Thank you for this approachable summary of your published work--very helpful.
As someone who has focused in a different arena (nicotine; disclosures at link below) with some similarities, what I would wish for, before laying out recommendations for policy and programs, is a discussion of goals and resolution of tradeoffs first. Then, and only then, would it make sense to begin discussing policy, regulation, and programs.
As an example, there is clearly tension between maximizing private and public revenue from gambling and minimizing health and social consequences of this behavior. What is the right mix? How much harm are we willing to accept to realize how much revenue?
This discussion is likely no easier than the intergenerational one around nicotine, but I don't see another way forward.
I am a big believer in accepting that I am wrong about something and the best way to find out wrong about what in particular is to interact with people who see things differently. Where does my analysis and recommendation fall down?
Love the article. Love to see more addiction stuff addressed on sensible medicine. Got very little training in medical school on addiction. We live in a time of addiction, whether it be food, drugs, booze, porn, video games, gambling, etc. Always remember There is a solution And it’s free. I am a Friend of Bill W.
This was fascinating. Would love to hear more about what gambling addiction actually is (have heard of it, but what does it mean clinically? how is it diagnosed? what are the impacts to patients with the diagnosis? how can it be treated? what is the cost to society?). I'm seeing some skepticism in the comments here which makes me think a lot of us could learn from such an explainer.
Addiction is a somewhat loaded term that implies that the subject of the addiction is beyond the control of the individual that suffers it. No addiction is a disease. Anything that can be eliminated by the simple act of willpower cannot fit the definition of disease and is, in fact, demeaning to those that suffer from true diseases. The cure for any behavioral addiction is simple: stop the behavior. No cost to society or anyone else.
Sorry, but this is another example of public health trying to turn everything into a public health issue. Stay in your lane. Yes, addiction/addictive behaviour is a problem but sports books are but one of many opportunities to gamble. Getting rid of them/regulating them won’t change that.
Except for addiction dynamics, gambling has been embraced by western societies - at least as far as regulated gambling.
With the enthusiastic advocacy in favor of "crypto" by the Trump administration, if financial speculation over unregulated digital assets wasn't enough, unregulated gambling will become prevalent - up to gambling permissionlessly over literally EVERYTHING, with the enablement of what is called "prediction markets".
The point is much more political than healthcare related: if we can burn our money, if bad investments, bad luck or bad life choices can ruin our lives, why shouldn't we be allowed to gamble?
I do find it annoying when “analysts” talk about betting lines. I want analysis; not reports of how a bunch of randos are lighting their money on fire.
It’s like “journalists” who report on Twitter reactions. I don’t particularly care about what a bunch of randos think, about anything. Which is why I’m not on Twitter.
I could not agree more with the authors. In my home city of Houston, a beloved public figure and wealthy furniture store owner offers free mattresses or certain expensive furniture if a certain Houston sports team accomplishes a given goal like the World Series for the Astros. Since he stands to lose money if they win, he either bets against them or puts a big wager on their winning. He is trapping Houston citizens into joining him in betting to his shame. It is a shame for which he has NOT been held liable.
I have to confess that when I first read the title of this article I thought it must be one of those April Fools spoofs. But a quick look at my calendar told me that was wrong. Gambling has nothing to do with health nor do other "addictive" behaviors. They are signs of societal and moral decline. Government intervention and regulation has a consistent record of failure in trying to control these behaviors. See "the war on drugs" for further details. These and other attempts to "medicalize" everyday life are counter to the idea of Sensible Medicine.
I agree - except for when pathological dynamics of addiction need consideration.
Still, whether the healthcare resources are better used "curing" the addicted or preventing the problem completely (for example with a successful "war on..."), is an open topic.
There is always someone who wants to tell everyone else how to live their lives. This is, finally, leading to the demise of most of what is mislabeled "public health". As this article clearly underscores it is often neither public nor healthy and it cannot be permanently discredited soon enough.
In that same vein, this is neither Sensible nor Medicine.
It's refreshing to read the comments regarding this article. Perhaps it is a sign of the times. Attempting to legislate the morality of a civilization is a slippery slope when individual freedom is impinged upon. The idea that society is injured by an individual's actions leads to the belief that many are responsible for that individual's well being. Our empathy for the individuals hurt by gambling, smoking, alcohol, etc. inexorably leads to calls for limiting individual freedom. On cue, the calls for Congress to save us from ourselves creates a system where the exact people who passed the laws supporting this are now asked to take away another individual freedom to ameliorate their mistake. Have we not learned yet that these supposed saviors are incapable of solutions? Unfortunately, human behavior has no better lesson than to learn the costs of freedom by experiencing the results of it.
Regulating sports betting has nothing to do with legislating morality. There is nothing the least bit immoral about betting on sports.
The problem with sports betting is the fact that some people are unable to control themselves and end up ruining their lives and the lives of their families. The point of legislation is to prevent or limit that harm.
"Freedom" is just a confusing smoke screen libertarians appeal to whenever they don't like some law. Is addiction without proper information, "freedom"? Is taking care of the addicted with limited public resources, "freedom"? Is throwing away one's hard-earned (or easily-inherited) resources, freedom?
We protect and educate children and our fellow humans whenever it's necessary; we don't let them "learn by making mistakes". Ofc there is a limit, but "freedom" has nothing to do with that - although some pretend it does: it's about how many resources we want to allocate to that goal.
The point is instead that our whole society is based on "employing" resources allocated to the individual, however the individual sees fit. Therefore it doesn't make much sense to allow some expenses and forbid others (as we see with drugs).
IMO until we question the roots of our socioeconomic models (freedom of contract for example), we will just be limiting the damages of "bad" money-spending behaviours with some form of palliative cures. We know that there will be people damaged by XXX, but we like XXX so much that we don't care; yet we will allocate some resources to feel better about causing damages to (innocent?) people.
It's like every other get rich quick scheme...the bottom 90% must feed the top 10% who win. Or perhaps it is the same 20% winning 80% of the time and the bottom 80% winning 20% of the time.
Everyone can win which is the sales pitch, even for stocks and other financial instruments. The majority must always lose to pay the small minority. The game runners take their cut and that is steady income no matter how many win or lose.
It's a job to them and they need a constant flow of customers to replace those who have burned out. Thus you see the mindless marketing to fools who know not how the game is really played.
The house always wins otherwise there would be no one providing the thrills of betting.
It's worth asking why women aren't pulled into this. To a greater extent it is men, mostly younger that are having the biggest problems with this. The obvious answer is that men watch more sports but there must be more to it.
If it's a topic of interest for you I'd suggest listening to Gambling with Michael Lewis a Revisionist History podcast. One of the big revelations is how good the gambling companies are at finding and excluding winners while sheltering losers from potential help. Gambling would suggest you have a chance, you really don't if you follow their rules.
while there may be some problem with the article as noted by earlier posts, it was nice to read something without the snark. I believe a bottom line principle should be that private companies and individuals should not be able to off-load negative externalities onto the public. For sure, all addiction cost from legally obtained sources should have built in fees/taxes to pay for the addiction services. Carbon should be taxed. Solid waste at the source should be taxed. Building in flood or fire prone areas must include the cost of said risk. Maybe ski lift tickets include a contribution to local ER's and orthopedist costs.
Free speech in general is very costly to maintain, requiring generations of individual and government belief in such, so that institutions act without malevolent intent as is now the case. Capitalism in classic form requires stability to function. What passes for capitalism now is anything but, as most are trading this and that believing in nearly zero-sum "games," when real investing in the future should often be a win-win process, particularly when all stakeholders are included.
Thank you for this approachable summary of your published work--very helpful.
As someone who has focused in a different arena (nicotine; disclosures at link below) with some similarities, what I would wish for, before laying out recommendations for policy and programs, is a discussion of goals and resolution of tradeoffs first. Then, and only then, would it make sense to begin discussing policy, regulation, and programs.
As an example, there is clearly tension between maximizing private and public revenue from gambling and minimizing health and social consequences of this behavior. What is the right mix? How much harm are we willing to accept to realize how much revenue?
This discussion is likely no easier than the intergenerational one around nicotine, but I don't see another way forward.
I am a big believer in accepting that I am wrong about something and the best way to find out wrong about what in particular is to interact with people who see things differently. Where does my analysis and recommendation fall down?
Thank you for any thoughts.
Joe
Disclosures: https://www.pinneyassociates.com/tobacco-harm-reduction/
Love the article. Love to see more addiction stuff addressed on sensible medicine. Got very little training in medical school on addiction. We live in a time of addiction, whether it be food, drugs, booze, porn, video games, gambling, etc. Always remember There is a solution And it’s free. I am a Friend of Bill W.
This was fascinating. Would love to hear more about what gambling addiction actually is (have heard of it, but what does it mean clinically? how is it diagnosed? what are the impacts to patients with the diagnosis? how can it be treated? what is the cost to society?). I'm seeing some skepticism in the comments here which makes me think a lot of us could learn from such an explainer.
Addiction is a somewhat loaded term that implies that the subject of the addiction is beyond the control of the individual that suffers it. No addiction is a disease. Anything that can be eliminated by the simple act of willpower cannot fit the definition of disease and is, in fact, demeaning to those that suffer from true diseases. The cure for any behavioral addiction is simple: stop the behavior. No cost to society or anyone else.
Sorry, but this is another example of public health trying to turn everything into a public health issue. Stay in your lane. Yes, addiction/addictive behaviour is a problem but sports books are but one of many opportunities to gamble. Getting rid of them/regulating them won’t change that.
Except for addiction dynamics, gambling has been embraced by western societies - at least as far as regulated gambling.
With the enthusiastic advocacy in favor of "crypto" by the Trump administration, if financial speculation over unregulated digital assets wasn't enough, unregulated gambling will become prevalent - up to gambling permissionlessly over literally EVERYTHING, with the enablement of what is called "prediction markets".
The point is much more political than healthcare related: if we can burn our money, if bad investments, bad luck or bad life choices can ruin our lives, why shouldn't we be allowed to gamble?
I do find it annoying when “analysts” talk about betting lines. I want analysis; not reports of how a bunch of randos are lighting their money on fire.
It’s like “journalists” who report on Twitter reactions. I don’t particularly care about what a bunch of randos think, about anything. Which is why I’m not on Twitter.
Now get off my lawn 😉
I hate to think we have already lost the game. The lack of hope and realizable solutions makes things all seem hopeless.
I could not agree more with the authors. In my home city of Houston, a beloved public figure and wealthy furniture store owner offers free mattresses or certain expensive furniture if a certain Houston sports team accomplishes a given goal like the World Series for the Astros. Since he stands to lose money if they win, he either bets against them or puts a big wager on their winning. He is trapping Houston citizens into joining him in betting to his shame. It is a shame for which he has NOT been held liable.
That is, morally liable. The Church has been especially silent on this topic.
Liable for what? Giving away mattresses or discounting furniture?
Liable for spreading the culture of casual gambling.
I have to confess that when I first read the title of this article I thought it must be one of those April Fools spoofs. But a quick look at my calendar told me that was wrong. Gambling has nothing to do with health nor do other "addictive" behaviors. They are signs of societal and moral decline. Government intervention and regulation has a consistent record of failure in trying to control these behaviors. See "the war on drugs" for further details. These and other attempts to "medicalize" everyday life are counter to the idea of Sensible Medicine.
I agree - except for when pathological dynamics of addiction need consideration.
Still, whether the healthcare resources are better used "curing" the addicted or preventing the problem completely (for example with a successful "war on..."), is an open topic.
Every time I read or hear the words “common-sense measures” my skin crawls.
There is always someone who wants to tell everyone else how to live their lives. This is, finally, leading to the demise of most of what is mislabeled "public health". As this article clearly underscores it is often neither public nor healthy and it cannot be permanently discredited soon enough.
In that same vein, this is neither Sensible nor Medicine.
An invitation to more surveillance, where regulatory capture is inevitable given the $. Keep government out of it as far as possible.
It's refreshing to read the comments regarding this article. Perhaps it is a sign of the times. Attempting to legislate the morality of a civilization is a slippery slope when individual freedom is impinged upon. The idea that society is injured by an individual's actions leads to the belief that many are responsible for that individual's well being. Our empathy for the individuals hurt by gambling, smoking, alcohol, etc. inexorably leads to calls for limiting individual freedom. On cue, the calls for Congress to save us from ourselves creates a system where the exact people who passed the laws supporting this are now asked to take away another individual freedom to ameliorate their mistake. Have we not learned yet that these supposed saviors are incapable of solutions? Unfortunately, human behavior has no better lesson than to learn the costs of freedom by experiencing the results of it.
Regulating sports betting has nothing to do with legislating morality. There is nothing the least bit immoral about betting on sports.
The problem with sports betting is the fact that some people are unable to control themselves and end up ruining their lives and the lives of their families. The point of legislation is to prevent or limit that harm.
"Freedom" is just a confusing smoke screen libertarians appeal to whenever they don't like some law. Is addiction without proper information, "freedom"? Is taking care of the addicted with limited public resources, "freedom"? Is throwing away one's hard-earned (or easily-inherited) resources, freedom?
We protect and educate children and our fellow humans whenever it's necessary; we don't let them "learn by making mistakes". Ofc there is a limit, but "freedom" has nothing to do with that - although some pretend it does: it's about how many resources we want to allocate to that goal.
The point is instead that our whole society is based on "employing" resources allocated to the individual, however the individual sees fit. Therefore it doesn't make much sense to allow some expenses and forbid others (as we see with drugs).
IMO until we question the roots of our socioeconomic models (freedom of contract for example), we will just be limiting the damages of "bad" money-spending behaviours with some form of palliative cures. We know that there will be people damaged by XXX, but we like XXX so much that we don't care; yet we will allocate some resources to feel better about causing damages to (innocent?) people.
It's like every other get rich quick scheme...the bottom 90% must feed the top 10% who win. Or perhaps it is the same 20% winning 80% of the time and the bottom 80% winning 20% of the time.
Everyone can win which is the sales pitch, even for stocks and other financial instruments. The majority must always lose to pay the small minority. The game runners take their cut and that is steady income no matter how many win or lose.
It's a job to them and they need a constant flow of customers to replace those who have burned out. Thus you see the mindless marketing to fools who know not how the game is really played.
The house always wins otherwise there would be no one providing the thrills of betting.
It's worth asking why women aren't pulled into this. To a greater extent it is men, mostly younger that are having the biggest problems with this. The obvious answer is that men watch more sports but there must be more to it.
If it's a topic of interest for you I'd suggest listening to Gambling with Michael Lewis a Revisionist History podcast. One of the big revelations is how good the gambling companies are at finding and excluding winners while sheltering losers from potential help. Gambling would suggest you have a chance, you really don't if you follow their rules.
Agree. Same with porn and video games? What is it about the male brain?
I wish I had an answer!
while there may be some problem with the article as noted by earlier posts, it was nice to read something without the snark. I believe a bottom line principle should be that private companies and individuals should not be able to off-load negative externalities onto the public. For sure, all addiction cost from legally obtained sources should have built in fees/taxes to pay for the addiction services. Carbon should be taxed. Solid waste at the source should be taxed. Building in flood or fire prone areas must include the cost of said risk. Maybe ski lift tickets include a contribution to local ER's and orthopedist costs.
Free speech in general is very costly to maintain, requiring generations of individual and government belief in such, so that institutions act without malevolent intent as is now the case. Capitalism in classic form requires stability to function. What passes for capitalism now is anything but, as most are trading this and that believing in nearly zero-sum "games," when real investing in the future should often be a win-win process, particularly when all stakeholders are included.