This article explores the role of Gamification Strategies and Health Policies through the lens of the film industry. The object of this article is not to make any judgments on medical treatments or drug evaluation policies but rather to reflect solely on how gamification strategies and enabling technologies might have resulted in totally different outcomes to the ones portrayed in the Dallas Buyers Club.

1. Health Gamification, Dallas Buyers Club, Invictus and Wolf of Wall Street
This article explores the role of Gamification Strategies and Health Policies through the lens of the
film industry. The object of this article is not to make any judgements on medical treatments or drug
evaluation policies but rather to reflect solely on how gamification strategies and enabling
technologies might have resulted in totally different outcomes to the ones portrayed in the Dallas
Buyers Club.
For those who have not seen this outstanding film, it is based on a real life story of a hustler called
Ron Woodroof who was diagnosed with AIDS in 1985 and given 30 days to live by his doctors. At the
time of his diagnosis, there were some field trials of a powerful but toxic drug treatment which Ron
was refused but which he managed to obtain illegally. As the film develops, Ron discovers a Doctor
in Mexico who is having success with alternative non-toxic treatments that were not approved by
the authorities in the USA. Ron manages to smuggle the drugs over the border and through his
research and self-treatment manages not only to extend his own life but also to help many more
AIDS sufferers by setting up a membership scheme in which AIDS victims paid $400 per month for
free access to the same treatments he uses on himself.
The Authorities and the Medical Profession do everything in their power to shut Ron’s activities
down and he loses his court battles and suffers sever financial penalties despite trying to work with
the Authorities and share the results of his research. Ron eventually dies in 1991 and in the film’s
closing credits, it refers to the approval of much smaller quantities of the toxic drug for AIDS

2. treatment, implying that Ron did not die in vain and that some of the lessons from his case have
been learnt to the benefit of future AIDS sufferers.
Analysing this film purely from the perspective of gamification strategies (see my White paper at
http://www.slideshare.net/dwortley/gamification-and-enabling-technologies-white-paper) and
enabling technologies, Ron got caught up in a set of games rules that gave him no hope of life
beyond 30 days. These rules were developed to benefit society by ensuring that new drug
treatments are scientifically and intensively researched before being allowed for widespread public
use. The Federal Drug Agency (FDA) and health professionals were the Games Masters who
controlled the games rules and the players (patients and clinicians) whilst the general population of
non patients are the “Fans” who help to finance the game through taxes and health insurance. Since
Health is an area where most people are not knowledge professionals or sufficiently informed or
affected to challenge the Games Masters, individual players like Ron have little or no chance of
changing the rules.
In this instance, the enabling technologies of the day allowed Ron to research his condition
electronically and, motivated by the dire nature of his prognosis and refusing to die without a fight,
Ron is able to acquire knowledge and set about what amounted to treatment field trials on himself,
becoming in a very short timescale more expert on the specifics of his condition and treatment than
the professionals in charge of his health. This was back in 1985 but today the opportunities for
patients to becoming informed about their own health are very much greater.
To finance his own treatment, Ron adopted gamification strategies that focused on at least 4 of my
“A Team” factors – Authority, Affectedness, Alignment and Adjacency. In normal circumstances,
there is no way that a lay citizen could possibly challenge the Authority of a health professional but
the fact that Ron successfully treated himself subverted traditional authority and, especially in the
eyes of fellow AIDS sufferers, Ron had far greater Authority than the doctors and he was therefore in
a stronger position to influence their behaviour.
Ron used Affectedness in his gamification strategy by focusing on AIDS patient support groups where
everyone at the meetings was very personally affected by the disease and therefore Ron’s marketing
strategy for financing these drugs was very effective.
Because Ron was an AIDS sufferer himself, all his potential customers were very closely aligned to
his viewpoint and emotionally very close to him (Adjacency)
Taking all these gamification strategies together Ron also applied an important gamification principle
of “Reciprocity” is setting up the Dallas Buyers Club by insisting that everyone who wanted
treatment had to pay $400 per month for treatment, placing a value on what he had to offer and
ensuring commercial sustainability.
In the film, the FDA and medical professionals understandably saw Ron as unwanted and unworthy
competition and, albeit in a small way a threat to their Authority and their ability to manage this
deadly health game on their own terms. Their gamification strategy was based on eradicating Ron’s
Authority with a series of tactics designed to penalised Ron for non compliance with their rules.
From the perspective of the film, they were only partially successful and, if the substance of the film

3. is accurate, Ron managed to extend many life expectancies beyond what they would have been
without Ron’s persistence.
This leads on to the film Invictus, starring Morgan Freeman as Nelson Mandela. There is a scene in
this film which, in my mind, illustrates a different gamification strategy to the one adopted by the
FDA in the Dallas Buyers Club. In South Africa, the dominance of the white minority over the black
indigenous population could be seen as a massive game in which the authority of the Government
and the use of Apartheid was under constant threat. When Mandela came into power, the natural
reaction of the majority of black people was that it was an opportunity to turn the tables and
enforce their rules on white people. There was one scene in Invictus where Mandela uses an
alternative gamification strategy to his advantage and to the benefit of the whole population.
Instead of acceding to the wishes of a policy committee who wanted to changed South Africa’s flag
and national colours, Mandela persuaded them to adopt a “win-win” approach by bringing the
whole country behind a unified belief in their country. It was a very bold and clever strategy and
shows that in gamification the best way to display authority is to empower others with authority.
What would have happened in the Dallas Buyers Club is the FDA and Medical profession had
adopted Mandela’s “win-win” strategy and instead of trying to crush Ron had seen it as an
opportunity to “co-produce” more effective AIDS treatments by working with Ron and using the
clinical data he could provide. How many additional lives could have been saved by this approach
and at what risk?
I make this observation not to suggest that there should be a free for all on medical treatment but
rather to suggest that today’s world of the informed and empowered citizen makes it even more
essential that all knowledge professionals need to “co-produce” the solutions that challenge society
today and gamification strategies offer a perspective that could be effective in many public and
private sectors.
In total contrast, the film “Wolf on Wall Street” shows another aspect of society where the
knowledge professionals still hold authority and, if the film is any reflection on real life, totally abuse
that authority in a wholly unethical application of gamification strategies. Of all the films I have seen
in recent times, this has to be one of the worst examples of self-indulgence in film making to create
a three hour monstrosity of a film that despite some fine acting performances from the lead
characters is an overblown parody that totally lack any moral dimension. Sadly, it is unlikely that
individual citizens will ever challenge the financial specialists and bankers that act as the Games
Masters in this sector.

4. To draw a conclusion after that senior citizen “rant”, I think that is inevitable that health services will
need to adopt gamification strategies that engage citizens in “co-producing” sustainable health
policies for the future and, in the internet of things and wearable sensor technologies, the tools to
facilitate this are rapidly becoming available.
David Wortley FRSA
Author of Gadgets to God – Reflections on our Changing Relationship with Technology
www.gaitss.net