Monday, March 2, 2009

Book 23 of 52: Normal at Any Cost

When I was in grade school, my doctor predicted that I'd grow to be 5'8" tall. I hit the 95th percentile in both height and weight. My father is 5'10" and my mother 5'8", so the prediction seemed accurate to everyone involved -- and he thought maybe I'd grow a little taller.

Not the case. I'm just under 5'6" tall, which is fine. I mean, really -- it's an average height. But for a long time, I was bitter because I never got those extra two inches. If I was a few inches taller, I'd be a better sports player, I thought. I certainly would have been a better first baseman. Heck, I might have even made varsity my freshman year.

What if someone had told my parents there was a way to press me toward 5'8" as my final height? What would they have said? I'm going to guess "no way," knowing my parents, but I'm not sure others would have been so or are so quick to say no, especially if a few thousand dollars to get those two issues were not an issue, and the FDA gave such treatments for "short statured" children a stamp of approval without saying what exactly made someone "short."

Normal at Any Cost: Tall Girls, Short Boys, and the Medical Industry's Quest to Manipulate Height(pub. date March 19) by Susan Cohen and Christine Cosgrove looks into the issues surrounding "treating" children for height, whether it was trying to suppress girl's height by pumping them full of estrogen to stunt growth, or injecting children with human growth hormone (hGH) harvested from cadaver pituitary glands.

Yes, both of these things were done, to sometimes disastrous results. The tall girls were pushed early into puberty, and many developed fertility problems and increased cancer risk. Some patients injected with the pituitary growth hormone developed Creutzfeldt-Jakob disease, a human form of mad cow that is lethal -- all for a few inches of height.

Petituary hGH is no longer available (thank God), but synthetic hGH is, and injected to children who are short if parents want it and can pay for it. Normal at Any Cost: Tall Girls, Short Boys, and the Medical Industry's Quest to Manipulate Height is harsh on such issues, especially treating children who do not show a hormone deficiency, because the long term effects of such treatments are not known, and not always proved to push up height. Indications of increase cancer rates are a primary concern, but for an extra two inches, some parents are willing to try.

The authors are anti-big pharma and present those companies as wanting to benefit from what isn't really a medical condition (instead of, say, developing drugs for crippling diseases or even offering free drugs to people who can't afford it) and using a treatment for those with a real medical issue (e.g. low hGH levels) and spreading it to as many people as possible, even if they aren't sick. The cover is rather ominous looking, too -- black and white with bold dashes of red. This is not a happy book.

Is it really so bad being short that it's worth this kind of risk? Or injected children with expensive shots for years without a guarantee that it'll work? I don't know, and I can't say because I've never been short. I've dated shorter men, and never considered their height an issue (yes, I wore heels when out with them, and they never seemed to mind). I've gotten my ass kicked by soccer players shorter than me, and was hurt so badly by a short girl's kick to the shin that I was sidelined for the rest of my senior year. My brother played soccer with Vinny, a short but amazing soccer player. I heard whispers along the sidelines that his parents were going to do something to try to spur on his growth. Why, I thought? He was so good as it was, and he seemed like a well adjusted kid with lots of friends. Did they think a few extra inches would make a difference in his soccer ability? Fifteen years later, does that even matter? I can't imagine anyone from that team became a soccer superstar.

I imagine that being short can affect self image, but so can a lot of other things, especially pre and during puberty. I had such severe eczema as a teenager that I had to wrap my hands in ace bandages to hide it -- I even had to go to the emergency room once to get things under control. I was horrified by the appearance of my skin, and, yes, it was rough, especially when I had to go to the dermatologist every two weeks to have warts on my hands frozen with liquid nitrogen (open skin from eczema lead to frequent infection). But with the help of my parents and a general well adjusted upbringing, I got over it. My brother got over his acne, my friend got over her crooked teeth, and we all soldiered on. I still remember the time when my dad said, "well, Jenny, you'll never be a hand model," and I laughed.

But this book isn't just about height. It's about playing medical God. Anytime someone start messing with a child's development or a reason other than disease -- and the FDA says it's OK -- I worry. The authors ask the natural question as to whether this going to extend the womb. If you can play with a child's height, what's to stop from selecting embryos with a propensity for tallness from the get go?

So even though this book is a case study of one issue -- height -- it raises important issues about medicine, what it can do, what it can't do, and how far we're willing to go to test the limits. In the cases of those estrogen dosed girls (a treatment that STILL happens today though far less frequently) and pituitary gland hGH children, doctors tried something to disastrous results. Will the same happen with children and synthetic hGH? It's yet to be seen -- and no one knows for sure, which is scary.

But then there's this: I recently met up with another runner from Dailymile.com, and I described myself as the "short blond in a black tank top." He almost didn't find me because he was looking for a short woman, and at 5'6" plus three inch heels, I can see why he was confused. Yet I said I was short. But would it have been worth injecting me with an unproven substance to make me taller, even if I was projected to be 5 feet tall? I don't even drink diet soda or use artificial sweeteners because it's not natural. So injected hGH isn't exactly on my list of priorities.

Expect a lot of controversies from this one, and a lot of rebuttals from big pharma. Should be an interesting one to track.

In other news, my review of book 21 of 52 ran in Saturday's St. Petersburg Times. Check it out here!

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1 comment:

butterflywings said...

Hi. I'm a 5'0 woman (rounding up). I had hGh. I'm glad I did. Without, I might be 4"8. Those 4 inches do actually make a huge difference; from being just short, to standing out as, well, a freak. I don't think it's necessarily a bad thing. You say it's about self-image as if that's trivial - it isn't.
Antibiotics aren't 'natural' either.