Stamping Out Short People
Growth hormone is just the start of human enhancement
By Gregory Stock
It's official. We've entered the Age of Enhancement, an era in which medicine's job is not only to heal the sick but to enhance the well. As of this summer, doctors have the US government's approval to make humans taller. Can stronger, smarter, and faster be far behind?
The milestone was passed July 25, when the Food and Drug Administration officially recognized the practice of giving supplemental injections of human growth hormone to healthy but short children who have normal levels hGh. Four years of shots could mean an extra three inches for a boy who would otherwise reach just 5'3" or a girl who would ordinarily mature to 4'11" - the bottom 1.2 percent of the growth charts, a demographic that includes the likes of Mickey Rooney, Paul Simon, Judy Garland, and Danny Devito.
In 1985, hGh became one of the first bioengineered drugs approved (it previously had been extracted from cadavers). Initially, the hormone was manufactured only for young patients with pituitary diseases that left their bodies unable to make enough of their own. But soon pediatric endocrinologists were prescribing it to kids whose parents thought they were just too damn short. This "off-label" use was technically legal, but it was done without fanfare or insurance coverage. And it cost parents nearly double the bill for the most expensive four-year college education: Full treatment can run up to $200,000.
Nathan Fox
Now that the FDA acknowledges off-label use, the treatment will go mainstream, the diagnosis will get a billing code, and the insurance companies will be pressured to cover the cost. The FDA takes pains to point out that it isn't condoning cosmetic use - that horror of horrors - since these treatments would be allowed only for a single new pediatric indication: non-growth hormone-deficient short stature, or NGHDSS. Federal regulators didn't just wake up one day to discover that an estimated half-million short kids were ill. NGHDSS is a fig leaf for enhancement.
To be sure, the FDA has come close to this before with Prozac, Ritalin, and Viagra - drugs that blur the line between therapy and enhancement, need and desire. But this time the FDA is doing the blurring, inventing short stature to disguise its acceptance of enhancement.
Why does the FDA bother? Beyond cloistered policy circles, the enhancement taboo has long been irrelevant. And if today's antiaging research bears fruit, the current pussyfooting over a few height-challenged kids taking hGh will seem quaint. Then it won't only be short kids hankering for a few more inches - it will be all of us wanting to reach our hundredth birthday with the vitality of middle age. Politicians would undoubtedly label the intervention preventive therapy for age-related disease. And they'd be tempted to call it a fundamental human right that the government should protect.
The core issue is not whether enhancement is a good idea, but when we'll have interventions worth making. In my view, the sooner the better. Enhancement is not only well aligned with our aspirations for healthier, happier lives, but progress toward it will be egalitarian. This is counterintuitive, but adding a few decades to the poor souls whose genetics are marching them toward an early grave should be a lot easier than pushing the centenarians of the world to 120. Enhancement technology, by its very nature, will inevitably narrow the differentials between us.
The FDA should be figuring out ways to establish the safety and efficacy of enhancement. As it stands, the approval process for new drugs is slow, risk-averse, and expensive; if unchanged, it will afflict rather than protect us. The biggest risk isn't that we'll make mistakes or create a race of superhumans. It's that we'll proceed too cautiously with health enhancements that would benefit us all.
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Gregory Stock (gstock@ess.ucla.edu) is the director of the UCLA School of Medicine's Program on Medicine, Technology and Society.
