In Monday's issue of the CMAJ, editor-in-chief Dr. John Fletcher says doctors and hospitals have a responsibility to prevent harm, but fundraising lotteries have the potential to severely affect people with a gambling addiction.
"It is contradictory for legislation to ban hospitals from selling one potentially harmful, but legal, addictive product on their premises — tobacco — while allowing them to actively promote another — lotteries," he writes. "Have we lost our moral compass to such an extent that we are blinded to our duty to "first do no harm" by the attraction of easy revenue?"
An estimated four per cent of Canadian adults are thought to have a gambling problem. But this small segment generates about 23 per cent of gambling revenue in the country, the editorial says.
Fletcher said out-of-control gambling can have devastating consequences for an individual addicted to playing the odds as they spend more and more chasing losses and looking for the big win.
"They will mortgage the house, run up debt on credit cards," he said Monday from Ottawa. "And this can bankrupt someone personally and lead to families who lose their home, lead to divorce. And a high proportion of people with problem gambling get depressed and some commit suicide."
Fletcher said he isn't arguing for a ban on gambling or an end to hospital lotteries, noting the latter are a way of raising money for good causes while providing "a bit of fun" for most people.
But he believes measures are needed to protect people vulnerable to a gambling addiction, who could blow through hundreds of dollars on a hospital lottery website in a few minutes because of incentives that "entice more and more spending."
For most lotteries offered by hospitals and health advocacy groups, buying tickets in bulk saves you money.
For example, the cost of one ticket in Canada's longest-running hospital lottery — that mounted by Toronto's Sick Kids — is $100. But buy 10 at once and the cost is $500; buy 30 in one go and the total cost is $900.
"It gets cheaper the more you spend," said Fletcher, who advocates for a removal of such incentives, an individual spending cap and warnings to the public about spending too much on lotteries.
"The direction I'm coming from is that doctors are in a privileged position in society, as are hospitals. We trust doctors and hospitals to look after us when we're sick and to put our health and well-being to the fore.
"So that's why we as doctors should do no harm and why hospitals have a responsibility to ensure that their fundraising doesn't harm vulnerable people."
Dr. Robert Bell, president and CEO of University Health Network, said he was disappointed by the editorial.
The Princess Margaret Cancer Centre, part of the hospital network, operates a twice-yearly lottery that gives people a chance to win houses, cars, trips and cash prizes worth millions of dollars in total.
Bell said a 2011 Swedish study of different forms of gambling found lotteries were far less hazardous to at-risk and problem gamblers than other games of chance, including interactive Internet gambling, casino gambling, and electronic gaming machines, for instance
"So I think ... the form of gambling we're talking about — that is, lotteries — is the least associated with problem gambling," he said.
"And, of course, the hospital lotteries do a tremendous amount of good in providing funding for enhancing patient care and certainly funding crucial research — funding that is difficult to raise in other ways."
Bell said the Princess Margaret lottery offers people a chance to game while doing something beneficial.
"So we think we're offering a good mix of both."
There are numerous hospital lotteries across Canada, from the B.C. Children's Hospital Dream Lottery to the Lifestyles Lottery put on by the QEII Health Sciences Centre in Halifax. Many health advocacy groups, such as the Heart and Stroke Foundation and the Canadian Cancer Society, also mount their own fundraising lotteries.
Fletcher said larger hospitals often raise $10 million or more from annual lotteries, while smaller hospitals can generate close to $1 million.