Opinion: Prediction markets are betting against public health

Gambling has long regarded as a vice: dangerous, addictiveand deliberately stand out from everyday life. Casinos are zoned away from schools. Sportsbooks display warnings. The risk is recognized, even when gambling laws and restrictions are lacking.

But what happens when gambling is repackaged under the guise of asset trading and made accessible on a daily basis? Prediction market platforms like Kalshi, Polymarket and Manifold are betting that Americans won’t notice the difference.

These platforms allow users to buy what they call “stocks” or “contracts” to trade based on real-world outcomes, including elections, inflation reports, court rulings and geopolitical events. These platforms are presented as prediction tools and not gambling. They look more like spreadsheets than slot machines. Users do not bet. trade. Probabilities are reframed as probabilities. Risk becomes insight.

This shift is not subtle. In late 2025, CNN announced a partnership with Kalshi incorporating forecast-market probabilities into its coverage. The real money chances have begun appears along with reliable journalism.

After the US Supreme Court struck down the federal ban on sports betting in 2018, legal betting expanded rapidly. Today, about 22 percent of Americans and 48 percent of men ages 18 to 49 report having at least one online sports betting account, according to a poll 2025 from the Siena Research Institute and the University of St. Bonaventure. Most states now allow it sports betting in some form, and about 30 allow online betting.

THE National Council on Problem Gambling estimates that approximately 2.5 million US adults have serious gambling and substance use problems in 2024 overview found that nearly 20 million reported indicators of problem gambling behavior in the past year. The 2025 poll found that among gamblers, 52 percent reported loss chasing (continuing to bet in an attempt to win back money they had already lost), 20 percent said they lost money they couldn’t afford to lose, and only 9 percent had sought help.

The cultural script for gambling damage still has a familiar aesthetic: a casino floor, a sports betting booth, an apocalyptic despair. Prediction markets disrupt this image by making gambling feel mental.

Timothy Fong, an addiction psychiatrist and professor of psychiatry at the University of California, Los Angeles, who has studied gambling disorder for more than two decades, argues that this reframing hides the real danger. “You don’t have to consume your body for it to have a tremendous effect on your body, your brain, your mind, your spirit and your wallet,” she told me. The harm from gambling, he stressed, is not only financial. It extends to physical health, mental health, family stability and public health.

In behavioral psychology, one of the strongest drivers of risky behavior is the belief that ability or intelligence can control uncertainty. In gambling disorders, this is often called the illusion of control. Market forecasting applications lean towards this. Their design encourages users to feel not impulsive but informed, as if the right podcast episode, chart, or probability can turn luck into dominance.

When trusted institutions—particularly the mainstream media—reinforce this framework, the guardrails fall further. As Fong put it, “When you normalize an activity and promote it to CNN with partnerships, what are you doing? You’re reducing the perception of harm.” And, he added, when you “reduce the perception of harm, then that increases the likelihood of engagement.”

This change matters most to the people who are most likely to be affected. In Fong’s view, normalization doesn’t just expand the market for gambling. It changes who enters it first, particularly young people aged 16 to 24 and those with mental health problems, substance use disorders or financial vulnerability.

From a neurobiological point of view, the mechanism is known. Gambling activates the brain’s reward circuitry. Dopamine increases not only when one wins, but when one anticipates a win. Uncertainty itself becomes reinforcing. Mobile platforms intensify the cycle through real-time updates on ever-changing odds and push notifications that keep attention locked in an alert state.

This chronic activation takes its toll. Stress and reward pathways remain active, disrupting sleep, increasing cortisol, exacerbating anxiety and reducing concentration. Over time, compulsive commitment deepens depression and erodes impulse control, using the same neurological scaffolding that sustains other addictions.

Clinically, patients who struggle with prediction markets are no different from those impaired by traditional gambling, Fong said. The pattern is the same: escalating losses, secrecy, shame, loss-chasing, relapse, and the defining characteristic of addiction — wanting to stop and not being able to.

What makes prediction markets uniquely disturbing is not only how they operate, but also what they ask users to bet on. Platforms collectively turn real-life events such as elections, wars, public health crises and economic downturns into tradable assets. These results are emotionally charged and morally complex. When personal finances are tied to geopolitical events, emotional regulation becomes more difficult, not easier.

This reframing also makes it harder to detect damage. Gambling disorder remains underdiagnosed in part because patients rarely exhibit voluntary gambling behavior unless directly prompted. When behavior is labeled as trafficking or predicting, clinicians and families may miss it entirely. Losing sleep after a sports bet is worrying. Obsessively refreshing election odds in a polished app often don’t.

The setting hasn’t caught up to the new aesthetic, though some have efforts are made Prediction markets occupy a changing legal space. Because they are not always treated as gambling, they may avoid the safeguards required by sportsbooks, including warning labels, spending limits and age verification rules. Just this year, legal battles on whether betting on these platforms constitutes gambling, its introduction bipartisan legislationand a federal investigation All underline how volatile this boundary remains.

We’ve seen this pattern before: a product scales faster than society’s ability to measure its harm, and faster than the government’s willingness to curb it. Fong captured the moment succinctly: “Not only is the horse out of the barn, but all the horses are out of the barn.”

For clinicians, this means asking new questions about financial risk-taking that can act like an addiction. For policymakers, it means closing regulatory loopholes that allow high-risk products to be disguised as complexity. For the public, it means recognizing that not all bets are obvious and not all losses are announced loudly.

When everything is a gamble, the cost isn’t always measured in dollars. Sometimes it is paid for sleep, stability and mental health. For decades, public health has watched risky behaviors become accepted through rebranding. Gambling cannot be next.

Ayesha Khan is a medical student at CUNY School of Medicine and a Truman Scholar. Her work focuses on the intersection of health policy, climate change and health equity.

This article was originally published on Undark. Read it original article.

Previously Posted at undark.org

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