02/14/2009 05:12 am ET | Updated Nov 17, 2011

The Short End of the Stick

Julie Goodman also contributed to this article.

When Barack Obama takes office next week, he will make history as the first African American president. Race notwithstanding, this past election season was rife with discussions of sticky issues, including gender and age. But what about height?

At 6'1", Obama towers over McCain, who measures up at 5'7". Sure, a taller guy might look more powerful, more competent, and more authoritative. But could such a seemingly insignificant characteristic as height really sway voters?

You bet. A study surveying presidential elections from 1824 to 1992 found a positive correlation between the height of winners and the victory margin. And get this -- the survey also found that the more worrysome the political, economic, and/or social threats during the election time, the taller the president. How's that for a "tall order" of business?

Of course, we would be hard-pressed to find someone in an exit poll who voted against McCain because he was 'too short' -- but the study suggests that Americans harbor a subtle form of prejudice called 'heightism,' in which short-statured people are seen as inherently inferior to their taller counterparts - particularly in times of economic and political trouble.

Like the causes of short stature, heightism can take many forms. Most of us are familiar with the stigma that plagues dwarfs, who have battled centuries of stigmatization.

But heightism also afflicts people without inborn genetic conditions -- those who are "just short." The medical term used to label this (and shortness is indeed 'medicalized') is idiopathic short stature (ISS), or shortness with no known cause. While displaying no medical problems, many individuals with ISS experience psychological problems (think Napoleon Complex). Many short men complain of difficulties on the dating scene and in the workplace, and many short children find themselves the victims of playground taunts and bullying.

Meanwhile, parents navigating in an era when medical treatment often slides into "medical enhancement," are presented the option of giving their healthy ISS children the latest growth-inducing pharmaceuticals. The drug of choice is synthetic growth hormone, first developed by the biotechnology company Genentech under the name Protropin. The drug reached the market in 1985, just after the National Institutes of Health (NIH) yanked the natural hormone, extracted from cadavers for safety reasons (a few recipients had developed Creutzfeldt-Jakob disease). While the natural hormone had been reserved for kids with growth-related hormone deficiencies, doctors began prescribing the abundant synthetic drug for off-label use in ISS children. In 2003, almost two decades later, the FDA bowed to clinical practice and approved synthetic growth hormones for ISS.

How effective is this drug when given to ISS children? In a 20-year study reported in 2008, Dr. Kerstin Albertsson-Wikland and her colleagues at the Queen Silvia Children's Hospital in Sweden investigated the impact of hormone injections on final adult height.

The study randomly assigned children to either high doses of hormone, low doses, or no treatment at all. The children were then followed until they reached their "adult height." Not surprisingly, Albertsson-Wikland found that the kids who received growth hormone treatment grew taller than did the untreated children, with the higher dose yielding the most added height.

But there was a caveat: the children had to have parents of normal height. If children were born to just-as-short parents, the growth hormone didn't work, indicating that other genes and well as the hormones play an important role in height determination.

Some other observations: boys responded better to growth hormone treatment than did girls (Albertsson-Wikland attributed the gender difference to the fact that during puberty, boys more than double their growth hormone production, while girls produce quadruple the amount. Therefore, girls in the study would have needed a higher dose of hormone to proportionally match the boys' hormonal boost). And finally, despite the general trend toward height increase, each individual child differed, sometimes dramatically, in their response to the drug.

So is treating short children with drugs the best course of action?

The answer depends on who you talk to. Albertsson-Wikland views treatment as a form of justice for short kids, who are born with the genes to be taller (as measured by their normal-height parents, anyway) but for some reason aren't.

ISS individuals born to normal-height parents "are not reaching their genetic potential," she says, "so there is something wrong with these children."

Therefore, Albertsson-Wikland believes that such a "wrong" should be righted, and since drugs can do the job (at least sometimes), why not try?

However, critics of growth hormone prescriptions for ISS children argue that the treatment contributes to prejudice and implies pathology where none exists. There are also side effects to consider. The drug is extremely expensive and usually not covered by insurance, raising concerns about social inequities. And in the age of steroid abuse, growth hormone's muscle-increasing, fat-decreasing properties offer a tempting alternative that can't be detected by normal drug tests for athletes.

Some physicians agree with the social stance against treatment, but they nonetheless have to practice medicine in the real world. "Sometimes you have to drop your society analysis and look at the individual," says Craig Alter, Professor of Pediatrics and Clinical Director at the University of Pennsylvania Children's Hospital of Philadelphia, who regularly sees patients with ISS.

And that individual is a child between 8 and 14 years old, with concerned parents who may have their own agenda. "There is a lot of push from intelligent families that know the system and want to get everything out of it," he notes. Often it is the parent who pressures the child, and sometimes even the physician, to agree to treatment.

While Alter is conservative in writing out prescriptions for synthetic growth hormone and believes the drug "should be reserved for those whom, in his opinion, "would suffer greatly for psychological reasons without treatment," other doctors treat ISS aggressively.

As the hormonal controversy and questions continue, so, too, does 'heightism.' It can be a stigmatizing as any other "ism" including that related to race or sex. While you determine where your sentiments lie, here are a few steps toward battling height prejudice:

•Be aware of "grow taller" scams.

Many companies market pills as growth-promoting agents. Despite the fancy claims, the ingredients are no different than what you would find in a daily multivitamin supplement and do not encourage growth. Likewise, the hyped stretching and meditation exercises to promote growth also fail.

•Become a Heightism Watchdog.

If you see heightism in the media, speak out! You can report incidents to the National Organization of Short Statured Adults (NOSSA), or you can publicize them on personal blogs or websites. NOSSA also suggests contacting the media outlet directly, calling elected officials, and using the power of consumer boycotts.

•Expand anti-bullying policies in schools to include height.

Many schools already have comprehensive anti-bullying campaigns and curricula. Anti-heightism education could easily be incorporated into these efforts.

•Empower ISS children.

Let them know about artists, musicians, and political figures of extreme short stature. Ghandi, for example, only measured about 5'3". And of course there was Napoleon, who was only 5'6".

We will soon welcome our first African American President to the Oval Office, showing how far our country has come in battling racial prejudice. Perhaps one day the same justice will happen for smaller individuals.

A short Commander-in-Chief? Let's take it an inch at a time.

Julie Goodman is a student at Brandeis University, near Boston.

Trisha Gura, Ph.D. is a science writer and the author of Lying in Weight: the Hidden Epidemic of Eating Disorders in Adult Women (Harper Collins, May 2007) and Body: The Complete Human (National Geographic, October 2007) and Going Hungry: Writers on Desire, Self-Denial, and Overcoming Anorexia (Anchor Books, September 2008).