Experts Debate the Cosmetic Use of Growth Hormones for Children
19 When it comes to your child, how short is too short?
question has experts split in a fierce debate over the safety and ethics and cosmetically
enhancing kids' height, following a government advisory panel's recommendation
that growth hormone be approved for use in healthy but unusually short children.
The hormone known
as Humatrope, made by Eli Lilly, is now approved only for use in children with
rare medical conditions. But the Food and Drug Administration is now mulling the
possibility of expanding its use to make extremely short children boys
under 5 foot 3 inches and girls under 4 foot 11 inches grow taller than
they naturally would. The cutoff point to be considered eligible for treatment
is under age 14.
believe approval of human growth hormone for non-medical reasons will rescue "vertically
challenged" children from the societal stigma of being small. But others
worry about the implications of such a decision: Will this send a message that
short stature is a sickness, an abnormality in need of a "cure"?
Not Easy Being Short
matter what size you may be, it is not difficult to empathize with the plight
of a short kid born into a society that seems to revere massive professional athletes
and where advertising thrives on images of tall, leggy supermodels.
kids report in some studies that they fall victim to the teasing of their peers,
while other research shows there are real differences in the way people are treated
based on their height.
Costa, 17, who testified before the FDA after receiving what she refers to as
"life-changing" growth hormone injections, remembers that at age 6,
"The kids were like, 'Your legs aren't long enough. You can't play in these
games. You don't run fast enough.' And, I couldn't reach the water fountain."
Being small in
a tall world can take a serious psychological toll on a child, many experts feel.
It's for that reason some doctors have been willing to prescribe the "off-label"
use of human growth hormones in healthy but extremely small kids.
had predicted Costa would only reach a height of 4 foot 8 inches but with growth
hormones she grew to 5 foot 2 inches and can personally attest to the fact that
"being taller helps your self-confidence when you're in a crowd of people.
It also helps you feel that you're not different, that you don't have to look
up to people, that you can just blend right in."
some experts feel the average 2 inches of height achieved by growth hormone injections
may not be worth the price (about $30,000) or the pain (six invasive injections
per week for several years) Costa disagrees. "To grow, even just 2
inches taller than 4-foot-8 is a big deal when it means that you can drive a normal
size car," she says.
Medicalization of Height
while some believe growth hormones can relieve children of being teased or picked
on, many worry giving short but healthy children growth hormones will only further
perpetuate the stigma attached to small stature.
message we send to society is that any boy who is less than 5-foot-3 is ill and
can avail themselves of a remedy. This is very dangerous as it causes people to
make judgments of acceptability and normalcy rather than simply being open to
variety and variation," explains John Tuohey, director of the Providence
Center for Health Care Ethics in Providence, Ore.
shortness is medicalized today, what's next?," asks Dr. Jeffrey Bishop, associate
professor of internal medicine at the University of Texas Southwestern Medical
Center at Dallas.
Bishop, Dr. Mark Groshek, of the department of pediatrics at Kaiser Permanente
in Centennial, Colo., worries once the door is opened for "healing"
short people, "we will face increasing pressure to fix or change more and
more things that are simply human characteristics and not illnesses."
the Slippery Slope and the Potential for Abuse
also express concern FDA approval of human growth hormone for healthy but short
children will weaken the restrictions that currently limit the widespread use
of the treatment in children.
the past, insurance companies would only cover growth hormone injections for children
with diagnosed growth hormone deficiencies. So for parents of kids who were unusually
short but able to produce growth hormone, the hefty price tag of injections put
an "economic brake" on their decisions to go through with the treatment,
explains Dr. Michael A. Levine, chairman of pediatrics at The Cleveland Clinic.
Should the FDA
follow its panel's recommendations, those the economic brakes would be released
and insurance companies would pick up the tab, says Levine. And parents, free
from the high costs of the hormone injections, will be more likely to push to
get their kids the treatment, he says.
Eli Lilly has proposed strict height restrictions, Levine says "this is clearly
an example of Pandora's box." Despite Lilly's assurances, he explains, it
is doubtful that the height predictions they propose will be followed by many
hope that doctors can discipline themselves to keep this treatment only for those
in greatest need. But the profession's track record in this regard doesn't make
me confident," adds Jonathan Moreno, director of the Center for Biomedical
Ethics at the University of Virginia.
measurements used to predict a child's height are flexible and can be massaged,
Levine notes. Without a safeguard, "Parents and physicians will figure out
ways to get around the recommendations, needlessly exposing children to risks
for questionable benefit," adds Dr. Daniel D. Broughton of Community Pediatric
and Adolescent Medicine at the Mayo Clinic in Rochester, Minn.
are the risks of using the growth hormone? Some are known and some unknown, says
Levine. In a small percentage of patients, the headaches developed during treatment
may or may not go away once treatment is discontinued. Other patients may develop
diabetes or arthritis while undergoing treatment.
unknown is whether treating a child with growth hormones is increasing the risk
of developing cancer as an adult, explains Levine. "While there is no evidence
of risk today, doctors have not yet been prescribing this type of growth hormone
for a sufficient number of years to be certain that they do not exist," he
is expected to make its final decision later this summer. For many parents, children,
and experts on both sides of the debate, the wait won't be a short one.
synthetic growth hormones have side-effects, individuals seeking height have an
alternative that consists of cartilage
building supplements available at most local GN.~*
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