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The 2010s saw a seismic shift in the business model for the video game industry. The widespread embrace of the "Live Service" model revolutionized the industry and enabled companies to maximize their profits, to the annoyance of many gamers. Theresa O'Reilly for NPR hide caption

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Forever games: the economics of the live service model.

April 22, 2024 • People used to pay one standard price for their favorite games in a one-off transaction. But now, many game companies are offering their games for free, supported by in-game purchases. This is called the live service model.

Accessibility has long been an afterthought in the video game industry. However, that's changed over the last decade as incentives have changed. It's estimated that there are 46 million gamers with disabilities, creating a strong incentive for video game companies to improve their accessibility efforts. Theresa O'Reilly for NPR hide caption

Designing for disability: how video games become more accessible

April 23, 2024 • Gaming provides entertainment and community for billions of people worldwide. However, video games haven't always been accessible to those with disabilities. But this is changing.

The explosive growth of Esports has made it so that elite-level competitive gamers can leverage their ability into a full-time job. But what does the life of a typical Esports pro look like and how do they think about their long-term prospects with Esports growth stagnating? Theresa O'Reilly for NPR hide caption

The boom and bust of esports

April 24, 2024 • The origins of competitive gaming are rooted in college campuses going back to the early 1970s. Now a globally popular industry, esports is at the center of many questions about long-term financial viability.

Despite the video game industry raking in more and more money every year, the working conditions for many designers leave much to be desired. Recent surveys show that developers don't believe their careers are sustainable, leading to a surge of unionization efforts in the industry. Theresa O'Reilly for NPR hide caption

Work. Crunch. Repeat: Why gaming demands so much of its employees

April 25, 2024 • Employees at video game companies are known for working long hours to meet product launch deadlines. This pressure, known in the industry as crunch, has only gotten more intense as games have grown more complex. Mounting layoffs in the growing industry have only made things worse on the labor front, inspiring some workers to take matters into their own hands.

Video Game Industry Week: The Final Level

April 26, 2024 • We wrap up our series on the economics of the video game industry with a triple roundup. Today, how the new ban on noncompete contracts could affect the gaming industry, whether young men are slacking off work to play games and the ever-controversial world of loot boxes.

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Video Game Industry and User-Generated Content: A Dynamic Interplay Between Laws and Video Game Community Norms

72 Pages Posted: 9 Feb 2020

Beata Sobkow

Independent

Date Written: August 14, 2017

In the course of the past few years, the traditional model of media production, based on the premise that content is produced by professional creators and then consumed by passive audiences, has become increasingly outdated. The development of new digital media networks and online content-sharing platforms has bridged the divide between creators and consumers, and significantly changed the way in which culture is produced, distributed and consumed. From user reviews and blogs to video ‘mashups’ and music remixes, it is clear that members of the public want to actively participate in the creation of original media content. On the other hand, many media producers feel very differently about the creative desires of their fans. Wishing to protect their intellectual and commercial interests, they frequently rely on intellectual property laws and license agreements to either completely restrict their fans’ rights to create user-generated content or, alternatively, seek to secure legal ownership of all such content. At first glance, it may seem that only one side’s interests can prevail. Focusing on the video game industry, this paper will argue that a compromise is possible. The interactions between developers and publishers of video games, and fans engaged in the creation of video game modifications show that IP owners can unlock the creative potential of their fans without having to surrender control over their IP or fan-made works. In fact, by departing from their standard deterrence-based strategies for IP protection, acknowledging the existence of community norms, and actively engaging in an open dialogue with their fans, IP owners can not only secure greater compliance with, and even increase the normative support for, their rules and policies but, potentially, also discover a more effective solution to the problem of piracy and online IP infringement.

Keywords: User-Generated Content, Mods, Modders, Video Games, Interactive Entertainment, Community Norms, Laws and Norms, Intellectual Property, Copyright

JEL Classification: K30

Suggested Citation: Suggested Citation

Beata Sobkow (Contact Author)

Independent ( email ), do you have a job opening that you would like to promote on ssrn, paper statistics, related ejournals, economics of networks ejournal.

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Library Resources for Doing Scholarly Research on Video Games

So you are writing a research paper about video games but aren't sure where to begin? Since video games are a new medium of art that requires an interdisciplinary approach to conducting research, databases that draw on many different publications can equip students and scholars with the tools they need to succeed.

Before you begin exploring databases, here are a few useful tips:

• For quick, targeted results,  search by abstract instead of by keyword or by title. In an academic paper, the abstract is a brief summary of what the paper or study is about. Searching by abstract will give you a list of all the articles that discuss video games in the summary, so it will help you narrow down more quickly whether or not the article will be useful to you.
• Use full-text filters to only get results where the entire article is available for you to read.
• For the most scholarly results, use peer-reviewed filters to find only articles vetted by experts in the field.

Recommended Databases

Note that some of these databases are accessible from home with a library card while others can only be used onsite at an NYPL location.

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For those new to academia/scholarly research, EBSCO's Academic Search is a staple in libraries nearly everywhere to conduct general research. It is a good starting point to see the current literature out there for any paper, in this case, gaming scholarship. However, just typing in "video games" alone in the search will lead you to over 300,000 results; how do you narrow it down? As mentioned above, use limiters such as peer-reviewed/full text enabled for high-quality articles that you can read fully. Other available search limiters are "magazines" (think video game magazines) and "company" (e.g. if you want to research a specific video game company such as Capcom or Square Enix). Academic Search is good if you want to study video games in terms of education, how to utilize them in a teaching setting, in the workplace, and more. 

Business Source Complete

If you are interested in researching video games from a business point of view, then EBSCO's Business Source Complete is the database for you. Here you will find SWOT (Strength, Weakness, Opportunities, Threats) analyses of gaming companies, research about NFTs (Non-Fungible Tokens), virtual and augmented reality, video games, and more. 

JSTOR (accessible from home with a library card)

Similar to Academic Search, JSTOR is a staple in many libraries and is a good area to conduct initial research while trying to figure out what you want your paper to be about. Typing "video games" alone in the search bar will net you more than 50,000+ scholarly articles about the popular entertainment medium. You can narrow your research to video games in Military Studies, Library Science, Political Science, and much more. 

"Can video games help alleviate seasonal depression?"

"Do violent video games cause behavioral problems in adolescents?" 

"Does Cognitive Dissonance explain the Console Wars?" 

"Does causing chaos in Grand Theft Auto correlate to causing chaos in real life?"

EBSCO's PsycINFO is useful if you are interested in studying video games in terms of the realm of psychology, and have ever pondered one of the above questions. You can find articles about video game addiction, aggression in players, mental health, personality development, and more.

Project Muse

This resource is a general favorite for anything art or media related, with tons of scholarly, peer-reviewed articles about video games including articles on diversity in video games, video games and the ecosystem, video games and civic development, and more. When starting research on video games, this database is highly recommended to be your number one starting point when trying to figure out what your paper is going to be about.  

Sage Knowledge

Sage is a good starting point if you want to read reference/textbook material about video games and gamification. In Sage you will find authoritative encyclopedias and handbooks that will help any gaming scholar in the beginning stages of their research. Some interesting encyclopedias that feature a chapter in video games are Death and the Human Experience, Out-of-School Learning, Communication Research Methods, and many more. 

Additional resources:

• Our  LibGuides page will point you to themed research guides of Library resources. For example, if you wanted to create a video game about a time-traveling librarian that takes place in New York City in the 1800s, looking at local history and newspapers may be something you want to do. If you know the research you want to do requires in-depth assistance, it's encouraged to make an appointment with a librarian . 
• This list of Fellowships around the city and at NYPL may be of interest to scholars. 
• Our Interlibrary Services and Documents is also a service for scholars to utilize if you need an article or not owned by the Library. You can also use interlibrary loan for video games as well. 
• Flipster  is a magazine database accessible with your library card that includes video game magazines.
• Finally, an external resource, the Internet Archive , has all kinds of old-school video games you can play, as well as gaming manuals and much more. Anyone who needs primary sources will find this very useful. 

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Does Video Gaming Have Impacts on the Brain: Evidence from a Systematic Review

Denilson brilliant t..

1 Department of Biomedicine, Indonesia International Institute for Life Sciences (i3L), East Jakarta 13210, Indonesia

2 Smart Ageing Research Center (SARC), Tohoku University, Sendai 980-8575, Japan; pj.ca.ukohot@iur (R.N.); pj.ca.ukohot@atuyr (R.K.)

3 Department of Cognitive Health Science, Institute of Development, Aging and Cancer (IDAC), Tohoku University, Sendai 980-8575, Japan

Ryuta Kawashima

4 Department of Functional Brain Imaging, Institute of Development, Aging and Cancer (IDAC), Tohoku University, Sendai 980-8575, Japan

Video gaming, the experience of playing electronic games, has shown several benefits for human health. Recently, numerous video gaming studies showed beneficial effects on cognition and the brain. A systematic review of video gaming has been published. However, the previous systematic review has several differences to this systematic review. This systematic review evaluates the beneficial effects of video gaming on neuroplasticity specifically on intervention studies. Literature research was conducted from randomized controlled trials in PubMed and Google Scholar published after 2000. A systematic review was written instead of a meta-analytic review because of variations among participants, video games, and outcomes. Nine scientific articles were eligible for the review. Overall, the eligible articles showed fair quality according to Delphi Criteria. Video gaming affects the brain structure and function depending on how the game is played. The game genres examined were 3D adventure, first-person shooting (FPS), puzzle, rhythm dance, and strategy. The total training durations were 16–90 h. Results of this systematic review demonstrated that video gaming can be beneficial to the brain. However, the beneficial effects vary among video game types.

1. Introduction

Video gaming refers to the experience of playing electronic games, which vary from action to passive games, presenting a player with physical and mental challenges. The motivation to play video games might derive from the experience of autonomy or competing with others, which can explain why video gaming is pleasurable and addictive [ 1 ].

Video games can act as “teachers” depending on the game purpose [ 2 ]. Video gaming has varying effects depending on the game genre. For instance, an active video game can improve physical fitness [ 3 , 4 , 5 , 6 ], whereas social video games can improve social behavior [ 7 , 8 , 9 ]. The most interesting results show that playing video games can change cognition and the brain [ 10 , 11 , 12 , 13 ].

Earlier studies have demonstrated that playing video games can benefit cognition. Cross-sectional and longitudinal studies have demonstrated that the experience of video gaming is associated with better cognitive function, specifically in terms of visual attention and short-term memory [ 14 ], reaction time [ 15 ], and working memory [ 16 ]. Additionally, some randomized controlled studies show positive effects of video gaming interventions on cognition [ 17 , 18 ]. Recent meta-analytical studies have also supported the positive effects of video gaming on cognition [ 10 , 11 , 12 , 13 ]. These studies demonstrate that playing video games does provide cognitive benefits.

The effects of video gaming intervention are ever more widely discussed among scientists [ 13 ]. A review of the results and methodological quality of recently published intervention studies must be done. One systematic review of video gaming and neural correlates has been reported [ 19 ]. However, the technique of neuroimaging of the reviewed studies was not specific. This systematic review reviewed only magnetic resonance imaging (MRI) studies in contrast to the previous systematic review to focus on neuroplasticity effect. Neuroplasticity is capability of the brain that accommodates adaptation for learning, memorizing, and recovery purposes [ 19 ]. In normal adaptation, the brain is adapting to learn, remember, forget, and repair itself. Recent studies using MRI for brain imaging techniques have demonstrated neuroplasticity effects after an intervention, which include cognitive, exercise, and music training on the grey matter [ 20 , 21 , 22 , 23 , 24 ] and white matter [ 25 , 26 , 27 , 28 , 29 ]. However, the molecular mechanisms of the grey and white matter change remain inconclusive. The proposed mechanisms for the grey matter change are neurogenesis, gliogenesis, synaptogenesis, and angiogenesis, whereas those for white matter change are myelin modeling and formation, fiber organization, and angiogenesis [ 30 ]. Recent studies using MRI technique for brain imaging have demonstrated video gaming effects on neuroplasticity. Earlier imaging studies using cross-sectional and longitudinal methods have shown that playing video games affects the brain structure by changing the grey matter [ 31 , 32 , 33 ], white matter [ 34 , 35 ], and functional connectivity [ 36 , 37 , 38 , 39 ]. Additionally, a few intervention studies have demonstrated that playing video games changed brain structure and functions [ 40 , 41 , 42 , 43 ].

The earlier review also found a link between neural correlates of video gaming and cognitive function [ 19 ]. However, that review used both experimental and correlational studies and included non-healthy participants, which contrasts to this review. The differences between this and the previous review are presented in Table 1 . This review assesses only experimental studies conducted of healthy participants. Additionally, the cross-sectional and longitudinal studies merely showed an association between video gaming experiences and the brain, showing direct effects of playing video games in the brain is difficult. Therefore, this systematic review specifically examined intervention studies. This review is more specific as it reviews intervention and MRI studies on healthy participants. The purposes of this systematic review are therefore to evaluate the beneficial effects of video gaming and to assess the methodological quality of recent video gaming intervention studies.

Differences between previous review and current review.

CT, computed tomography; fMRI, functional magnetic resonance imaging; MEG, magnetoencephalography MRI, magnetic resonance imaging; PET, positron emission tomography; SPECT, single photon emission computed tomography; tDCS, transcranial direct current stimulation; EEG, electroencephalography; NIRS, near-infrared spectroscopy.

2. Materials and Methods

2.1. search strategy.

This systematic review was designed in accordance with the PRISMA checklist [ 44 ] shown in Appendix Table A1 . A literature search was conducted using PubMed and Google Scholar to identify relevant studies. The keywords used for the literature search were combinations of “video game”, “video gaming”, “game”, “action video game”, “video game training”, “training”, “play”, “playing”, “MRI”, “cognitive”, “cognition”, “executive function”, and “randomized control trial”.

2.2. Inclusion and Exclusion Criteria

The primary inclusion criteria were randomized controlled trial study, video game interaction, and MRI/fMRI analysis. Studies that qualified with only one or two primary inclusions were not included. Review papers and experimental protocols were also not included. The secondary inclusion criteria were publishing after 2000 and published in English. Excluded were duration of less than 4 weeks or unspecified length intervention or combination intervention. Also excluded were studies of cognition-based games, and studies of participants with psychiatric, cognitive, neurological, and medical disorders.

2.3. Quality Assessment

Each of the quality studies was assessed using Delphi criteria [ 45 ] with several additional elements [ 46 ]: details of allocation methods, adequate descriptions of control and training groups, statistical comparisons between control and training groups, and dropout reports. The respective total scores (max = 12) are shown in Table 3. The quality assessment also includes assessment for risk of bias, which is shown in criteria numbers 1, 2, 5, 6, 7, 9, and 12.

2.4. Statistical Analysis

Instead of a meta-analysis study, a systematic review of the video game training/video gaming and the effects was conducted because of the variation in ranges of participant age, video game genre, control type, MRI and statistical analysis, and training outcomes. Therefore, the quality, inclusion and exclusion, control, treatment, game title, participants, training period, and MRI analysis and specification of the studies were recorded for the respective games.

The literature search made of the databases yielded 140 scientific articles. All scientific articles were screened based on inclusion and exclusion criteria. Of those 140 scientific articles, nine were eligible for the review [ 40 , 41 , 42 , 43 , 47 , 48 , 49 , 50 , 51 ]. Video gaming effects are listed in Table 2 .

Summary of beneficial effect of video gaming.

Duration was converted into weeks (1 month = 4 weeks); DLPFC, dorsolateral prefrontal cortex; GM, grey matter; FPS, first person shooting. * Participants were categorized based on how they played during the video gaming intervention.

We excluded 121 articles: 46 were not MRI studies, 16 were not controlled studies, 38 were not intervention studies, 13 were review articles, and eight were miscellaneous, including study protocols, non-video gaming studies, and non-brain studies. Of 18 included scientific articles, nine were excluded. Of those nine excluded articles, two were cognitive-based game studies, three were shorter than 4 weeks in duration or were without a specified length intervention, two studies used a non-healthy participant treatment, and one was a combination intervention study. A screening flowchart is portrayed in Figure 1 .

Flowchart of literature search.

3.1. Quality Assessment

The assessment methodology based on Delphi criteria [ 45 ] for the quality of eligible studies is presented in Table 3 . The quality scores assigned to the studies were 3–9 (mean = 6.10; S.D. = 1.69). Overall, the studies showed fair methodological quality according to the Delphi criteria. The highest quality score of the nine eligible articles was assigned to “Playing Super Mario 64 increases hippocampal grey matter in older adult” published by West et al. in 2017, which scored 9 of 12. The scores assigned for criteria 6 (blinded care provider) and 7 (blinded patient) were lowest because of unspecified information related to blinding for those criteria. Additionally, criteria 2 (concealed allocation) and 5 (blinding assessor) were low because only two articles specified that information. All articles met criteria 3 and 4 adequately.

Methodological quality of eligible studies.

Q1, Random allocation; Q2, Concealed allocation; Q3, Similar baselines among groups; Q4, Eligibility specified; Q5, Blinded assessor outcome; Q6, Blinded care provider; Q7, Blinded patient; Q8, Intention-to-treat analysis; Q9, Detail of allocation method; Q10, Adequate description of each group; Q11, Statistical comparison between groups; Q12, Dropout report (1, specified; 0, unspecified).

3.2. Inclusion and Exclusion

Most studies included participants with little or no experience with gaming and excluded participants with psychiatric/mental, neurological, and medical illness. Four studies specified handedness of the participants and excluded participants with game training experience. The inclusion and exclusion criteria are presented in Table 4 .

Inclusion and exclusion criteria for eligible studies.

i1, Little/no experience in video gaming; i2, Right-handed; i3, Sex-specific; e1, Psychiatric/mental illness; e2, Neurological illness; e3, Medical illness; e4, MRI contraindication; e5, experience in game training.

3.3. Control Group

Nine eligible studies were categorized as three types based on the control type. Two studies used active control, five studies used passive control, and two studies used both active and passive control. A summary of the control group is presented in Table 5 .

Control group examined eligible studies.

3.4. Game Title and Genre

Of the nine eligible studies, four used the same 3D adventure game with different game platforms, which were “Super Mario 64” original and the DS version. One study used first-person shooting (FPS) shooting games with many different game titles: “Call of Duty” is one title. Two studies used puzzle games: “Tetris” and “Professor Layton and The Pandora’s Box.” One study used a rhythm dance game: Dance Revolution. One study used a strategy game: “Space Fortress.” Game genres are presented in Table 6 .

Genres and game titles of video gaming intervention.

* West et al. used multiple games; other games are Call of Duty 2, 3, Black Ops, and World at War, Killzone 2 and 3, Battlefield 2, 3, and 4, Resistance 2 and Fall of Man, and Medal of Honor.

3.5. Participants and Sample Size

Among the nine studies, one study examined teenage participants, six studies included young adult participants, and two studies assessed older adult participants. Participant information is shown in Table 7 . Numbers of participants were 20–75 participants (mean = 43.67; S.D. = 15.63). Three studies examined female-only participants, whereas six others used male and female participants. Six studies with female and male participants had more female than male participants.

Participant details of eligible studies.

3.6. Training Period and Intensity

The training period was 4–24 weeks (mean = 11.49; S.D. = 6.88). One study by Lee et al. had two length periods and total hours because the study examined video game training of two types. The total training hours were 16–90 h (mean = 40.63; S.D. = 26.22), whereas the training intensity was 1.5–10.68 h/week (mean = 4.96; S.D. = 3.00). One study did not specify total training hours. Two studies did not specify the training intensity. The training periods and intensities are in Table 8 .

Periods and intensities of video gaming intervention.

The training length was converted into weeks (1 month = 4 weeks). ns, not specified; n/a, not available; * exact length is not available.

3.7. MRI Analysis and Specifications

Of nine eligible studies, one study used resting-state MRI analysis, three studies (excluding that by Haier et al. [ 40 ]) used structural MRI analysis, and five studies used task-based MRI analysis. A study by Haier et al. used MRI analyses of two types [ 40 ]. A summary of MRI analyses is presented in Table 9 . The related resting-state, structural, and task-based MRI specifications are presented in Table 10 , Table 11 and Table 12 respectively.

MRI analysis details of eligible studies.

* Haier et al. conducted structural and task analyses. + Compared pre-training and post-training between groups without using contrast. TFCE, Threshold Free Cluster Enhancement; FEW, familywise error rate; FDR, false discovery rate.

Resting-State MRI specifications of eligible studies.

Structural MRI specifications of eligible studies.

Task-Based MRI specifications of eligible studies.

All analyses used 3 Tesla magnetic force; TR = repetition time; TE = echo time, ns = not specified.

4. Discussion

This literature review evaluated the effect of noncognitive-based video game intervention on the cognitive function of healthy people. Comparison of studies is difficult because of the heterogeneities of participant ages, beneficial effects, and durations. Comparisons are limited to studies sharing factors.

4.1. Participant Age

Video gaming intervention affects all age categories except for the children category. The exception derives from a lack of intervention studies using children as participants. The underlying reason for this exception is that the brain is still developing until age 10–12 [ 52 , 53 ]. Among the eligible studies were a study investigating adolescents [ 40 ], six studies investigating young adults [ 41 , 42 , 43 , 47 , 49 , 51 ] and two studies investigating older adults [ 48 , 50 ].

Differences among study purposes underlie the differences in participant age categories. The study by Haier et al. was intended to study adolescents because the category shows the most potential brain changes. The human brain is more sensitive to synaptic reorganization during the adolescent period [ 54 ]. Generally, grey matter decreases whereas white matter increases during the adolescent period [ 55 , 56 ]. By contrast, the cortical surface of the brain increases despite reduction of grey matter [ 55 , 57 ]. Six studies were investigating young adults with the intention of studying brain changes after the brain reaches maturity. The human brain reaches maturity during the young adult period [ 58 ]. Two studies were investigating older adults with the intention of combating difficulties caused by aging. The human brain shrinks as age increases [ 56 , 59 ], which almost invariably leads to declining cognitive function [ 59 , 60 ].

4.2. Beneficial Effects

Three beneficial outcomes were observed using MRI method: grey matter change [ 40 , 42 , 50 ], brain activity change [ 40 , 43 , 47 , 48 , 49 ], and functional connectivity change [ 41 ]. The affected brain area corresponds to how the respective games were played.

Four studies of 3D video gaming showed effects on the structure of hippocampus, dorsolateral prefrontal cortex (DLPFC), cerebellum [ 42 , 43 , 50 ], and DLPFC [ 43 ] and ventral striatum activity [ 49 ]. In this case, the hippocampus is used for memory [ 61 ] and scene recognition [ 62 ], whereas the DLPFC and cerebellum are used for working memory function for information manipulation and problem-solving processes [ 63 ]. The grey matter of the corresponding brain region has been shown to increase during training [ 20 , 64 ]. The increased grey matter of the hippocampus, DLPFC, and cerebellum are associated with better performance in reference and working memory [ 64 , 65 ].

The reduced activity of DLPFC found in the study by Gleich et al. corresponds to studies that showed reduced brain activity associated with brain training [ 66 , 67 , 68 , 69 ]. Decreased activity of the DLPFC after training is associated with efficiency in divergent thinking [ 70 ]. 3D video gaming also preserved reward systems by protecting the activity of the ventral striatum [ 71 ].

Two studies of puzzle gaming showed effects on the structure of the visual–spatial processing area, activity of the frontal area, and functional connectivity change. The increased grey matter of the visual–spatial area and decreased activity of the frontal area are similar to training-associated grey matter increase [ 20 , 64 ] and activity decrease [ 66 , 67 , 68 , 69 ]. In this case, visual–spatial processing and frontal area are used constantly for spatial prediction and problem-solving of Tetris. Functional connectivity of the multimodal integration and the higher-order executive system in the puzzle solving-based gaming of Professor Layton game corresponds to studies which demonstrated training-associated functional connectivity change [ 72 , 73 ]. Good functional connectivity implies better performance [ 73 ].

Strategy gaming affects the DLPFC activity, whereas rhythm gaming affects the activity of visuospatial working memory, emotional, and attention area. FPS gaming affects the structure of the hippocampus and amygdala. Decreased DLPFC activity is similar to training-associated activity decrease [ 66 , 67 , 68 , 69 ]. A study by Roush demonstrated increased activity of visuospatial working memory, emotion, and attention area, which might occur because of exercise and gaming in the Dance Revolution game. Results suggest that positive activations indicate altered functional areas by complex exercise [ 48 ]. The increased grey matter of the hippocampus and amygdala are similar to the training-associated grey matter increase [ 20 , 64 ]. The hippocampus is used for 3D navigation purposes in the FPS world [ 61 ], whereas the amygdala is used to stay alert during gaming [ 74 ].

4.3. Duration

Change of the brain structure and function was observed after 16 h of video gaming. The total durations of video gaming were 16–90 h. However, the gaming intensity must be noted because the gaming intensity varied: 1.5–10.68 h per week. The different intensities might affect the change of cognitive function. Cognitive intervention studies demonstrated intensity effects on the cortical thickness of the brain [ 75 , 76 ]. A similar effect might be observed in video gaming studies. More studies must be conducted to resolve how the intensity can be expected to affect cognitive function.

4.4. Criteria

Almost all studies used inclusion criteria “little/no experience with video games.” The criterion was used to reduce the factor of gaming-related experience on the effects of video gaming. Some of the studies also used specific handedness and specific sex of participants to reduce the variation of brain effects. Expertise and sex are shown to affect brain activity and structure [ 77 , 78 , 79 , 80 ]. The exclusion criterion of “MRI contraindication” is used for participant safety for the MRI protocol, whereas exclusion criteria of “psychiatric/mental illness”, “neurological illness”, and “medical illness” are used to standardize the participants.

4.5. Limitations and Recommendations

Some concern might be raised about the quality of methodology, assessed using Delphi criteria [ 45 ]. The quality was 3–9 (mean = 6.10; S.D. = 1.69). Low quality in most papers resulted from unspecified information corresponding to the criteria. Quality improvements for the studies must be performed related to the low quality of methodology. Allocation concealment, assessor blinding, care provider blinding, participant blinding, intention-to-treat analysis, and allocation method details must be improved in future studies.

Another concern is blinding and control. This type of study differs from medical studies in which patients can be blinded easily. In studies of these types, the participants were tasked to do either training as an active control group or to do nothing as a passive control group. The participants can expect something from the task. The expectation might affect the outcomes of the studies [ 81 , 82 , 83 ]. Additionally, the waiting-list control group might overestimate the outcome of training [ 84 ].

Considering the sample size, which was 20–75 (mean = 43.67; S.D. = 15.63), the studies must be upscaled to emphasize video gaming effects. There are four phases of clinical trials that start from the early stage and small-scale phase 1 to late stage and large-scale phase 3 and end in post-marketing observation phase 4. These four phases are used for drug clinical trials, according to the food and drug administration (FDA) [ 85 ]. Phase 1 has the purpose of revealing the safety of treatment with around 20–100 participants. Phase 2 has the purpose of elucidating the efficacy of the treatment with up to several hundred participants. Phase 3 has the purpose of revealing both efficacy and safety among 300–3000 participants. The final phase 4 has the purpose of finding unprecedented adverse effects of treatment after marketing. However, because medical studies and video gaming intervention studies differ in terms of experimental methods, slight modifications can be done for adaptation to video gaming studies.

Several unresolved issues persist in relation to video gaming intervention. First, no studies assessed chronic/long-term video gaming. The participants might lose their motivation to play the same game over a long time, which might affect the study outcomes [ 86 ]. Second, meta-analyses could not be done because the game genres are heterogeneous. To ensure homogeneity of the study, stricter criteria must be set. However, this step would engender a third limitation. Third, randomized controlled trial video gaming studies that use MRI analysis are few. More studies must be conducted to assess the effects of video gaming. Fourth, the eligible studies lacked cognitive tests to validate the cognitive change effects for training. Studies of video gaming intervention should also include a cognitive test to ascertain the relation between cognitive function and brain change.

5. Conclusions

The systematic review has several conclusions related to beneficial effects of noncognitive-based video games. First, noncognitive-based video gaming can be used in all age categories as a means to improve the brain. However, effects on children remain unclear. Second, noncognitive-based video gaming affects both structural and functional aspects of the brain. Third, video gaming effects were observed after a minimum of 16 h of training. Fourth, some methodology criteria must be improved for better methodological quality. In conclusion, acute video gaming of a minimum of 16 h is beneficial for brain function and structure. However, video gaming effects on the brain area vary depending on the video game type.

Acknowledgments

We would like to thank all our other colleagues in IDAC, Tohoku University for their support.

PRISMA Checklist of the literature review.

For more information, visit: www.prisma-statement.org .

Author Contributions

D.B.T., R.N., and R.K. designed the systematic review. D.B.T. and R.N. searched and selected the papers. D.B.T. and R.N. wrote the manuscript with R.K. All authors read and approved the final manuscript. D.B.T. and R.N. contributed equally to this work.

Study is supported by JSPS KAKENHI Grant Number 17H06046 (Grant-in-Aid for Scientific Research on Innovative Areas) and 16KT0002 (Grant-in-Aid for Scientific Research (B)).

Conflicts of Interest

None of the other authors has any conflict of interest to declare. Funding sources are not involved in the study design, collection, analysis, interpretation of data, or writing of the study report.

Gaming to excess: Science-backed interventions can help people press pause

Cognitive behavioral therapy and mindfulness training are promising treatments for problem gaming

Vol. 55 No. 5 Print version: page 52

• Video Games
• Psychotherapy

Dan’s interest in video games started as many do: at age 5, playing educational games. By age 8, his parents—a working couple in rural Switzerland—tried to cap his PlayStation use to an hour a day. 

As a teen, though, Dan, a pseudonym used in a 2021 case study, was spending upwards of 12 hours daily playing mostly first-person shooter games. He rarely saw peers outside of school and lost an apprenticeship because of perpetual tardiness and fatigue ( Niedermoser, D. W., et al., International Journal of Environmental Research and Public Health , Vol. 18, No. 4, 2021 ).

It wasn’t until his next job stipulated psychotherapy that Dan and his parents began to view, and treat, his habit as an addiction. According to the study authors, who saw him at their private psychiatric practice, the approach worked: After 8 months of weekly cognitive behavioral therapy, Dan had reduced his gaming time to about 1.5 hours a day and, uniquely, hadn’t “shifted” his addiction to another vice, like pornography viewing or tobacco use, the authors say. Dan’s depression and insomnia—which were severe and moderately severe, respectively, at the start of therapy—receded, too. 

Dan’s story—boy overcomes gaming disorder, a condition that the World Health Organization added to the International Classification of Diseases (ICD-11) in 2018—is presented in the researchers’ paper as a success. “In this case,” they wrote, “the patient could keep and probably successfully finish his apprenticeship. This is of major importance for his later prospects to live a self-determined and independent life.”

But not all mental health professionals would tell stories like Dan’s the same way. Some might point to Dan’s often absent parents as the root of the issue and so the first place to intervene, while others might see Dan’s case as a missed opportunity to nurture a young person’s passion and sense of competence. Until arriving in therapy, Dan thought of gaming not as a problem but as a path to wealth and fame. And some psychologists bristle at the term gaming “disorder” or “addiction,” which they see as more about politics than science. “A problematic diagnosis may promulgate policy efforts that restrict free speech and minors’ rights, without appreciable positive impacts,” a group of psychologists wrote in a 2018 APA Division 46 (Society for Media Psychology and Technology) statement expressing concern over the WHO’s classification.

Despite the concept’s controversy, some people’s gaming habits are significantly conflicting with multiple areas of their life, which calls for clinical attention. Many of them, however, are finding balance with psychologists’ interventions—or in some cases, simply time, said Zsolt Demetrovics, PhD , chair of the Centre of Excellence in Responsible Gaming at the University of Gibraltar.

“The nature of development of most addictive disorders is progressing to worse, and that’s not clearly the situation in the case of video games,” he said. While more longitudinal research is needed, “there are signs of a much higher proportion of spontaneous recovery or just normalization of gaming after a more problematic period of gaming than in the case of other disorders.”

An evolving problem

Some data suggest 76% of under-18-year-olds and 67% of adults  play video games in the United States . “Esports,” or competitive video gaming, is a fast-growing extracurricular activity at high schools and colleges across the United States.

But more people are gamers than they realize, including those who compete with their friends through Wordle or fire up Candy Crush on their phone while waiting in line, said  Mitu Khandaker, PhD , a game designer and arts professor at New York University’s Game Center who served on a panel APA hosted at the Consumer Electronics Show in January.  

“Games, and our desire to create them, have always existed,” said Khandaker, the founder and CEO of  Glow Up Games,  which builds games that feature and celebrate Black and Brown characters and storylines. “Games exist at this intersection between whatever our latest technological capability is and whatever it is that we want to express as a culture at the time.” 

Still, the ubiquity and history of gaming doesn’t shield games from becoming problematic for some people. To the contrary, their increasing pervasiveness and advanced design is precisely what can make their use harder and harder to control. Researchers have shown how, for instance, even some of the simplest social media and game apps on phones use psychological theories, including the mere exposure effect (the more you see it, the more you like it), the Zeigarnik effect (the tendency to remember interrupted tasks better than completed ones), and social comparison to encourage prolonged usage ( Montag, C., et al.,  International Journal of Environmental Research and Public Health , Vol. 16, No. 4, 2019 ).

“The element that really is a game changer is the online element,” said  Mark Griffiths, PhD,  a distinguished professor of behavioral addiction at Nottingham Trent University in England. “You could technically play 24 hours a day, 365 days a year.”

But most people don’t. According to a 2016  study  that looked at a random sample of 3,389 gamers in Norway, just 1.4% were “addicted gamers,” meaning they experienced the so-called four pillars of addiction—relapse, withdrawal, conflict, and problems—at least sometimes, and 7.3% of study participants were pegged as “problem gamers,” meaning they met two or three of the criteria sometimes. The rest of the sample was considered either “engaged” (3.9%) or “normal” (87.4%) ( Wittek, C. T., et al.,  International Journal of Mental Health and Addiction , Vol. 14, No. 5, 2016 ).

A 2022 meta-analysis of 61 studies across 29 countries found other estimates of pathological gaming range from 0.3% to 17.7% ( Kim, H. S., et al.,  Addictive Behaviors , Vol. 126, 2022 ).

“A small but significant minority of people, usually young people, have a genuine problem with their video game playing,” said Griffiths, who is the director of the International Gaming Research Unit. “Whether we call it a disorder, whether we call it addiction or a problem—to me, that’s irrelevant. We have a small group of people where video game playing is basically negatively affecting every other area of their life.” 

That appears to be the case for some of the tens of thousands of members in a  Reddit community called StopGaming .

“Playing video games makes me procrastinate from doing important work. Playing video games prevents me from connecting with others. Playing video games prevents me from making life decisions,” one self-described addict wrote. “I need help.”

[ Related: Developing games that build skills and promote well-being ]

Categorizing the concern

According to the American Psychiatric Association—which added “internet gaming disorder” (IGD) to the research appendix of the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) in 2013—the condition is a “persistent and recurrent use of the Internet to engage in games, often with other players, leading to clinically significant impairment or distress.”

The WHO similarly says the condition is characterized by “impaired control over gaming, increasing priority given to gaming over other activities to the extent that gaming takes precedence over other interests and daily activities, and continuation or escalation of gaming despite the occurrence of negative consequences.” 

A person is only typically diagnosed with IGD, the organization says, if their behavior patterns are severe enough to impair multiple key areas of their life, such as their employment and their personal relationships, and endure for at least 12 months.

“We’ve got lots of biological studies, lots of nationally representative, large-scale epidemiological studies. We’ve got a massive increase in the number of papers on treatment … and the number of dedicated gaming treatment clinics,” Griffiths said. “So for me, it is quite clearly a genuine disorder.”

But there’s little consensus when it comes to how best to categorize, and study, the concept.  Vivien Wen Li Anthony, PhD , an associate professor at Rutgers University School of Social Work and scientific director for video gaming and esports at the university’s Center for Gambling Studies, and others view gaming disorder as a behavioral addiction, similar to a gambling, sex, or food addiction. 

Anthony points to  research  showing how, like other behavioral addictions, video games activate the same brain regions associated with reward and reinforcement as psychoactive drugs, but gamers don’t experience the types of physical withdrawal symptoms seen in substance-based addictions ( Weinstein, A., & Lejoyeux, M.,  Dialogues in Clinical Neuroscience , Vol. 22, No. 2, 2020 ). Problem gamers also tend to experience a loss of control and significant impairment in other areas of their life, she said.

Still, gaming has some features that set it apart from other behavioral addictions—namely, its lack of natural guardrails. “If you’re a sex addict, you don’t tend to be having sex for 10 hours in a row, but with gambling and gaming, people have incredibly long playing sessions every single day,” Griffiths said.

Other potentially addictive substances and activities also aren’t introduced in toddlerhood, Demetrovics added. “When we talk about gaming, it’s technically all kids, all adults,” he said. “So whatever intervention or regulation we want to introduce, we have to think about the whole population.” Plus, for a minority of gamers, gaming is indeed a  legitimate career trajectory .

Douglas Gentile, PhD , who runs Iowa State University’s  Media Research Lab , prefers to conceptualize problem gaming as an impulse-control disorder. In one of his earlier studies, which followed more than 3,000 children in Singapore for 3 years, he and colleagues found that pathological gaming tendencies were persistent over time and, among other traits, predicted by impulsivity ( Pediatrics , Vol. 127, No. 2, 2011 ).

“If my belief about this is accurate, then the solution doesn’t need to be you have to quit cold turkey and never play again,” Gentile said. “The issue is one of balance.”

Other psychologists see excessive gaming not as a condition itself, but rather as a symptom of, or coping mechanism for, life circumstances or mental illness.

“Are there people who have allowed games to take up a bigger space in their life because of circumstances? Or because of not knowing positive gaming strategies? Absolutely,” said  Ashley Elliott, PsyD , a psychologist in private practice in Arlington, Virginia, and a workshop consultant for  Take This,  a mental health nonprofit that serves the gaming community. “But for the majority of people who are experiencing these things, the game is not the culprit. Life is the culprit.” 

A  2023 study  in the  Journal of Sleep Research  (Liu, Y., et al., Vol. 32, No. 4), for one, found that adolescents with insomnia were more than twice as likely to develop IGD and substance use than those without the sleep disorder. One study that tracked hundreds of kids in South Korea over 4 years also suggests that issues like academic stress can lead to decreased self-control, which in turn raises the risk of pathological gaming ( Jeong, E. J., et al.,  Journal of Youth and Adolescence , Vol. 48, 2019 ).

“What tends to happen is you have someone who started with mental illness, and then they look for something fun that makes them feel important, or at least distracts them from their distress,” study coauthor Chris Ferguson, PhD, a psychology professor at Stetson University in DeLand, Florida, said. “And games are fun, so it’s like self-medication.”

In some cases, like Dan’s from the case study, though, the reverse pattern is plausible, too. Gentile said he was surprised to see his research suggest that psychiatric disorders including depression, social phobias, and anxiety seemed to follow problematic gaming.

“This demonstrates that these are likely comorbid problems, because if you just went in and treated the depression, that’s not going to fix it—the gaming seems to be an independent or interacting factor,” Gentile said. “A good clinician doesn’t say, ‘Well, which one came first? We’ll just treat that one.’ A good clinician has to look at the total picture.”

Helping those at risk

One thing most psychologists do agree on is that sheer time spent gaming isn’t enough to qualify someone’s gaming as pathological. It’s all about context.

“Anything you love to do, you’re probably sacrificing some other area of life for,” Gentile said. “If you love golfing, you might skip out of work early some days or refuse to do something with your partner on a weekend. Does that harm your work? Yes. Does that harm your relationship? I guess that depends on your partner. But that doesn’t make it an addiction.”

While researchers are still working to understand what sets the “addicted” gamers apart from the “normal” ones, some traits—including being male, young, high in impulsivity and neuroticism, and low in openness and conscientiousness—put people at higher risk for the problem.

One 2023 study in the journal  Computers in Human Behavior  (Fraser, R., et al., Vol. 144) also found that people who said they felt less meaning in life were more likely to experience greater gaming disorder symptoms. Other research shows “psychological needs frustration” and “obsession passion” is related to problem gaming ( Remedios, J. C., et al.,  Addiction Research & Theory , 2023 ).

People’s motives for gaming matter, too. If you play for fun and socialization, for example, your gaming is more likely to remain healthy. But, “if you play games in order to forget about your problems, and you want to overcome your negative feelings with gaming, that predicts a problem,” Demetrovics said, pointing to his work and to Griffiths’s work ( Comprehensive Psychiatry , Vol. 94, 2019).

Certain conditions, including depression, anxiety, attention-deficit/hyperactivity disorder (ADHD), and social phobias also tend to co-occur with problem gaming, research shows ( González-Bueso, V., et al.,  International Journal of Environmental Research and Public Health , Vol. 15, No. 4, 2018 ). The links make sense: Differences in the dopamine receptors among people with ADHD, for one, may help explain their need for highly stimulating activities, like gaming. Their tendency to hyperfocus, too, might make them especially susceptible to playing for long hours.

Brain differences don’t explain everything. “You can take five people who have a gaming disorder, and they’ll all have a different etiology explaining why they’re hooked on those games,” Griffiths said. “Some of them will be because of a predisposing psychological or physical or neurodevelopmental illness. For others, there may not be any comorbidities at all.”

But for all of them, there are potential solutions.

Cognitive behavioral therapy seems to be especially promising. A 2020 study in the journal  Clinical Psychology and Psychotherapy  (Han, J., et al., Vol. 27, No. 2), for example, found the modality significantly improved problem gamers’ symptoms of IGD, as well as anxiety, impulsivity, and social avoidance, as compared to problem gamers assigned to a “supportive therapy” treatment.

A range of medications, including antidepressants and stimulants typically used to treat ADHD, can also benefit problem gamers, a 2023 meta-analysis found ( Clorado de Sá, R. R., et al.,  Psychiatry Investigation , Vol. 20, No. 8, 2023 ). “Several addiction drugs seem to be helpful here, too, which is interesting because that kind of makes the point plain that this is a brain disease, and it’s not that different from [substance use disorders],” Gentile said.

Anthony’s work has also revealed how mindfulness can curb people’s problematic gaming habits. In a small, 2017 Stage 1 clinical trial, she and colleagues randomly assigned participants to a mindfulness-based intervention or a support group. After 8 weeks, the mindfulness group had significantly greater reductions in the number of DSM-5 criteria they met for IGD, as well as fewer cravings for video gaming and maladaptive cognitions associated with gaming. The benefits held at the 3-month follow-up ( Li, W., et al.,  Psychology of Addictive Behaviors , Vol. 31, No. 4, 2017 ).

“Mindfulness doesn’t just help to regulate the behavior, it also helps cope with any sudden urge or craving,” Anthony said. “And, for people who use gaming as their primary way to cope with negative moods, emotions, or interpersonal conflict, mindfulness teaches alternative coping skills.”

Policy interventions may also help combat problem gaming. One 2023 study found that a year after China implemented policies to curb problematic smartphone use, the amount of time kids spent on their phones significantly dropped ( Yang, Q., et al., BMC Psychiatry , Vol. 23, No. 1, 2023 ). The group that had met criteria for addiction also fell below, on average, that threshold a year out.

Household rules can make a difference, too. In one of Gentile’s favorite studies, he and colleagues followed about 1,300 kids in two states over the course of a school year. They found that if parents set limits on the time and content of their kids’ video games, the kids tended to get better sleep, gain less weight, get better grades, and display more prosocial behavior and less aggression, as rated by their teachers ( JAMA Pediatrics , Vol. 168, No. 5, 2014 ).

“One simple thing—setting limits on amount and content of your children’s media—­influences all of that,” Gentile said.

Even simpler: Learn about your kids’ interest in gaming before condemning it, psychologists stress. “We always encourage parents to play together with their kids, to try to understand what they do and why they do it, because otherwise, it just looks like a stupid, useless activity,” Demetrovics said. “There might be rational reasons or seemingly irrational ones, but we have to go together on this path with them.”

Further reading

Can you really be addicted to video games? Jabr, F.,  The New York Times Magazine , Oct. 22, 2019

Prevalence of gaming disorder: A meta-analysis Kim, H. S., et al.,  Addictive Behaviors , 2022

An official Division 46 statement on the WHO proposal to include gaming related disorders in ICD-11 Ferguson, C., et al.,  The Amplifier Magazine , 2018

Esports see explosive growth in U.S. high schools Flannery, M. E.,  neaToday , Sept. 16, 2021

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Pharma’s digital Rx: Quantum computing in drug research and development

The development of molecular formulations that become drugs to treat or cure diseases is at the heart of the pharmaceutical industry. Development is so fundamental that pharma spends a full 15 percent of its sales on R&D—a huge sum that accounts for more than 20 percent of total R&D spending across all industries in the global economy. This investment goes hand in hand with innovation: constantly seeking to improve the R&D process, pharma companies have for decades been early adopters of computational chemistry’s digital tools, such as molecular dynamics (MD) simulations and density functional theory (DFT). More recently, pharma R&D has taken advantage of artificial intelligence (AI). The next digital frontier is quantum computing  (QC).

In a recent article , we analyzed the impact of QC on the chemical industry, which, similarly to pharma, relies on the development and manufacture of molecules, and concluded that it will be one of the first industries to benefit. In this article, we explain the profound impact that QC could have on the pharma industry and present use cases for its application. We also provide a set of strategic questions to get clarity on the path forward for industry players.

Pharma’s focus on molecular formations makes it well suited for QC

Identifying and developing small molecules and macromolecules that might help cure illnesses and diseases is the core activity of pharmaceutical companies. Given its focus on molecular formations, pharma as an industry is a natural candidate for quantum computing. The molecules (including those that might be used for drugs) are actually quantum systems; that is, systems that are based on quantum physics. QC is expected to be able to predict and simulate the structure, properties, and behavior (or reactivity) of these molecules more effectively than conventional computing can. Exact methods are computationally intractable for standard computers, and approximate methods are often not sufficiently accurate when interactions on the atomic level are critical, as is the case for many compounds. Theoretically, quantum computers have the capacity to efficiently simulate the complete problem, including interactions on the atomic level. As these quantum computers become more powerful, tremendous value will be at stake.

The basics of quantum computing

A conventional computer, built on transistor-based classical bits operated by voltages, can be in only one of two states: 0 or 1. A quantum computer, instead, uses systems based on quantum physics, such as superconducting loops or ions hovering in electromagnetic fields (ion traps), which are operated by microwave radiation or lasers, respectively. As a result of the laws of quantum mechanics, such systems can be held in a special physical state, called a quantum superposition, in which quantum bits (qubits) exist in a probabilistic combination of the two states—0 and 1—simultaneously.

The implications of these effects for QC are dramatic. Qubits can process far more information than conventional computers can. Qubits use the characteristics of quantum-mechanical systems to solve complex equations in a probabilistic manner, so a computation solved with a quantum algorithm enables sampling from the probabilistic distribution of being correct. The combination of greater speed with probabilistic solutions means that quantum computing fits well with a certain subset of computing needs and applications, such as optimization, the simulation of chemicals, and AI.

While the technology behind quantum computing is rather difficult to understand intuitively (see sidebar, “The basics of quantum computing”), its impact is much easier to grasp: it will handle certain kinds of computational tasks exponentially faster than today’s conventional computers do. Thus, once fully developed, QC could add value across the entire drug value chain—from discovery through development to registration and postmarketing.

QC’s biggest impact on pharma will be in the discovery phases

While QC may benefit the entire pharma value chain—from research across production through commercial and medical—its primary value lies in R&D (Exhibit 1).

Currently, pharma players process molecules with non-QC tools, such as MD and DFT, in a methodology called computer-assisted drug discovery (CADD). But the classical computers they rely on are sorely limited, and basic calculations predicting the behavior of medium-size drug molecules could take a lifetime to compute accurately. CADD on quantum computers could increase the scope of biological mechanisms amenable to CADD, shorten screening time, and reduce the number of times an empirically based development cycle must be run by eliminating some of the research-related “dead ends,” which add significant time and cost to the discovery phase. Exhibit 2 shows where QC-enhanced CADD would improve the development cycle.

QC could make current CADD tools more effective by helping to predict molecular properties with high accuracy. That can affect the development process in several ways, such as modeling how proteins fold and how drug candidates interact with biologically relevant proteins. Here, QC may allow researchers to screen computational libraries against multiple possible structures of the target in parallel. Current approaches usually restrict the structural flexibility of the target molecule due to a lack of computational power and a limited amount of time. These restrictions may reduce the chances of identifying the best drug candidates.

In the longer term, QC may improve generation and validation of hypotheses by using machine-learning (ML) algorithms to uncover new structure-property relationships. Once it has reached sufficient maturity, QC technology may be able to create new types of drug-candidate libraries that are no longer restricted to small molecules but also include peptides and antibodies. It could also enable a more automated approach to drug discovery, in which a large structural library of biologically relevant targets is automatically screened against drug-like molecules via high-throughput approaches.

One could even envision QC triggering a paradigm shift in pharmaceutical R&D, moving beyond today’s digitally enabled R&D toward simulation-based or in silico drug discoveries—a trend that has been seen in other industries as well.

The following QC use cases apply to different aspects of drug discovery and will emerge at different points over an extended timeline. All of them, however, may enable more accurate and efficient development of targeted compounds.

Target identification and validation

During target identification, QC can be leveraged to reliably predict the 3-D structures of proteins. Obtaining high-quality structural data is a lengthy process often leading to low-quality results. Despite all efforts, researchers have yet to crystallize many biologically important proteins—be it due to their size, solubility (for example, membrane proteins), or inability to express and purify in sufficient amount. Pharma companies sometimes develop drugs without even knowing the structure of a protein—accepting the risk of a trial-and-error approach in subsequent steps of drug development—because the business case for a given drug is potentially so strong.

AlphaFold, developed by Google’s DeepMind, was a breakthrough in AI-driven protein folding but has not resolved all of the challenges of classical computing-based simulation, including, for example, formation of protein complexes, protein-protein interactions, and protein-ligand interactions. It’s the interactions that are most difficult to classically solve and, thus, may benefit from QC, which allows for the explicit treatment of electrons. Additionally, QC may allow for strong computational efficiencies here given that Google’s AI model—which is trained on around 170,000 different structures of protein data—requires more than 120 high-end computers for several weeks.

Hit generation and validation

QC’s ability to parallel process complex phenomena would be particularly valuable during hit generation and validation. With existing computers, pharma companies can only use CADD on small to medium-size drug candidates and largely in a sequential manner. Computing power is the bottleneck. With powerful enough QC, pharma companies would be able to expand all use cases to selected biologics as well, for instance, semi-synthesized biologics or fusion proteins, and perform in silico search and validation experiments in a more high-throughput fashion. This use case would go beyond the identification of the protein and eventually encompass almost the entire known biological world. With a robust enough hit-generation and validation approach, this step would already deliver potential lead molecules that are much easier and quicker to optimize.

Lead optimization

During lead optimization, which is a top-three parameter to improve R&D productivity, 1 Steven M. Paul et al., “How to improve R&D productivity: The pharmaceutical industry’s grand challenge,” Nature Reviews Drug Discovery , March 2010, Volume 9, pp. 203–214, nature.com. QC may allow for enhanced absorption, distribution, metabolism, and excretion (ADME); more accurate activity and toxicity predictions for organ systems; dose and solubility optimization; and other safety issues.

Data linkage and generation

The metalevel of R&D very much consists of linking appropriate data together—for instance, creating sensible connections between data points through effective (semantic) management. The more complex the biological information that can be processed, the more extensive the graphs that inform the drug discovery research process become. There is currently research on “topological data analysis” under way that aims to identify “holes” and “connections” across large data sets. 2 Silvano Garnerone, Seth Lloyd, and Paolo Zanardi, “Quantum algorithms for topological and geometric analysis of data,” Nature Communications , January 2016, Volume 7, Article 10138, nature.com. This may at some point enable R&D specialists to identify concrete cases and “industry verticals” where such algorithms are applicable, for example, in identifying connections across brain cells in response to a drug.

Moreover, QC could be used to “deepfake” missing data points throughout the research process, that is, generate a type of fake data by using ML algorithms. This could be particularly useful wherever there is a scarcity of data, such as in rare diseases, that can then be mitigated through artificial data sets. QC will set a new bar here regarding speed in training ML models, amount of initial data needed, and level of accuracy.

Clinical trials

Clinical trials could be optimized through patient identification and stratification and population pharmacogenetic modeling. 3 Paul et al., 2010. In trial planning and execution, QC could optimize the selection of the trial sites. QC could also augment causality analyses for side effects to improve active safety surveillance.

Beyond research and development

While the potential value of QC in pharma R&D is immense, it will also likely play a role further down the value chain. In the production of active ingredients, QC may aid in the calculation of reaction rates, optimize catalytic processes, and, ultimately, create significant efficiencies in the development of new product formulations. In the business-related value pools, QC in pharma could include the optimization of logistics (for instance, the optimization of on-site flows of materials, heat, and waste in production facilities) and improvements in the supply chain. Finally, toward market access and commercial, QC may even enable automatic drug recommendations.

Rollout of QC in pharma R&D will occur over two clear time horizons, characterized by a gradual tech transition

The development of quantum computers began nearly four decades ago, but it is the gains in QC technology realized over the past few years that paved the way for practical applications in pharma. We see the key, value-adding QC activities in pharma unfolding over two distinct eras as the technology further matures (Exhibit 3):

• From 2020–30: Not fully error-corrected QC. Early commercial activities related to quantum computing are already under way as we leave the first horizon—which focused on quantum-inspired algorithms over the past 40 years—and enter the horizon of not fully error-corrected QC. Often referred to as “noisy intermediate-scale quantum” (NISQ), this phase describes the not-error-corrected characteristics of near-term devices that are based on an initially considerable number of quantum bits (qubits) to solve problems classic computers can’t solve yet and do not provide fault tolerance. The timeline for the development and implementation of QC technology, and its adoption across companies, is very much under debate. NISQ, as a class of probabilistic computers that still (mostly) produce error-prone results, may potentially provide a near-term solution for a limited set of use cases. Companies eyeing QC’s potential should take this uncertainty into consideration.
• Beyond 2030: Fully error-corrected QC. Beyond 2030, fully error-corrected QC is expected, in which full value through QC will be captured. In this horizon, QC gets implemented at scale, and later adopters also implement the technology. In other words, chemicals players may start creating value with QC by the mid-2020s ; pharma companies are expected to move more solidly into the space shortly thereafter. Compared with the chemical industry, pharma researchers primarily target more complex and larger molecular systems, which can’t be replicated with either high-performance computers or today’s limited quantum computers.

Exactly when a particular company begins to capture QC’s benefits will depend on its tech starting point (that is, its current level of R&D digitization) and its business focus: the number of small active pharmaceutical ingredients (APIs) in its portfolio. Pharma companies that have a strong footprint in CADD and focus their R&D on smaller molecules will be among the first to take advantage of emergent QC. Exhibit 4 maps key CADD methods along the drug-discovery continuum and offers an indication of the applicability of QC. It’s expected that QC will be mostly applicable in the discovery phase of hit generation, hit-to-lead, and also in lead optimization.

In the next five to ten years, we expect that the first QC tools pharma players deploy will rely on hybrid methodologies that use classical algorithms alongside QC subroutines when they can create additional value. The prominent examples are the imaginary time evolution (an algorithm to find the ground-state and excited-state energy of many-particle systems) and the variational quantum eigen-solver, or VQE (an algorithm to calculate the binding affinity between an API and a target receptor). The value that algorithms such as VQE will add depends on the size of the quantum hardware. Describing small-molecule drugs generally requires less-mature quantum computers, while biologicals will be tackled only as QC matures.

Taking steps now can position pharma players for QC success later

The pharma sector is well positioned to take full advantage of this opportunity. Its tech-ready culture already embraces a wide array of digital tools: CADD, AI, ML, and non-QC DFT- and MD-simulation tools already play a big role in the sector’s R&D. On top of this, pharma players are already working with quantum-chemical simulations, so the barrier to entry is quite low. Scientists will not have to change the way they develop drugs in any fundamental way—they will just be working with more capable tools.

That said, companies will make their own decisions regarding whether and how to move toward a QC-enabled business. Some pharma players may take a pass on deploying QC, others may wait and observe, while still others are going “all in,” ginning up early in-house development. Most pharma players, however, will likely undertake joint-development strategies with upstream players. No matter what, answering some key strategic questions will help companies make more informed decisions on their stance for QC.

Assess the opportunity

Pharmaceutical companies should assess QC now and potentially lay the groundwork to reap the benefits of the technology later. QC may give many of them a huge opportunity, yet each pharma player needs to figure out how much exposure it has and the size of its QC opportunity in the context of its current pace of development. Thus, pharma players should consider three key strategic questions to determine their optimal QC strategy (Exhibit 5):

• Will QC demonstrate promise to disrupt my area of play and reorganize the competitive landscape?
• Have I identified opportunities in my value chain where QC’s potential may translate into value and in which time horizon?
• Can I dedicate resources to investigate QC opportunities, and can I scale up capabilities?

Subject to the above answers, moving early can help secure valuable intellectual property for the algorithms that drive QC and can also address a key issue: pharma won’t be the first industry sector to benefit from QC, so late-moving players could face a lack of suitable talent.

Establish partnerships

Some pharmaceutical players have already realized the need to join forces on the topic of QC and have started to collaborate and/or form partnerships. For example, QuPharm formed in late 2019 by major pharmaceutical players to pool ideas and expertise around QC use cases. QuPharm also collaborates with the Quantum Economic Development Consortium (QED-C), which was created in 2018 by the US government as part of the National Quantum Initiative Act and aims to enable commercial QC use-case efforts. Additionally, the Pistoia Alliance is a life sciences membership organization, which was organized to facilitate precompetitive collaboration and foster R&D innovation.

Partnering with pure quantum players taps into their existing expertise to test early use cases and facilitate development. At the moment, there are more than 100 QC-focused companies—both start-ups and established firms—around the world, focusing on software, hardware, or enabling services. Approximately 25 companies are targeting applications in the pharma industry. Less than 15 focus on algorithms or solutions for pharma players, and very few are focusing exclusively on the needs of pharma players.

Develop capabilities

Digital talent gaps are already a reality, and QC may only exacerbate them. Unlike other important digital tools, such as AI, quantum computing depends on niche know-how. Pharma companies already struggle to attract people with capabilities in the less specialized digital technologies, and hiring quantum-computing experts may prove to be even more of a challenge.

Ensure organizational collaboration

A pharma company’s “way of working” will also be central to its success in QC. The traditional walls that separate the work of the organization’s various functions and units—for example, research, tech, business—will have to fall away. Cross-functional collaboration in both spirit and action will characterize the pharma companies that are able to take full advantage of QC.

Quantum computing could be the key to exponentially more efficient discovery of pharmaceutical cures and therapeutics as well as to hundreds of billions of dollars in value for the pharma industry. Experts predict, for example, that today’s $200 billion market for protein-based drugs could grow by 50 to 100 percent  in the medium term if better tools to develop them became available. Given QC’s vast potential, we expect global pharma spending on QC in R&D to be in the billions by 2030. Pharma companies would be well advised to assess the QC opportunity for themselves and begin laying the groundwork in securing their place in this new competitive and technological landscape.

Matthias Evers is a senior partner in McKinsey’s Hamburg office, and Anna Heid is a consultant in the Zurich office, where Ivan Ostojic is a partner.

The authors wish to thank Nicole Bellonzi, Matteo Biondi, Thomas Lehmann, Lorenzo Pautasso, Katarzyna Smietana, Matija Zesko, and the many industry/academia experts for their contributions to this article.

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