Monday, 15 January 2024

The inanity of 'public health': gambling edition

The British Medical Journal has published another little rant about gambling from two academics of no fixed ability. It’s kind of fascinating watching the ‘public health’ racket try to get its grubby little hands on this issue. They clearly realise that there is money in it and they instinctively hate the activity, but they know nothing about it and can’t be bothered to learn.

The article is titled ‘How we can solve the crisis in UK gambling policy’ but it contains not a single policy proposal, nor even a description of the problem (sorry, ‘crisis’) that they are supposedly trying to solve. Normally, the authors of opinion pieces like this have a particular policy in mind - usually a ban of some sort - and they cite a bit of modelling or some other quack science that suggests the policy will work. They will editorialise a bit about how dreadful a particular industry is and how weak the government has been and how everyone is going to die of liver cirrhosis or heart disease by 2030 unless something is done, but the article will at least have a purpose.

This one is rather different. Insofar as it has a purpose, it is to solidify the idea that something must be done and that people in ‘public health’ should decide what that thing is at some point in the future. But it is completely devoid of ideas, contains no insight at all and simply copies and pastes rhetoric used in similar articles about other lifestyle issues, most obviously smoking. As such, it is modern ‘public health’ academia stripped down to its essence, a load of empty waffle and pompous clichés. 

The word ‘industry’ appears 24 times and it’s not a long article. That could be some kind of record. There is no acknowledgement that the gambling industry is really a group of competing industries (including, with the lottery, the British government) who produce very different products. To BMJ readers, the very word 'industry' has sinister connotations that grow stronger with repetition.  
 
The authors want a revolution in the way gambling is viewed, one which gives know-nothing 'public health' grifters the top seat at the table.

The Gambling Act 2005 was harmful from its inception. Designed to make the UK the centre of the online gambling industry [eh?! - CJS], it defined people, not products, as the problem, and required the regulator and local authorities to “aim to permit” gambling. A public health approach cannot be “bolted on” to legislation that is based on completely opposing logic. A public health approach requires a transformational shift.

 
And what would that look like in practice? The authors spend the next ten paragraphs not telling us, but it seems to involve giving 'public health' academics lots of money and burning the existing literature on gambling disorders.

Concerning gaps can be found in the evidence base around gambling, including a lack of research focusing on characterising the true nature, scale, and cost of harms to those affected and society. These lacunas, favourable to industry, are products of a system where, for decades, the industry has been the dominant funder. Research programmes are fragmented and much of the output continues to focus on individuals and not the industry. Until the silo of gambling research is breached, and academics are required to compete alongside other areas of public health for funding, it is likely that the same conditions will endure.

 
Notice how many bald assertions appear in that paragraph. We are told that "the true nature, scale, and cost of harms" associated with gambling have been deliberately overlooked. Even if that were the case, how would a better estimate help form better policy rather than help activists get publicity? They complain that "much of the output continues to focus on individuals and not the industry". What would be the optimal amount of research focusing on individuals? None? How would it help to focus research about a psychological condition on "the industry"?

The authors then lay out “four critical areas”. They have already mentioned three of them: how industry funding supposedly shapes gambling research, how problem gambling shouldn’t be seen as an issue of personal responsibility, and the alleged problems with industry-funded research (again). They do not provide any evidence that these are genuine problems and I would like to see them in a room with academics such as Mark Griffiths and Jonathan Parke who have been studying gambling for years (sometimes with industry grants) and see if they will tell them to their faces that they are corrupt - which, when you boil it down, is what they’re insinuating.

Finally…
 

Which brings us to our fourth and most important point. If, in the absence of industry derived funds, the NHS cannot afford to manage the burden of harm caused by the way we regulate gambling then the solution is not more funding, but a change to the regulations.

 
"Industry derived funds" refers to the forthcoming gambling levy which the real headbangers in 'public health' are theoretically opposed to because, as the BMJ authors see it, it "entrenches the dangerous idea that the industry can grow without limits, as long as it pays for the harm it causes". We shall see whether these reservations prevent them from taking money from the gambling levy pot when the time comes. 

The idea that the NHS cannot afford to manage the "burden of harm" related to gambling is nuts. Gambling isn't really a health issue at all and the wowsers have had to go to great lengths to present it as one.If everyone stopped gambling tomorrow, the impact on the NHS would be too small to measure.

But they claim not to want more funding. Instead they want "a change to the regulations". Very well. Which ones? What new regulations need to be introduced and why? Again, they don’t say. Instead they say...
 

It is extraordinary that we welcome industry funding for “problem gambling” clinics. Imagine if instead of adopting effective tobacco control policy, including measures to protect policymaking from industry influence, we had praised tobacco companies for funding cancer treatment services.

 
Everything comes back to tobacco with these people. They are incapable of seeing an issue through any other prism. But gambling is an activity not a substance. Problem gambling is a psychological disorder not a physical disease. The vast majority of gamblers do so enjoyably and without developing a problem. Even among problem gamblers, only a fraction get into serious money trouble and only a tiny fraction suffer ill health as an indirect result.
 
In any case, we do tax tobacco to pay for the negative externalities. 
 

If we, as health professionals and policymakers, fail to call for a new Act, and allow the current approach to gambling regulation to be preserved under the guise of “public health,” we are part of the problem, not the solution.

 
But you’re not really health professionals or policy-makers, are you? One of you is a social anthropologist and the other one writes identikit articles about alcohol/smoking/gambling/Brexit that read like they were written by ChatGPT (look at the state of this, for example).

It's difficult to know what else to say about an article that doesn't say anything. There have been a lot of these recently. On the odd occasion when the people who write them suggest some policies, the policies are preposterous and only confirm that they don't know what they're talking about.
 

We thank Mark Petticrew for his thoughtful and insightful feedback during the drafting of the opinion piece.

 
Imagine asking for input from Mark Petticrew and finding it insightful.
 
Apparently, the Lancet is publishing something about gambling soon. That should be a laugh. The authors have just had a two day workshop. I wonder when any of them last placed a bet?
 


Posted by Christopher Snowdon at 5:32 pm

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