Margaret McCartney: Game on for Pokémon GoBMJ 2016; 354 doi: https://doi.org/10.1136/bmj.i4306 (Published 09 August 2016) Cite this as: BMJ 2016;354:i4306
All rapid responses
I have read the very interesting article of Margaret McCartney and I would like to add my input on using Pokémon Go for health purposes, from a serious-gaming perspective.
Undoubtedly, Pokémon Go is a very motivating location-based game, which utilises the Self-Determination Theory  efficiently and focuses greatly on the Relatedness factor, in order to engage the players. Naturally, the fact that players are motivated by the game to engage in a virtual scavenger hunt, explore their surroundings, socialise, and be physically active creates new opportunities for health research. As McCartney states in her article: "Increased physical activity is a tantalising side effect". The benefits can also go beyond physical wellbeing though, reportedly affecting the mental health of those with depression and anxiety, as well as people on the autism spectrum.[3-5]
Over the last few weeks, there is a discussion about turning these "side effects" into a "cure", i.e. repurposing this commercial, entertainment game to a serious game for physical and mental health and use it as a health tool for people suffering from depression, anxiety, obesity, and autism.[3,5-7] There are many articles in various websites praising the health benefits that could come from Pokémon Go (even though there is not any strong scientific proof), directly proposing it to patients as a health tool or "winking" at them about using it, while hosting testimonials (mostly tweets) of satisfied players/patients. Nevertheless, repurposing a game for a different domain is not a "plug n’ play" process and precautions should be taken before patients use it for health purposes.
The strong motivating nature of Pokémon Go can create issues around adverse effects. For people with anxiety, the very thing that brought them to Pokémon Go – the task of collecting Pokémon monsters – may end up causing more anxiety. For people on the autism spectrum, finding balance when playing the game can be a problem, since they may become too lost in it and want to play all the time. For obese people, the over-engagement can lead to physical injuries. Naturally, all these statements are still hypotheses; nevertheless, they should be examined in order to safeguard the sensitive groups of players, prior to proposing playing the game for improving their health.
The past has taught us a similar lesson with repurposing Nintendo Wii and its games (mainly Wii Sports: an entertainment, physical game of various sports activities) for health purposes and specifically for the physical activity of the elderly at care homes. At first, Nintendo Wii games were seen as a means of exercise for the elderly and many care homes adopted them. It was not only after a few months, when primary research on adverse effects, interaction problems and physical injuries revealed that repurposing the game – without making any design or interaction changes – could lead to harm or to unpleasant situations for the frail elderly players.[9,10]
No matter how Pokémon Go’s popularity and commercial success is going to unfold over the next months and years, the game managed to become a successful showcase of a location-based game. The early indications around the health benefits of playing Pokémon Go could be characterised as positive. However, the first important step, before "applying" Pokémon Go to the health domain should be the study of its adverse effects. The ultimate goal would be the minimisation of these effects, thus respecting the players' physical and emotional safety and, at the same time, ensuring the robustness of the following research results around the potential health effects of the game.
1. Ryan RM, Deci EL. Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. American psychologist 2000;55(1):68.
2. Marsden P. The Psychology of Pokémon Go - Augmented Reality Creates "Augmented Self". Digital Intelligence Today. http://digitalintelligencetoday.com/the-psychology-of-pokemon-go-augment... (accessed 29 Sept 2016).
3. McCartney M. Margaret McCartney: Game on for Pokémon Go. BMJ 2016;354:i4306.
4. Mitchell L. The Brain Benefits of Pokemon GO. University of Utah Health Care. http://healthcare.utah.edu/healthfeed/postings/2016/09/mental_pokemon.php (accessed 29 Sept 2016).
5. Grohol J. Pokemon Go Reportedly Helping People’s Mental Health, Depression. PsychCentral. http://psychcentral.com/blog/archives/2016/07/11/pokemon-go-reportedly-h... (accessed 29 Sept 2016).
6. Baranowski T. Pokémon Go, go, go, gone? Games Health J 2016;5(5).
7. Fennell D. Pokémon Go to Combat Type 2 Diabetes? Diabetes Self-Management. http://www.diabetesselfmanagement.com/blog/pokemon-go-combat-type-2-diab... (accessed 29 Sept 2016).
8. Borland S. Elderly 'addicted' to Nintendo Wii at care home. The Telegraph. http://www.telegraph.co.uk/news/uknews/1563076/Elderly-addicted-to-Ninte... (accessed 29 Sept 2016).
9. Gerling KM, Masuch M. When gaming is not suitable for everyone: Playtesting Wii games with frail elderly. 1st Workshop on Game Accessibility; 2011.
10. Neufeldt C. Wii play with elderly people. International Reports on Socio-Informatics 2009;6(3):50-59.
Competing interests: No competing interests
We read with great interest McCartney’s article on Pokémon GO.  however, we have one major concern about the public health issue, such as in Ayers et al’s report  about the negative impact of Pokémon GO – a new distraction for drivers and pedestrians. In fact, Pokémon GO has become a global phenomenon. It is one of the most popular apps developed by Niantic, a location-based augmented reality game, where players use a mobile device's Global Positioning System (GPS) to locate, capture, battle, and train the virtual creatures (Pokémon). Besides promoting physical activity, it raises concern about accidents and being a public nuisance. [2,3]
Therefore, an acronym POKEMON was proposed to help memorize the possible symptoms of the game players. The acronym has seven components:
(1) Park anywhere - players like to gather in parks and, sometimes, they park their cars anywhere just to capture the Pokémons;
(2) Outdoor activities - this game really encourages outdoor activities;
(3) Knock on door - players will knock on other people’s doors to gain permission to capture the Pokémons appearing inside, sometimes resulting in trespassing. Sometimes, players also carelessly knock down people while they are walking with their eyes trained on their mobile devices;
(4) Engaged - players are engaged and sometimes addicted to this game, which will then affect their eyesight;
(5) Mass zombies - players often walk slowly in groups, with their eyes staring at their mobile devices, which looks like a mass of zombies;
(6) Overlook danger - players often overlook the danger ahead, causing accidents; and
(7) Neck pain/Nocturnal activity - nuchal pain may develop with prolonged neck flexion while playing the game, and players also like to come out at night to hunt for the creatures (table 1).
We hope this easy to remember acronym will help to raise the awareness of physicians and parents about the potential benefits and risks of this new popular game.
1. McCartney M. Margaret McCartney: Game on for Pokémon Go. BMJ. 2016 Aug 9;354:i4306.
2. Ayers JW, Leas EC, Dredze M, Allem JP, Grabowski JG, Hill L. Pokémon GO - a new distraction for drivers and pedestrians. JAMA Intern Med. 2016 Sep 16. doi: 10.1001/jamainternmed.2016.6274. [Epub ahead of print]
3. Serino M, Cordrey K, McLaughlin L, Milanaik RL. Pokémon Go and augmented virtual reality games: a cautionary commentary for parents and pediatricians. Curr Opin Pediatr 2016 28(5):673-7.
Competing interests: No competing interests
I read this article with interest but have some reservations regarding the placement of Pokemon characters, confidentiality and clinical governance.
Whilst on call recently, a member of the public walked in to our Emergency Department Resuscitation room looking for one of the Pokemon characters.
A crab-like pokemon was seen in front of me, in the notes room of our Medical Admissions Unit, by one of our Foundation Year doctors.
One of my consultant Colleagues had a pokemon character seen sitting on the chair in his outpatients department.
I understand that these characters are either placed by the designers of the game or can be summoned by users and are placed according to GPS location so may simultaneously appear on multiple floors of a building such as ours (15 floors).
All of these cases, to my mind, highlight potential cases of breaches of confidentiality and issues with clinical governance. If characters are placed in medical areas I would worry they are in other areas such as schools, care homes, changing areas, etc.
Should these areas not be out of bounds to protect the most vulnerable in our society?
Competing interests: No competing interests