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    Sunday, October 16, 2005

    Treatment Target: The New York Times Sunday Magazine has an excellent excellent examination of the use of growth hormone to treat naturally occurring short stature. The upshot - it isn't for the children. There's little concrete evidence, in fact, that children are harmed by their short stature:

    The underlying presumption has always been that if you're outside the normal range when it comes to height - just like you're outside the normal range with your blood calcium level or thyroid level - there should be some ramifications of that. And the presumption has been that there are psychological, sociological and economic ramifications, and some of that has been borne out. But in terms of the psychological disability, it's really been the case that the more we've looked, the less we've found.

    But what about kids who are short who get the drug? Do they get an added psychological benefit from knowing they've increased their height by an inch or two? Apparently not:

    Even an Eli Lilly-sponsored study published in 2004 concluded that data "do not support the use of [growth hormone] treatment for idiopathic short stature to improve psychological dysfunction." In an earlier study, European researchers could find no significant differences in the quality of life between young adults who had been treated with growth hormone as children and a control group of adults (equally short as children) who had not - except that adults who had taken the drug as children had a romantic partner less often than those who hadn't used it.

    Once again, it may be better to stand around and do nothing.

    So who does this very expensive cosmetic treatment benefit? The parents:

    "Often parents think the children have a complex about size," says Dr. Mark A. Sperling, a professor of pediatrics at the University of Pittsburgh, "but I think it's the parents who have a complex."

    The article opens with the description of an experiment to determine how other kids view their short peers. The children were asked to cast a play using their classmates as the actors. They were asked who would make the best bully, the most picked-on,the good leader, etc. Height had nothing to do with the types of roles kids assigned their peers. Height seems to be more of a grown-up hang-up than a kid hang-up.

    Full disclosure: I have a personal interest in this. My pre-teen son is in the lowest percentile for height. He would qualify for growth hormone therapy, and it's something that briefly crossed my mind when one of his doctors suggested it. My husband never thought it worth considering, being of the opinion that it's best to make the most of whatever life deals you. In the end, I decided against pursuing it largely because I didn't feel it was my right, even as a parent, to make that decision for him. He's too young to decide what risk he'd be willing to assume for the rest of his life. What if, years from now, some horrible health risk from the indiscriminate use of growth hormone comes to light? Would it have been worth it for what is, after all, merely an issue of vanity?

    It tugs at my heart when he asks me how old I was when I had my growth spurt, in anticipation that his is just around the corner (I never had a growth spurt) or to see him frown ever so slightly when other people comment on how tall his older brother is becoming, as if it's an achievement of its own.

    Yet, being short isn't really a handicap. It might bother him, but not any more than teenage acne or disliking the shape of his nose. And he certainly hasn't suffered socially. Of all of our children, he's the most warm and engaging, and he profits from it at school among his peers and his teachers. And, although he's never said as much, I get the distinct feeling that he views any impediment his height may bring as just something to be conquered. When he was four years old, a little girl in his pre-school class taunted him from the top of a playhouse that he was "too little" to ever climb that high. But he tried and tried again for a whole week until he finally got to the top of that playhouse roof, where he stood, hands on hips and shouted, "I am not too little!" That spirit lives in him today. He's outside now practicing and practicing - for basketball tryouts.

    Would that spirit have lived on if we had given him growth hormone shots? I don't think so. He would have gotten the explicit message that there was something wrong about being short, which in turn would have made him much more self-conscious about his height. And I'm willing to bet that he wouldn't be taking on the challenge of basketball.

    posted by Sydney on 10/16/2005 02:42:00 PM 0 comments


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