As a publisher it really sucks. The DSPs must know these ads are shit. It would be trivial to filter them with a bit of AI.

I've asked my Google partnered SSP to disallow ethically bankrupt ads like gambling, alcohol etc. They say "we've asked the partners to block those categories"... and then it just keeps happening. They're either unable or unwilling to help. I had to take ads down for several days at my own expense due to rogue ads. The ads are now in safe frames which doesn't pay quite as well but I'm okay with it.