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http://www.cbsnews.com/stories/2003/11/18/60II/main584265.shtml(CBS) For many children, being the shortest kid in class means being picked on, being called names and suffering the humiliation of being chosen last in gym class.
Kids used to have to live with the teasing, but now, the 21st century family can change all this with injections of something called human growth hormone. A recent FDA approval now allows the shortest children out there to take daily shots of the drug.
This kind of medication is not at all uncommon. In fact, it's become a growth industry in America. But, as correspondent Vicki Mabrey reported last fall, it raises some troubling questions. For short kids like 14-year-old Michael Finley, only one thing matters.
Michael says he’s grown around 3 or 4 inches in a year. But those inches have not come easily. Every night, he gives himself an injection that helps him grow.
The medication Michael takes is a synthetic growth hormone that's virtually identical to a natural hormone we all produce in our pituitary gland. It tells our bones and muscles to grow.
Since kids do most of their growing at night, Michael takes his shot before going to bed.
For nearly 20 years, artificial growth hormone has been used to successfully treat kids who don’t produce the hormone on their own.
What’s different now is that last summer the FDA voted to approve Eli Lilly’s growth hormone, Humatrope, for healthy children who do produce the hormone, but are still in the shortest 1.2 percent of their age group. Translated into adult height? That’s about 5 feet 3 inches for a man or 4 feet 11 inches for a woman.
In some ways, the FDA's decision is just a formality. Thousands of kids who don't fit that profile have been taking it anyway.
Michael didn’t fall into that category because when he went to the doctor he was 4 feet 10 inches -- in the 25th percentile for his age group. But it was perfectly legal for his doctor to give him a prescription -- so that's what she did.
At the time, Michael says he was concerned that his height was holding him back, especially when he tried out for the basketball team.
"I tried out for the team in seventh grade,” says Michael. “I had practiced everyday, too, like, because, you know, I wanted to make it so bad … I thrived for it. … I didn’t make it.”
Not making the team is a disappointment many of children have to live through. But in the Finley household, the failure was devastating. Michael's mother, Micki, is only 5 feet tall. But his father, Lee, was a star player in high school. And his sister Cindy, at 5 feet 10 inches, is following in dad's footsteps.
For Michael, pick-up games in his Dallas suburb are a daily ritual with brother, Will. The two brothers were evenly matched, until last year, when Will, 18 months younger, outgrew Michael.
“They’re best friends, they’re real close. But when your little brother is almost a foot taller than you, he would say, you know, ‘He’s bigger than me. Why is he bigger than me? It’s not fair,’” says mother, Micki. “I don’t know what to tell you. I can’t help you." The Finleys went to see Dr. Dana Hardin, a pediatric endocrinologist and head of the growth hormone program at Children’s Hospital in Dallas. She examined Michael and monitored his growth for several months. Tests indicated Michael was producing adequate levels of growth hormone, but x-rays of his bones revealed his adult height would probably be only 5 feet 5 inches.
What made Michael a good candidate for growth hormone?
“His family stature, his genetic potential. His father is very tall, his mother is average height for a woman,” says Hardin.
“More than just looking at his family height, I looked at his rate of growth over time. And Michael was not keeping up with the growth curve.”
Was it a hard decision for Michael to make? What does he think he’ll get from being taller?
"No,’” says Michael. "Females can be shorter than males. And that's all right with them. It's just some males want to be taller, because they think, 'Well, I'm a man. I should be tall and strong.'"Since artificial growth hormone was first manufactured in 1985, it's helped thousands of sick children. But increasingly, the drug is touted for more controversial uses - athletes and aging adults take it to increase muscle mass and stay young.
The FDA's approval of human growth hormone for use in healthy children was based on studies presented by Eli Lilly. Those studies showed that if children received hormone injections "three times weekly," they would grow an average of 1.5 inches. With shots "six times weekly" at a higher dose, the average was 3 inches. In approximately 10 percent of the children, the drug did not work at all.
The most common side effects were mild -- ear infections and joint and muscle pain.
With the number of healthy children using growth hormone now likely to skyrocket, a lot of people are wondering how safe the drug really is.
Dr. Glenn Braunstein, chairman of medicine at Cedars-Sinai Medical Center in Los Angeles, chaired the FDA advisory panel that reviewed Eli Lilly’s application.
“It’s got a very good safety profile,” says Braunstein.
The studies Lilly presented found that, on average, children could gain 1.5 to 3 inches if they started taking the drug during adolescence. Even though there were few side effects during the trial, Braunstein says little is known beyond that.
“What we don’t know is what’s going to happen 30, 40 years down the road,’ says Braunstein. “But that’s true of any drug.”
Isn’t it difficult as a physician to prescribe a drug for a perfectly healthy child?
“Yes. I agree. And that’s why you have to weigh the risk versus the benefit,” says Braunstein. “So if the benefit is going to be potentially increased height, less social isolation or bullying, a child that is happier, than a small risk may be worth it.”
To Arthur Caplan, a bioethicist from the University of Pennsylvania, this is a critical moment in time because we're beginning to accept artificial means to improve healthy children.
“Every kid has something they’re not good at, every person has something that is less than normal. That’s what we have to live with in life. We don’t try to fix it with drugs. We sort of say we’ve got to learn to cope with some of our foibles, something that’s less than perfect. That’s what humans are.”
Caplan also worries that since the drug is now approved for short but healthy children, it won’t be long before we all start feeling a bit inadequate.
“We’re all going to wind up having a campaign aimed at us that says, ‘You feeling a little short? Worried about that? As a kid, as your mom, what about injections,'” says Caplan.
”People are going to be saying, ‘Hmm, 6 feet 3 inches, that’s not really quite big enough to be a good forward on my high school basketball team; 6 feet 5 inches might. Let’s try it.’”
What does this tell us about what parents might be willing to do for their children down the road?
“It’s a kind of canary in the cave. There’s a whole slew of things coming down the road, where we’re going to have the same discussions,” says Caplan. “And I think what parents are going to do is, they’re going to face the question, ‘How much manipulations, how much engineering do I want to do on my child?’”
But ethical questions were not of great concern to another one of Dr. Hardin's patients, Stephen Thompson, because he says he knows what it's like to be short.
Thompson, a junior at Texas A&M University, now fits in just fine, but when he entered high school, he was just 4 feet 11 inches.
“I was trying to stay strong for myself, for my family. So my outward persona was happy, probably,” says Thompson. “But on the inside, I was dealing with a lot of depression.”
Thompson says people thought he was 10, 11, or 12 when he was 15, 16 years old: “I’d go to a restaurant, sometimes they’d say, ‘Do you want to see the kids' menu?’ And you know, I mean, it sounds funny. You try to laugh at it. But really, you know, it’s devastating.”
It took nightly injections for two and a half years, but Thompson eventually reached 5 feet 9 inches. He says he no longer feels like he’s trapped in a little boy’s body -- a welcome change that lets him be just another guy on campus.
“It changed my whole outlook on everything,” he says. Thompson was lucky because his insurance company paid for his hormone injections - a treatment that runs about $20,000 a year. What's unclear, however, is how the FDA's new approval will impact who's covered and who's not.
“I personally don’t think that society should pay for this. I think that society’s health care dollars are better spend on prenatal care and immunization of children,” says Braunstein.
But won’t this just wind up being an option for the rich if insurance won’t pay for it?
“It may be, but that doesn’t necessarily mean that we should not allow people who are very distraught and have the financial wherewithal to get the drug and to use the drug,” says Braunstein.
For now, a foundation partly funded by Eli Lilly is helping the Finleys pay for Michael’s treatment. His doctor estimates he might eventually stand over 6 feet tall.
As for the three inches he’s grown? Michael says they’ve helped him reach a benchmark he’s been waiting for all his life. He’s now a little taller than his mother.
“That was a good feeling. I can look down at her and go, ‘Hi, Mom,’” says Michael.
And his friends’ reactions?
“They’re like, ‘Wow, so what are you doing,’” says Michael. “Well then, I told them I was taking growth hormone. Like ‘Oh really?’ And so they were like thinking, ‘Hmm, maybe I should try that.’”
His mother, Micki, says it’s worth it: “I could honestly look him in the face and say, ‘Michael, I tried the best I could. And I got you a couple extra inches in there.’” Since this story aired last fall, Michael Finley has grown another two inches. But now, he's quit taking the injections because the foundation stopped paying for the treatment, and his family's insurance company won't cover the shots.
