Is a Fun, Therapeutic Game Possible?

Steph Smith: Welcome back to the A16Z podcast. I'm your new host, Steph Smith, and this week we have a very exciting crossover episode from our sister podcast, Bio Eats World. In this episode, we cover the evolving intersection between bio and gaming, together with A16Z bio and health general partner Vijay Pande, games general partner Jonathan Lai, and Olivia Webb, A16Z's bio and health editorial lead. The three come together to discuss whether games can indeed be both fun and therapeutic.

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Olivia Webb: Hello, and welcome to BioEats World, a podcast at the intersection of bio, healthcare, and tech. I'm Olivia Webb, the editorial lead for bio and health at A16Z. Here at Andreessen Horowitz, we love to talk about the intersection of bio, health, and other areas of emerging tech. So today's episode is particularly exciting. It's a crossover between the Bio and Health Fund and the Games Fund. In this episode, you'll hear from Vijay Pande, the founding investor of A16Z's Bio and Health Fund, and a general partner focused on biopharma and healthcare. You'll also hear from Jonathan Lai, a founding investor of A16Z's Games Fund, and a general partner focused on the intersection of games, consumer social, web3, and more. In this episode, we discuss what constitutes a game, how games and bio can overlap, and what we call the healthy dessert problem, the challenge of building a game that's both fun and therapeutic. Let's get started.

Olivia Webb: We usually just dive right into the meat of the conversation on BioEats World, but both of your backgrounds are actually very relevant to the conversation we're about to have. So Vijay, could you kick us off by telling us about your background in games?

Vijay Pande: I feel like I've either had just two or three jobs or zero jobs, depending on how you count them. Before coming to A16Z, I was a professor at Stanford for almost two decades in several departments at the intersection of medical school and the School of Sciences. My interest in healthcare, drug design, and all of that really stemmed from that period. But actually, before then, much earlier, when I was a teenager, I was at Naughty Dog Software. Naughty Dog is a pretty well-known studio. It was co-founded by friends of mine, Andy Gavin and Jason Rubin. And so, in the early days of Naughty Dog, it was just the three of us. That's amazing. At the time, it was just fun and interesting and so on. But Andy and Jason did a great job, especially after I moved on and built Naughty Dog into something huge. Naughty Dog is a very famous studio. They put out the Uncharted series and also The Last of Us, which is even now getting made into an HBO series, I believe. That's quite a claim to fame you've got there, Vijay, in the games world. That's good to hear. Although, again, I left early enough that I think Andy and Jason deserve the credit. But it was a great experience to learn the business and to be a part of it during those early years.

Olivia Webb: And I'm happy to jump in and just briefly introduce myself as well. So I'm John. I'm one of the general partners in A16Z Games Fund One, which is the firm's first fund dedicated to investing in games that we launched earlier this year. And I've spent over a decade working in games as a developer and publisher. The intersection between games and bio has just personally interested me for so long. So I've obviously been a lifelong gamer, so I'm excited about games naturally. But what you may not know is that I was also pre-med early on in college. And so I almost went down the path of applying to med school. Well, you know, it's never too late. Maybe that's part of the conversation for today.

Olivia Webb: Before we go too much deeper, I would like to set a definition. What is a game? How do you define a game?

Jonathan Lai: That is a great, big, broad question that I think many people would disagree on. But I think most game designers have sort of coalesced around three core principles as defining a game. The first is motivation. The second is mastery. And then the third is feedback. So just really quickly, motivation is why you're doing a certain activity. This is commonly expressed as a goal, like putting the basketball through the hoop or getting to the end of the level on Super Mario. The best goals are intrinsically set by the players themselves. A lot of games double down on competitive play or multiplayer play. For mastery, that is essentially the rules of the game. In soccer, you can't touch the ball with your hands. In Super Mario, you need to jump over enemies. These rules show the player how to win. And then finally, there's feedback, which is how players learn the rules of the game. The best games typically teach you iterative loops with clear cause and effect. For example, in Super Mario, you touch Goomba and you immediately die. That's a very clear iterative loop. It teaches you to avoid enemies. This also works the other way around. When you do the right things, you're rewarded with positive feedback, like colorful explosions or UI effects when you beat a level.

Olivia Webb: The way you describe it sounds like life is a game. You could say that. Maybe that's one of the takeaways from this episode. Vijay, you've talked before about how biology is becoming more of a developer's art. Can you talk about that, elaborate on it?

Vijay Pande: Yes. I think when we talk about life sciences and its eventual impact into healthcare, there is a significant ongoing shift from discovery to design, from empirical discovery to an iterative process with continued improvement. We see this in new ways of designing drugs and therapeutics, diagnostics, and even outside of healthcare, like in food and other areas. This is much more akin to other types of developers, like software developers. The big issue is that these loops are much slower than in software. In software, you can test code changes in seconds or minutes. Here, you're lucky if you can get things done in days to a week. But even a week gives you 50 shots per year at iteration, which can still be very material.

Olivia Webb: This is a good transition point for us to start talking about the intersection between games and bio. John, you talked about Chris Dixon's essay about strong and weak forms of technology applied to games. Maybe start with the essay and then talk about how you conceive of this as it applies to games.

Jonathan Lai: Our partner Chris Dixon wrote a great essay classifying new technologies into either weak or strong forms. A great example is mobile phones. The BlackBerry was a weak form, adapting the PC keyboard into a handheld device. Then came the iPhone, a strong form that reimagined the handheld device from the ground up. When thinking about the intersection of bio and games, there's been overlap already, but primarily weak form. These are games that are primarily games but have a secondary healthcare benefit. For example, MMOs like World of Warcraft have been great at fostering online communities, helping with loneliness and depression. Games like StarCraft and League of Legends train hand-eye coordination and multitasking under pressure. These are weak form intersections. But over the last five years, we've seen strong form games emerge, designed specifically for healthcare benefits. These have gameplay as an engagement mechanic layered on top of core utility. For example, Supernatural is a VR app where you work out while playing a Beat Saber-type game. These strong form products target specific conditions, with games as the delivery vehicle.

Olivia Webb: I really like that framework. In healthcare, weak form technology assumes the world won't change. Strong form changes the world. The problem in healthcare is that we've had too much weak form. Games are best in class at motivation and onboarding. A lot of people's knee-jerk reaction to a healthy game is that it's either not healthy or not a dessert. But games can be different because they can be fun and positive in addictive ways. Maybe that's what people need to be convinced of.

Vijay Pande: Games can be different because they can be fun and therapeutic. The challenge is designing a game that doesn't fall into the chasm where it's not fun enough or not effective. Frankly, the cure for some diseases may never be a drug but could be a game. For example, there have been clinical trials for games for Alzheimer's. Keeping your mind active is something people do informally, but you can imagine formalizing that. For depression, cognitive behavioral therapy could be gamified. The knee-jerk reaction in healthcare is that a therapeutic has to be a pill, but in areas where biology is complicated, a game might be plan A.

Jonathan Lai: Games are best in class at teaching new forms of behavior and getting people to stick with it. If you're trying to convince someone to lose weight or practice a treatment regimen, games are great at motivation and onboarding. The challenge is designing a game that's both fun and therapeutic, which is the healthy dessert problem. It's challenging to design a game that doesn't fall into the chasm where it's not fun enough or not effective enough.

Olivia Webb: How do you think developers can overcome the healthy dessert design challenge? For example, HIPAA compliance training is outdated. How can developers bridge that gap?

Jonathan Lai: Historically, teams have come from one side of the industry. You've had games people who don't know science or healthcare folks who don't know games. The holy grail is a team with both. When you have individuals who know both, it's like they're telepathic. They can work harmoniously together. With the pervasiveness of gaming, there's a new generation of MDs and PhDs who deeply understand gaming. This unique opportunity didn't exist 30 years ago.

Vijay Pande: We've started seeing a couple of strong form games emerge. For example, we invested in a company called Lumi, which makes a game called Kinder World. The core loop is raising a plant, which teaches mindfulness and presence. Players love it for moments of meditative calm. It also reminds them to take care of themselves. The developer is adding multiplayer mode where you and I might be in charge of watering the same plant. It becomes a checkout system. If I haven't watered the plant in three days, you might text me to see how I'm doing. It's a fun dessert that works in both directions.

Olivia Webb: How do you think about monetization and distribution? If someone could build a Fortnite for depression, how would that work?

Vijay Pande: More healthcare is being driven direct to consumer. People are looking for health solutions. You could have a direct-to-consumer motion where the game is sold that way. On the other extreme, a doctor could prescribe a game. There could be a PBM for games or digital therapeutics. Modernization could be natural through that channel. Direct-to-consumer opportunities lean into what games are good at, naturally viral experiences. The holy grail would be a game-led bottom-up sales motion into hospitals and doctors, starting with patients. Imagine a patient asking their doctor to include the game as part of their treatment.

Jonathan Lai: The metaverse and Web3 are exciting. The VR element of the metaverse is intriguing for creating new worlds where you could have a game or workout. The social side of the metaverse would make it stickier. Web3 could allow health insurance companies to reduce premiums based on verified activity. The metaverse is already here in games like Fortnite, Roblox, and League of Legends. These are universes with rich IP and communities. Web3 games are still early, like the Angry Birds era. There's so much more to build.

Olivia Webb: Thank you for joining BioEats World. BioEats World is hosted and produced by me, Olivia Webb, with the help of the Bio and Health team at A16Z and edited by Phil Hegseth. BioEats World is part of the A16Z podcast network. If you have questions or want to suggest topics, please email BioEatsWorld at A16Z.com. If you're enjoying BioEats World, please leave us a rating and review wherever you listen to podcasts.