Mechanics

Health may be a human right for others, but you’re going to fight for it.

Users cross the morbid frontier with a plan, a map, a wallet, provisions and a cache of clues. They have a tough job ahead in Diabetes Agonistes. Seize the minions of chronic illness! Reclaim the birthrights of strength and safety! End the pain; end the suffering; end the fear of your own body!

Whoa, whoa, not so fast. Everything you try in this godforsaken fantasy will be challenged or opposed. What you see and feel is a fraction of what’s actually there; and much of that is out to get you. So be careful.

The minions you’re chasing are feral, ugly, numerous, devious, nuanced, complicated and uncannily intelligent. They’re thriving like a nest of vipers while you gingerly probe their squirming skins. When you grasp one it may throttle or bite, or emit begging sighs that lure you inward or downward, but probably not onward. After all, you want to live strong but the minions of chronic illness frankly want you to die. They might go so far as to kill you! It’s not hopeless though. Their crushing powers to confuse and depress may yield eventually, but not to chemical or nuclear weapons. Only to insight tempered with rare, gemlike passion you store in your heart for this quest. Health may be a human right for others, but you’re going to fight for it.

There are structural mechanics in the morbid frontier. By that I mean programmatic activities. Remember you’re in a video game now where NOTHING happens unless you trigger it. The good news is that your path is packed full of affordances. They are the logical, functional, evocative, riveting means to your ends. They’re also symbolic and deeply disturbing. Purpose-built to ignite learning and motivation. In the morbid frontier, everything you’ll do to overcome The Problem inflames your own personal desire to learn and go farther, and accomplish more.

Let’s begin to envision the game mechanics of Diabetes Agonistes.

Trusted Advisor. You may traipse solo through the morbid frontier, if that’s your style; or bond with a droid who has special powers. To interpret clues, weigh choices, fabricate tools, detour into branches, avoid pitfalls, barter, negotiate, interrogate, assassinate. All handy services, but beware of friends. Droid talents and loyalties are time and place dependent, devilishly restricted. You won’t know their limits until you test them; and you won’t be able to test a droid until you badly need it. You must learn when to fire and replace trusted advisors before they steer you into deep shit.

Meaning Maker. You may journey through the morbid frontier for the fun of it, as though it were some grotesque carnival. That would be thrilling and satisfying, but not winning. To win you must continuously make meaning from your experience. The meaning you make guides you onward, makes you more resilient. Emerging knowledge gradually transforms you into a master of fate. Take note of this. Diabetes Agonistes doesn’t teach you; it teaches you nothing. You force the quest to reveal truths that you can use. Making meaning is like fetching the key that turns the lock, from a ring of glittering duds.

Highways and Byways. You enter the morbid frontier with a map. Unfortunately, the map is a character with a quirky personality, a hidden agenda, and is somewhat unreliable. It doesn’t show you which way to go; doesn’t show all the ways to go; it merely indicates topography and suggests possibilities. You interpret the map, filling in gaps with your intuition and discoveries. You treat the map as a data store rather than a bundle of insight. You filter it for wisdom while suspecting it may be lying to you or mistaken. By improving the map in time you will gradually become a skilled cartographer for higher, more difficult levels of the morbid frontier.

Profit and Loss. You carry a digital wallet, starting in the Arcade and throughout Diabetes Agonistes. The wallet is initially stocked with enough capital to float your quest; but not enough to complete it. The wallet holds identity cards, credit cards, biocurrency and tokens that have specialized uses and surprising half-lives. In the morbid frontier you draw down this capital to pay for provisions and clues, bail, gadgets, services like protection, ferries and contract kills, healing balms and magic incantations. You may replenish your capital by earning rewards, trading objects, robbing minions and their bosses, ransacking their troves, trading on the Metabolic Exchange. The wallet is your permanent and personal property. It goes with you when the game is over and you’re on to a new quest in Humaginarium.

Are there more mechanics than these I’ve just shared? Indubitably. I want to keep writing about them. I’ll resume in my next post.

Morbid Frontier

This frontier is a newfangled transubstantiation of the body.

The exposition of Diabetes Agonistes turns on goal-setting, surveillance, and discovery of The Problem – by users who are going to experience and try solving it. In the real world The Problem is called metabolic syndrome – a nexus of chronic illness including diabetes mellitus type 2. In the fantasy of Diabetes Agonistes The Problem has no name. It’s an ominous presence, an irresistible force that manifests metaphorically, visually, dramatically as a vague, existential threat. More suicide bomber than complex medical condition.

Up to this point, users have glimpsed and probed the borders of a frontier full of hazards and portentous implications. They’ve observed and gathered biological phenomena that eerily materialized before their eyes – each unpacking different clues and warnings about what lies ahead in a quest. The clues suggest where and how The Problem may be found, observed, engaged. Warnings promise enrichment and fun to “all ye who enter here,” while darkly insinuating ambush and horror for hapless adventurers.

The frontier I’m talking about is a new transubstantiation of the human body. Rather than body into wafer, this is body into earth and sea. The frontier is underpinned by computational models of physiology and biochemistry that we’ve exploded and reorganized, reshaped and robed as a chronological, three-dimensional space like Eä and Arda and Middle-earth. Those dreamscapes are symbols of nature at every level and civilization in every moment. They are make-believe geography and history that were created to be explored, claimed and defended by questers pursuing salvation and truth along with victory and peace. Somewhat like the mythos of yesteryear, our new biological fantasy evokes metabolic structures, forms, content, mechanics and processes of a diseased human body; not as a body per se, but as a world that users bravely traverse and strive to master.

A typical user enters this frontier by choosing among three trails that present different perspectives on The Problem. Each trail attracts a different kind of user, but all lead precariously to the same endgame.

The first trail is elemental. It winds through the biochemistry of a metabolically disordered body at its least visible and experiential; its most enigmatic and elusive. From the elemental perspective, the constituents of metabolism have existed for billions of years – since life on earth began in the primal slime – and will continue long after their human hosts have departed. They are like the Valar. They make human life possible; they can sustain or end it in a snap; but all the same they are woefully indifferent to it. Their concern is all life, not human life in particular; and their fate is not bound to ours. This is a molecular agon.

The second trail is combinative. It makes its way among microbial tribes of the afflicted body, populated by wholly formed and determined agents who have unique personalities and life stories. Some tiny organisms are virtuous, others malevolent; some are brilliant, others mechanical; some are empathetic, resilient, capable of serving the greater good; others selfish and moronic, having little on their minds beyond the next meal and procreation. Neither immortal nor transcendent, they persist as long and as well as their tribe does; causing or enduring metabolic disorders and maybe overcoming them alone or with help; but rarely able to survive far from home. The whole of their population is equal to the sum of its parts. This is a cellular agon.

The third trail is civic. It cuts across the anatomy of an unwell body in which relations between tribes are modulated by rules, authorities, competing interests and economic pressures. The actors encountered here are systems rather than molecules or cells. When they are not disoriented by morbidity, they rest in balance and harmony: the endgame of homeostasis. However they are extremely vulnerable to attack, and in defending themselves these organs, tissues and fluids may spiral into conflict and chaos that end badly. This is a physiological agon.

Three trails through one frontier, with discrete beginnings but myriad links, dependencies and interferences. No matter where users begin, their quest ranges through all, interweaving their bewildering and frightful perspectives. What will it be like to play on and in them? That’s for my next post.

Quick Wins

She tries to do the right thing and she counts on quick wins to hold it all together.

I’m observing a typical user of Diabetes Agonistes: a woman in her mid-30s, perched on the lower rungs of the middle class; a little large she is with high blood pressure and sugar. She’s attractive, gregarious, restless when she isn’t busy, dreamy when she has time for herself. Years ago she finished high school and landed a sales job in the local mall; now she’s a merchant. A single mother whose days are stretched to the breaking point; but to her it feels heroic. She works hard, plays nice, is conscientious about her family and customers. She reads little for pleasure, but has her favorite shows and podcasts. She tries to do the right thing even when that isn’t easy or obvious or cheap, and she counts on quick wins to hold it all together. Quick wins are also why she plays video games, most days for an hour or less; in the train on the phone, at home on the computer. Her favorite kinds of games stymie her as much as life sometimes does, but they also throw off hot sparkling bursts of light, the crackling noise of walls collapsing, the thrill of snatching well-earned victories from the jaws of near defeat.

She heard about Humaginarium from a boyfriend. He said it’s pretty cool, “but you might not go for it because it’s gory.” Pretty cool as in really nice looking, gory as in bloody; yet no gratuitous violence, and that detail got her attention. She’s bored by dumbass shooters and bosomy warriors. It’s free, he added; it streams so it starts right up, no downloads, hardly any latency. “It’s different from anything I’ve ever played,” he allowed, so maybe she’ll have a look? He got into it two weeks ago and he’s still working through the first level. “Damn thing reminds me of Jules Verne” – 3D science fiction fantasy, clue-finding and brainy calculation, mysteries locked in enigmas that are supposedly true – TRUE – “as the human body itself.”

Her eyebrows went up when she heard that. “The human body? Is it a sex game?” He pondered, “actually more sensuous than sensual.” She wasn’t sure what that meant and neither was he. “Rated M, not A.” Okay, good enough!

One night after brushing her teeth she entered Humaginarium in a browser on her laptop and soon found herself wandering a fabulous Arcade. It was confusing and disorienting, yet funny. “Like I’m Alice in Wonderland,” she mused, “or Spirited Away” as she watched and touched things that seemed to have minds of their own. Lots of colors and movement, fractal images and eerie sound effects, curious linkages that eventually made her suspect something was going on: it wasn’t just random game mechanics. She was witnessing the “miracles” of birth, growth, decay and death of the body as though they were magic shows. They helped her form mental models of wellness that are religion in Humaginarium: things to adore and believe in. A firm grasp of wellness finally unlocked a portal into a different and strangely hidden world, one fraught with danger and mystery yet irresistibly beautiful; the hidden world of morbidity.

She wanted to stop right there, not because she wasn’t curious; she was actually intrigued. But over an hour had passed as she explored the Arcade and turned that lock in the portal. It was past midnight now and her alarm clock was set for 6:00 AM. She wondered, “what will happen if I just stop?” Would she lose everything and have to start over? “This is ridiculous, it’s just a game,” and she decided to exit. Before closing the app asked, Do you want to keep your Humaginarium Key? “Sure, why not? What for?”

The next day on the commute to work she had a few minutes to spare, so she started Humaginarium on an iPad. “This won’t work,” she murmured. Wrong! It worked just fine. The app retrieved her Key from Dropbox, authenticated her identity, and transported her right back through the gates of … what … Heaven? Hell? It’s fun is not knowing which. On the other side of the portal she learned she has to quest. She can start right away and collect greater honors and rewards for speed. Or she can slow down a bit and learn before she leaps. She didn’t have time to decide. As the train approached her stop she had to exit.

Sadly she didn’t return to the game until the end of the week, for reasons that have nothing to do with this history. When she regained her previous position in Humaginarium she watched a quick replay of everything that previously happened to her. Now she was ready to forge ahead. She spent an hour collecting raw intelligence about her adversaries and allies in this weird biological fantasy. When she had enough of that, she entered a path that led to…. We’ll find out where in my next post.

Scientific entertainment. La Baigneuse Valpinçon (1808), by Jean-Auguste-Dominique Ingres; pictured with microbiota in the human alimentary canal.

Green Light Redux

Two federal agencies have invited us to request SBIR Phase 1 funding.

I’m taking a break from game design this week to talk about progress on another front.

Back on April 10, I announced that the National Science Foundation approved Humaginarium’s Project Pitch. Today I’m announcing that the National Institute of Diabetes and Digestive and Kidney Diseases has approved our Specific Aims. Two US federal agencies have thus invited Humaginarium to apply in 2019 for substantial, non-dilutive, SBIR Phase 1 funding. In my opinion, that’s cool!

Specific Aims is a single page argument that our groundbreaking idea for biomedical innovation is a good fit for NIH support; and that it’s a good candidate for commercialization. I dubbed the idea Metabolic Genii.

In popular culture, a genie is Robin Williams magically springing from a bottle to make jokes and grant wishes. I’m fine with that; it fits our brand well enough, but the word genie is actually more meaningful. It’s a variant of genius, and a genius (plural: genii) is an attendant spirit: a force that influences actors for better or worse.

Metabolic genii are digital affordances that empower folks who have or risk developing metabolic disorders. The genii enable them to inquire what’s up with their bodies and gain a bit more control over their medical outcomes.

Like any genius worthy of that moniker, metabolic genii are extremely creative. Ours are creative like scientists rather than sorcerers. They intelligently pan for the personal gold in every individual they meet, ultimately enabling users to feel a little like Aladdin, with wishes that now make a lot more sense and eventually may come true.

The terminal objective of our Specific Aims is a set of six precise, repeatable techniques that reliably convert basic health literacy (acquired in a separate project) into resolute behavior. These six techniques are drawn from a social science palette that includes situational awareness, choice architecture, scenario planning, nudge theory, decision science, and reinforcement theory of motivation. According to my reading of research literature, these powerful and accessible affordances have never been synced to produce sustainable medical outcomes. We’re about to sync them in order to discover what happens next.

What do we expect to happen next? Empowerment. Users will demonstrate their ability and desire to make evidence-based decisions about illness and wellness; and furthermore make those decisions as sticky as flypaper. Sound easy? Sorry, it’s never been done before. That may be why health education mostly doesn’t work. At all.

Who is going to benefit from this project? Of course Humaginarium and its investors will benefit, but more importantly 60% of the adult population stands to benefit. That is the proportion who already have a poorly controlled chronic illness (the numbers are increasing). That’s also the proportion who play video games, the medium we are using to generate basic health literacy (and yes, those numbers are increasing too).

What will our R&D be like? It begins with a re-review of secondary research that bears on our terminal objective. From there it takes the form of agile discovery. We are not going to think this problem to death. Instead we shall design activities that a large number of experts and ordinary consumers can experience and comment with feedback. Each of these activities generates data that indicate efficacy and flow into other parts of the Metabolic Genii system.

Our Phase 1 research and development yields proof-of-concept of this system; and verifies its theoretical efficacy. If results are encouraging, we will migrate our hardening techniques into a Phase 2 design-build-test-deploy project. At that point, our world begins to resemble an oyster.

Metabolic Genii and it’s counterpart Diabetes Agonistes are now as two horses pulling a chariot named Humaginarium. Our chariot isn’t racing against competitors; there is none working at our level. We’re racing against time. We want to stymie metabolic disorders and other chronic illnesses as quickly and as soon as possible.

Click here to read the Specific Aims.

Provisioning

Success depends not on what users know but what they discover and use.

This is the game objective of Diabetes Agonistes:

  • Seize the causes of metabolic disorders
  • Confound their powers to harm
  • Claim the birthright of homeostasis

Reminder: this serious objective is met with play, not with study. It’s pursued in a fantasy; not real life. Users solve tough problems on a personal quest through the make-believe. Yes, they will eventually do similar things in their own real life; and they will do it better because they practiced first in Diabetes Agonistes. But I’m not concerned with that now. Right now I’m thinking only about how to play a really good game.

Each of the three jobs I mentioned – seize, confound, claim – is an agon. Each is beautiful and magical, yet difficult and messy. Users who don’t carefully prepare before questing will fail fast and often.

Players who are MDs and RNs – there will be plenty (real and aspiring) among our play testers – may opt to ‘damn the torpedoes’ because they’re confident of their scientific and clinical acumen; they may plunge headlong into the fight to prove they can beat this silly game sim in record time. By design though, they’ll get plastered by adversaries who have even more confidence, and with good reason.

Preparation for questing is necessary and also voluntary. Like everything else in Diabetes Agonistes, success here depends not on what users know but what they choose to discover and then use. It depends on clue finding and strategy. Diabetes Agonistes does not leverage motor skills like an arcade game.

Users who earnestly examine their surroundings for clues soon find a checklist that helps them prepare. The checklist is for provisioning. It helps them acquire and create things they’ll need to survive an agon. A checklist guides individual discovery of things like:

  • Who are my adversaries?
  • Why are they adversaries?
  • What are their powers?
  • Where are they now?
  • Do they morph and mutate or always stay the same?
  • Are they immortal or can they be killed?
  • Who are my allies?
  • What can they do for me now and later?
  • Why should I join this quest; what’s my purpose here?
  • What do I win; what larger difference may I make?

Our principal mechanic for clue finding in Diabetes Agonistes is a metaphor for geolocation. Users can (if they wish) lease a dirigible airship with credits stored in their key. They can steer this airship above a phantasmagoric terrain that elegantly symbolizes human biology and physiology. This landscape is not a funky realistic model of the human body as in most healthcare simulations; it’s not like Lemuel Gulliver in Brobdingnag, or Frankenstein’s cadaver, or a Russian scientist in the movie Fantastic Voyage. Instead it’s an experiential metaphor that showcases metabolism in the human body as a fabulous, habitable world.

Users survey this world from high and low altitudes. They probe it for insights that can be used when pursuing the game objective, but they don’t do that peacefully. Adversaries who dominate the terrain have radar; they sense when their empire is being scrutinized and they don’t like it. The knowledge of others inflames them! Once detected, they do everything they can to capture or kill users who spy on them, knowing that those who escape may come back to haunt them.

In addition to geolocation, users may discover clues in curious containers. Some containers explode when touched inappropriately, others open when gently coaxed; some open freely, others unlock with credits stored in a key; some are unique and can’t be shared, others can be traded. Some are useful and endow users with powers to heal or cure, others are evil and extremely dangerous.

When users guess they have all the clues they need for what comes next, their questing may begin. I’ll describe that beginning in my next post.

Dark Glass

Diabetes Agonistes is more than adventure: it’s also a system simulation of human physiology.

In the Humaginarium Arcade, new users create their own mental model of wellness: a grail most worthy of questing. Each model releases a unique and reusable key to a magic portal. The portal itself is a translucent barrier, beyond which users see only darkly and with longing – like the shadow of death. They can use their key to open the portal, then plunge inward and downward into a labyrinth of exquisite beauty and danger.

The first instance of Humaginarium is a prototype with just one quest on the far side of the portal. Once we decide the best way to make and deliver interactive adventure, that is also edifying, then the far side of the portal will resemble catacombs, starting in a lobby with networked branches that dissolve into mystery. Users will choose branches according to their needs and interests; and for the prospect of challenge and fun.

For now though, the first and only branch is called Diabetes Agonistes. This is an adventure with metabolic syndrome and diabetes mellitus type 2. In the fantasy of Humaginarium, these are not diseases; they are adversaries.

When users arrive in the lobby of catacombs, they are given a job to do: prepare to enter the labyrinth in search of adversaries and their minions. Find and overcome them, and win back the grail that they imprisoned and maligned, maybe destroyed.

Be careful though! Adversaries do not forgive trespass; they come after users who invade their empire. As users put up defenses, they may be out-smarted, out-maneuvered, out-foxed by brainless pathogens, genomic saboteurs, biochemical cannibals and their ilk. Failure in this fantasy is not just an option; it may seem unavoidable.

How do users prepare for questing in Humaginarium? By sizing up their adversaries, probing them for weakness, arming themselves for conflict, ideating a plan that is not utterly hopeless. All of this is possible in Humaginarium because Diabetes Agonistes is more than adventure: it’s also an engaging system simulation of human physiology.

To prepare for engagement, users can hover over that system, like a balloonist over a battlefield, zooming points of interest, soaring higher to avoid detection and attack, dropping surveillance robots or provisions in places where they may be needed in the approaching journey. This hovering is limited in duration and resources. It can be steered and stretched within limits to increase its utility, but it doesn’t obviate the risks and dangers of questing. It informs users about their adversaries but doesn’t weaken or reveal their adversaries’ secrets.

Before this, users left the Humaginarium Arcade with an individualized mental model of wellness. Now they complete their prep for questing with an individualized mental model of illness. They have made ready to play in a fantasy where all hell will break loose.

In my next post, I’ll describe the mechanics of preparation. This is a delicate subject because it is an intensely cognitive activity. Can we keep users pumped for questing while they ponder the fearful unknown, before they meet their first disgusting orc?

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.