Drugs Can Make Short Kids Grow but Is It Right to Prescribe Them?
09/15/2003 at 01:00 AM EDT
By middle school, Andrew Menas shad become used to the short jokes: "How's the weather down there?" children would ask. He stood just 4'4" in fifth grade, a time when every one of his male classmates had shot past 5 ft. "People look at bigger kids with more respect. They think they have more power," says Menas,
who couldn't reach the top row of lockers, couldn't see the altar at church and shied away from games of pickup basketball.
Menas, now 18, hadn't always been short for his age. When he was a toddler, his growth rate was average or even above average. But after second grade he gradually fell behind the other boys in his suburban Baltimore neighborhood. "He wore the same winter coat for three years," says his mother, Chris, 50, a reading tutor at an elementary school. She and her husband, James, 50, a federal civil servant, sought the advice of doctors, who couldn't determine why Andrew wasn't growing properly. Finally, in 1998, a specialist prescribed injections of human growth hormone—a therapy used to boost growth with a chemical derived from the pituitary gland. While most children who take the drugs grow less than two inches, in Andrew's case the results were spectacular: At his graduation last June from Loch Raven High School in Baltimore, Menas stood 5'11" among the tallest people in his class. He stopped taking the medicine in August. "It's changed our lives," says his dad. "The taller the male, the better."
Many in America seem to agree. In July, after years of testing, the Food and Drug Administration approved human growth hormone for use by children who, for no known medical reason, have projected adult heights of less than 5'3" for boys and 4'11" for girls. The hormone treatment is expected to sell well even at a cost of up to $30,000 a year—despite fierce resistance from critics. "It's the drug companies trying to prey on parental insecurities," says Dr. Neal Barnard, president of the Physicians Committee for Responsible Medicine, a group that opposes the new FDA ruling. "They are trying to push designer kids." David Sandberg, a pediatric psychologist at the State University of New York at Buffalo, agrees: "This ruling makes the medical profession complicit with promoting negative stereotypes that say being shorter is bad." Even some supporters of HGH are concerned about possible side effects, which may include diabetes, excess pressure from brain fluid and other ailments yet to be seen. "We don't know about 20 or 30 years down the road," says Dr. Glenn Braunstein, who chaired the FDA committee that approved HGH.
Still, many doctors welcome the drug to the arsenal of medicines they already use to improve patients' lives. They point to studies that have shown short men are likely to make less money, to struggle with low self-steem and to suffer from depression when compared with their taller peers. "I've had kids come into the clinic and tell me they were ridiculed—locked inside a locker at school or stuffed in a trash can because they were small," says Dr. Debra Counts, the University of Maryland Medical Center endocrinologist who over-saw Menas's care. "Yes, short stature is not an organic disease, but it is a problem that causes a diminished quality of life."
In Andrew's case, doctors predicted in 1998 that he would grow no taller than 5 ft. "We thought, 'Oh my gosh, that would be horrible for a male,' " says Chris Menas. "Girls would be so much taller and, I hate to say it, but even in getting a job it would be a huge disadvantage." At first Andrew was terrified of the shots of HGH he had to inject into his own leg six days a week. But with time the injections became routine—and caused Andrew to sprout upward. His appetite increased, his hair and nails grew at a record pace, and he slept longer hours, like a typical growing teen. In his sophomore year he tried out for the soccer team but was rejected because of his height. But as a 5'7" senior, he tried again and easily made the team. "It's a lot easier when you are taller," he says. "People don't push you around."
Having experienced the stigma that society attaches to shortness, the Menases don't say it's bad to be short. But given a choice—even one with risks—they are happy with their decision. "You want the best for your kids," says Andrew's mom. "I just wanted him to be as tall as everyone else."
Giovanna Breu in Chicago, Melody Simmons in Baltimore and Carolyn Howard in Glen Head