Video games often get a bad rap. Too often, the learning and play potentials of games are lost in a media hungry for bad news.

Re-Mission is a game that indisputably has a good moral fiber that is gradually gaining some press. The game’s creators at Hopelab have clearly recognized that joy and play can both educate and entertain. Re-Mission does both well. It would be worthwhile to understand how.


The gamer plays as a nanobot accompanied by an advice giving, C3PO-like sidekick fighting against cancer. The avatar, named Roxxi, fights the bad guys involved with childhood cancers such as acute lymphocytic leukemia, acute myeologenous leukiemia, osteosarcoma, among others.

The diseases are often accompanied by bacterial infections that must be fought as well. The player uses the antibiotic, chemo, radiation, and relaxation therapies taken by the patient within whom the player fights. These therapies become the player’s ammunition.

Respect for the player

Where the game shines is in connecting with the player’s plight. It does not pull punches. It uses real medical terminology and dumbs nothing down. It does not overwhelm with facts, but it presents the knowledge necessary, while noting that the stakes are about life and death.

Here’s an example of a pre-mission briefing from one of the 20+ missions provided:

“Patient name – Taylor D

“age – 17, gender – female

“Taylor was diagnosed with medulloblastoma, a brain tumor. She presented with severe headaches and dizziness. She had a complete resection of her tumor followed by radiation therapy to the tumor site, full brain and spine over 6 weeks. She is now on weekly chemo maintenance. She requires Magnetic Resonance Imaging (MRI) to make sure there are no tumor cells in her spinal column and is anxious about her upcoming MRI.

“Roxxi, you are to tag along on a spinal tap to seek out and destroy any brain tumor cells that might have entered the spinal column. If you spot any, destroy them quickly, as they become harder to kill once they are latched on. Be warned, fear of the spinal tap has made Taylor very stressed. Electrical nerve flares may cause you to short-circuit unless you calm her with some deep breathing exercises.”

One can see that real words and real situations are used. As such, the child feels his inherent ability to learn is respected. This is a huge positive towards actually being a good educational game.

In providing the player a path to learn about her disease without putting on kid gloves, the player also gains a sense of control. It addresses a major factor in the psychological health of the child during this tremendously stressful time.

A person can easily become depressed when feeling a lack of control. It is a situation created by not knowing what is going on and essentially feeling helpless: What is this disease? I feel better, why do I still have to take medications? I thought I beat this – why is it back? It’s not fair!

These questions and statements are addressed by the characters in the game who ask and say these same things, but come up with answers and continue the good fight.

In one scenario, the patient had been feeling better with a lowered fever. He felt like taking the medications was not necessary. The bacteria in this situation multiply and the fever returns – harder to fight than before. Without another course of antibiotics, the player has a much harder time fighting the infection. Since antibiotics taken by the patient are used as ammunition, the player directly feels the difficulty in fighting off the illness as the medication is depleted. Effectively, it creates a situation where a person learns the importance of taking medications and the reasons for doing so.

Addressing non-compliance in this manner removes a large factor that can contribute to not wanting to take medication – specifically guilt. A child can already feel somehow guilty because she has a chronic illness such as cancer. It is an illness that stems from the person’s owns cells. Saying “you did nothing wrong” is, unfortunately, often not enough to alleviate the pangs of guilt.

There is a strong desire to cut back on medications when a person feels “fine.” Medication can be seen as the punishment that accompanies guilt. Stopping it may feel like progress. It is much easier to believe that one is doing well because she feels well. Not taking medications can seem to be a symbol of having conquered an illness. Adults (including some physicians) function this way when non-compliant with simple 10-day antibiotic regimens – a drop in the bucket compared to what these kids have to take.

Feeling blamed for a very justified feeling of wanting to be through with the illness only infuriates the situation. But recognizing this feeling and the reasons behind it, as well as giving real convincing information as to why it is necessary to continue treatment even when feeling better, can create a situation where medication compliance is improved and the child feels better about herself.

By providing a translation of illness into the concrete realm of a video game, the person is separated from the illness and the fight against it is better understood. The game allows a change from feeling, “I am bad, therefore I have an illness” to “I have an illness, and there are things I can do to fight it.”

Good use of Humor, Setting, and Characters

There are two main characters – one is the energetic kid the player controls and the other is a “wise-fool” type who makes several C3PO and even Shakespeare references throughout the game. The sidekick’s presence mimics an adult world that defers to the child’s strength and agency to get through the illness while providing direction to get her through.

The kid’s sarcastic humor, and desires to show off and fight are all characteristics with which a child can readily identify. Having such a character can more thoroughly involve the players that this game targets.

Even the environment has a certain character as well. Traveling throughout the lymphatic, circulatory, nervous, and digestive systems all have distinctive feels from the lightning-like impulses of the spinal cord to the mucous-lined esophagus. Some aspects of these scenes might officially be considered “icky,” but they are done in a way that children and adolescents can enjoy.

Other characters that are largely unseen are the patient in whom the player fights and the caretakers involved. For example, the player activates a type of call-light to request the physician to beam down radiation to an area. From that area, the player can recharge her ammunition to continue the fight. Creating a team scenario provides the player the very important perspective that she is not alone in fighting the real-life cancer.

Measurement of how one is doing is tied to real factors such as how extensive the bacteria grows or the severity of a temperature spike. Again, there is a connection drawn between game and world.

Any story or character will not fit all of its audience. But it is clear that the makers made attempts to connect to kids, and I believe they do a strong job.


The gameplay is actually challenging and enjoyable. Too often, games of edutainment are neither educational nor entertaining. Re-Mission is a clear exception.

The leukemia, bacteria, and other baddies all have their own unique fighting styles. Several situations are presented that are both fun in terms of gameplay as well as realistic to the medical situations.

The game even innovates by taking mechanisms directly from nature. Cancer cells divide over time. An enemy that continues to divide can be a challenging foe. It is a concept that is clearly very organic and even definitively so in the case of cancer.

I am quite surprised that this sort of dividing motif is not used more often in games. It is a very simple yet tremendously effective technique of applying pressure and tension to the experience. Here, it provides a feeling that taking the medications and the work of the battle are a race against time – which it is. A person can’t just take medications later. They need to be taken as scheduled for good reason.

Appropriately, different medications are used for different situations. Antibiotics do not work against cancer cells, chemotherapy does not work against bacteria, and radiation can be used against some particularly difficult bad guys. Certain cells become more resistant to chemo and alternative or upgraded weapons will be needed. Some bacteria in context of a compromised immune system require heavy hitting medications such as IV antibiotics.

Sometimes a player needs to take care to avoid killing healthy white blood cells while fighting the enemy, such as Reed-Sternberg cells which are indicative of Hodgkin’s. Needing to spare the healthy cells and being careful to only target the ill is exactly the job of fighting cancer. It is simultaneously a successful game mechanism.

Game Difficulty

The game’s difficulty can be a challenge. Most first or third-person games nowadays involve three dimensions. However, free movement in all three dimensions is less frequently seen and can take some time for adjustment.

To Hopelab’s credit, translating the navigation of the human body’s winding 3-D environments into a keyboard and mouse experience can be a difficult task. Still, I hope they add some customizable keys in a future patch.

The enemies themselves provide for a welcome challenging experience. Kids are quite adept at playing video games and using the controls inherent in immersing themselves in alternate environments. Anything too easy will not be respected as a good game.

In case things get too difficult, cheats and gameplay difficulty options are readily provided in the Options menu. One can uncover exactly how far into the game he is by viewing the available levels and gaining access to all of them without having to beat the one before. There are easy, normal, and hard levels. Also, options of invulnerability and/or unlimited ammunition are provided.


Overall the game gives a sense of control while also describing that there is a team of people who are trying to help fight the illness. It does not ignore the illness, rather it says that it is difficult, and that life is at stake. Meanwhile, in providing an enjoyable learning experience, it arguably helps the crucial job of giving a person feelings of control and hope.

Update 2008-01-12:

Here is a link to Hopelab’s Re-Mission outcome studies.