Normal at Any Cost: Tall Girls, Short Boys, and the Medical Industry's Quest to Manipulate Height (review)

In his novel I Was a Teenage Dwarf, Max Schulman describes the distress of thirteen-year-old Dobie Gillis, who is shorter than every boy and girl in his eighth grade class at John Marshall Junior High School. The novel nicely captures the social disadvantages of below-average stature for young men in the 1950s. In their new book, journalists Susan Cohen and Christine Cosgrove explore the fate of Gillis's real-life counterparts as well as girls who were "handicapped" by above-average height. Cosgrove's interest in the subject is rooted in personal experience: as a teenager, she was given synthetic estrogen to stunt her growth and keep her from reaching the "abnormal" height of six feet. Cohen has done extensive work on the development of the first synthetic growth hormone and other issues in bioethics. This mixture of professional background and personal insight leads to a meticulously researched and compelling book.

The authors examine how the definition of "normal" height was constructed by a combination of medical and social forces. One of the main tasks of pediatricians in the post—World War II era was to measure their patients' growth and development against standardized tables of height and weight. Initially, deviation from the standardized norm was taken as a sign of disease or malnutrition, but soon "abnormal" height itself became a disease in need of treatment. This medical demarcation between "normal" and "abnormal" was reinforced by gender expectations for girls and boys. An article in Parents magazine warned that "tallness can be a real handicap for a girl," especially in the postwar era when women were expected to marry and have children (p. 5). Girls could be "saved from spinsterhood" by receiving a new "wonder" drug—the synthetic estrogen diethylstilbestrol (DES), which when administered during early puberty would keep their adult height within socially accepted norms.

Children considered below average in height received the height-enhancing human growth hormone (hGH). This drug was initially developed to treat pituitary dwarfism, but soon anxious parents were bringing short children, boys especially, to pediatric endocrinologists in the hopes their children could attain a "socially acceptable height" (p. 90). Psychologists warned that short boys might develop an inferiority complex or compensate for their short stature by turning into tyrannical "Napoleons." The pediatric psychologist John Money claimed that short men were especially prone to become homosexuals. Even psychologically healthy short men faced discrimination in the job market and earned less money than did tall men. Randy Newman's hit song "Short People" (1977) both satirized and reinforced this prejudice with its declaration "short people got no reason to live" (p. 112).

Cohen and Cosgrove demonstrate that these "wonder drugs" did not always live up to their promise, as tall girls continued to grow and short children did not reach their predicted height. Moreover, these treatments often caused severe medical problems. Tall girls who received synthetic estrogen experienced weight gain, nausea, vomiting, and extremely heavy and painful menstrual periods. Later in life, these women were more likely to develop fertility problems and cancer of the breast and reproductive organs. In 1984, scientists discovered that individuals who had received hGH as children were at risk for Creutzfeldt-Jakob disease (CJD), a rare type of spongiform encephalitis related to mad cow disease that was transmitted through contaminated human pituitary glands and other tissues. This discovery temporarily brought hGH treatment to a halt in the United States. The following year, in 1985, the FDA approved the drug Protropin, a synthetic form of hGH manufactured by the biotechnology company Genentech. Curing the "disease" of shortness thereby became a big business for the pharmaceutical industry.

Cohen and Cosgrove intend their book to be a "cautionary tale" of "how quickly medicine can move from curing disease, to treating disability, to leveling disadvantage, to satisfying desire for perfection" (p...