Yves here. We must confess that this article confirms our priors, that the treatment prediction markets as a non-sanctioned/restricted activity is a sign of societal breakdown.
By Ayesha Khan, a medical student at the CUNY School of Medicine and a Truman Scholar. Her work focuses on the intersection of health policy, climate change, and health equity. Originally published at Undark
Gambling has long been treated as a vice: risky, addictive, and deliberately set apart from everyday life. Casinos are zoned away from schools. Sportsbooks display warnings. The danger is acknowledged, even when laws and restrictions on gambling fall short.
But what happens when gambling is repackaged under the guise of asset trading and made accessible on a daily basis? Prediction market platforms such as Kalshi, Polymarket, and Manifold are betting that Americans will not notice the difference.
These platforms allow users to buy what they call “shares” or “contracts” to trade on real-world outcomes, including elections, inflation reports, court decisions, and geopolitical events. These platforms present themselves as tools for forecasting rather than gambling. They resemble spreadsheets more than slot machines. Users do not bet; they trade. Odds are reframed as probabilities. Risk becomes insight.
This shift is not subtle. In late 2025, CNN announced a partnership with Kalshi that would integrate prediction-market probabilities into its coverage. Real-money odds began appearing alongside trusted journalism.
After the U.S. Supreme Court struck down a federal ban on sports betting in 2018, legal wagering expanded rapidly. Today, about 22 percent of Americans and 48 percent of men ages 18 to 49 report having at least one online sportsbook account, according to a 2025 poll by the Siena Research Institute and St. Bonaventure University. Most states now permit sports betting in some form, and roughly 30 allow online betting.
The National Council on Problem Gambling estimates that about 2.5 million adults in the U.S. have severe gambling problems, and the organization’s 2024 survey found that nearly 20 million reported indicators of problematic gambling behavior in the past year. The 2025 poll found that among bettors, 52 percent reported chasing losses (continuing to gamble in an attempt to win back money already lost), 20 percent said they lost money they could not afford to lose, and only 9 percent had ever sought help.
The cultural script for gambling harm still assumes a familiar aesthetic: a casino floor, a sportsbook counter, a telltale desperation. Prediction markets disrupt that image by making gambling feel intellectual.
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 obscures the real risk. “You don’t actually have to ingest into your body for it to have a tremendous impact on your body, your brain, your mind, your spirit, and your wallet” he told me. The harm from gambling, he emphasized, is not just 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 skill or intelligence can control uncertainty. In gambling disorders, this is often called the illusion of control. Prediction-market apps lean into it. Their design encourages users to feel not impulsive but informed, as if the right podcast episode, chart, or probability can turn chance into mastery.
When trusted institutions — particularly mainstream media outlets — amplify that frame, the guardrails fall further. As Fong put it, “When you normalize an activity, and you promote it on CNN with partnerships, what do you do? You decrease perception of harm.” And, he added, when “you decrease perception of harm, then that increases likelihood of engagement.”
That shift matters most for the people most likely to be harmed. In Fong’s view, normalization does not simply broaden the market for gambling. It changes who enters it first, particularly young people ages 16 to 24 and those with mental health conditions, substance use disorders, or financial vulnerability.
From a neurobiological perspective, the mechanism is familiar. Gambling activates the brain’s reward circuitry; dopamine surges not only when someone wins but when they anticipate a win. Uncertainty itself becomes reinforcing. Mobile platforms intensify the loop through real-time updates on constantly shifting odds and push notifications that keep attention locked in a state of watchfulness.
This chronic activation takes a toll. Stress and reward pathways remain engaged, disrupting sleep, elevating cortisol, worsening anxiety, and impairing concentration. Over time, compulsive engagement deepens depression and erodes impulse control, using the same neurological scaffolding that sustains other addictions.
Clinically, patients who struggle with prediction markets look no different from those harmed by traditional gambling, Fong said. The pattern is the same: escalating losses, secrecy, shame, chasing losses, relapse, and the defining feature of addiction — wanting to stop and being unable to.
What makes prediction markets uniquely unsettling is not only how they function, but what they ask users to gamble on. The platforms convert collective real-life events such as elections, wars, public health crises, and economic downturns into tradable assets. These outcomes are emotionally charged and morally complex. When personal finances become tied to geopolitical events, emotional regulation becomes harder, not easier.
This reframing also makes harm harder to detect. Gambling disorder remains underdiagnosed in part because patients rarely volunteer gambling behavior unless asked directly. When the behavior is labeled trading or forecasting, clinicians and families may miss it entirely. Losing sleep over a sports bet draws concern. Obsessively refreshing election probabilities on a polished app often does not.
Regulation has not caught up to the new aesthetic, though some attempts are being made. Prediction markets occupy a shifting legal space. Because they are not always treated as gambling, they may evade safeguards required of sportsbooks, including warning labels, spending limits, and age-verification norms. Just this year, court fights over whether wagers on these platforms constitute gambling, the introduction of bipartisan legislation, and a federal investigation all underscore how unsettled that boundary remains.
We have seen this pattern before: A product scales faster than society’s ability to measure its harm, and faster than the government’s willingness to contain it. Fong captured the moment succinctly: “Not only has the horse left the barn, but all the horses have left the barn.”
For clinicians, this means asking new questions about financial risk-taking that can function like addiction. For policymakers, it means closing regulatory gaps that allow high-risk products to masquerade as sophistication. For the public, it means recognizing that not all bets are obvious and not all harms announce themselves loudly.
When everything becomes a wager, the cost is not always measured in dollars. Sometimes it is paid in sleep, stability, and mental health. For decades, public health has watched dangerous behaviors gain acceptance through rebranding. Gambling cannot be next.
