I’ve written a lot about growth hormone fraud, but this article is not about fraud. It is about waste. It is legal to use growth hormones to treat shortness in children, but that doesn’t mean that insurance and Medicaid should pay for it. One month ago, the New York Times Magazine covered this subject in an article by Stephen S. Hall. The long and short of it is while growth hormones can add an inch and a half to a child’s final height, it is not clear that this is of any value. There are far better uses for the $20,000 or more per year (treatment is typically 4-5 years) per child spent on growth hormones.

If the treatment is of limited value, why is anyone receiving it? The article quotes Dr. Alan D. Rogol, a professor of pediatrics at the University of Virginia, “Short stature became a disease when unlimited amounts of growth hormone became available.” In other words, marketers of growth hormones are creating a market for their drugs.

When the market for growth hormones for treating AIDS wasting plummeted due to the efficacy of anti-retrovirus treatments, the makers of growth hormones searched for new markets. See Serono Sales Director Pleads Guilty to Kickbacks. Short children were an easy target.

Stephen Hall describes a growth chart being distributed to doctors by Eli Lilly. The chart has a red line at the 1.2 percentile, showing the cutoff point for F.D.A.-approved use. The line draws attention to the cutoff and encourages children and parents to think of shortness as a medical problem. Eli Lilly estimates that there are 400,000 children between the ages of 7 and 15 who are at or below the 1.2 percentile, which is a substantial market for a $20,000 per year drug. Not only that, but no many how many kids they treat, the number of children in the lowest 1.2 percentile will not decrease (since 1.2 percent of kids will always be the shortest 1.2 percent).

In the Journal of Clinical Endocrinology & Metabolism Michael Freemark wrote, “the use of GH in very short children may create an unending cycle of catch-up; increases in the ultimate heights of very short children would necessitate reclassification of some previously normal children (short but with height predictions exceeding current cutoffs) as ‘idiopathically short.’ This may be the only circumstance in which treatment of one group of children creates illness in another previously healthy group.”

What is it that growth hormones are really trying to treat? Originally, growth hormones were used to treat children with growth hormone deficiency, but now it has been approved by the FDA for treating people who are idiopathically short—a fancy term for just plain short. The treatment addresses a perceived psychological effect through making physical changes. Usually, we call this cosmetic treatment, and most insurance companies and Medicaid programs do not cover most cosmetic treatments.

Furthermore, there is no evidence that short stature really is a psychological problem or that growth hormones have any positive effect on the purported problem. Studies by David Sandberg and by F Ulph, P Betts, J Mulligan and R J Stratford show that evidence does not support the common wisdom that being short is harmful. While there was no connection between short stature and psychosocial adaptation, socioeconomic status has a significant effect on psychosocial adaptation, so cash assistance to needy families would probably have a greater benefit to society than treating short stature does.

For a point-counter point on growth hormone treatment, read My Little Brother on Drugs