Vital Sings: Video Games

Premieres: April 20, 2020.

Dr Sanjay Gupta: 00:23

Video games provide us with an escape from the real world, an alternative reality, where we can have some fun, work out our aggression,  and learn something new.

Dr Sanjay Gupta: 00:32

Welcome to Vital Signs, I’m Dr. Sanjay Gupta.

Dr Sanjay Gupta: 00:35

Video games look very different than the day Pong came on the scene in 1972. The 80s bought us Tetris, a game where blocks of different shapes fall from the sky, faster and faster and faster. Then came, perhaps the best known face in video gaming, Super Mario.

Mario: 00:52

It’s a me, Mario!

Dr Sanjay Gupta: 00:54

But, nowadays, it’s not all fun and games. Researchers are coming to realise, there’s a largely unlocked  potential for video games to train our brains to be stronger, faster, better.

Kathy Lasky: 01:08

Good job. Good job. Pull the toes back, and stretch. Lift and out.

Dr Sanjay Gupta: 01:16

Kathy Lasky is in great shape, for 71.

Kathy Lasky: 01:19

And stretch it out.

Dr Sanjay Gupta: 01:21

71 and a half, she likes to say. Kathy eats right, exercises, and gets plenty of sleep.

Dr Sanjay Gupta: 01:29

And you’re still  working?

Kathy Lasky: 01:30

Yes. 37 years, the same job, Pharmacy Technician. I tried to retire four years ago, and after a few months it just wasn’t for me.

Dr Sanjay Gupta: 01:42

What happened?

Kathy Lasky: 01:44

Daytime T.V. gets very old. I wanted to be stimulated, as I always had been in the workplace. I did not want to sink into depression or dementia, go backwards; being a senior. I still had  a lot to contribute and I wanted to be vital.

Dr Sanjay Gupta: 02:04

Physically Kathy was feeling great, but mentally she was starting to get a bit foggy.

Kathy Lasky: 02:10

So, I got the catalogue from the school district, The Continuing Ed. I read about brain fitness, and it said to sharpen your skills, your cognitive skills, improve your memory, and everything that an adult needs in their later years, and no computer skills required.  I thought, I’m in! That’s perfect for me.

Dr Sanjay Gupta: 02:33

Sold?

Kathy Lasky: 02:33

Sold, yes.

Dr Sanjay Gupta: 02:35

For the last 12 semesters, Kathy has been coming here, to San Diego Community College, almost religiously; to play video games.

Dr Sanjay Gupta: 02:46

Three times a week. Three hours, roughly, a day; that’s a lot?

Kathy Lasky: 02:51 Yes.

Dr Sanjay Gupta: 02:51

Most people probably couldn’t put in that kind of time. What would you tell those folks?

Kathy Lasky: 02:56

I would say, how much time do you spend watching television? How much  time do you spend on Facebook? How much time do you spend on the telephone? I think you have time.

Dr Sanjay Gupta: 03:07

Participants in the recent ACTIVE Study, that’s Advanced Cognitive Training for Independent and Vital Elderly, took part in 10, one hour, speed training sessions, over the course of five weeks. They played games like Double Decision. Well, a decade later, they were found to have a 33% lower risk of developing dementia. And, patients who received additional booster sessions,  saw that risk drop by 48%.

Dr Sanjay Gupta: 03:34

So, I think what this Double Decision game has taught us, more than anything else, is that the speed of processing may be as important, if not more important, than memory of reasoning itself. If you want to reduce your rates of developing dementia, focus on speed.

Dr Sanjay Gupta: 03:51

There’s a lot of research going on, in terms of preventing, or decreasing the risk of dementia, various medications people can take.  How did you, sort of, balance this idea that I could maybe take a pill that’s a cognitive enhancer, may decrease my risk of dementia, versus up to nine hours a week of this sort of brain training?

Kathy Lasky: 04:12

I am a Pharmacy Technician, I’m well aware of what’s available, and I have seen results: good; but this is so much better. All medication, as you know, has side effects, and I don’t want something preventative, I want to be  pro-active about it all.

Dr Sanjay Gupta: 04:33

The concept at play here is known as Neuroplasticity. It’s this idea that your brain can form new neural connections to prevent future problems or even to make up for one’s that are lost, due to a brain injury like a concussion, or a disease like Alzheimer’s.

Dr Sanjay Gupta: 04:51

Kathy likes the discipline and the social interaction that comes with attending a class, but game maker Posit Science says its games, including Double Decision,  are played by hundreds of thousands of people all over the world every year, and most of them are playing right at home.

Dr Sanjay Gupta: 05:07

Are you going to keep doing this?

Kathy Lasky: 05:08

Yes.

Dr Sanjay Gupta: 05:08

I mean, til when?

Kathy Lasky: 05:10

I’ll never stop. As long as I can get to class, I pencil it right in with everything else.

Dr Sanjay Gupta: 05:16

This is a whole new way of thinking about video games, which is no surprise considering how much they’ve changed over the last few years.

Dr Sanjay Gupta: 05:27

But, what will the future of scientific gaming look like?

Dr Sanjay Gupta: 05:36

At the Cognitive Neuroscience Research Lab at the University of California, San Francisco, Dr. Adam Gazzaley is working to figure that out.

Dr. Gazzaley: 05:43

Good. I mean this is, like, really nice activity.

Dr Sanjay Gupta: 05:46

What sort of things in the brain or behaviours, could you potentially address using games like this?

Dr. Gazzaley: 05:53

I think it’s incredibly broad, the different type of brain systems that you’ll be able to improve. Our Centre,  over here, really focuses on attention processes. How we direct our limited resources where and when we want them. And we know that when these abilities decline, you see all sorts of conditions arise: from ADHD to depression, autism, even things like Alzheimer’s.

Dr Sanjay Gupta: 06:17

Adam and his team are building video games from scratch, with some pretty lofty goals. The trick is figuring out what the video games should look like and how they should work, in order to challenge the brain in  just the right way. To do that, Adam and his team needed to improved upon standard EEG and MRI imaging techniques. They wanted to paint a better picture of what was happening inside someone’s brain, not just right after they played the video game, but even as they were playing the video game.

Dr. Gazzaley: 06:47

We could just strip off the skin, look inside, see the golden fibres, which is the white matter that connect areas of the brain. See the cortical surface of the brain. With a touch of a button we could add in more structures  or look at new fibres, and really see the brain in a way that’s much more interactive.

Dr Sanjay Gupta: 07:04

So, the yellow here, represents?

Dr. Gazzaley: 07:06

The yellow here represents the white matter fibres that connect different brain areas together. And the blue, the purple area, represents the cortex of the brain, the surface of the brain, where the higher order thought takes place.

Dr. Gazzaley: 07:20

But, what makes the GlassBrain so exciting, is that it’s not just MRI. We can overlay on top of it these type of signals. So, what you’re looking at here now,  represented by different colours, are frequencies, electrical activity in the brain, that’s captured in real time: in our case, while I was playing a video game.

Dr Sanjay Gupta: 07:41

Ahead on Vital Signs, we’re going to live inside Ajay’s brain as he breaks a sweat, challenging his body but also his brain, to level up.

Dr Sanjay Gupta: 07:52

You’re looking at what could very well be the future of medicine, but keep in mind, it’s also a sport.

Announcer: 07:58

We’re live here at  Germany, for  the main event! Who will get a shot at the one million dollars?

Dr Sanjay Gupta: 08:04

You think video gaming isn’t a sport? Well, this may change and boggle your mind.

Dr Sanjay Gupta: 08:11

Take a look at these prize pools. For the Tour de France, about $2.56 million dollars. For Superbowl, just north of $7.5 million. For the Masters Golf Tournament and the Cricket World Cup, $10 million. And, for Dota 2 International Championship, $20,770,460  dollars. It might just be the biggest game you’ve never heard of.

Commentator: 08:34

Oh, he’s going to go in. This should be the first blood. They’ve got the , as well. There’s probably going to be a double. Denis . It hits!

Dr Sanjay Gupta: 08:48

You’ve probably never seen a match-up like this before. The game is Doda 2, and this is the International Tournament. At stake? A whole lot of cash, and bragging rights,  if you’re team if the best in the world.

Commentator: 09:02

He’s won one million dollars!

Dr Sanjay Gupta: 09:13

These are the evil geniuses. Last year they took home first place and more than $6.5 million dollars. D2s most seasoned player is Clinton Loomis, known far better by his gamer name, Fear.

Dr Sanjay Gupta: 09:28

How did you get into gaming in the first place?

Fear: 09:30

I started playing online, and just got really hooked to this game, and then eventually out of nowhere, some team was, like, “Do you wanna win some gear, by playing in this tournament?” I’m, like, “Yeah. Sure. That sounds fun.” And it just slowly progressed, into getting paid that little bit. First you got gear, and then you got paid a little salary, and then here we are today, with multi-million dollar tournaments.

Dr Sanjay Gupta: 09:51

Just going back to that earlier time though, what was it about the gaming that really attracted you do you think?

Fear: 09:58

It was just, like, very  mentally stimulating, I guess. It could keep my attention for hours, and then you make little mistakes and like you just want to play a new one, to like fix those mistakes. So, every game just make you want to play better. So, it was just very addicting, I guess.

Dr Sanjay Gupta: 10:19

And that addiction, helps explain why Dota claims more than 13 million new players a month.

Dr Sanjay Gupta: 10:23

Spending too much time in video gaming’s alternative world can lead to some serious, real world, injuries.

Dr. Levi: 10:30

So, this is your ulna styloid-

Dr Sanjay Gupta: 10:33

Dr. Levi Harrison is the self-proclaimed, and now trademarked E-Sports doctor. Dr. Levi is an orthopaedic surgeon, specialising in hand, wrist, and upper extremity conditions.

Dr Sanjay Gupta: 10:46

Gamers seek him out from just down the street in California, and from as far away as the Middle East.

Dr. Levi: 10:53

If you had to say three exercises that help you the most, which one’s are those?

Patient: 10:56

I’d say the one that does … Here.

Dr. Levi: 10:58

Yes. Yes.

Patient: 11:01

And then the … the like, finger one’s.

Dr. Levi: 11:03

Oh yeah, that’ll help a lot.

Dr Sanjay Gupta: 11:05

Who is your most typical patient?

Dr. Levi: 11:07

Most typical patient is a guy between the ages of 18 and 24 years old. Now 24, is really … is getting up there.

Dr Sanjay Gupta: 11:17

Are there certain types of injuries, that are the most common?

Dr. Levi: 11:19

Well, yes, I see a lot of repetitive stress injuries, specifically tendonitis. I also see carpal tunnel. I see cubital tunnel. I see tears in the TFCC, the triangular fibro-cartilage complex,  which is really interesting. I also see tendonitis of the wrist, something called DeQuervain’s tenosynovitis.

Dr Sanjay Gupta: 11:37

If somebody came to me, and I don’t take care of these types of injuries, but if someone came to me and said, “Look, I’m having a lot of pain from playing these games.” I would say-

Dr. Levi: 11:46

You would say?-

Dr Sanjay Gupta: 11:46

Don’t play these games as much.

Dr. Levi: 11:48

And I would say, “Not necessarily.”

Dr. Levi: 11:50

One, after I do the evaluation, I have the gamer, for example, come in with all their equipment. So, we sit here, and we go through the full evaluation of what they’re doing improperly and what can  be corrected. So, after I correct those things, then I give them specific exercises, for them, to use. And, then we go through the part of resting; that is taking a five minute break every 60 minutes. Doing the stretches. Doing the exercises. But more importantly, staying well hydrated when you’re gaming, and getting time to wake up, to stand up, and to rest. To not just sit there for 12 or 14 hours.

Dr Sanjay Gupta: 12:25

But the problem with extreme gamers: they just don’t know when enough is  enough.

Dr Sanjay Gupta: 12:36

China was the first country in the world to declare Internet Addiction a clinical disorder in 2008. These teenagers in Beijing can’t pull themselves away from the computer. Not to eat. Not to sleep. Not even to go to school. The documentary Web Junkie follows them as their parents  have them admitted to Daxing Internet Addiction Treatment Centre. It’s an attempt to break them of their bad habits.

Tao Ran: 13:08 (subtitled)

Some kids are so hooked on these games, they think going to the bathroom will affect their performance, so they wear a diaper.

Dr Sanjay Gupta: 13:22

We decided to go see Director, Tao Ran, ourselves. He’s the psychologist who established this facility to teach children how to use the  internet responsibly.

Dr Sanjay Gupta: 13:32

Tao says he’s rescued thousands of addicted teens through a mixture of medicine and psychology. He thinks 80% of teenagers can recover if their family is engaged in the process, but only half that if they’re going it alone.

Tao Ran: 13:49 (partly subtitled)

The reasons for internet addiction are the feelings of inferiority, introversion, and poor inter-personal relations. The feeling of inferiority mainly comes from the family,  and a child with that feeling has a disgruntled and depressed mood, and cannot release it. That’s why they turn toward the internet, to express their mood.

Tao Ran: 14:10

Children are likely to stay away from internet when the relations between them and their parents are strengthened.

Dr Sanjay Gupta: 14:17

Only now, looking back, can these teens fully appreciate the depths of their addiction.

Dr Sanjay Gupta: 14:22

18 year old Wang used to play anywhere from 5 hours a day, to an entire night.

Wang: 14:30

I haven’t been to school for two years, and gained almost 30 kilogrammes. I’m always having headaches and getting dizzy.

Dr Sanjay Gupta: 14:38

14 year old Shen also gained a lot of weight and started having trouble with his eyesight, and tells us he didn’t have a lot of energy.

Shen: 14:47

I get up and have breakfast. Then, I play video games until lunch. After lunch I take a two hour nap and then I play until 10 p.m. After eating some more, I continue to play until 3 a.m., then I go to bed.

Dr Sanjay Gupta: 15:04

So, here, the boys are learning basic life skills like washing clothes and making their beds, as well as games that challenge their minds and bodies. They tell us Tao’s programme has helped their relationships with their families, and that when they leave they’re going to spend more time in the real world.

Dr Sanjay Gupta: 15:23

Up next on Vital Signs, video games like you’ve never seen them before.

Dr. Gazzaley: 15:28

There’s no medications here, this  is a game. The idea is that it’s a digital medicine.

Dr Sanjay Gupta: 15:34

People who play video games actually see more than the rest of us. They make better and faster use of visual input, according to a recent Duke University study. What if we could all benefit from this? The goal is for doctors to one day prescribe video games, like they would a medicine. Think controllers, instead of pills. And this, might not be too far off.

Dr Sanjay Gupta: 15:59

Meet Ajay, he’s a  Research Associate at Adam Gazzaley’s lab, at UCFS. You can see he’s healthy as a horse, but Adam’s plan is to push Ajay’s brain beyond its limits. To give him cognitive abilities that are almost superhuman.

Ajay: 16:15

Yes, so basically I’m just going to be doing what we call a visual search. I’m just going to be looking for a target object amongst a bunch of distractors, and I’m going to be using physical movements to respond to the correct target.

Dr Sanjay Gupta: 16:34

So this is Ajay, he’s playing this game, as you can see behind me. He’s also all wired up; that’s EEG monitoring. Take a look at the game on this screen, and I think more importantly is this, over here. This is actually Ajay’s brain, as he’s playing the game. You see the brain, but you also see what’s happening inside the brain, as a result of that EEG monitoring.

Dr Sanjay Gupta: 16:57

What makes the GlassBrain so revolutionary,  is not just the real time 3D visualisation with the lag time of just two tenths of a second, but also something known as a ‘feedback loop’, that’s the ability of the game to use the data streaming out of Ajay to optimise the game engine itself. Too easy, the game gets harder. Too difficult, it’s let up a bit.

Dr Sanjay Gupta: 17:23

So back here, for example, is an area of the brain that’s typically responsible for vision.

Dr. Gazzaley: 17:22

Mm-hmm (affirmative).

Dr Sanjay Gupta: 17:27

So, if someone’s not … you’re not seeing as much  frequency or activity back there, the game may change in response to that?

Dr. Gazzaley: 17:33

Exactly. And the rewards would change in response to that, and when they do bring on that activity at a higher level, they get rewarded.

Dr Sanjay Gupta: 17:40

Changing the brain takes time and patience.

Dr Sanjay Gupta: 17:44

In 2011, Adam co-founded Akili Interactive, to expand his research from a purely academic setting into a clinical one.

Dr Sanjay Gupta: 17:53

Eddie Martucci is Akili CEO.

Eddie Martucci: 17:57

Akili, as a company, we formed about four  years ago, four and a half years ago now, with a vision of creating a new type of medicine, a new type of medical product that could be just as effective and save as drugs, as traditional medical devices, but operate in an entirely new way such that patients actually had a very different experience: they almost had fun with the product.

Eddie Martucci: 18:18

So, what we did, is we combined some really strong neuroscience algorithms and then we built those into action video game interfaces.

Dr Sanjay Gupta: 18:27

The result is Project EVO.

Ashley Mateus: 18:30

This is treatment software, that we’re going to have you demo-

Dr Sanjay Gupta: 18:33

Should I be nervous?

Ashley Mateus: 18:34

I don’t think so. This customises to everyone. So, it’ll adjust to your abilities, as you go along.

Dr Sanjay Gupta: 18:41

Much like a pharmaceutical company guards the R&D of its medications, we can’t even show you the screen of this iPad while I play.

Ashley Mateus: 18:48

That was awesome. I told you five is hard to get here.

Dr Sanjay Gupta: 18:51

The game, for now, is proprietary, but here are a few screenshots to give you an idea of what I’m seeing.

Dr Sanjay Gupta: 18:58

Another reason secrecy is so important,  Akili is running what’s known as a ‘randomised double blind placebo controlled trial’, that means neither the researchers not the participants know who’s getting a placebo, and who’s getting the real treatment. It’s the gold standard when it comes to testing if, and how well, a medication or therapy works.

Ashley Mateus: 19:20

You did it. You got all five.

Dr Sanjay Gupta: 19:20

I got five stars. All right.

Ashley Mateus: 19:20

Yeah.

Dr Sanjay Gupta: 19:22

So, what can we tell here?

Eddie Martucci: 19:25

Sure. So, this is just a quick snapshot of play data. It’s collecting at 30  frames a second, so every second that you were playing, we were getting 30 snapshots of your data. And so we use those data for a number of things, we build cognitive profiles out of them, but importantly, we adapt. So, one of the analogies we make is that, when we have this rich data, imagine a self-adapting treadmill.

Dr Sanjay Gupta: 19:47

Right.

Eddie Martucci: 19:47

So, imagine you’re on a treadmill, and it’s not just set at 10 or just set at one, based on your performance and how well your physiology’s doing, this is constantly changing over time, and so we use the rich data to make sure that we’re doing that in a very precise  way.

Dr Sanjay Gupta: 20:01

So, you can’t make a diagnosis, but what can you tell me? What sort of insight can I take away from what I just did?

Eddie Martucci: 20:09

The most important in what you just did, is we can see your trajectory over time and we can watch how you’re able to manage multiple strings of information, and that’s actually critical to our treatment. It meant that you were able to, essentially, multitask with lots of incoming information, at a relatively high level.

Dr Sanjay Gupta: 20:25

How unique is what you’re doing here?

Eddie Martucci: 20:28

Pretty unique. Pretty unique. The neuroscience  can stand alone, as a new type of medicine. The gaming can stand alone, from its entertainment quality alone. Combining those two into a new medical product, we think that’s pretty novel.

Dr Sanjay Gupta: 20:42

In fact, it’s never been done before. Once clinical trials are complete, Akili plans to petition the U.S. Food and Drug Administration to approve its video game as a medical device. At first to treat ADHD, but then other illnesses, such as autism, Alzheimer’s, Parkinson’s disease; anything  where the cognitive control centre of the brain, the pre-frontal cortex, is affected.

Dr Sanjay Gupta: 21:05

In terms of getting approvals for this sort of stuff from the F.D.A., this is a bit of a paradigm shift. How does that work from your perspective, when you’re trying something new like this, where do you even begin?

Eddie Martucci: 21:16

That’s right. It’s a great question. We are a medical device company, at the core. We make medical device software and algorithms. But that said, the FDA has never seen or approved a medical device quite like this, that on the front end, looks like a video game.

Eddie Martucci: 21:31

So that process takes time. It takes education, with all the stakeholders in the system. And, really, at the end of the day, it takes data. We’re not trying to innovate by saying you don’t need clinical trials. On the contrary, we think you need robust multiple clinical trials, to demonstrate effect.

Dr Sanjay Gupta: 21:46

Not to sound glib, but do you imagine doctors actually writing a prescription for this sort of thing?

Eddie Martucci: 21:51

That’s our hope. What we want is that, we want for every aspect of the treatment that a patient receives,  to be just like it is in the drug industry, with the exception of what a patient goes home with, is actually a phone or a tablet, or downloads it to their own device; instead of a pill.

Eddie Martucci: 22:10

But, doctor prescription: absolutely. Insurance coverage: absolutely.

Dr Sanjay Gupta: 22:15

It’s safe to say, the makers of Space Invaders, Centipede, Pac-Man, never say this coming: a future where video games could be used to treat what ails us; and that future is now.

Dr Sanjay Gupta: 22:27

We put so much emphasis on exercise and the importance of keeping  our bodies healthy as we age, but what good is a healthy body without a sharp mind to go with it?

Dr Sanjay Gupta: 22:36

Happy, safe gaming.

Dr Sanjay Gupta:

22:38 From Vital Signs, I’m Dr. Sanjay Gupta. Thanks for watching.

END