Reaching new heights

My nephew, Jordan, is planning on a major growth spurt, which, I’m afraid, is just not going to happen.

At 13, Jordan is a bit taller than the average child his age – 5 foot, 7 inches – but in this family that’s a little on the short side. My husband is the shortest man in the family at a mere 6’4″. And by the time he, his brother, and our older nephew turned 13, they were already topping the 6-foot mark. Jordan warns them that he’ll one day be the tallest, but we all think that’s pretty unlikely. Unless, of course, he takes growth hormones for a few years.

If you think that growth hormones for a young man of normal height sounds crazy, I agree. But at what age and what height would it not sound crazy? That’s a central question in a current debate that exploded last month when the FDA approved the use of Humatrope (a synthetic growth hormone produced by Eli Lilly and Co.) for children of “idiopathic short stature.” In other words: kids who are short, but whose physical stature is not caused by disease or metabolic problems, now have the means to slightly increase their height.

There are so many things wrong with this issue, I hardly know where to start.

MostlyOK!

Children with growth inhibiting diseases have been taking growth hormones since the mid-80s. Some have called this practice the “medicalization of shortness.” Today, the oldest of these children are only in their early 30s, so whatever long-range side effects might be in store for them as they age is still unknown.

Here’s what is known: The rapid growth caused by the additional hormones have caused curvature of the spine in some children and symptoms of diabetes in others. And there have been almost 30 reported cases of intracranial pressure, a condition that mimics brain tumor symptoms.

In an interview last week with the Los Angeles Times, David Orloff, M.D., the Director of the Division of Metabolic and Endocrine Drug Products for the FDA, described the side effects of Humatrope as being “mostly reversible,” and the drug itself as being safe “by and large.”

Just imagine if your child’s doctor used an ambiguous term like “by and large” to describe a drug’s safety. Who could possibly feel comfortable in subjecting their child to years of treatment with such a drug? Especially when it’s used to address a personal trait (not a medical condition) that presents no danger at all to their health.

Even worse, growth hormone doesn’t work for all kids. And for those who do get results, their extra growth usually adds up to only an inch or two at most.

But of course, the kids don’t make the decision to take hormones; the parents do. And for some parents the prospect that their child might grow up to be a short adult is too much to bear. They fear the prejudices that society will heap on their child, and then display those very prejudices by trying to subvert their child’s natural size.

Growth market

Eli Lilly executives estimate that around 400,000 children will meet the criteria of the new FDA approval – that is: kids aged 7 to 15 years who are in the shortest 1.2 percent of children. Of this group, possibly only 10 percent will sign on for the treatment, because once you get past the safety issue, there are two other glaring problems: 1) The hormone has to be taken by injection almost every day of the week for several years, and 2) The treatments cost between $10,000 and $30,000 per year.

But even with these obvious drawbacks, the FDA approval opens up a lucrative new market that’s expected to generate as much as $18 billion every year. And the FDA action will help boost this new market enormously because health insurers will now be under more pressure to cover the treatments.

With breakthrough “medical” developments like this, is there any wonder why health insurance rates continue to go through the roof?

The price of self-esteem

When FDA advisors held meetings this past June to deliberate the expanded use of Humatrope, a number of children who had taken the drug testified about how the growth hormone had changed their lives after having suffered humiliations such as playground bullies and not being able to reach the water fountain.

These poignant stories apparently had some effect on the FDA officials. But I have to wonder if anyone stepped up to make several obvious points. Such as:

Every child who’s abnormally short, who may gain a couple of inches on their projected height, is still short throughout their childhood.
Playground bullies will always be bullies. If you don’t get picked on because you’re short, you’ll get picked on because your clothes are wrong, or your ears stick out, or you have a funny nameor because you’re tall! The list of bully targets is endless.
If you can’t reach the water fountain, you learn to improvise. You find a way. And you earn self-esteem in overcoming obstacles.

And self-esteem is the heart of the issue here. Growth hormone therapy doesn’t just medicalize shortness, it also medicalizes self-esteem. The LA Times article told of a man named Steve whose short daughter was having a tough time at school. Steve is a martial arts instructor, and in his classes he encourages the building of a positive self-image. So rather than pumping his daughter full of synthetic hormones, he addressed his daughter’s height in a wholly natural way: by helping her establish confidence in herself while developing good self-esteem.

Cost: None
Side effects: None
Knowing your child will face the world confidently without relying on drugs: Priceless

To Your Good Health,Jenny Thompson
Health Sciences InstituteSources:

“FDA Approves Drug for Use in Healthy, Short Children” Vicky Que, National Public Radio, 8/12/03, npr.org

“Does Shortness Need a Cure?” Melissa Healy, Los Angeles Times, 8/11/03, latimes.com

“FDA Approves Growth Hormone Short for Short Kids” Health Scout, 7/27/03, healthscout.com

“Standing Tall – Experts Debate the Cosmetic Use of Growth Hormones for Children” Jamie Cohen, ABC News, 6/19/03, abcnews.com