I remember seeing a sports game where you could give your players steroid shots, it even had a little movie of the needle going into their butts, and then them getting a look of pain on their faces. Sadly I don't remember the name of the game.
The only way these games are going to be accepted is if Americam devs like EA or insert any here get involved to Westernize this stuff for the so called "mainstream" audience. Imagine Final Fantasy=Dragon Age or something.
True hardcore gamers don't need Achievements/Trophies to be recognized as such!