Behavior

Without getting to the why there is no getting to behavioral outcomes.

Is scientific entertainment™ an offshoot of behavioral science or behavioral medicine? With the FDA approving video games as therapy for the first time, the question is hardly idle. The answer may explain how Humaginarium achieves meaningful outcomes.

Behavioral science is the study of human behavior through observation, modeling, and experiment. Behavioral scientists investigate why people do what they do, and how they might do better. The scientists have a voracious appetite for meaning, so they stir separate disciplines into a unified mode of inquiry, wrangling diverse epistemology in order to discern and use truth in more holistic and robust ways.

Behavioral medicine is likewise the study of human behavior with a unified mode of inquiry. Practitioners study why people are unhealthy or at risk of illness, prone to injury, difficult to treat, heal, or cure; why they’re frail or short lived, and how they can manage health with more than biomedicine. Having a voracious appetite for meaning, practitioners look beyond clinic to identify environmental, psychological and social dimensions, causes, or palliations of disease – and try to make good use of them.

I now think that scientific entertainment is indeed an offshoot of these correlates; that it’s “behavioral entertainment.” It involves depictions of human behavior derived from observation, modeling, and experiment. It relates why people do what they do, and how they might do better. For example, why they often increase risks rather than avoid or control them; and how they might act differently to produce more desirable outcomes.

Could it be that standup comedy on The Daily Show is also behavioral entertainment; likewise animation by Pixar, theater by Lin Manuel Miranda, painting by Banksy, fiction by Margaret Atwood, movies by Guillermo Del Toro, music by Bob Dylan, and video games by Will Wright? All of these make audiences feel good while moving them to create and use new meaning.

If scientific entertainment in Humaginarium is behavioral, it’s important to remember that behavior is more than how people act; it’s also why. As Robert Sapolsky makes abundantly clear, without getting to the why there is no getting to behavioral outcomes.

In humans, “why” leads through a morass of conscious choices and decisions, through nervous reactions of the senses, all the way to the tremulous molecules that compose our bodies and microorganisms that live in and on us – some keeping us alive and others just the opposite.

I’m claiming to be behavioral, but not behaviorist. I don’t suppose that humans are machines that can be programmed with external conditioning. More in line with behavioral economics, I think people should not be trained, conditioned, or forced to do anything they prefer not to do.

The job of scientific entertainment in Humaginarium is to help them recognize choices and make decisions in what they believe is their own self-interest. That’s our nudge to wellness™.

The nudge is what allows us to generate behavioral outcomes. As I have often heard the butterfly say to the fish, “the best thing in the world you can be is yourself.” People who find themselves in Humaginarium may grow more confident that they’re incredibly beautiful and brave and may become ever more so.

Fantasy

Transforming the body from oozing, sticky humors into a cosmic miracle.

A more explicit way of saying “scientific entertainment” is “biological fantasy.” Both may be rare enough to qualify for trademark protection, provided they actually make sense and are useful. Do they, and are they?

Scientific entertainment and biological fantasy are oxymorons that label customer experience in Humaginarium. Each should negate itself because everybody knows that biology is real and fantasy is fake; that science is momentous and entertainment is merely fun. Add two polar opposites together and logically expect a nil result. Does that mean we’re making zero-sum, inconsequential mind games for customers of Humaginarium?

I don’t think so because, in the context of learning, the whole is always greater than the sum of its parts. Look at it this way. Biology is the aspect of human nature that is real and tangible, but largely invisible and incomprehensible to regular folks. How do we know? Stop somebody on the street and ask a profound question about biology, for example, “What is a stem cell?” In most neighborhoods the answer may range from clueless to ridiculous, though every human life depends on stem cells and our species would go extinct without them. In this way biology is weirdly physical, immediate, deterministic, and largely unfathomable. (By the way, that lovely blob in the illustration below is a stem cell.)

Unlike biology, fantasy purveys intangible figments of the imagination that are nonetheless visible to the mind’s eye and fairly easy to understand. That’s partly why fantasy is a massively popular art form. People get it! To test this distinction, ask somebody on the street what a soul is, and you’ll likely get a devout or convinced or passionate response. Stem cells exist in and around us, yet folks know little if anything about them. Souls don’t exist anywhere, yet they’re a ubiquitous felt presence in real life. How can this be?

Probably because fantasy isn’t fake! Unreal yes, because it’s made up; but fully-conceived fantasy is at least as meaningful and truthful as biology; in fact more so for the vast majority. In scientific entertainment or biological fantasy, consumers confront what for them is unknowable and therefore frightening (the contests of the human body with morbid threats). They confront these threats with beliefs they can grasp and control to suit their longings and needs; and that activity is motivating. Though you may never hear the word fantasy in health care, I’m pretty sure it’s an uninvited guest at every medical procedure and sleepless night of worry. Patients leave the door unlocked because fantasy doesn’t negate science; instead it makes science believable, trustworthy, and useful to them.

What sorts of fantasies are churning in Humaginarium? Obviously science fiction because we picture and animate human physiology; and simulate its progressions with computer models. Like the wings of a fairy, fantasy surrounds and moves with our biology – not in order to falsify it, but to simplify and disarm it; and make it coherent, responsive, and beautiful. The imaginative rendering of scientific subject matter is called reductionism. It’s an aesthetic at the core of all great art (including the medical arts).

Beyond science fiction, Humaginarium presents immersive fantasy that alchemizes the oxymorons into seamless perceptual experiences. Customers don’t experience science and entertainment; instead they experience scientific entertainment with breathtaking epistemic powers. We present liminal fantasy that reframes the human body, transforming it from a pool of oozing, sticky humors into the cosmic miracle that “in fact” it “really” is. We present dark fantasy marbled with infection, inflammation, deterioration, and death that is coming after you and may catch you unawares and unguarded. We present comic fantasy sparkling with cuteness and jokes that ventilate the struggle for survival with the laughter of relief. Our initial visual prototypes did this job with steampunk, which somehow works like fictional nonfiction. There’s another oxymoron for opening doors of perception.

So then, does scientific entertainment make sense? You bet it does. Is biological fantasy useful? Only for certain things, like having a happier and longer life.

Scientific entertainment. Variation on Working in Marble by Jean-Léon Gérôme

Visualizing

Our virtual human body looks and acts like an incredible video game.

Members of the Humaginarium tribe are called customers, consumers, patients, users, gamers, players, learners, and (my favorite) eyeballs. Each of the monikers emphasizes a different role. The special role performed by eyeballs is to view.

So what engages eyeballs in Humaginarium? The answer isn’t obvious. After all Humaginarium is scientific entertainment that’s not been done before at scale; has never been done for a mass market of regular folks. Members of our tribe will surely be astonished and amazed by what we show them. Will they like the show and keep coming back for more?

To increase the chances we invented an intriguing visual style in the confluence of medical and fantastical illustration. One depicts a natural, objective world of the senses. The other imagines a make-believe, subjective world of the mind.

Our medical illustration is state-of-the-art CGI of human anatomy (structure), physiology (function), and pathology (abnormality). This kind of digital visualization involves dimensional, colorful, high-resolution, high-fidelity, animated pictures. It looks sophisticated and technical, but the roots of medical illustration trace all the way back to pharaonic Egypt. It informed Classical and Renaissance science and art and continued to evolve in the centuries that followed. Modern medical illustration that leverages technology began with Spanish neuroscientist Santiago Ramón y Cajal and blossomed in American surgeon Frank Netter‘s Atlas of Human Anatomy. These artist-doctors rendered Homo sapiens in elegant and precise drawings that were (and still are) used by clinicians and educators.

New medical CGI renders Homo sapiens as discrete atoms, and complete organisms, and at every scale in between including molecular and cellular. Want to zoom a chromosome? No problem, have a look. Want to strum an auditory ossicle? Right this way, point the light. Our medical CGI prompts folks to view and manipulate every ingredient of a virtual human body without ever cutting into a real one.

This kind of visualizing is naturalistic, but is it realistic? My answer is no, because a realistic picture of anatomy, physiology, and pathology is extremely hard to parse and comprehend; and therefore not as useful. State-of-the-art medical CGI is very useful because it idealizes subject matter. The rendered biology appears true to nature, yet easy to see and experience; moreover it’s beautiful, no less than great works of art and architecture. To encounter awesome new medical illustration is to gaze in wonderment.

The beauty of medical CGI serves as a docking station for fantastical CGI. It allows actual organic matter to dovetail with absurd and ridiculous inventions; together they generate nothing short of visual magic. People have always experienced this kind of magic without thinking much about it. For example as children with a wishbone after dinner, a ringlet of hair in a locket, and a baby tooth under a pillow. In these everyday examples and in Humaginarium, the real body acts like a wardrobe that opens into Narnia.

What does our scientific Narnia look like? Well, there’s a substratum of idealized anatomy, physiology, and pathology; that’s the natural world of Homo sapiens. Pure figments of our imagination populate that world: things like gardens with unmarked paths, caves with cryptic messages etched on the walls, opalescent pools that ripple when they speak, supernatural humanoids and beasts, horrifying monsters, criminals intent on gambling momentary gratification for a lifetime of pain, immanent spirits, enchanting songs. Our fantastical CGI is overlaid on the natural kind and littered with tangible clues like those that Jules Verne created for his adventurers.

Much of the spectacle in Humaginarium throbs with attitude and nervous energy. Members of our tribe don’t stroll through an art gallery but work hard to find their ways through a maze of chronic illness, in an enchained world that yearns to be free. That’s why our virtual human body looks and acts like an incredible video game. It doesn’t invite eyeballs to observe and learn. Instead it challenges them to survive and prosper despite the odds. That is why they like the show and keep coming back for more

Learning

The most desperate problems emerging from chronic illness have a surname: Vulnerability.

Humaginarium is entertainment for consumers who have, risk, or wonder about chronic illness. Participation is voluntary. Nobody is forced or cajoled to join. Like a carnival barker, the only promise we make is fun. It’s important to say this because unlike presenters of classic health education, Humaginarium must offer art that regular folks like and want for its own sake, whether or not it solves their problems.

Thanks to art, Humaginarium probably has more in common with medicine than bland health education does. Truly? Well yes, because medicine historically is a mixture of art and science, with art doing the lion’s share of the job until the mid 20th century. Even today in the technical vanguard of biomedicine, art is a critical component of what matters to most people: healing and wellness. When medical arts are eclipsed by instrumentation and data, health care can begin to seem manipulative and futile, if not ridiculous, to the folks it serves.

Humaginarium likewise is a mixture of art and science. Though we don’t boast about solving problems, that’s actually why we exist. Real-life problems; often unacknowledged, misunderstood, denied, hidden, scorned, or ignored by the kinds of folks who buy video games for escapist fantasy rather than useful information. As they enjoy the experiences we prepare for them, their health issues are pulled through an aesthetic ringer I call catharsis. That’s pretty much the same ringer that doctors and shamans have used for millennia and still use today.

In my view all the most desperate problems caused by chronic illness have a surname: Vulnerability. By that I mean weak defenses against illness and the clueless pursuit of wellness. Vulnerable consumers don’t make themselves better; they let things get worse. They don’t relish the esoteric complexity of the body; they’re obsessed with appearances. They don’t ask hard questions they can’t begin to answer; they delegate that to experts who know everything. Experience eventually shows how little medical experts actually know and how risky and inefficient such delegation can be.

As a problem solver, Humaginarium is not paternalistic. It doesn’t tell consumers what to think or do beyond one simple command: win the game. That’s their mandate. Thing is, they have to figure out how to win. On their own. They can share ideas and experience with peers, but they can’t delegate.

Instead players build their own knowledge and make their own choices in their own self-interest; and health literacy emerges. This learning style is called constructionism. You’ll find it in healthcare simulations for medical students and physicians, but you won’t find it in health education for patients who need it just as much. Why? That doesn’t matter. It’s about to change.

Consumers initially come to Humaginarium not for information or simulation or education of any kind, but to be amused. To enjoy a virtual experience of the human body in its battle with unfair, unfeeling, out-of-control destiny. As in all their favorite video games, players must develop new competencies to win. But this time their gains deliver more than make-believe victories.

Capabilities learned in Humaginarium are wholly transferable. A fight for health in our fantasy prepares people for a similar fight in real life where, maybe for the first time, they’ll deeply understand and strive to control existential threats like diabetes, cancer, or heart disease. We want them to bring better defenses against illness and longings for wellness to the battle. Ones that fit their own circumstances more or less perfectly.

When that happens, Humaginarium may perform like a magical healing art of the 21st Century.

Resolution

Every neuron plays a role in destiny, and individuals who get that will keep their resolutions.

Humaginarium modulates playing and learning so transparently that consumers don’t know or care which experience they’re having in the moment. They care only about winning and they know when they reach the pinnacle. What happens next?

That’s a choice. Some consumers play again at higher levels of difficulty and challenge, or with different people. Others change course for a completely separate challenge and experience. Still others exit the entertainment and make use of what they learned in real life. How does that happen?

It starts with self-assessment of health and lifestyle risks typical of illness battled in a just-played game. By completing an intelligent questionnaire, individuals enable our back end system to identify vulnerabilities and threats in their environment, medical history, and genetic phenotype. The assessment produces a kind of living quest map with critical branches.

The next step is to design a choice architecture based on a personal quest map. The architecture computes formative and summative impacts of choices on an adjustable timeline. Shorter and longer term outcomes are modeled by altering choices. It’s plain to see that no quest map produces immortality and freedom from pain, but at the same time regular folks can discover far more control over symptoms and outcomes than they ever thought possible.

The penultimate step is to make a resolution. Fiddling with choice architecture heightens self-awareness and the sense of personal responsibility for illness and wellness. Resolution cements hard and easy choices into a promise, like the New Year’s resolution we make and break year after year. What’s different about this?

The fantasy novelist Ursula K. Le Guin has an answer. She writes that “need alone is not enough to set power free: there must be knowledge.” In other words, one’s need to lead a longer, healthier life is inconsequential unless it is based on understanding, the deeper the better. In matters of illness and wellness, that’s understanding of one’s body. Not just what it looks like and how it feels, but how it works and grows; how it avoids and overcomes adversity; how it decays and fails. Precisely the things that are observed and learned while playing for hours and hours in Humaginarium.

Knowledge rather than yearning positions resolution for success. Along with knowledge comes sentiment such as courage, resilience, curiosity, conation. Every neuron plays a role in one’s destiny, and individuals who understand that are more likely to keep a resolution.

The logic here is tight yet incomplete. It still leaves people vulnerable to a threat that dates back to Ancient Greece and is more common than ever in a depressed and depressing world. It’s the Sisyphean Condition.

People who confront and master a chronic illness in Humaginarium are not cured. People who self-assess, design a choice architecture, and make a brave resolution continue to struggle, rolling their own immense boulder to the top of a hill where it inevitably rolls down another side. Does that make them futile? No. Foolish? I don’t think so because now they understand their struggle; they know where their controls are; and in the spirit of Albert Camus, they have captured meaning and purpose in a world that can seem, to people with a chronic illness, utterly cruel and indifferent.

The final step after resolution is community building. Individuals who have played, learned, assessed, designed, and resolved are still pretty much on their own. We can’t leave them there and expect the best outcomes. Instead we invite them to join self-assembling communities of interest on our social network where personal decision-making continues with those who care deeply about each other. Which is just about everybody who has or treats a chronic illness.

Money

The mechanism for empowerment is not rocket science. It’s health science.

The annual spend on health care is well over three trillion dollars in the United States; far more than in any other country. How much is three trillion? Three thousand billion. 20% of gross domestic product. Every year. Merriam-Webster defines trillion as “an indeterminately large number.” It’s imponderable. And the spend on health care is increasing.

But precisely who spends all that money? Is it the United States? Not exactly. Regular folks known as taxpayers and adult consumers actually foot the bill. The US government merely regulates the market.

Normally when regular folks decide to spend even a little money, it’s for something they want. To solve a problem or satisfy a need. Is that why Americans spend so much on health care? You’d think so, but I wonder. The United States ranks eleventh of industrialized nations on aggregated measures of quality, efficacy, accessibility, efficiency, value, and equity of health care. We stand out only for extravagant cost. Does that sound like solving problems or satisfying needs?

The answer depends on who? As in, whose problems are solved and whose needs are satisfied. There are mainly four kinds of who in health care: providers, suppliers, payers, and patients. Three solve their problems and satisfy their needs by absorbing hefty shares of that trillion dollar spend. One doesn’t. Guess which one doesn’t.

The answer is patients. Patients, aka taxpayers, aka consumers, aka regular folks don’t charge for their health care. They pay for it. Actually they pay out the wazoo for treatment that on the whole is relatively poor. Why? Possibly because in care settings regular folks are helpless, ignorant, vulnerable, afraid, and malleable. People who fit that description are easy to control. They pay the money not to solve problems and satisfy needs, but because they don’t have much of a choice. Most don’t even know how to choose. Everything is so complicated! They can’t manage their spend though they underwrite the entire industry. Geez is right!

Enter Humaginarium. Why? To lower the cost of health care? No. To increase the quality, efficacy, and value of health care. No, no, and no again. To empower folks who maybe can do those things? Yes, indeed yes.

The mechanism for empowerment is not rocket science. It’s health science, a branch of knowledge that helps folks understand and make good choices, thus becoming good stewards of their bodies and not just bill payers. You will not find a provider, a supplier, or a payer in the health care industry who empowers patients with that knowledge, because it’s not their job. That’s not what they’re paid for.

Then whose job is it? Regular folks, of course. And an unprecedented, astonishing new program of job training for them is called Humaginarium. It’s in the pipeline! So consumers, now hear this:

  • You can understand things like physiology and pathology.
  • You can enjoy learning how your body deals with chronic illness.
  • You can make good medical and lifestyle choices.
  • You can be brave, curious, well-informed, and strong.

That’s your job. Humaginarium is like the eagles. Don’t look down. We’re coming to help.

Scientific entertainment. Variation on Daphnis et Chloé, by Louise Marie-Jeanne Hersent-Mauduit

Revenue

Humaginarium is more moonshot than pizza delivery.

When it comes to revenue, consider two types of startup. One wants to solve problems and also make money. The other wants to make money and also solve problems. They sound alike but their raison d’être is different. I thought I observed the difference in a series of pitches this week. Problem-solvers edified and inspired me whereas money-makers pressed for my buy in. Hopefully I’m not making this up. I think it’s real. The difference between the types of startup is like the difference between quality and utility, transformation and fulfillment, moonshot and pizza delivery.

Be that as it may, all startups have to spend and make money, the more the better. For their innovations to engage, they must scale so that they solve one huge problem for many different customers or a lot of little problems for just a few customers at a time. AAA game studios are examples of huge; indie studios of little. Ideally and rarely, when innovations solve a lot of huge problems for many different customers, brands like Amazon and Google are born. Humaginarium may be that kind of startup.

It’s a nice thought, but in any case where will our revenue come from? Most likely from multiple streams including:

  • Direct sales
  • Sponsorship
  • Advertising
  • Analytics

With a freemium pricing strategy, direct sales to consumers will occur when uncommitted users become paying customers. Why would they do that? In order to unlock extra content and premium services. Freemium will help Humaginarium build a large fan base by removing piddling barriers to entry. True, only a small portion of users will actually become paying customers, but the value of scale to us far exceeds the value of purchases alone. Strange as it sounded before Chris Anderson explained this for me, free is far more lucrative than subscription or PPV.

In addition to consumers, we will also book revenue with direct sales to organizations that hire Humaginarium. Hire us? For what? Most likely to develop branded content for their customers, members, students, or employees. This contracted work for hire will be vended by a sub brand named Humagine Learning. That brand draws from the same creative and technical resources as Humaginarium, but makes different products. Organizations get to own what they buy from Humagine Learning, and they also get to decide what it is and whom it’s for.

Our work for hire is a kind of “sponsored content,” but not the only kind. Content we make for direct sale to consumers can also be sponsored. For example, by nonprofits making program-related investments in health literacy or by for-profits trying to build their brands with a large audience of our consumers who have the problem that our sponsor claims to solve. In this way, the Cleveland Clinic could decide to sponsor our cardiovascular portfolio because it promotes health literacy in a segment of the population that the Cleveland Clinic famously serves.

Advertising is yet another revenue stream, different from sponsorship because ad sales are specifically for demand generation rather than brand building. Thus a pharmaceutical or food processing company might decide to advertise to consumers playing in our immunological portfolio. Why? Because the advertiser has a specific product that mitigates a chronic illness that we are helping consumers understand and maybe do something about.

Analytics is different from the previous streams but also valuable. Consumers who explore and challenge chronic illness in Humaginarium may generate mass insight into behaviors, beliefs, preferences, habits, and concerns that transcend play and factor into real-life choices. We will sell this insight to customers in health care and population health who can use it. For example, insight into complex emotional causes of medication non adherence for marketers of drugs.

These multiple revenue streams are organic to the value propositions of Humaginarium. They all represent transactions that reinforce our nudge to wellness. Unlike Walgreens selling liquor and tobacco products in their pharmacies, they fit our mission. Am I sure that there’s enough revenue in these combined streams to warrant investment in the highest quality scientific entertainment that I have in mind? I won’t know for sure until I have a financial model that presents the data and passes the test. However I’m pretty sure that Humaginarium is more moonshot than pizza delivery. The upside potential looks incredible.