Monday, November 28, 2005

Is Short Stature a disease?

Short People
By Miriam Schulman
At 5 feet, 1/4 inch, I admit to a vested interest when I criticize the recent FDA approval of using human growth hormone to treat "short stature" of unknown origin. The ruling allows doctors to prescribe the biosynthesized hormone Humatrope to children with projected heights of 4 feet 11 inches for women, 5 feet 3 inches for men, even if the cause of their shortness is undiagnosed.
In my case, the cause of my stature is pretty clear: My paternal grandmother was 4feet 9 inches, and several of my aunts and cousins have never grazed the 5 foot mark. In fact, I'm a giant at family reunions.
I'm not going to say our stature never caused us any problems. When I go grocery shopping, I often have to find some nice tall person to reach the Cheerios, and I had a car once that I could only drive with a pillow behind me. I'm also fairly certain that if I raised myself up to my full height?which is what the trail signs say to do if you encounter a bobcat?it wouldn't do much to intimidate the wildlife.
This is not meant to trivialize the problems that face Little People (the preferred term used by those with dwarfism, sometimes defined as adult height below 4 feet 10 inches). Many cannot reach an automatic teller, elevator button, credit card reader at the gas pump, vending machine, or public pay phone. Many also have orthopedic problems related to their dwarfism that certainly qualify as disabilities. And many?Little and short people alike?are the targets of discrimination based on their size.
But the FDA decision does medicalize normally occurring shortness in ways that I think should give us pause. In "treating" shortness, we tread the dividing line between medical care that cures diseases and medical care that seeks to enhance the characteristics of otherwise healthy individuals. As scientific research opens up the possibility of making us all taller, smarter, faster, we have to ask whether, at some very basic level, that makes us better.
It's also important to note that, in many cases, we will be making these decisions for our children. Growth hormone, for example, has to be administered to pre-school age youngsters. Parents will be guessing that the extra 3 to 4 inches will give their child important advantages that the child him- or herself would want.
Primarily, as I read it, parents are not worrying so much that their children's feet won't reach the accelerator pedal; they're more concerned that their children will not be taken seriously, will not rise to the top of their professions, will be discriminated against because of their height.
Let us say they are right. Is that sufficient reason to "treat" shortness? What about the other causes of discrimination? Should we "treat" dark skin coloring? Should we "treat" homosexuality?
Although it's an imperfect analogy, I'd like to argue that we should approach enhancement as we would any other technology that reduces biodiversity. There's inherent good in preserving differences among people, just as there is in preserving differences among species. When we set up a particular constellation of characteristics as normative and try to medicate everyone into conformity with them, who knows what we will lose?in the strength of character people develop as they cope with their differences, in the perspectives they bring to our common problems, in the advantages they may offer, which we, with our puny knowledge of human biological complexity, can not yet begin to fathom.

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