Betting your life on it
BMJ 2004; 329 doi: https://doi.org/10.1136/bmj.329.7474.1055 (Published 04 November 2004) Cite this as: BMJ 2004;329:1055All rapid responses
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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.
Competing interests: No competing interests
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
Competing interests: No competing interests
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
Competing interests: No competing interests
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
Competing interests: No competing interests
Product safety concerns in gambling : The role of technology
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
Competing interests: No competing interests