Pharmaville—the latest fad in online gaming

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As the web based, social network gaming sensation Farmville (www.farmville.com) sweeps across the “English countryside” with millions of followers in its wake, I thought it might be a good time to introduce Pharmaville—an idea for an internet game where players develop and sell drugs to improve human health.

Just as Farmville players build up virtual farms, breed new crops, and trade sheep, Pharmaville players join together to form companies, research new drugs, and market them to as many other players as they can. Instead of Farmville’s cute cartoon icons representing farmers, fruits, and vegetables, Pharmaville features brightly coloured pills, along with little avatars of white-coated researchers, well groomed key opinion leaders, and even better dressed young salespeople. Instead of Morris dancing, dubstep electronic dance music plays in the pubs.

As with all games, there are a few fundamental rules. New prescription drugs must be proved to be safe and effective before marketing, advertising claims have to be at least half true, and anyone caught misleading people too egregiously about a drug’s risks or benefits may face mild professional censure. An evaluation of the game’s first six months of pilot testing has produced some surprising findings, alongside the more expected results.

Unsurprisingly, one of the first classes of drugs developed by researchers within the Pharmaville companies was antibiotics, coincidentally products also valuable to those playing the Farmville game. In this virtual world, players with infections previously considered deadly were quickly cured by the new wonder drugs, bringing great kudos to the burgeoning online industry.

However, within weeks of the pilot testing beginning, confident young marketing executives were filling Pharmaville’s online forums with fascinating new questions. Rather than just cure the sick, what if their researchers could develop drugs to end the mild ailments and messy inconveniences of human existence? What if their therapies could prevent disease, rather than just treat its symptoms? What if pills could make life perfect?

At global webinars and narrowcast workshops these questions were debated with fervour, and, just two months into pilot testing, companies were trialling new products to solve sexual difficulties, cure the annoyingly cheerful, and lift the spirits of the sad and lost. To facilitate regulatory approval in this brave new world of therapeutics, the definitions of old medical conditions were formally renovated and new ones listed, as scientific innovation raised expectations of a better life for all.

Breakthrough discoveries of biomarkers in blood, brain, and bone served as surrogates for people’s risks of future disease, allowing companies to quickly demonstrate evidence of benefits for whole new classes of “preventive medicines.” In turn this new evidence enabled the industry’s trusted key opinion leaders to lower diagnostic thresholds for treatment, until in many cases they were removed altogether.

But with the prospect of such massive markets, competition for prescriptions soon became fierce, and the fictional drug companies began placing full page advertisements in Pharmaville’s growing number of online journals. By midway through the experiment one of those journals published a blog questioning the accuracy of many of its own advertisements, causing the industry collectively to withdraw support and sparking a public resignation of the journal’s respected coeditors. In another case a company created a whole new journal dedicated to publishing scientific articles about its own products.

Scholarships were dispensed to the best and brightest young students enrolling in Pharmaville’s new medical schools; sales representatives were recruited from college cheerleader sororities; and previously stuffy medical meetings became salacious and salubrious affairs. Sponsorship flowed to every corner of the healthcare establishment, from patient associations to prescribing software, from royal colleges to drug regulators.

By the fourth month of pilot testing, at a real world “meet up” in Slough organised through Facebook, one company took a group of high prescribing players to an educational event held inside a strip club, the sordid details of which emerged on Twitter later that same evening. The next month a whistleblower from one of Pharmaville’s drug companies released more than 100 000 documents on the Wikileaks website revealing how clinical trials with negative results had systematically been buried, serious side effects had been covered up, and influential critics were to be “neutralised” by using well oiled whispering campaigns. Just days before pilot testing was completed, Net Pharma, a US firm specialising in online clinical trials for drug companies, filed for bankruptcy, with all of its directors facing the possibility of mild professional censure.

Concerned about threats to the reputation of its potentially lucrative game, Pharmaville’s creators announced an internal investigation into the marketing strategies pursued by players during pilot testing, and plans for a full roll out have been put on hold. At the same time its lobbyists have been busy in Washington, DC, with 28 US senators writing recently to the president urging that intellectual property and copyright protections for the nation’s online games industry be strengthened in the current round of global free trade talks.

Pre-empting the findings of Pharmaville’s internal investigators, 55 professional medical associations announced a new global code of conduct that bans business class travel for medical avatars and prohibits the awarding of continuing professional development points for educational meet ups held at strip clubs. The tough new rules are being hailed as a major reform and a positive indication that the much anticipated launch of Pharmaville will be happening soon on a screen near you.