Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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Betting on harming both health and justice
- Nick Wilson (4 November 2004)
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Gambling and inequality
- Mark D Griffiths (9 November 2004)
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Deregulation of gambling, culture and politics?
- Dr.Naseem A Qureshi MD, IMAPA, LMIPS (10 November 2004)
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Gambling technology out of control - product safety concerns
- Roger P. Horbay (25 November 2004)
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Product safety concerns in gambling : The role of technology
- Mark D Griffiths (26 November 2004)
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Nick Wilson, Senior Lecturer (Public Health) Wellington School of Medicine, Otago University, Wellington, New Zealand
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The BMJ editorial by Griffiths provides strong arguments as to why gambling and problem gambling are public health concerns [1]. But there are also substantial ethical concerns around liberalising access to gambling given that it may contribute to poverty and increase inequality. For example, national survey data from New Zealand found that expenditure on gambling was disproportionately higher among people with lower levels of education, people with 'lower status occupations', Maori, and Pacific peoples [2]. This study also found that poorer socio-economic status (SES), was a statistically significant risk factor for 'current problem gambling and probable pathological gambling'. Such an association has also been reported in the Netherlands [3], in Sweden (when considering social welfare recipients as having low SES) [4], and in the United States [5]. Such health and justice problems suggest that, from a societal perspective, it may best for governments to further tighten restrictions on access to gambling as a whole, and particularly on the most hazardous forms for inducing gambling disorders (ie, gaming machines and track racing). References 1) Griffiths M. Betting your life on it. Problem gambling has clear health related consequences. BMJ 2004;329:1055-6. 2) Abbott MW, Volberg RA. Taking the pulse on gambling and problem gambling in New Zealand: A report on phase one of the 1999 National Prevalence Survey. Wellington: Department of Internal Affairs, 2000. 3) Hendriks VM, Meerkerk GJ, Van Oers HA, Garretsen HF. The Dutch instant lottery: prevalence and correlates of at-risk playing. Addiction 1997;92:335?46. 4) Volberg RA, Abbott MW, Ronnberg S, Munck IM. Prevalence and risks of pathological gambling in Sweden. Acta Psychiatr Scand 2001;104: 250?6. 5) Welte J, Barnes G, Wieczorek W, et al. Alcohol and gambling pathology among U. S. adults: prevalence, demographic patterns and comorbidity. J Stud Alcohol 2001;62:706?12. Competing interests: None declared |
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Mark D Griffiths, Professor of Gambling Studies Psychology Division, Nottingham Trent University, Burton Street, Nottingham, NG1 4BU, UK
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The letter by Nick Wilson (1) in response to my paper (2) raises issues that I indeed raised myself in an earlier version of my paper. Due to space constraints, my paper was cut at the proof stage. One of the things I specifically mentioned in my original paper referred to an earlier 1995 BMJ editorial on the topic of gambling and health. In that article, McKee and Sassi (3) argued that gambling was a health issue because it widened the inequalities of income and that there was an association between inequality of income in industrialized countries and lower life expectancy. This certainly complements the issues raised by Wilson (1) and demonstrates that social and public health policy regarding gambling needs to be addressed at both micro and macro levels within society. References (1) Betting on harming both health and justice. BMJ Rapid Responses, November 4 (located at : http://bmj.com/cgi/eletters/329/7474/1055#83926) (2) Griffiths MD. betting your life on it. BMJ 2004;329 1055-1056 (3) McKee M, Sassi F. Gambling with the nation’s health. BMJ 1995 311: 521-522. Competing interests: None declared |
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Dr.Naseem A Qureshi MD, IMAPA, LMIPS, Director, CME&R POBox.2292, Buraidah Mental Health Hospital, KSA.
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Sir: The editorial by Mark Griffiths [1] is an another example of a close and inseparable relationship between politics and health. In a nut and shell, the deregulation of gambling in the UK would have very bad effects on psychological, social, spiritual, and economic health of people in general in long term. Notably, both winners and losers with their close partners will suffer tremendously. Many of them worldwide, though exact incidence of gambling is not known, are already suffering from diverse adverse consequences of problem/pathological gambling. It is wise to know that over a period of time unproblematic gambling most often leads to problem/pathological gambling. Most notably in certain societies and cultures say in Muslim culture, gamling is perceived as a very bad habit and vehemently discouraged and moreover according to Islamic precepts it is completely prohibited. It is a man made social evil. Indeed, the impact of cultural beliefs and prohibitions is extremely powerful and most likely this is one of the reasons that gamling is not a common problem among people who pursue Islamic traditions. Gambling is "haram" in Islam, which abhors it. In sum, the UK government must think twice before passing this gambling bill. Otherwise, what health providers en masse are doing is to try to prevent and treat medical consequences of highly ill political moves of todays and yesterdays politicians in this world. By all means, this world is fast moving to a dangerous end. Which are the nations and who are the politicians behind this detestable end is moot. Reference: 1. Mark Griffiths. Betting your life on it. BMJ 2004; 329: 1055-1056. Competing interests: None declared |
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Roger P. Horbay, President 99 Thomas Blvd., Elora, Ontario, Canada, N0B 1S0
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I agree with the arguments presented in the BMJ editorial by Griffiths. However, I would like to add a few observations that warrant further investigation and consideration as factors in gambling related harm and policy considerations. Griffiths stated that, "Pathological gambling is characterized by unrealistic optimism on the gambler's part", and "...they are determined that a big win will repay their loans and solve their problems”. But where do these distorted beliefs come from? My own research and explorations into how electronic gaming machines (EGMs) work has revealed that technological innovations in EGMs has resulted in misrepresentations of the true probabilities of winning, that would naturally result in many players perceiving that the odds of winning are better than they actually are. Additionally, through an over abundance of near-miss effects and jackpot symbols displayed on EGM outcome displays, many players naturally think that they're getting closer to hitting the elusive jackpot. Technological innovations, gambling normalization and promotions are enhancing or creating false optimism and distorted beliefs. Without controls and disclosure that EGMs create distortions and misrepresentations, I think it's reasonable to say that unrealistic optimism and beliefs by players that they'll win big soon, stem from their experience playing the machines and the increasing gambling promotions that enhance these distortions. Even if these two characteristics (unrealistic optimism and belief that a win is near) are pre-existing, they are reinforced when playing EGMs by the distortions produced by the machines' outcome sequences and outcome displays. These distortions are evolving and being enhanced even more by technological innovations. Players simply don't realize that what they see on outcome displays has absolutely nothing to do with the probabilities of winning. If characteristics of pathological gambling are stemming or enhanced by the gambling experience, than this is not only a public health issue but also a product safety issue that needs to be addressed with appropriate disclosure and warnings of specific distortions and misrepresentations. Presently, players are held responsible for making gambling (purchasing) decisions. But this may be unrealistic and unfair because they lack adequate information to make rational and informed-decisions, especially while playing EGMs. Since distortions can easily prohibit rational decision-making, which can lead to loss of control, ways of countering this must be devised or protective measure, such as time and loss controls, should be put in place. Respectfully, Roger p. Horbay, HSC References: Turner, N.E., & Horbay, R. (2003). Doubling revisited: The mathematical and psychological effect of betting strategy. Gambling Research, 15 (2), 16–34. Turner, N.E., & Horbay, R. (2004). How Slot Machines & Electronic Gaming Machines Actually Work. Journal of Gambling Issues (http://www.camh.net/egambling/issue11/jgi_11_turner_horbay.html). Competing interests: I'm a stakeholder in a company that develops innovative educational tools to prevent and mitigate gambling related harm. |
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Mark D Griffiths, Professor of Gambling Studies International Gaming Research Unit, Nottingham Trent University, Burton Street, Nottingham, NG1 4BU
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Horbay (1) is quite right to highlight the potential product safety concerns regarding gambling generally, and slot machines more specifically. In many of my writings over the years I have pointed out the role of structural characteristics of gambling and how these may influence gambling acquistion, development and maintenance (including the faciliatation of erroneous beliefs). Highly accessible, fast-action, continuous forms of gambling with high event frequencies (such as slot machines) tend to be the most addictive. However, there is no precise frequency level of a gambling game at which people become addicted since addiction will be an integrated mix of factors in which frequency is just one factor in the overall equation. Other factors and dimensions (external to the person themselves) (2) include : * stake size (e.g., including issues around affordability, perceived value for money) * event frequency (i.e., time gap between each gamble) * amount of money lost in a given time period (which is important in chasing) * prize structures (i.e., number and value of prizes) * probability of winning (e.g. 1 in 14 million on the lottery) * size of jackpot (e.g. over £1 million on some lottery products) * skill and pseudo-skill elements (whether actual or perceived) * "near miss" opportunities (i.e., the number of near winning situations) * light and colour effects (e.g., the use of red lights on slot machines) * sound effects (e.g., use of buzzers or musical tunes to indicate winning) * social or asocial nature of the game (i.e., whether gambling is an individual and/or group activity and how social faciliatation can play a role) * accessibility (e.g., opening times, membership rules, number of outlets etc.) * location of gambling establishment (e.g., out of town, next to workplace etc.) * type of gambling establishment (e.g., betting shop, amusement arcade etc.) * advertising (e.g. television commercials) * the rules of the game (i.e., are they simple or difficult) Each of these differences may (and almost certainly does) have implications for the gambler’s motivations and as a consequence the social impact of gambling. It is also the case that technological advance could influence almost every one of these characteristics. Further examination of structural characteristics demonstrates that for many of the categorisations (e.g. the near miss, light and colour effects, sound effects, skill levels etc.) it is difficult to separate the gambler's individual psychology from the situation. For instance, the success of a slot machine's structural characteristics (where success is defined as an increase in gambling due to the structural characteristic) depends upon the psycho-structural interaction. The importance of a structural characteristic approach to gambling is the possibility to pinpoint more accurately where an individual's psychological constitution is influencing gambling behaviour. Such an approach also allows for psychologically context specific explanations of gambling behaviour rather than global explanations such as "addictive personality". Although many of the gambling-inducing structural characteristics are dependent on individual psychological factors (e.g. reinforcement) they are a direct result of the structural characteristics and could not have influenced gambling behaviour independently. It is for this reason above all others that a structural approach could be potentially useful particularly in the area of product safety issues. References (1) Horbay R. Gambling technology out of control - product safety concerns. BMJ, 25 Nov 2004. (2) Griffiths MD. Gambling technologies : Prospects for problem gambling. Journal of Gambling Studies 1999; 15: 265-283. Competing interests: None declared |
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