"Stunted growth" - an American cultural concept.

As an editorial in the August 21 Journal of the American Medical Association points out. "Parental pressure to mitigate short stature in their children is driven by a cultural `heightism' that permeates American society. Taller college graduates make more money, and 80 percent of U.S. presidents have been the taller candidate. Also revealing these prejudices are expressions such as `short-sighted' and `short end of the stick'." (So as not to offend short people, one humorist recently suggested the "politically correct" term height-challenged person as a substitute for "dwarf" in the story of Snow White.)

Regrettably, many American parents (and, even more regrettably, their children) view small stature as a handicap, leading to sense of inferiority, teasing by other children, or being treated a younger than their chronological age. Such cultural concepts are responsible for the increasing us (and subsequent controversy) of growth hormone to treat short-statured American children not shown to be deficient in growth hormone.

True growth-hormone deficiency in a child is a clear indication for the use of growth hormone-but the criteria for its diagnosis have not been clearly established. Many pediatric endocrinologists, under pressure from concerned parents, are thus using growth hormone without clear-cut medical indications for its use.

The potential side effects are many, including allergy, impaired glucose tolerance, hyperlipemia, slipped capital femoral epiphysis, transient peripheral edema, scoliosis, and leukemia. Although its enormous cost (as much as $15,000 to $30,000 a year) is sometimes met wholly or in part by the pharmaceutical companies when parents have no insurance to cover it, the cost to our healthcare system must be taken into account. As the JAMA editorial notes, one must ask whether a mere average one to two inches in height (and some children do not attain even this level) is worth the cost and the risk. Perhaps the money could be better spent for further education, job training, or professional counseling.