A Medical Solution to a Non-Medical Problem

ARTHUR CAPLAN

August 06, 1992|By ARTHUR CAPLAN

St. Paul, Minnesota. -- If you are short, this is your time in the limelight. Every four years short people become our national heroes as they prance, tumble and leap across our TV screens in the Olympics. If you are much over 5 feet 4 inches you can forget about winning a gold on the balance beam. Tall folks need not apply.

Matters are different on all other days for those who are short. Hey shrimp! How's it going, short stuff? How are ya doin', runt?

These unhappy phrases and other even less felicitous ones are all too familiar to every American kid who is short. I know because when I was a kid I rarely missed a chance to issue one of these zingers myself. And it is not just my presumedly mature and now more delicate sensibilities which are offended by ragging of this sort.

Study after study shows that, other things being equal, our society favors tall people over short ones for positions of leadership, authority, high incomes and power.

Suppose you and your spouse were very short. What if you found out that there was a new treatment, a hormone, that could alter your children's chemistry so that they would be taller than you. Would you want your child's height ''treated?''

Lots of parents are saying ''yes.'' For the question is no longer hypothetical. Parents all around America are pestering their doctors to use a new synthetic hormone on their kids so that they will not be short. Many pediatricians are giving human growth hormone to kids who lag behind on the normal growth curve, even though the side effects of long-term administration of the hormone are not known.

For almost two years the National Institutes of Health, with the support of Eli Lilly, the pharmaceutical giant, has been conducting a study to see what effect synthetic growth hormone has on children's height.

Eighty healthy kids, ranging in age from 9 to 15, are in the study. There is nothing wrong with them except that their growth rates indicate that the girls will not be any taller than 4 feet 11 inches and the boys 5 feet 4 inches. Half the kids in the study are getting shots of human growth hormone three times a week. The other half get placebo shots.

Recent breakthroughs in biotechnology are behind this effort to do something about short stature. For decades the only source of human growth hormone has been pituitary glands taken from the brains of dead bodies. Growth hormone was in such short supply that the small amount available was given to children diagnosed as suffering from extreme dwarfism.

But, thanks to biotechnology, it is now possible to make human growth hormone in the lab. Eli Lilly and Genentech hold the patents on the synthetic hormone. At $10,000 or more for a year's supply, they stand to make a lot of money if every short kid in North America gets three injections of the stuff a week for ten years.

Recently, Jeremy Rifkin, a well known critic of biotechnology, threatened to sue the National Institute for Child Health and Human Development to shut down the federal study. Mr. Rifkin and his allies argue that the government is sponsoring a study to find a medical solution to what is a non-medical problem. I think he has a point.

The problem is not, as Mr. Rifkin and other critics of biotechnology allege, the application of genetic knowledge to solve medical problems. What could possibly be wrong with trying to cure genetic diseases such as sickle-cell disease, hemophilia or Fanconi's anemia?

The ethical problem is that being short, of itself, is not a disease. If someone is unusually, atypically short because he does not produce growth hormone, it is reasonable to try and replace that deficiency.

But, is a boy or girl whose chemistry is normal but who still will grow up to be on the short side really to be thought of as ''sick,'' ''diseased'' or ''deformed''? Does a cultural prejudice against short people mean that doctors ought to tell kids destined to be short that they need medical treatment?

It is unethical for medicine and pharmaceutical companies to prey on yet another form of human insecurity to make a buck.

And, it is morally bananas for doctors to spend their time and energy figuring out what to do with kids who are somewhat shorter than average when there are so many other obvious, clear-cut medical problems and disorders that continue to ravage children in this and other countries.

The kids in the federal study should be told that they will grow up shorter than average but that perhaps they will be able to compete as Olympic gymnasts or divers. The pediatricians should put away their syringes and go after some real diseases.

The cure for short stature is for the rest of us to grow up about it.

Arthur Caplan, director of the Center for Biomedical Ethics at the University of Minnesota, is a columnist for the St. Paul Pioneer Press.

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