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Online sports betting has exploded over the past few years as 18 states have legalized it. Already a $70 Billion market, it’s projected to double in the next five years. But what does the rise of online sports betting mean for people with gambling disorder? We speak with Prof. Tim Fong, a gambling addiction expert, about the consequences of online sports betting–and how we can protect vulnerable people.

Transcript

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Dr. Abdul El Sayed: Owing to the BA-2 sub-variant of Omicron, COVID cases are yet again on the rise in Europe. The White House announces new leadership on its COVID-19 task force, but Congress still hasn’t funded critical COVID supplies. The Senate passed a bill to make daylight savings time permanent by unanimous consent. This is America Dissected. I’m your host, Dr. Abdul El-Sayed. Last week marked the tip-off of March Madness, and there is nothing like March Madness. The thrill of victory, agony of defeat, the Cinderella stories of teams that have no business in the big dance shining as they slay dragon after dragon. Mix metaphor? Yes. Appropriate? Absolutely. But this year, watching March Madness has been a little different. Make no mistake, my Michigan Wolverines are two and 0. Sweet 16, baby. But what makes watching, frankly, any sporting event different, be a basketball, football, baseball, because every single commercial break sounds like this:

[clip of ad] Sounds like you don’t want to just bet, you want to live your best life. Welcome to PointsBet. New customers get risk-free bets up to $2,000

Dr. Abdul El Sayed: Across the country, online sports betting has taken over the airwaves and the internet. Since 2018, 19 states, including my home state of Michigan, have legalized online sports betting, leading the emergence of online platforms like FanDuel, DraftKings, Barstool, MGM, and more. The accelerating rise of sportsbooks follows a 2018 Supreme Court decision, which struck down a 1992 law limiting sports betting to the state of Nevada. With states legalizing quickly thereafter, online sports betting has exploded. Already valued at nearly $70 billion, it’s expected to more than double in the next five years. The internet, like it does with just about everything, has put sports betting on steroids, making gambling available at any hour, any time, right from the ease of your pocket. But there’s a real cost to this. About 2% of Americans, more than seven million people, struggle with problem gambling. Addiction to gambling can cost them everything: their savings, their homes, their children’s college funds, their marriages, and even their lives.

[Male speaker] You know, gambling for some people is fun, and some people can do it normally. I’m not one of those people.

[interviewer] How much time a day did you spend on picking players?

[Male speaker] 80% my day was spent either researching or analyzing. I would listen to fantasy sports radio all day and have one earbud in my ear.

[interviewer] How much money did you lose?

[Male speaker] Close to $20,000?

Dr. Abdul El Sayed: Now it’s one thing when betting requires you to get in a car, go somewhere else, gamble your money. It’s another entirely when the casino is in your smartphone, when you can gamble that money away in seconds. And so the rise in online gambling has raised new questions about its risks and impacts on problem gambling across the country. Today, with America’s biggest month of sports betting in full swing, I want to dive into the risks, rise, and effects of online sports betting. I reached out to Dr. Timothy Fong of the UCLA Gambling Studies Program. He’s a psychiatrist specializing in gambling. He spent years treating and researching gambling addiction. He walked me through how the internet has led to an explosion of problem gambling, how governments have failed to prevent it, and what route, if any, he sees out of this. Our conversation after the break.

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Dr. Abdul El Sayed: All right, can you introduce yourself with the tape?

Dr. Timothy Fong: Yes. Hi! Good afternoon. My name is Dr. Timothy Fong. I’m a professor of psychiatry here at the UCLA David Geffen School of Medicine. I am the co-director of the UCLA Gambling Studies Program.

Dr. Abdul El Sayed, narrating: Dr. Fong is one of the leading gambling experts in the country, and chances are considering the massive increase in online sports betting, he’s going to have a lot of work ahead of him. I reached out because I wanted to understand problem gambling, both as a clinical issue and as a rising threat to the public’s health.

Dr. Abdul El Sayed: You have a really interesting academic background, you studied gambling as both a psychological and a health phenomenon. So I got to ask you, just very basic, why do humans gamble?

Dr. Timothy Fong: Why do humans breathe? Why do humans eat, why they sleep, why do they have sex? I mean, there are these natural, biological, and psychological drives to just improve our lives. Gambling, by its most simple definition, is putting something of value on an event of uncertain outcome in the hopes of obtaining a larger reward. So when you think about gambling, of course, you think about casinos and poker games and financial stocks, but from the caveman days, it’s things like Do I venture outside of my cave to try and get that animal, hunt them down? Gambling is, by definition, what we are as humans need to survive in order to advance as a race—for risk, for reward, for inventions, for just creativity and making things better in our lives. So it’s really just a fundamental part of decision making and how we view the world.

Dr. Abdul El Sayed: But it’s interesting, right? Because I think some of the risk-taking that we have, to we have to do in terms of being willing to put our bodies or our time even at risk to achieve the things that we need to survive and prosper, that seems like a bit of a different thing than the risks that large corporations have been able to entice us to take increasingly. And it feels like there is a way that they’ve sort of gamed that system. Am I wrong on that or are we just talking about differences in scale?

Dr. Timothy Fong: No, I think, I think you’re on to something because again, when we think about gambling in the modern day definition, we’re really thinking about games, we’re thinking about entertainment, we’re thinking about trying to tickle our dopamine systems, not because we have to, but because we want to. And I think that’s really the major difference. I think one of the things we focus on in treatment is not telling people to stop gambling. No, I want people to take risks. I want people to learn how to deal with loss. I want people to take chances on their lives. We want people to improve their lives by getting, you know, more reward. I think what we’re talking about that’s different is that industry or corporations or however you want to describe them—organized people, it could be criminal elements, you know, like mobs, it could be again, industry and gaming industry—they recognized for dozens, hundreds of years, that the human brain will respond to games of chance, to certain situations where they can try and win more reward, and I think that’s really what we’re at right now. So oftentimes I get this question a lot. Well, what do you think of gambling industry? Are they no different than, say, pharma, you know Big Pharma. Are they like corporate greedy? I’m like, No, you know, they’re a business, and their intent is to make money and they figured out how to tap into the human brain and human psychology to create demand for their services, which in this case are new forms of gambling and new forms of games.

Dr. Abdul El Sayed: So it’s like we’ve hit on this differential in terms of the dopamine hit that our brains evolutionarily have been wired to create so that we’re willing to take chances for gain that will sustain and perpetuate us, versus the dopamine hit that we take as a form of entertainment just like we get a dopamine hit from any, you know, any sort of chemical drug or the pursuit of sexual entertainment, et cetera. And I guess the question I have is that, is there any difference in the demographic of people? Is there a higher probability of the kind of gambling as entertainment in certain groups versus others? Is this something that’s more common in some communities versus others?

Dr. Timothy Fong: You know, it’s a really great question and here’s the way I think about it. You know, gambling from a pure biological standpoint, you know, every single human on Earth is wired very similarly to experience the same sort of thrill and action when they get a reward that they get without working for it. Benjamin Franklin said very clearly, The only thing sweeter than money earned is money won. So it’s just a natural reflex. When you win something or when you get something for free, you’re going to just get an explosion of dopamine that feels good. Combine that, though, with various cultures and ethnicities that promote, accept, or accelerate gambling activities, and that’s where you start to get some differences. For instance, we did a lot of work looking at Asian American cultures, particularly Chinese, Filipino, Southeast Asian, Vietnamese cultures that for the last 200 years in America, that those cultures perpetuate gambling. They have an acceptance, they have almost an expectation that as a person growing up in that culture that you will be gambling. They have various themes and holidays all celebrated in gambling, and that all leads to higher gambling participation rates. It leads to more gambling inside the various communities and things like that. Take out your culture. You mentioned you’re Muslim. You know, again, very different. Are there are certain Muslim communities who have more gambling? Or are there other Muslim communities that absolutely forbid it and you see that happening in a very rare basis? So absolutely community drives a lot of the certain values, which drives essentially the acceptance of gambling or the turning away from gambling, if you will, depending on your culture and heritage.

Dr. Abdul El Sayed: You know, we often in our society, there’s sort of a stereotype that that younger men tend to be the most likely to be willing to take risk. Do you see a higher probability of participating in gambling among younger men in America?

Dr. Timothy Fong: When I first started doing this work back in the early 2000s, it was about 80% and men to 20% women that were not only participating in gambling but also were coming into treatment for gambling disorder. Over the last 15, 20 years, we’ve seen more women come to treatment. We’ve seen more women gambling in casinos and gambling recreationally. And now in the last couple of years with sports betting, you see a lot more women talking about sports and betting on sports. That has a spillover effect where again, we do see more women gambling. We do still see more women participate in gambling, but ultimately it’s still a very predominantly male field in terms of who is gambling and who’s coming to treatment for gambling addiction. Some have argued, Well, you know, that’s this biological difference between men and women. Others argue, No, it’s completely cultural, it’s just the way we marketed gambling. But again, I think it’s a little bit of both. I mean, there’s no doubt that gambling on sports in particular is a very, at this point still, male-dominated and male-oriented activity. But again, it’s shrinking. It’s starting to get more females are involved. In my mind, it isn’t so much based on gender who is vulnerable to develop gambling addiction, it’s based on early onset of gambling. It’s based on whether or not you have untreated psychiatric conditions, things like trauma and depression. It’s also based on your own ability to handle stress and emotional coping. So in that respect, all genders are at risk but more than likely right now what we do see is definitely more men than women gambling.

Dr. Abdul El Sayed: It’s a fascinating thing, right, because for some people, you get a momentary hit of dopamine. It’s an excitement and then you move on. And for others, the experience of gambling, that dopamine hit becomes an addiction. What do we know about the neuroscience behind gambling addiction? How common is it, and are there some correlates that that we can think about to help us understand who is most likely to be vulnerable?

Dr. Timothy Fong: There are. It’s really interesting. So you think about gambling addiction, or as we call it now, gambling disorder, it’s considered an addictive disorder, just like tobacco, alcohol, cannabis use disorders. So that means it’s the exact same genetics, the same biology that’s impacted. So when you think about the biology of addiction, well, what’s different? You know, how are you born different? You’re born with a different predisposition for dopamine receptors. You also have more efficient dopamine release when you’re exposed to the stimuli or the substance. With gambling, we know that that’s true. We know that there’s no, you know, substance that’s been ingested that changes the brain functioning, right? So it has to be all kind of what you’re born with. And we see that with a lot of gamblers that, and from the very beginning, from the first time that they gamble, they respond to it differently, right? Much more intense. Much more a Wow! Much more inside the brain, you know, more dopamine being released than someone without a gambling disorder or more efficient dopamine receptor. Or even actually less efficient dopamine receptors. So it gets confusing. It’s not just a simple story, are they’re too much or too little, but I call it, it’s just different. And I’ve gone away from calling men and women with gambling disorder damaged or dysregulated, because that doesn’t help anybody. They’re just built, they’re built literally differently, biologically so that when they get exposed to gambling at a young age, their bodies and their brains react differently than people without gambling disorder. Now, some people argue, Well, if you don’t have the biological genetic differences, can you develop a gambling addiction by just purely doing it over and over and over and over? The answer to that is yes. And why do we know that is because you think about any gambling experience, right? It’s stressful, there’s adrenaline, there’s anticipation, there’s excitement. There’s all these neurochemical that your body’s generating, right, fight or flight. And if you live in that state for two weeks, four weeks, six weeks, eight weeks, three months, six months, your body’s going to make adaptations. It’s like literally being, you know, at a frontlines of battle every day. Then over time, that’s when the body changes, and that’s when things like tolerance start to develop. That’s when things like withdrawal from gambling start to develop. So we know that. Unfortunately, what we don’t have, you know, any biological test. You know, blood test or brain scans that we can use to diagnose men and women gambling disorder. We just base it off psychiatric history, family history, and experience that they talk about. And when patients tell me, you know what Doc, the very first time I went gambling, I felt normal or I felt alive, or I felt in ways I never thought I could feel—that tells me their body, their brain is built differently. Because I remember the very first time I went to go gambling and I’m like, Yeah, this is fun but you know what, it’s not, it’s not as fun as some other things in my life. And I think that highlights some of the biological differences that folks with disorder, gambling disorder have

Dr. Abdul El Sayed: And what proportion of people who gamble will develop a disorder?

Dr. Timothy Fong: Well, we know that about 1% of the population walking around America right now have an active gambling disorder. So that’s one out of 100. When you actually look at out of all the people gambling, it’s about 60% of the population gambles. So you actually want to do the math, it’s going to be somewhere between whatever, 4 – 10% of people who gamble on a regular basis will have a gambling disorder. So you might say, Wow, that’s not that many, I mean, the vast majority of people who gamble regularly don’t develop problems. That’s true. But again, it’s also true for alcohol and tobacco. The vast majority of people who drink don’t develop alcohol use disorder but that percentage, that 1% of the general population with gambling disorder, is a very, very big number. Take California, you know, 35 million people, 40 million people, that means close to, you know, almost three million people are really struggling with gambling addiction. You know, your state of Michigan again, whatever, it’s 20 million people, it’s a lot of lives. And it’s similar to the same rate for bipolar disorder and schizophrenia. So, you know, we’re talking about some really, really big numbers. And the difficulty with gambling addiction is that when you have it, you don’t know it. You’re in denial. You say, I don’t have a gambling problem, I have a money problem, or a problem with luck, or I have a problem because my spouse doesn’t let me out, she’s too controlling. And you don’t realize that the reason you have gambling, or a problem in your life is because of a gambling disorder, not because of something else. And I think that shame, that denial, that’s stigma—all that contributes to people not recognizing that they have a disease. I think of it, you know, high hypertension is a silent killer. You know, gambling in that way is, oftentimes think of as a silent addiction. You can’t see it, you can’t smell it but you sure as heck can feel the consequences. And making those connections are very important.

Dr. Abdul El Sayed: And one of the correlates that you highlighted was early gambling, right? Early gambling was a predictor of gambling disorder. And I would imagine early gambling is a function of access to gambling. When gambling is an easy thing to do and it’s readily available, the probability that you’re going to gamble early is higher, ergo the probability of gambling disorder is higher. And I want to move into the sort of brave new world that we’re in now when it comes to gambling, the sort of entry of the internet into the gambling space and the capacity to gamble from anywhere, anytime on a smartphone. How has online gambling changed the gambling ecosystem, and what has it meant for people who live with gambling disorder?

Dr. Timothy Fong: We’ve had online or internet gambling since the late ’90s. So it’s been there. But what we really have over the last, I’d call it, three years is now mobile gambling at a very high level of sophistication on our phones. So we’re talking about rapid internet speeds and access to complex betting programs and software that are very, very, you know, intense. It doesn’t take much. So what we’re seeing right now is that we’re starting to see more people come into treatment at a younger age, meaning it’s taking them less time to develop a gambling addiction than before. Whereas, you know, 15 years ago, it might take a couple of years, seven to eight years to develop a gambling disorder. Now we’re seeing it happening within a matter of a few months or even within a year. It just makes sense, you know, when you have a tool in your hand to access the very behavior that is potentially addicting 24-hours a day with no limits, that’s when you develop problems. It isn’t just the rise in technology, but it’s the rise in fast and available capital. So I saw a patient this week who described it so well. She’s like, I don’t go to the casino, I’m not going to waste my time driving a casino, I just gamble exclusively on my on my phone and when I run out of money and I run out of credit cards, I get online payday loans. She was able to get $3,000 in one evening at home by three different online payday loan vendors. So imagine growing up in the ’80s or ’90s, if I wanted to get $500 from the bank, it’s going to take eight weeks, right? So she described that combo that I think is most alarming, which is easy access to gambling combined with easy access to money. That’s how you get that combination of potential rise in addiction for folks who never would have been exposed to this kind of addiction risk before, because 15 years ago, they didn’t have easy access to casinos, they didn’t have easy access to money. So that’s probably the biggest concern that we have right now.

Dr. Abdul El Sayed, narrating: We’ll be back for more with Dr. Tim Fong after this break.

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Dr. Abdul El Sayed, narrating: And we’re back with more of my conversation with Dr. Tim Fong.

Dr. Abdul El Sayed: What you’re describing, really, is a payday loan industry and an online gambling industry that have combined in a one-two punch to exploit really vulnerable people with gambling disorder. What has been the upside for families, right? Because the challenge of gambling disorder is that it wreaks financial havoc on people and their families. Have we seen the consequences of gambling disorder on the financial, on the financial well-being of folks? Has that gotten worse with the advent of online facilitated gambling?

Dr. Timothy Fong: For sure. And you know, here in California, we have a statewide gambling treatment program and we treat gamblers and we also treat the affected individual, meaning family members, friends, whoever’s life been impacted by someone else’s gambling. And our affected individuals, they talk about, you know, depression, anxiety, drinking excessively, suicidal thoughts because it’s so difficult to live with a gambler because of the financial strain. The average amount of debt that our gamblers have at the time they come into treatment is about $20,000 but their average income is about $45,000. So you accelerate that across thousands of households, and you see, that’s why it keeps up so much financial stress for people, why it’s so, so difficult. And there’s no doubt that the financial consequences are one of the greatest harmful consequences of gambling disorder. And you’re absolutely right, when you have—and again, the financial industry, they’re not always in partnership with the gambling industry, but they’re there. So I think, I oftentimes think about this a lot, when we made it so easy for men and women to gamble and to get free capital, but we made it so hard for people to access health care or therapy or healthier connections. And I think that’s where you know, things have just been so backwards, so backwards.

Dr. Abdul El Sayed: So what you’re describing really is a blast radius of mental illness that arises from this singular disorder and the ways that a couple of very large industries have been able to exploit it. I want to, I want to ask, how has treatment for this illness, how has that changed in the era of online sports betting? I mean, are you seeing more patients? Is it harder to treat simply because it’s so much easier for folks to access that very thing that they’re addicted to? How do you think about treatment?

Dr. Timothy Fong: So here’s, here’s the state: in 2000 and, the year where we’re recording this, 2020, for treatment for gambling disorder, we know very simply that professional treatment works. We don’t have FDA-approved medications, but we do have some medications are effective. But good, old fashioned, evidence-based psychotherapy, group support through Gamblers Anonymous really work. And we know that in our treatment program, about 40% of gamblers that come into treatment do very, very well and stop gambling a year later. So we know it works. The hard part is getting people to come to treatment. And despite the rise in online gambling, mobile sports betting, and all the attention paid to gambling, calls to the helpline, calls to the gambling help lines across the nation are down. That’s also, we know people don’t like calling helplines. We know most people are searching online for help so we know that online searches are probably up. But online responses to gambling problems, I think, are not as robust as it could be. So, you know, when you get people into treatment, treatment works. Increasing treatment demand again, is very tough. You know, think about a lot of the gamblers that we work with, when we say, What got you to come into treatment? And they’re like, Oh, my life had fallen down to the point where I was going to, they’re going to kill myself or kill someone else, or I had to come in and treat me because my wife was going to leave me or my husband was going to leave me. So by the time people entered treatment, we’re talking really severe gambling disorder. You know, to borrow the language of other medical fields, it’s metastatic. It’s spread throughout not only their lives, their family lives, but the lives around them and their own community. So how do we, as a health care profession, get people who are experiencing gambling problems at an early stage into treatment? That’s the million dollar question that we’ve been trying to figure out, and it’s not easy. It is not easy to get anyone with any sort of addictive disorder to come in during their early, first one or two months of their addiction. I think that’s a very difficult. Same thing with cancer. How do we get people with colon cancer who experience no symptoms, how do we get them into treatment sooner? Always goes back to screening and education, right?

Dr. Abdul El Sayed: Yeah. What proportion of overall gambling volume is attributable to people with gambling disorder? Do we know that answer?

Dr. Timothy Fong: You know, I’ve heard that question asked for years, and sometimes I’ve heard up to 60% of the revenue generated by a gambling industry is generated by men and women with a gambling disorder. But I’ve also heard numbers as low as 10%. I mean, no one really knows because, you know, the gambling industry, they have those figures, but they really don’t know who is disordered and who’s not. And for us, I can just tell you that the patients that I see, you know, it’s enormous amounts of money. Probably the largest I’ve seen is a guy who spent like $30 million a year—30 million a year!—at casinos, and it had a tremendous impact on him financially. And that got to affect someone’s bottom line somewhere. So I think it goes to this larger percentage. Same thing you think about tobacco and alcohol, what percentage of those industries are supported by people with active addictive disorders to those substances? What about the caffeine industry? What about the sugar industry? So it goes back around and round. I think the emphasis should be more on what is the gambling industry doing to put out a product that’s as safe as possible to minimize harm? And what are we doing as a public, as a legislator to do that? I think that’s where it’s different, where you see gambling revenue oftentimes advertised by states as, It’s good for the kids, this is for homelessness, this is good for our state so we don’t have to raise taxes. And I’ve always had a problem with that because it’s like, you know, you’re trying to appeal to people’s good senses that mitigate a sense of guilt, but at the same time, you’re kind of getting people to pay money on a behavior and not really educating that you know, there is this element that for about 1% of folks are going to develop this addiction.

Dr. Abdul El Sayed: I mean, that is the, that is really the essence of what it comes down to because the hard part is that oftentimes some of these industries that have a cost on the public’s health, they’re often excused because they plug a certain hole in a budget, in large part because we’re unwilling to actually plug those holes in budgets by, you know, asking rich people to pay their fair share. But that’s, that’s another issue. But when it comes to the gambling industry, I mean, there is a real public health question here of what will it take, what would it take for us to recognize the fact that the gains of this industry come on the backs of the financial ruins of families and people because of the advent of this disorder and they’re exploiting a disease? What, have you seen efforts to try and curb the consequences of particularly online sports betting that have been effective?

Dr. Timothy Fong: I, yes and no. I mean, we definitely know what works, and what works is prevention, education and building up treatment systems to identify and treat people who need help. I think with the online sports betting, here’s a perfect example, we have 30 states right now that have legalized some form of sports betting. Some of those states have put more money back into prevention of gambling addiction, treatment, early intervention. Other states have not. Some states have said, Well, we’re going to do mobile sports betting and allow you to open up an account in your home and never leave your home. Others have said, No, no, no, no, we’re only going to allow brick and mortar sports betting in casinos. So every state’s got a little bit of a different story, but I think there’s no doubt that we have to look at what does it mean when you open up a new form of addictive behavior that generates revenue in your state? And what does it mean if you don’t reinvest into the community to make sure that that damage is mitigated? And I think that’s a perfect example of that would be New York, where in January 2022, when they opened up online sports betting, mobile sports betting in New York, in the first month, I think it was something like $1,8 billion was wagered with a net tax gain of something like 700 million or $770 million in tax revenue just for that one month. And so the real question is again is what are they going to do with that tax revenue? Are they going to fill potholes? Are they going to backfill pensions? Are they going to, you know, put money into treatment programs for those people who developed a gambling disorder in the month of January 2022 when you went live, you know? And that answer is, we don’t know. So the terms I like to use are “science-based legislation” and those sound really nice, but it’s true. It really is, wait a minute. If we’re going to expand mobile sports betting or any type of sports betting in the various states, we have to acknowledge and accept that they’re going to be a human cost to that. And if we’re going to allow that, how do we mitigate and reduce that human cost? And I think that’s the part. I think most states now are accepting that gambling addiction is a legitimate condition, and they recognize when you expand gambling, there’s going to be this. That wasn’t the case 20 years ago, where oftentimes people would expand gambling and give no money to gambling addiction prevention and treatment, saying, Oh, it’s not a real disease, it’s just a matter of willpower, or it’s just an excuse that people lose too much. That’s changed. We’re thankful for that. What we don’t know is what is the actual amount that we need to invest to make it still a positive net gain for the state? In other words, when you increase revenue from gambling and you have jobs and economy and demand and all that, the goal is that hopefully with this revenue will make the general quality of life of our state better. That’s where the debate comes in. Some anti-gambling expansion activists will say, Look, gambling is not a zero-sum game, it’s a negative-sum game. It causes more damage. As an example, have you ever thought about gambling and its impact on the environment? And people would argue, What are you talking about, there’s no, how could that impact the environment? Well, in many, many ways, you know, if you open up a casino, there’s a tremendous environment impact: traffic, energy, all that cost. Even mobile sports betting, you know, the energy it takes just to run those companies, the energy it takes to invest the money and all of that, the electricity use, all of that are environmental impacts. Some have argued, Well, why do we even have gambling at all? Why do we have tobacco? Why do we have alcohol? We don’t need tobacco and alcohol to survive as a species but we have it. I think it goes back to again, these are industries and behaviors that are ingrained in our, in our DNA that are not going to go away. So even if you ban gambling, it’ll still occur in the underground, unregulated space.

Dr. Abdul El Sayed: Yeah. And I think you make a really important point around the consequences of prohibition. The worry and is one that you’ve well-articulated, is what happens now when the state is beholden to these industries to plug a particular deficit that it incurs, and now its hand is in the pot too. And that may prevent it from being able to engage from a political economy perspective with the real costs that it imposes on the people who pay so deeply into the system. I mean, if that number that you mentioned, that 60% number is true, that means that 60% of the state tax money that is coming from the gambling industry is coming on the backs of people who are problematically gambling, i.e. coming on the backs of a bunch of folks who, because of their financial ruin, are now going to be more beholden to the state in the first place. And so it becomes a bit of a circular problem.

Dr. Timothy Fong: Yeah. It is, and it goes back again and again to that moral question that if you’re a governor and you say, Am I comfortable with generating two or $300 million dollars by whatever percent that have an addiction? That’s ultimately what we’re talking about. And I think that’s a very tough question. I think the lottery is another perfect example. It’s been around 40 years. You know, we know that it’s a disproportionate tax on lower socioeconomic classes. It’s a disproportionate tax on people who struggle with basic math, but it disproportionately affects lower socioeconomic communities. And we also have more lottery retailers in the poorest communities in almost every state in America. So it’s the same regressive targeting of communities of color and underserved and lower socioeconomic class. But the question is, is it chicken or the egg? Is it that they drive down and create poverty, or is it that poverty is sustained because the industry targets them deliberately? You know, and that’s beyond my scope as an addiction psychiatrist. My hope is that we, the legislators that hear this and the policymakers that hear this say, You know what? Yeah, we recognize that people are going to develop addiction from this, and it’s our duty, along with the industry’s duty to help those people not develop as severe a problem as possible, and to give them easy access to help should they want to get it. That’s the most important thing, and I think that’s so hard that gambling addiction, by definition, again, people don’t seek help until much later. The gambling helpline ads, they’re everywhere. You know, they’re in the casino, they’re in the back of our lottery tickets. They should be on our mobile sporting betting apps, pop ups all the time. The real question, ow do you get people to log on and recognize, Wait a minute, I need to stop this before I lose too much money? That’s a question even science has not been able to answer yet.

Dr. Abdul El Sayed: Well, on that note, Dr. Tim Fong, we appreciate you being on the right side of this conversation and being available both to share your expertise on gambling disorder, and for the work that you do in your community. We really appreciate your time.

Dr. Timothy Fong: Thank you. Really appreciate it. Well, one last shout out for anyone who’s concerned or just questioning about their own gambling behavior, call 1-800-gambler. That’s a national helpline that works. Or 1-800-522-4700 is another national helpline for gambling.

Dr. Abdul El Sayed: Thank you so much.

Dr. Abdul El Sayed, narrating: As usual, here’s what I’m watching right now. Cases are going up again in countries across Europe, including the U.K., Germany, the Netherlands, and Italy. This bump in cases is attributable to the BA-2 sub-variant of Omicron, which studies have shown is up to 80% more transmissible than BA-1, which caused the record-setting spike in cases across the U.S. a few months back. Why are cases going up? Well, it’s some combination of the transmissibility of BA-2, waning immunity, and the rollback of COVID precautions like vaccine verification and masking. Here’s the thing, the rise in Europe, it could spell trouble back home because throughout this pandemic, Europe has been about two to four weeks ahead of us. Data from the CDC show that some communities have seen a 1000% increase in SARS-CoV-2 in their wastewater, an early sign that cases may be on the upswing. Meanwhile, the proportion of cases attributable to BA-2 has nearly doubled in the U.S. from 14% last week to 26% this week. That said, overall COVID cases are still headed downwards. It’s not yet clear that we’re definitely going to see a bump in cases here in the U.S., but we’re certainly vulnerable. That same combo—BA-2, receding COVID precautions, waning immunity—it’s happening here, too. The whole argument behind declaring the pandemic over was that we should learn to live with the pandemic. It was that we knew how to keep cases low: a combination of available testing, masking where we needed it, and treatment. The problem, though, is that Congress still hasn’t funded the $30 billion the White House originally requested to be able to do just that. While the White House has since whittled their requests down to 22 1/2 million, the congressional GOP continues to balk at any COVID funding at all. For their part, the White House has announced a change in the guard at the COVID 19 task force. Dr. Ashish Jha, Dean of the Brown University School of Public Health and former guest on the show, will be leading the task force after April. Dr. Jha led a global health center at Harvard prior to the pandemic. His appointment signals that the White House is moving toward a more long-term approach to COVID management, which we should all hope, focuses on global equity and prevention. You all remember last week’s episode. It was all about the health hazards of daylight savings. It dropped on Tuesday. And you know what else happened that day?

[voice clip] The Senate unanimously passed a bill that would make Daylight Savings Time permanent. It’s not law yet, but suddenly there’s growing momentum.

Dr. Abdul El Sayed: Coincidence? You decide. If the Senate had to pass a bill to decide on whether to tie shoes, it’d spend months in a committee, only to fail because some senators took money from the Velcro lobby. For the Senate to pass unanimously, well, it was a fluke owing to a few senators, including Senator Tom Cotton, not registering that it was even on the floor. The bill now proceeds to the House. While I love the fact that if the bill passes, we won’t have to move our clocks forward or back, I don’t love the fact that it’s permanent daylight savings time rather than Standard Time. That means that in some parts of the country, like the Upper Peninsula of Michigan, for example, the sun won’t come up until 10 am. Can you imagine being in high school by 7:30 and knowing that the sun doesn’t even have to wake up until you’re out of second period? But seriously, beyond messing with our circadian rhythms, it also poses some serious safety risks. In the winter, kids will have to wait outside and what is effectively pitch dark for the bus. And that’s basically the reason we bailed on permanent daylight savings time last time we passed it in the ’70s. What’s that quote about history? Those who don’t read it, are doomed to repeat it. Well, here we are.

That’s all for today. On your way out, I want you to do me a favor. Can you rate and review the show? It really does help. Also, if you love the show in one rep us, drop by the Crooked store for some American Dissected merch. We’ve got our logo mugs and t-shirts, our Science Always Wins t-shirts, sweatshirts, and dad caps, and our Safe and Effective tees, which are on sale for $10 off while supplies last. America Dissected is a product of Crooked Media. Our producer is Austin Fisher. Our associate producer is Olivier Martinez. Veronica Simonetti mixes and masters the show. Production support from Tara Terpstra, Lyra Smith, and Ari Schwartz. Our theme song is by Taka Yasuzawa and Alex Sugiura. Our executive producers are Sarah Geismer, Sandy Girard, Michael Martinez and me, Dr. Abdul El-Sayed, your host. Thanks for listening.