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March 2003

Odds and Ends

The new governor of Maryland, Robert Ehrlich, was elected, in part, on a campaign promise to install thousands of slot machines at the state’s racetracks as a method of raising revenue. It turns out that two leading legislative opponents of the proposal know first-hand what the dangers are all about, having grown up with fathers addicted to gambling. So, the governor was asked by a reporter if he ever knew anyone with a serious gambling problem.

“I know people who have gotten into trouble with alcohol, and chocolate and gambling,” he said. “There’s a small percentage of society who cannot handle freedom.” The lieutenant governor, Michael Steele, snipped, “It’s a behavioral issue. Just like smoking. You wanna stop — you stop.”

If this is what they believe, then Ehrlich and Steele are in trouble themselves, victims of an addiction to arrogance and ignorance. Fifteen years ago, the Surgeon General reported that “nicotine is a drug that causes addiction.” An estimated 35 million Americans have tried and failed to quit smoking at least once. So it never really is as simple as “you wanna stop — you stop.”

It is actually dangerous to believe that people simply need to be told how to behave and they’ll comply — and that if they don’t they deserve to be sick. Regrettably, humans are not that receptive to direction. Most Americans, for example, are aware of the dangers of being sedentary and overweight, yet growing numbers are both. Many will not take a daily pill to keep their blood pressure under control.

Information about a potentially risky behavior, while necessary, is not usually sufficient to motivate people to change a life-long habit or even to induce them to maintain a short-term regimen. Even when armed with good information, people’s behavior is strongly influenced by where they live and work, how they were raised and educated and the choices available to them. Putting new casinos at existing race tracks in poor neighborhoods is not likely to help people prevent or overcome addictions.

Whatever the merits of slot machines in Maryland, the governor ought to realize that the downside is a lot more destructive than popping bon bons because for many people, gambling is an addiction, but without the drugs. For some policy makers, the addiction is easy money, but without the responsibility.

 
 
 

Essays on Good Behavior
2008

Decontructing the Kennedy Coverage - June 2008
Stuck Reading the Small Print - May 2008
Let Them Eat Cupcakes? - April 2008
My 81-Year Old Mom: Drug Safety Expert? - March 2008
A Paradox of Progress - February 2008
“Trust but Verify.” Verify? - January 2008
2007

Better Computer Use Could Enhance Health - December 2007
Expand Care to Treat Broad Patient Needs - November 2007
Science Message Muddled, Public Befuddled - October 2007
Health Reform May Require Outside Instigators - September 2007
Research in the Medical Marketplace - August 2007
No Free Lunch for Health Care Reform - July. 2007
So Many Choices, So Little Information! - June 2007
Improving Health, Climate Similarly Daunting Challenges - May 2007
Lessons and Cautions - April 2007
The Price of Patient Passivity - March 2007
Lipstick-On-A-Pig Health Reform- February 2007
Power,Politics and Performance - January 2007
2006

Quantifying People Particles- Dec. 2006
Great Expectations - Nov. 2006
November Solutions - Oct. 2006
Consequences of Terror Fatigue - Sept. 2006
Carrots and Two-by-Fours- August 2006
The Simple Life - July 2006
Visions of Riskless Solutions - June 2006
The Cure Is First, Then the Disease - May 2006
Give Me Ambiguity, or Something Else - April 2006
A New Vision of Aging - March 2006
Pedestrian Solution to Health Care - Feb. 2006
Daunting in the Dark - Jan. 2006
2005

Reframing the Suboptimal - Dec. 2005
Coming Home to Roost - Nov. 2005
No Killer Apps in Health Information - Oct. 2005
Homeland Security and Public Health - Sep. 2005
They Only Play One on TV - Aug. 2005
Suzy Spotless Takes on Obesity - July 2005
Obligations of Science and Society - June 2005
Caveat Viewer - May 2005
Putting Yourself First - April 2005
Risking the Social Contract - March 2005
Intelligence Quest - Feb. 2005
Political Science - Jan. 2005
2004

Renewing Old Values - Dec. 2004
Home Depot Health Care - Nov. 2004
Radicchio and Responsibility - Oct. 2004
What We Know and When We Know It - Sept. 2004
Evidence-Based Medicare: A Start- Aug. 2004
Leave No Scientist Behind - July 2004
FDA Gives Plan B an F - June 2004
Is Our People Healthy - May 2004
A Full Partnerhsip for the Future - April 2004
Demography Is Destiny - March 2004
Feeling Safe or Being Safe? - Feb. 2004
Prevention Deficit Disorder - Jan. 2004
2003

New Roles, New Spirits - Dec. 2003
La Dolce Vita - Nov. 2003
Pointing Fingers in the Dark - Oct. 2003
Keeping Fit for a Lifetime - Sept. 2003
You Get What They Pay For - Aug 2003
Good At-Bats - July 2003
Undermining Science - June 2003
SARS and the Free Market - May 2003
A Bold Commitment - April 2003
Odds and Ends - Mar. 2003
Neglected Questions - Feb. 2003
Ship Happens - Jan. 2003
2002

Inconvenient Information - Dec. 2002
Capturing the Value of Health Research - Nov. 2002
Whose Science is it, anway? - Oct. 2002
Grief: Our most prevalent condition - Oct. 2002
A Tale of Two Cities - Sept. 2002
The Opportunity of Cost of Time - Aug. 2002
Balancing the Research Portfolio - Jul. 2002
Point, Click, Heal - Jun. 2002
From Lab to Living Room - May 2002

The Zigzag Path to Truth - Apr. 2002

If it Weren't for the honor - Mar. 2002
No Magic Arrow - Feb. 2002
Media and Messages - Jan. 2002
2001

Persistant Prompting - Dec. 2001
The Winds of Spore - Nov. 2001
Eating Your Heart Out - Sept. 2001
A New Way to Purchase Health - Aug. 2001
These essays appeared in the Center's
newsletter and may be quoted with attribution.

All Essays written by:
Jessie C. Gruman, Ph.D.
President
Center for the Advancement of Health