Growth hormone given to normal kids.

When scientists introduced synthetic human growth hormone in 1985, the triumph was tempered by concerns about whether the substance would be overprescribed.

Would its use be restricted to the 14,000 children in the United States with growth hormone deficiency? Or would doctors provide a medically assisted growth spurt for the much larger number of children who are merely short for their ages? The first study to examine this question has found that the latter is the case, report Leona Cuttler and her colleagues at Case Western Reserve University in Cleveland. Just 4 of 10 children now getting the treatment are actually growth hormone deficient (GHD) or suffer from chronic kidney failure-the only government-approved conditions for the hormone's use.

Yet many pediatric endocrinologists nonetheless "consider [growth hormone] treatment appropriate for selected short non-GHD children," Cuttler and her colleagues report in the August 21 Journal of the American Medical Association.

Some of these children have other medical problems that stunt growth, such as impaired but still functional kidneys or a malformation of the gonads known as Turner syndrome. But many others receive treatment because their parents "are driven by a cultural 'heightism' that permeates American society," Barry B.

Bercu of All Children's Hospital in St. Petersburg, Fla., says in a JAMA editorial.

Physicians, like parents, appear to be swayed by societal rather than medical factors, the study found. Some of them prescribed the hormone out of a "desire to address a perceived impairment" rather than the medical judgment that the child needs the hormone, say Cuttler and her colleagues.

Each decision to prescribe growth hormone is an expensive one, since a course of treatment costs from $13,000 to $16,000 a year, the researchers report. The price of treating all the genuinely hormone-deficient children in the United States would total $182 million a year. If the group of potential candidates for the therapy were broadened to include 1.7 million children who though short are not hormone deficient, the cost would soar to $22 billion a year.