Livingstone & Adams's observations were not limited to Australia and New Zealand [1]. The governments are involved deeply in conflicts of interest in the regulation of gambling; older adults in Nova Scotia perceived the government's role in gambling as confusing, contradictory and disturbing, saying that the government's foot was on the gas and the brake at the same time [2]. Electronic gambling machines (EGM) are placed in socio-economically disadvantaged areas; lottery sale data from 39 states over 10 years showed a strong and positive relationship between sales and poverty rates [3]. Livingstone & Adams's suggestion of ‘upstream’ measures, such as a pre-commitment system to limit the gamblers' expenditure and a redesign of the EGM games to prevent harmful gambling, may have little chance of being implemented. The objective of a club or a casino is to increase, not limit, revenues, not just its own but those of surrounding businesses as well [4]. Games are designed to yield optimal prize structure, such as a few large prizes and a large number of small prizes in lotteries [5], not to be less harmful.

Measures directed at the gamblers may be more acceptable to the government and the private industries. Before, during and after measures are suggested below.

Before measure. Because of the widespread placement of the EGM, an informed choice measure [6] seems to be required; the knowledge of random events, problem gambling awareness and self-monitoring and coping skills may help to prevent problem gambling [7]. The suggested measure warns the gamblers before they start gambling and involves a notice at the machine of the very low probability of winning, not a statement of 10 000 000 : 1 probability but a sentence that the gamblers may understand, such as: ‘If you played this machine at one dollar a spin, it would cost you $100 000 and take you three and a half days of non-stop playing to win a jackpot of $10 000’. [Note: The calculation is based on the data in Livingstone & Adams of 10 million : 1 probability and a speed of 3 seconds per spin; 10 000 000 spins × 3 seconds divided by 60 seconds × 60 minutes × 24 hours × 50 lines × double credit = 3.47 days.]

During measure. This measure is designed to inform the gamblers during their gambling sessions. If a pre-commitment system is installed to track the amounts of money the gamblers spent, it should be programmed to keep track of the rewards they receive during each session. The system envisioned requires the gambler to initialize each session; the machine then records the total amount of money it receives and the total amount of money it returns to the gambler, and prints those amounts for the gambler at the end of each session. Although there is the possibility that the gamblers may feel a sense an entrapment and increase the frequency and amounts of their gambling [8], the difference between the money spent and money received should remind them of the futility of their investment.

After measure. If the before and during measures fail, self-exclusion [9], an after measure, is the measure of last resort. Operated on the principle that the gamblers have to accept the responsibility of keeping their gambling expenditure at affordable levels, self-exclusion requires the gamblers to register to exclude themselves from further gambling and to seek professional treatment services. Self-exclusion seems effective in being a barrier to gambling excess and a gateway to further treatment services [10].

An argument can be made that although accurate information may be a sensible way to assure the ‘safety’ of gambling products, gamblers may ignore the information because of their irrational beliefs [11]. The suggested measures are based upon the assumption that the gamblers are the only people who can help themselves. If, in spite of the extremely low probability, the small return on investment and the assistance given in the self-exclusion programme, they still return to gambling [12], then no one can really help them. After all, money is in the gamblers' hands; it is up to them to put responsible gambling principles [13] into practice. Walking away from the gambling machine is responsible; putting money into the machine is gambling.

Declaration of interest