Gambling industry link to Harvard draws questions
The Institute for Research on Pathological Gambling and Related Disorders is a unique part of Harvard Medical School: Virtually all its funding comes from the gambling industry.
Over the last four years, the institute has received nearly $5 million in industry funds, which its researchers have used to publish findings in reputable scientific journals suggesting that gambling and other addictions have common roots. But the data have also been used by the industry to help persuade state lawmakers around the country to approve gambling facilities, as well as promote a positive image for gambling.
The gambling industry often uses the Harvard research selectively to rebut charges that gambling is widely addictive and foments social problems, say industry opponents.
"They point to the Harvard research all the time," said the Rev. Tom Grey, a Methodist minister who heads the nonprofit National Coalition Against Legalized Gambling and travels frequently to lobby against gambling expansion. "It's a good investment. They're getting Harvard cheap at this point."
Harvard Medical School and gambling industry officials vigorously defend the arrangement, saying that the scientists involved face no restrictions or pressure, and that the research produced has already shed light on gambling addictions and may lead to treatments. Many independent scientists praise the research as scientifically sound.
But at a time of heightened scrutiny of corporate influence on science, the partnership places Harvard Medical School in a delicate position.
Harvard researchers, like those at most medical schools, receive money from pharmaceutical companies. But critics say the arrangement with the gambling industry is in a different class: Harvard Medical School and drug companies have a common interest in finding treatments, but the gambling industry's product -- wagering -- has nothing to do with healing patients. The Harvard institute's existence is entirely dependent on gambling industry support, with the money passed from casino companies to a gambling industry nonprofit organization, then on to Harvard. An industry-dominated board of directors governs the nonprofit. Critics say the arrangement leaves the Harvard institute vulnerable to subtle pressure from its funding source.
The institute's research effort has found links between gambling addiction and other addictions, raising the notion of an addictive personality, rooted in genetics, that puts people at risk. The effort is also beginning to examine using treatments for drug addicts on gambling addicts.
But critics say the institute's focus on gambling addiction is being used by the gambling industry to help reshape Americans' attitudes about gambling: that it is a fun, leisure-time activity with few, if any, negative consequences except for a small percentage of people with "pathological" addictions. These critics say that the Harvard effort largely ignores research into gambling's impact on communities and families. Moreover, they say the reseach is selectively used by the gambling industry to make its case before state legislatures.
Dr. Howard J. Shaffer, the Harvard institute's director, said its work was unbiased and driven only by the desire to help addicted gamblers. The research is careful and rigorous, and reviewed by independent scientists before publication, he said.
"Both opponents and proponents of gambling have used our work," said Shaffer. "I am, first and foremost, a scientist."
Harvard Medical School, which closely monitors the research, backed the partnership.
The medical school's Dr. Raphael Dolin, dean for academic and clinical programs, who oversees research ethics, wrote in an e-mail response to a Globe query: "The intent for the research is to examine serious medical and social issues related to gambling disorders."
In 1975, only Nevada had casinos. Now, 29 states do, with even more allowing horse and dog track betting and government-run lotteries. Last year, 30 states considered gambling legislation. Annual industry revenue increased increased from $34 billion in 1993 to $72 billion last year, making the industry more lucrative than professional sports or Hollywood.
Expansion requires political support -- gambling interests must persuade legislators and electorates to approve new casinos and other types of gambling. Voters in Oklahoma, Nebraska, California, Florida, Michigan, and Washington state will face gambling-related ballot questions next month.
And with the recent retirement of Massachusetts House speaker Thomas M. Finneran, a Mattapan Democrat and a gambling opponent, a dormant gambling debate on Beacon Hill may soon return to life.
In these political fights, debate often centers on the science, with studies and counterstudies on gambling's effects on individuals, communities, and economies pushed before legislatures.
Gambling companies and Native American tribes often use the research funded through Harvard to make their case. Gambling interests have wielded the research during legislative debates in Maryland, Rhode Island, Pennsylvania, Massachusetts and other states in recent years. And the Harvard research, or links to it, is prominently displayed on gambling company websites, as well as the site of the gambling industry's lobby, the American Gaming Association, which serves as the industry's clearinghouse for information disseminated to lawmakers, the media, and the public.
Last September, as debate on slot machine expansion unfolded in Maryland, chief gambling industry lobbyist Frank J. Fahrenkopf Jr., told lawmakers there that Harvard research indicated that 1.14 percent of adult Americans suffered from pathological gambling problems -- an uncontrollable addiction tantamount to a mental illness -- thus refuting the "exaggerated claims" of industry opponents, who have argued the number is higher.
Fahrenkopf said in an interview that the data flowing out of the Harvard institute was invaluable in battling the gambling industry's opponents.
"If I have to go on a television show and debate my good friend the Reverend Grey, and he says 20 percent of people are addicted, I can point out to him that Harvard Medical School says it's about 1 percent. Facts are stubborn things," he said.
However, Fahrenkopf did not tell the Maryland legislators that the gambling industry funded the work. He also failed to mention aspects of the study showing more widespread gambling problems.
The Harvard researchers analyzed dozens of previous studies on the prevalence of gambling addiction to reach an overall figure. But the industry typically omits the study's broader findings, including that almost 4 percent of adults had some degree of a gambling problem: The study found that, in addition to pathological gamblers, another 2.8 percent of adults were problem or "at-risk" gamblers, less addicted than pathological gamblers but likely to require clinical care at some point in their lives. Moreover, the study found that 20 percent of adolescents were pathological or at-risk gamblers and that the lifetime problem gambling rate among adults had doubled between 1977 and 1997.
Shaffer said he had no control over how the Harvard-funded research is used, while acknowledging that "gambling proponents tend to focus on the lower numbers."
The gambling industry's path to Harvard began on the Missouri River nearly a decade ago.
In the early 1990s, casino companies eagerly sought to open riverboat casinos in Kansas City, but city officials insisted, as a condition of granting licenses, that riverboat casino developers fund research into addictive gambling.
The American Gaming Association quickly decided to expand the research effort, seeing an opportunity to avoid the tobacco industry's mistake of denying its product was harmful, Fahrenkopf said. In 1996, the association started the industry-funded National Center for Responsible Gaming to fund research that would seek to pinpoint the most problematic gamblers and develop treatments. Fahrenkopf wanted a high-profile home for the effort.
"I kept coming back to Dr. Shaffer," he said, explaining that the Harvard professor's work was heavily cited in the small world of gambling addiction studies. Shaffer has a long background in drug addiction work, running Boston's methadone treatment program and all drug treatment at Cambridge Hospital for nearly two decades. He is a founder and current director of Harvard Medical School's Division on Addictions. In the last decade, he has branched out to study other addictions, most prominently gambling addiction.
Fahrenkopf asked Shaffer whether the industry's research effort could be based at Harvard. Harvard Medical School administrators approved the plan with the provisions that the gambling industry would not be allowed to review results of studies before publication and that scientists be allowed to publish any results. In 2000, the NCRG promised Harvard Medical School's Division on Addictions $2.4 million for two years of work.
The Harvard institute has kept about half the industry money for in-house research, distributing the rest in grants to researchers at other universities. Harvard renewed its contract with the NCRG for another two years in 2002 and recently signed a three-year deal expiring in 2007, maintaining the $1.2 million annual funding level. The contract is renewable at the discretion of the NCRG board, a 19-member panel the gambling industry touts as balanced between industry and non-industry people. However, four of 10 non-industry representatives have financial ties to the industry that are not disclosed in NCRG publications or federal tax forms, the Globe found.
The institute has its own board, all scientists, to set its agenda and oversee the research at Harvard and other universities where it decides to send money. Harvard Medical School's administration has reviewed the arrangement twice in the last four years, the last time in February.
"They found no evidence of concerns that the research was not of high quality or contained any bias," said Harvard Medical School spokesman Don Gibbons.
But Henry Lesieur, a clinical psychiatrist at Rhode Island Hospital's gambling treatment program who was on the NCRG board in its first year, said gambling researchers believed that the industry would not fund research that ran counter to its interests.
"The [NCRG] board of directors really decides what's going to be studied. And it's mostly controlled by people from the industry," he said.
Lesieur and another researcher, UCLA's Dr. Richard Rosenthal, resigned from the board three years ago after concluding that the gambling industry wielded too much influence over the research.
Lesieur and other critics of the Harvard institute listed a number of potential research topics they said the Harvard institute has not touched for fear of offending the gambling industry: Does proximity to a casino increase prevalence of problem gambling? Are slot machines particularly addictive? What happens to the families of compulsive gamblers? Some studies have been done by other researchers on these questions, but many specialists said none of the questions has been definitively answered.
"We can only fund what people apply for," said Shaffer. Any researcher in the United States and Canada can apply for grants from the Harvard institute. "We don't get many social-impact applications," he said.
However, the Harvard institute, in an announcement sent to scientists in 2002, indicated an interest in funding neurological and behavioral research. Shaffer said the next round of grants would contain more social impact and epidemiological studies.
Harvard scientists and officials said their research serves a social good: It may lead to treatments for gambling addiction. Shaffer explained that the institute's work has shown that the brains of gambling and drug addicts function similarly, raising the notion that drug addiction treatments could also help problem gamblers.
"While there is a genetic predisposition for addiction, the predisposition isn't specific," said Shaffer, explaining that there may be underlying physiological similarities among all types of addicts. Recent research led by the Harvard institute has raised the notion that gambling addiction, rather than being a unique phenomenon, arises from some underlying addictive personality, which Shaffer said "represents a paradigm shift."
Among the researchers funded by the Harvard institute is the University of Minnesota's Dr. S.W. Kim, who said his work showed the drug Revia, used to block habit-forming neurological pathways in alcohol and heroin addicts, might help problem gamblers.
"If it's a [pathological] gambler, I can stop them gambling in two weeks," said Kim. "I just give them the pills and they stop."
But Bob Breen, director of the Rhode Island Gambling Treatment Program in Providence, suggested a simpler way: "If you're not exposed to slot machines, you're not going to become addicted to them."
Boston University's Edward J. Federman, who got a $160,639 grant from the Harvard institute to study gambling habits in elderly people with mental impairments, said of the general thrust of the Harvard institute's research agenda: "Those are legitimate areas of research . . . but you could see why people would say that this kind of research gives ammunition to the industry."
Globe correspondent Zachary Lowe contributed to this story. Raja Mishra can be reached at rmishra@globe.com.
Correction: Because of reporting errors, this Page One story on Nov. 6, 2004, about a gambling addiction research institute at Harvard Medical School contained several errors. The story, quoting critics of the Harvard Institute for Research on Pathological Gambling and Related Disorders, said it had not studied whether proximity to casinos increases the prevalence of problem gambling, but the institute has done several studies that address this question. Also, the story wrongly described the profession of Henry Lesieur, a psychologist at Rhode Island Hospital, and incorrectly described a panel from which he and Dr. Richard Rosenthal of UCLA resigned, and the year they stepped down. They resigned in 1997 from an advisory board of the National Center for Responsible Gaming, not the organization's governing board.
