Say your son or daughter is short. Not just a little short, but shorter than
99 percent of kids his or her age.
How much would you spend per inch to make him or her taller? One thousand
dollars? Ten thousand?
According to research published recently in The Archives of Pediatrics &
Adolescent Medicine, the average price tag for using growth hormone to add two
inches of height to children with little else wrong other than natural shortness
is about $100,000.
More and more parents are willing to foot the bill.
"Some children added two inches. Some added three or four. Some added none,"
said physician Joyce M. Lee, who examined Food and Drug Administration data to
conduct the cost-effectiveness study at the University of Michigan's division of
child endocrinology. "Per inch, it comes to $52,634."
For years, growth hormone has been used without controversy to help increase
the height of children suffering medical problems from hormone deficiencies to
genetic disorders.
In such cases, growth hormone injections replace what the body lacks. It
allows children to grow an average of three inches, and even more.
But since 2003, the debate over the use of growth hormones in otherwise
healthy children has intensified. That year, Indianapolis-based Eli Lilly &
Co. received approval from the FDA to use its version of human growth hormone,
Humatrope, in children diagnosed with idiopathic (arising from unknown causes)
short stature. California-based Genentech received similar approval in 2005 for
its drug, Nutropin.
Technically, it made only children in the lowest 1.2 percentile of the growth
charts eligible for a diagnosis for I.S.S.
"When we talk about children with idiopathic short stature ? we're talking
about the shortest of the short," said Eli Lilly spokesman Gregory Clarke. "They
are equally as short as children with growth hormone deficiency or Turner
Syndrome (a chromosomal disorder). I think it is most important to look at the
patient need."
Demand for drugs increasing
No one knows how many children take growth hormones but demand for the drugs
has increased, spokesmen for Lilly and Genentech said.
Last year The New York Times reported that Pfizer sold $736 million of its
growth drug Genotropin, up 53 percent. Eli Lilly sold $430 million of Humatrope,
up 16 percent. Genentech's growth drug sales were up 10 percent to $345 million.
Other drug companies experienced less dramatic yet still significant increases.
Physician James L. Casey, chief of pediatric endocrinology at the University
of Kansas Hospital, said growth hormones are "a wonderful medication when used
appropriately."
But Casey and others physicians fear that, all too often, it is not being
prescribed or used properly.
"There's no question that the general trend is more, more, more,"
endocrinologist Adda Grimberg, of Children's Hospital of Philadelphia, told The
Times. "Higher doses, more indications. It works; it's safe; let's try it. And
we are feeling that pressure from all sides, not just the pharmaceutical
industry but also from society, because many parents want their children to be
taller."
Instead of being given to children with something wrong, hormone therapy is
being prescribed for children who, genetically, are just naturally very short.
In them, the drug — which can be used for an average of five to six years — adds
only an inch or two at a very high cost. Like all drugs, it has potential
side-effects from headaches and abdominal pain, to hip problems and, most
severely, though rare, increases in the pressure on the brain.