ownership will be exchanged for services in some cases, for hard cash in others. However not all contributors will receive Humaginarium stock; only those who want it and can materially enhance the company’s total value.

Even after three years in my virtual garage, that word “rational” still sounds a little jarring. It gets my hackles up because I don’t associate rational with guesswork, intuition, smoke and mirrors, or the Midas touch. However many valuations of early stage companies are concoctions of just these sorts of things. Pre-money valuations are often guesswork loosely based on creative analytics. As much art as science, maybe more. How’s that for full disclosure?

My first approach to pre-money valuation was led by a sensible financial advisor and for that reason it went nowhere. Months were spent trying to build a kind of sand castle with blueprints, but every time we stood back to look, ocean waves from the real world would wash over and turn it into mush. I still have some artifacts of that effort, but I doubt they will ever be used. They don’t enhance the value of the company.

More recently I met with Steve Lindo, a fellow member of the MATTER Healthcare Incubator, whose early-stage company Simergent recently closed a nifty second round of funding. I told him afterwards that he managed to call me out of the dense woods and on to a marked path, one that he had recently walked and was still navigating though Simergent is farther along than Humaginarium. By the way I talk a lot about the value of peer-to-peer learning, positioning it as a capstone of my innovative health education. Steve and Bob dialoging in a small, windowless conference room is a stellar example of how peer-to-peer works. Two explorers on a mountain trail, talking about conditions and directions, shortcuts and pitfalls, techniques and models that may hopefully lead to a summit.

Steve explained several tested methods for pre-money valuation. Everything made basic sense and I was encouraged because he spoke from experience and deep reflection. Afterwards I spent a few hours researching his methods and a couple others that surfaced online. I also sent questions to experts about non sequiturs of pre-money valuation that I just couldn’t make sense of (because, it turned out, they are nonsensical).

My net result is a hybrid methodology that nicely organizes the economics of Humaginarium (rather than some sand castle), plus a list of very doable analytical tasks to come up with my number. I wound up feeling pretty sure that my first pre-money valuation will be drafted soon, this month, so that I can head over to current and emerging stakeholders with a cap table that is as much science as art, maybe even more. That will be awesome disclosure!

Sustainment

Games require non games to capture their full value.

I enjoyed writing my compact Evidence for humaginarium.com. So much has been published about the utility and efficacy of games for learning, games for impact, games for change, games for health. Some of it substantiated and reliable, and some merely personal opinions. I tried sticking to facts.

What could I state about the value propositions of Humaginarium that is evidence-based and beyond reasonable doubt? How could I say it for an audience that doesn’t read scholarly papers, doesn’t care about video games or health education, and maintains a laser focus on controlling financial risk? I’m referring to investors and sponsors seeking assurance that Humaginarium will produce meaningful outcomes if it works as planned.

After posting Evidence I shared it with a few of the subject-matter experts whose research it epitomizes. I asked for feedback, in particular about whether it includes things that are false or misleading or leaves out things that are important.

I received several thoughtful responses including a vital observation by a co-editor of Computer Games and Instruction. It has a kind of sum-up-to quality so I quoted him at the new end of the deck. Here’s what he wrote:

“The big thing that Sig and I noted was that learning is substantially enhanced by helping learners reflect on underlying concepts of game actions, not leaving that to the learners to discover by themselves.” John Dexter Fletcher, email on April 4, 2019

I think the crucial point here is that games require non games to capture their full value. Without the addition of non game experience that dovetails with play, the cognitive and behavioral gains of play may not be realized or sustained. That’s consistent with findings I didn’t originally include in Evidence, demonstrating that games are not self-teaching. As another scholar put it: Instructor guidance must be applied during crucial states in game play to ensure that learning closure occurs. Players must be guided, prompted, motivated and sometimes forced to learn from their experience.

That’s going a bit far, in my opinion, but my opinion isn’t the organizing principle of Evidence. I accept empirical research as factual. Yet it’s also problematic here because entertainment and education don’t always coexist peacefully. One may try to destroy the other as they compete for dominance. Is there a way to forge a peace that allows us to reap the benefits of both at the same time?

I think Humaginarium has found that way. We have integrated extremely important non game experience into our model unit before and after game play.

Non game experience first occurs in a virtual arcade that helps consumers form a robust mental model of biological homeostasis: in other words, the healthy human body. With that model in mind, they enter a fantasy world of video games that are sheer and shameless entertainment. I don’t condone serious games that “force” folks to learn from their experience. Consumers must always have – and feel they have – the unfettered choice to learn and also to play without learning.

After a game is played, consumers can choose to start a diagnostic activity that helps them understand structural differences between the healthy human body they want and unhealthy body they actually have; the body that they are beginning to understand and engage for the first time thanks to playing the game. The diagnostic activity is where “instructor guidance” takes place in Humaginarium: not in game, where it may interfere with flow and fun, but right after the game when consumers have decided that they’re ready to reflect on their experience and make resolutions to take better care of themselves.

Can we be sure we won’t lose them in the interstices between game and non game experience? I think so. We use tech known as stealth assessment. Game mechanics trigger behaviors in players that make palpable their conditions, and symptoms, and beliefs, and worries, and longings. Stealth assessment is seamlessly woven directly into the fabric of game play. It’s quiet yet powerful technology by which consumer performance data are continuously gathered during the course of playing and learning, with inferences made about the level of legacy and emerging competencies.

Stealth assessment design has to include a competency model (what knowledge and skills should be assessed), an evidence model (what behaviors or performance should reveal those competencies), and a task model (what tasks will elicit behaviors that comprise evidence). The data generated by such tasks in game, and captured by stealth assessment, build bridges from the homeostatic paradigm to the fantasy of play to the urgent reality of illness and wellness.