Doctors at Stanford University are studying a medication they hope will alleviate the suffering of millions of American women. But their target isn't breast cancer, osteoporosis, or a similarly well-known affliction. Despite its alarming impact on its victims, the malady in question has received comparatively little medical scrutiny. It's a "hidden epidemic," according to the Stanford researchers: compulsive shopping disorder.
That's right. What was once merely a punchline in television sitcoms is now being taken seriously by many clinicians. According to the Stanford study's leader, Dr. Lorrin Koran, compulsive shopping is "motivated by 'irresistible' impulses, characterized by spending that is excessive and inappropriate, has harmful consequences for the individual, and tends to be chronic and stereotyped." Compulsive shoppers "binge buy" -- most often clothes, shoes, makeup, and jewelry -- and then suffer intense guilt. That, in turn, helps trigger another frenzied trip to the mall, and the cycle continues.
As many as 8 percent of all Americans may be "shopaholics," and according to Dr. Koran, approximately 90 percent of them are women. (All of the 24 participants in the Stanford study are female.) Michael Elliott, another of the Stanford researchers, ascribes the heavy gender bias to the fact that "women are assigned the shopping role for the family in our culture."
Could compulsive shopping be a health hazard associated with America's unparalleled economic prosperity? "It seems to be a disease of affluence," says Dr. Jerrold Pollak, a clinical psychologist who's treated several shopaholics. "Advertisers...would like us to think that shopping is a reason to live," agrees Dr. Cheryl Carmin, another clinical psychologist. "If you do not have the time or inclination to go to the mall or grocery store, there are catalogs, delivery services, home shopping networks on TV, and endless items to buy via the Internet." Indeed, this year, US advertisers will spend $233 billion -- an amount equal to six federal education budgets -- to persuade Americans to buy, buy, buy.
Yet the possibility that US advertisers may be driving certain women in our society to psychosis is only part of the story. It seems that the pharmaceutical companies' quest to cure the effects of excessive marketing may itself be little more than a cleverly-disguised marketing scheme. The Stanford study, like many of its kind, is being funded by a pharmaceutical company. The undisclosed drug is an FDA-approved antidepressant, specifically an SSRI -- a selective serotonin re-uptake inhibitor. (The researchers are also studying behavioral therapies for compulsive shoppers.)
The researchers running the Stanford study refused to reveal their sponsor. However, only five SSRIs are currently on the US market. Pfizer (makers of Zoloft), Eli Lilly (Prozac) and SmithKline Beecham (Paxil) all reported that they are neither conducting nor planning any studies of their drugs for compulsive shopping. Solvay (Luvox) also seems an unlikely candidate. In 1997, researchers at the University of Iowa tried using Luvox to treat compulsive shoppers and found no measurable differences between the effects of the drug and those of a placebo. Perhaps the manufacturers of Luvox want to give their product another shot. More likely, however, the mysterious benefactor of the Stanford Study is Forest Pharmaceuticals (Celexa). Their PR department neither confirmed nor denied any involvement in Koran's study.
Why would a pharmaceutical company anonymously spend money to license one of its top-selling drugs for a marginal disorder like compulsive shopping? A big part of the answer is profit. The mystery company presumably hopes to carve a unique slice out of the mental-disorder pie in order to market it together with a ready-made treatment. This is not at all a new strategy for the world's mammoth pharmaceutical firms, as David Healy, a professor at the University of Wales College of Medicine, explains in his book "The Anti-Depressant Era." Healy's book describes a process by which companies seek to "educate" both patients and clinicians about a new disorder, to sell the disorder in preparation for selling its cure. Funding clinical trials is a crucial part of that process.
Mental-health professionals do recognize and take seriously the behavior pattern described by Dr. Koran as compulsive shopping disorder (although the disorder's gender-lopsidedness is suspiciously reminiscent of 19th century "female diseases" like neurasthenia and hysteria, syndromes that called for the medical treatment of "female" behavior). However, it isn't listed as a valid disorder in the official diagnostic manual of the American Psychiatric Association. That's because most health care professionals don't view compulsive shopping as a unique disorder, but rather as a symptom of a broader, underlying disorder, such as anxiety or depression, for which several medical and behavioral-therapy treatments already exist.
This is where market manipulation comes into play. Imagine that Ms. X, who has never heard of compulsive shopping disorder as such, spends all kinds of money on things she doesn't need, feels bad about it, spends even more money, and quickly runs into crippling debt. Ms. X might join Debtors Anonymous or some other self-help group. She might link her behavior to depression or an anxiety disorder and seek the help of a mental-health professional who could employ any number of medical or non-medical treatments. But, if Ms. X and her health-care provider have instead heard a lot about compulsive shopping disorder, and there happens to be a newly-licensed drug specifically for it, then she is suddenly a prime customer. A market has been created, prescriptions will increase, and the drug's manufacturer will make money.
"Companies can not only seek to find the key to the lock," Healy writes, "but [they] can dictate a great deal of the shape of the lock to which a key must fit."
Multi-national pharmaceutical companies who make SSRI's certainly have the resources to pull this off. In January, enormous Glaxo Wellcome merged with even more-enormous SmithKline Beecham to become the world's biggest drug company, valued at roughly $189 billion. Pfizer's $90 billion purchase of Warner-Lambert in February was only slightly less impressive. Pharmaceutical companies enjoy higher profits and lower taxes than most other US industries, according to a recent study by the Congressional Research Service. And business is booming: Drug sales rose 9 percent last year to almost 3 billion prescriptions, with antidepressants leading the charge by jumping 17 percent.
At the same time, while in 1997 overall health service costs rose only 5 percent, prescription drug prices rose by 14 percent. The industry argues that their rising prices, disproportionate profits, and tax breaks are needed to offset the massive costs of researching and developing new medications for the public good. Yet recently there's been a dearth of real breakthrough "wonder drugs" like a polio vaccine. No wonder then that these companies turn to market manipulation. Creating simultaneous supply and demand for products such as the shopaholic pill nets both profits for shareholders and "medical advances" for a pill-hungry public.
The industry spends enormous sums advertising their prescription drugs -- $1.8 billion on direct-to-consumer advertising last year alone. With that advertising budget, these companies shouldn't have much trouble selling their pills to people who are already compulsive buyers.
If the treatment Dr. Koran and the other Stanford researchers are studying proves ineffective, we may never know what drug was meant to become the shopaholic pill. But, if this study proves at all successful, chances are we'll hear a lot more about compulsive shopping disorder. The extent of this "hidden epidemic" will be revealed through well-publicized studies, clinical papers, and journal articles. The disorder may even make the pages of the next diagnostic manual. And shopaholics everywhere will be encouraged to make just one more purchase: a little pill to make it all better.