Betsy
09-08-04, 03:57 AM
I'd like to see a similar study done on those with intersex conditions, particularly those who are informed about their condition and if surgery was an option, one that was opted out of.
Betsy
Shortness not a factor in healthy adjustment
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UB study suggests height has no role in popularity
By HENRY L. DAVIS
News Medical Reporter
9/7/2004
Contrary to popular opinion, being short may not be as bad as people assume it is.
Height plays no role in the number of friendships very short or very tall children have, their acceptance by peers or their adjustment in life, according to a new University at Buffalo study.
Short children get teased, but so do most children during adolescence, the researchers found. The study is bound to add to the controversy over the costly treatment of healthy short children with human growth hormone to make them taller.
For years, so little extracted human growth hormone existed that only the shortest children deficient in the hormone or suffering from rare growth-stunting conditions received therapy to make them taller.
But the development of synthetic growth hormone almost two decades ago encouraged expanded use. In 2003, the Food and Drug Administration approved Eli Lilly & Co.'s Humatrope for very short but otherwise healthy children, a decision partly rooted in the belief that short stature is emotionally disabling.
Most of what's known about the presumed stigma of short stature comes from children whose parents take them to specialists for an evaluation, said Dr. David E. Sandberg, lead author in the study in the journal Pediatrics. The study is believed to be the first to look at this issue in the general population.
People may desire to be taller and believe tallness conveys advantages, but the study suggests extremes in height - being very short or tall - don't appear to have a bearing on a child's popularity or reputation.
"You can demonstrate in the lab that being taller is better, but if you actually look at people's lives, you can't distinguish," said Sandberg.
Sandberg and his colleagues don't advocate denying growth hormone to healthy short children but suggest physicians use caution when prescribing it.
"For some children, we can't make a definitive diagnosis, but they are so short that it's clear there is something wrong. Their height will constitute a physical disability," he said. "We have to distinguish between those people who are on the short end of normal and those who are significantly below that."
He and others worry that giving short but healthy children growth hormone will only further perpetuate the stigma attached to small stature. If parents and doctors automatically attribute emotional problems to height, they may be missing the true cause of a child's difficulties, said Sandberg, an associate professor of psychiatry and pediatrics.
The dilemma for physicians is figuring out what degree of short stature in otherwise healthy children is disabling enough to warrant therapy and when treatment should end, experts say.
Cost and the difficulty of the therapy come into play. Treatment requires almost daily injections over four or five years at about $20,000 annually for an average height gain of 2 inches.
The decision to use human growth hormone in children who don't have a confirmed disease isn't easy. Specialists say that short stature is a complex condition that is not entirely understood, and that some short children without obvious growth hormone deficiencies should get treatment depending on the circumstances.
"The drug should not be given indiscriminately. But it is also very dangerous to fall into the trap of saying we should not treat short children just because we don't see growth hormone deficiency," said Dr. Teresa Quattrin, chief of pediatric endocrinology at Women and Children's Hospital and a UB associate professor.
When to stop treatment raises difficult questions as well. What do you do if the therapy makes short children taller than other children who are ineligible for the drug? What difference does tallness make without short people?
"Many children get treated until they stop growing. Ours is a minority view, but there isn't good justification for making a person taller once they are normal height," said Dr. David Allen, a University of Wisconsin professor of pediatrics who co-wrote a recent article on the ethical issues raised by expanded access to growth hormone.
Co-authors of the study included researchers at Concordia University and Children's Hospital of Pittsburgh. The study received funding from the Human Growth Foundation, Genentech Foundation for Growth and Development and the Children's Growth Foundation.
e-mail: hdavis@buffnews.com
Betsy
Shortness not a factor in healthy adjustment
--------------------------------------------------------------------------------
UB study suggests height has no role in popularity
By HENRY L. DAVIS
News Medical Reporter
9/7/2004
Contrary to popular opinion, being short may not be as bad as people assume it is.
Height plays no role in the number of friendships very short or very tall children have, their acceptance by peers or their adjustment in life, according to a new University at Buffalo study.
Short children get teased, but so do most children during adolescence, the researchers found. The study is bound to add to the controversy over the costly treatment of healthy short children with human growth hormone to make them taller.
For years, so little extracted human growth hormone existed that only the shortest children deficient in the hormone or suffering from rare growth-stunting conditions received therapy to make them taller.
But the development of synthetic growth hormone almost two decades ago encouraged expanded use. In 2003, the Food and Drug Administration approved Eli Lilly & Co.'s Humatrope for very short but otherwise healthy children, a decision partly rooted in the belief that short stature is emotionally disabling.
Most of what's known about the presumed stigma of short stature comes from children whose parents take them to specialists for an evaluation, said Dr. David E. Sandberg, lead author in the study in the journal Pediatrics. The study is believed to be the first to look at this issue in the general population.
People may desire to be taller and believe tallness conveys advantages, but the study suggests extremes in height - being very short or tall - don't appear to have a bearing on a child's popularity or reputation.
"You can demonstrate in the lab that being taller is better, but if you actually look at people's lives, you can't distinguish," said Sandberg.
Sandberg and his colleagues don't advocate denying growth hormone to healthy short children but suggest physicians use caution when prescribing it.
"For some children, we can't make a definitive diagnosis, but they are so short that it's clear there is something wrong. Their height will constitute a physical disability," he said. "We have to distinguish between those people who are on the short end of normal and those who are significantly below that."
He and others worry that giving short but healthy children growth hormone will only further perpetuate the stigma attached to small stature. If parents and doctors automatically attribute emotional problems to height, they may be missing the true cause of a child's difficulties, said Sandberg, an associate professor of psychiatry and pediatrics.
The dilemma for physicians is figuring out what degree of short stature in otherwise healthy children is disabling enough to warrant therapy and when treatment should end, experts say.
Cost and the difficulty of the therapy come into play. Treatment requires almost daily injections over four or five years at about $20,000 annually for an average height gain of 2 inches.
The decision to use human growth hormone in children who don't have a confirmed disease isn't easy. Specialists say that short stature is a complex condition that is not entirely understood, and that some short children without obvious growth hormone deficiencies should get treatment depending on the circumstances.
"The drug should not be given indiscriminately. But it is also very dangerous to fall into the trap of saying we should not treat short children just because we don't see growth hormone deficiency," said Dr. Teresa Quattrin, chief of pediatric endocrinology at Women and Children's Hospital and a UB associate professor.
When to stop treatment raises difficult questions as well. What do you do if the therapy makes short children taller than other children who are ineligible for the drug? What difference does tallness make without short people?
"Many children get treated until they stop growing. Ours is a minority view, but there isn't good justification for making a person taller once they are normal height," said Dr. David Allen, a University of Wisconsin professor of pediatrics who co-wrote a recent article on the ethical issues raised by expanded access to growth hormone.
Co-authors of the study included researchers at Concordia University and Children's Hospital of Pittsburgh. The study received funding from the Human Growth Foundation, Genentech Foundation for Growth and Development and the Children's Growth Foundation.
e-mail: hdavis@buffnews.com