Will He Measure Up?

Height matters. No child wants to enter adolescence as the brunt of jokes, the last pick on sports teams, the teenager who shops in the kids' department for clothes. Parents worry that their short children won't get dates and will be left out as adults in the social race for the top. Studies show tall men get paid more. Since 1900, the taller candidate has won nearly every presidential election--and one of the exceptions, George W. Bush, lost the popular vote.

Modern medicine has heard their pleas. This summer the Food and Drug Administration approved Eli Lilly's Humatrope--a recombinant version of the body's own naturally occurring growth hormone--for use in children with "idiopathic short stature," meaning shortness for no known medical reason. Until then, it had been sanctioned only for short kids with deficient hormone levels and other medical problems. Although the new approval limits use to the smallest 1 percent of children, the decision drew fire. Ethicists charged that drug companies were turning normal human variation into a medical problem and preying on parents' fears. But the decision is never as easy--or as superficial--as it's been made out to be.

Kathleen Havener of Fort Wayne, Ind., debated for five years before putting her son Nathan, now 9, on growth hormone two years ago. "The longer we waited, the further he fell behind, until he was off the growth chart altogether," she says. Now the kid who never seemed to outgrow his clothes has caught up with a quarter of his class in height, has better self-esteem and is more athletic.

But there are good reasons that a parent might decide against treatment. The cost averages $20,000 a year for four to five years. The hormone has to be injected rather than taken orally. And the final height gains are usually modest. In Eli Lilly's key study, kids who took three shots a week for four years grew an average of just one and a half inches more than children taking placebo injections. Six shots a week at higher doses produced gains of two to four inches in other studies. But still, that's not going to turn a potential jockey into a basketball star--it'll just get an exceptionally short kid into the low end of the normal range. "Parents have to ask, 'Is an inch worth $25,000?' " says Dr. Ora Hirsch Pescovitz, chief of pediatric endocrinology at Indiana University.

So far the side effects of growth hormone appear rare--and seem to go away when treatment is stopped. "All the evidence shows that growth hormone is one of the safest drugs we have," says Dr. Pinchas Cohen, director of pediatric endocrinology at UCLA. "Thousands of patients have been followed for the last 16 years." But what about longer-term problems? Adults whose bodies produce a large excess of growth hormone have higher rates of colon cancer--and though no one has shown such a problem with hormone treatments in children, doubts persist. "Hormones are like spider webs. You pull one strand and it affects everything else," says Dr. Neal Barnard, president of the Physicians Committee for Responsible Medicine.

In this age of extreme makeovers, where will the trend toward child improvement end? And once medicine defines short stature as a disability, should society foot the bill through higher insurance premiums? Being short isn't necessarily that bad. "I have a wonderful life," says Ethan Crough of Hoboken, N.J., who's 30 and 4 feet 2 inches. "I never failed at anything--except Greek mythology in college." But that won't stop parents like Kathleen Havener from worrying--and seeking out treatment.

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