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Artillery Row

The anti-gambling house of cards

Gambling and the simplistic dogma of public health

It is with a heavy heart that I must inform you that a medical journal has been writing about gambling again. This time it is an anonymous editorial in The Lancet titled “Gambling: a harmful commodity”. Gambling is not actually a commodity. The inspiration for this title was almost certainly the modern temperance textbook “Alcohol: No Ordinary Commodity”. Alcohol isn’t a commodity either.

It begins:

Gambling is often seen as a bit of harmless fun: a light-hearted flutter on a sporting event or a quick try with a scratch card. But gambling harms physical and mental health and can do wider damage to societies. One study suggests that past-year problem gambling affects 0·1–5·8% of adults globally.

Lancet readers will be relieved to know that problem gambling prevalence in the UK is at the very low end of this range. The latest figures show that it is “statistically stable at 0.3 percent”. Alas, Lancet readers may never know because the editorial doesn’t mention it.

… efforts to address gambling have tended to focus on individual responsibility and neglected broader systems policy changes. Why? In large part, because of the gambling industry’s adoption of tactics used by other harmful industries such as tobacco and alcohol to avoid meaningful regulation.

What are these “tactics”? What is “meaningful regulation”? The editorial does not describe the problem, let alone acknowledge the trade-offs. It only provides a string of clichés about “the gambling industry” and it does not offer any solutions beyond word salads like “broader systems policy changes”. It does not include a single solid policy proposal. The best it can do is demand “regulation” and “taxation” and splutter something about the “accessibility, availability, and geolocation of gambling products”. 

What is it, for example, about casinos that is currently under-regulated? What about bingo? Dog racing? Fruit machines? Does the Lancet have a view on the government’s plan to introduce affordability checks? If taxation is the answer then what, exactly, is to be taxed and how would that help? Do not expect any answers from the author of the Lancet editorial because although gambling is being rebranded as a “public health” issue, no one in “public health” seems to know very much about it, except that it is bad.

Decades of industry-funded research has hampered the production of independent and robust evidence on the harms of gambling.

This claim is central to the “public health” lobby’s Year Zero approach to gambling. I have written before about how they are rubbishing the entire academic literature on pathological gambling so they can replace it with junk social science that supports bone-headed prohibitionist policies. Put simply, the existing literature correctly sees problem gambling as a complex mental disorder (“gambling disorder”) that is best dealt with by clinicians and augmented by harm reduction policies. By contrast, the “public health” approach is to stigmatise gambling, demonise the gambling industry and use tobacco-style regulation to deter as many people from gambling as possible. The difference between the two approaches is that the former is based on evidence and works whereas the latter is based on wilful ignorance, creates negative unintended consequences and fails.

Industry funding to charities dedicated to gambling education and treatment, such as GambleAware, allows the gambling industry to control the narrative and portrays the industry as doing good for society.

For years, we have been told that Britain is suffering from a spiralling epidemic of gambling addiction caused by a rapacious industry that bombards us with advertising. Add in some dodgy statistics about suicide and make the occasional mention of money laundering and that is “the narrative”. The idea that the industry has been controlling that narrative is eccentric. The idea that it has been doing so through a charity like GambleAware is deranged. GambleAware runs the National Gambling Helpline which helps thousands of people every year. If the industry didn’t fund it, the Lancet would be writing furious editorials asking why not. It has lobbied for tighter advertising restrictions and a mandatory levy on gambling companies, neither of which the industry wants. The only way you could consider it to be a sinister front group pushing an industry-friendly agenda would be if you knew nothing about it and considered anything short of prohibition to be industry-friendly.

Although some groups are at higher risk of gambling disorders, such as young men on low incomes and from marginalised groups, the epidemiological landscape of gambling is changing, with more women and adolescents engaging in harmful gambling.

The rate of problem gambling among women has not changed. It was 0.2 per cent in 2010 and it was still 0.2 per cent in 2021. Among 11-16 year olds, the article linked to by the Lancet notes that there was a fourfold increase in problem gambling between 2016 and 2019. Such an implausibly large change often indicates a methodological issue. Sure enough, the diagnostic test moved online in 2019. The rate had been flat before and it has been flat since. It is a statistical artefact, not evidence of a genuine increase in prevalence (see page 14). 

Besides, the dichotomy of harmless gambling versus gambling disorder propagated by the industry is oversimplified, with research showing that so-called low-risk and moderate-risk gamblers can account for the majority of gambling-related harms. 

This is another cut and paste from the temperance lobby who claim that there is more alcohol-related harm among the large number of moderate drinkers than among the small number of heavy drinkers. Known as the “prevention paradox”, this theory appeals to the puritanical “public health” lobby because it gives them cover to go after drinking in all its forms rather than trying to tackle heavy drinking. It is doubtful whether the theory stands up when it comes to alcohol, but unless you use a ridiculously broad measure of “harm”, it certainly doesn’t stand up with gambling.

The inclusion of the gambling industry in the co-creation and implementation of solutions to problems it has created is morally dubious and doomed to failure. Pervasive advertising and marketing of gambling, particularly the association with sports, has replaced tobacco and alcohol advertising, which has been more heavily regulated.

Gambling advertising hasn’t replaced alcohol advertising and gambling advertising is more heavily regulated than alcohol advertising. For example, gambling advertising can only be broadcast after 9pm except during sports. Alcohol advertising can be broadcast at almost any time. In any case, there has been no increase in the rate of problem gambling since gambling advertising was legalised in 2007. On the contrary, it has fallen.

The health harms of gambling are not a matter for individuals’ willpower and control, but the result of relentless profit-driven tactics. This requires robust wide-reaching regulation and legislation in response, based on the approaches used for tobacco and alcohol control. Understanding the commercial determinants of health provides a framework to do so. Gambling needs to be treated like the harmful industry it is.

You will have noticed that gambling has now ceased to be a commodity and has become an industry. In truth, it is an activity and it is an activity that thrives regardless of whether a legal industry exists to facilitate it, as any number of Chinese and American punters could tell you. There may be policies that the government could usefully introduce to help the 0.3 per cent of the population who have a gambling problem, but do not expect to find them in the pages of The Lancet where juvenile howls of anti-capitalist rage take precedence over reasoned debate. 

The “public health” lobby has had years to prepare for gambling to be uncomfortably squeezed into its remit. Its supposed experts will soon be gorging on a slush fund worth millions of pounds for “research” and yet they remain pitifully ignorant about the most basic facts. The best they can manage is to demand that “the approaches used for tobacco and alcohol control” be somehow crowbarred in to this very different market (or rather markets, since gambling covers a vast range of activities). There is scant acknowledgement that the “health harms” of gambling are psychological rather than physical and no realisation that the anti-tobacco policies they yearn to recreate, such as plain packaging, smoking bans and extortionate taxation, simply do not transfer to gambling. What they have instead is unshakeable confidence in their simplistic dogma and a binary view of the world — and that goes a long way in the clown country of Britain these days.

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