Monday, October 17, 2005

Small Gains   posted by Jason Malloy @ 10/17/2005 05:58:00 AM

The New York Times Magazine queries - is an inch Worth $100,000? (The Short of it). I guess that depends where it goes . . .

Down the toilet is where, apparently, according to the article, which describes the modern trend for parents and doctors to favor expensive Human Growth Hormone treatment for young boys who happen to naturally develop at the extreme left-hand side of the height bell curve – completely normal males who won’t even hit the 5 foot mark. The parents and health professionals are under the reasonable impression that height below the 2nd percentile, must provide these boys with some significant social handicaps – handicaps which could eventually affect their mental health and major life outcomes (ability to acquire mates, wages, job security, etc.). Unfortunately, attempts to empirically verify the assumptions behind this treatment have all failed:

Several years ago, around the time the Food and Drug Administration was considering the use of human growth hormone to treat extremely short but otherwise normal children, researchers were working up the results of a large-scale psychology experiment involving hundreds of middle-school and high-school students in the Buffalo area - including some who were extremely short but otherwise normal. The students didn't know the study was about height. All they knew was that each of them had been asked to be the director of a class play. They were given thumbnail sketches of various characters in the drama - "a good leader," "teases others too much," "gets picked on" and so forth - and were then asked to cast the play by selecting classmates who best fit each role.

If short stature is a ticket to social prejudice and psychological purgatory, which has been the animating idea behind expanded use of growth hormone in the last 20 years, you would have expected the shortest children in the Buffalo study to be lining up to collect their Tonys in victimhood; they would have been nominated by classmates for every beleaguered role: being picked on, behaving shyly, acting withdrawn, being left out. But that, surprisingly, was not the case. A team of psychologists, led by David E. Sandberg at the University at Buffalo, concluded that a child's stature, whether tall or small, had "minimal detectable impact" on his or her social standing among schoolmates. At least in this setting, even extremely short children (those around the first percentile) made friends and earned the respect of their peers as easily as kids of average size.

Sandberg’s evaluations have found these kids at the 1st percentile to be emotionally, socially, and behaviorally normal, something replicated by similar research in England. This isn’t a trivial find considering that typical treatment runs about $20,000 a year for 4-5 years, and typical gains are only about 1-2 inches. And yet clinical comparisons between an HGH group and a control group found:

. . . no significant differences in the quality of life between young adults who had been treated with growth hormone as children and a control group of adults (equally short as children) who had not - except that adults who had taken the drug as children had a romantic partner less often than those who hadn't used it.

So the largest scientifically verified benefit of this $100,000 treatment is less sex partners! With treatments like these, as they say, who needs sickness?

I can see why it would be tempting, even prudent, for parents to disregard such results, though. We’ve all heard the one about the taller presidential candidate, and it’s not as if the literature isn’t full of examples of the woes of shortness. Even this article admits:

There is a considerable literature suggesting that taller men receive higher pay than shorter men, and one recent study concluded that economic discrimination against short adult males was equal in magnitude to racial or gender bias in the workplace.

Right, ‘considerable literature’, so then did the paper that followed the HGH “adults” measure things like job security and wages? If it didn’t look at these kinds of things then we have a poor study design (I’d bet subjects are still too young to catch the most important variables), but if it did and didn’t find any difference, we have results that can at least fairly be regarded by concerned parents as anomalous – at odds with the larger literature. Because of a number of safe study designs, like comparing the taller of two identical twins, Steven Landsburg noted that we know height is worth about $1000 per inch per year. Sadly these substantial returns wouldn’t even match the treatment costs after an entire adulthood of working, but shortness appears to be related to more than just money – long term mental health may also suffer in important ways:

In a study of records for nearly 1.3 million Swedish men, the investigators found that for every 2 inches a man gained in height, his suicide risk dipped by 9 percent. Overall, the shortest men in the study were about twice as likely as the tallest men to commit suicide.

So we have $2000 extra dollars a year and 9% less of a chance of killing yourself. On top of this, many other studies show that inches have a significant impact on romantic outcomes, both indirectly through greater income, and directly, as increased male height is considered more attractive. Taller males have more, and more attractive, sexual partners, are less likely to be bachelors or childless, and have more children compared with others who do reproduce. A burden humorously illustrated in this unscientific ABC News pseudo-study by some very heartless, um, ‘size queens’:

” ABCNEWS put together an experiment to test just how willing women are to date shorter men . . . To see if the women would go for short guys who were successful, ABCNEWS' Lynn Sherr created extraordinary résumés for the shorter men. She told the women that the shorter men included a doctor, a best-selling author, a champion skier, a venture capitalist who'd made millions by the age of 25.

Nothing worked. The women always chose the tall men. Sherr asked whether there'd be anything she could say that would make the shortest of the men, who was 5 feet, irresistible. One of the women replied, "Maybe the only thing you could say is that the other four are murderers." Another backed her up, saying that had the taller men had a criminal record she might have been swayed to choose a shorter man. Another said she'd have considered the shorter men, if the taller men had been described as "child molesters."

So given what we know about height, it’s not totally unreasonable for parents (who probably want grandchildren) to continue to want to boost their extremely short children at great expense, despite some of these more direct studies suggesting no pay-off – at least at the time of young adulthood.

A height skeptic might wonder if any of these correlations matter in the ways we assume they do, after all “correlation isn’t causation” and the precise relationship between height and income or height and suicide may have nothing to do with height by itself. To illustrate, men who are married make more money at sales, presumably because a third skill – influencing people – gave them an advantage at both finding a partner and making more sales. Therefore just because there is a correlation between marriage and sales, doesn’t imply that giving some sales failure a wife (from your harem, in the manner of a grateful Saudi sheik) will improve his sales ability. This sheik wife may be like HGH tallness.

I am not a height skeptic, in part because the path between height and at least some male outcomes (perceived dominance/attractiveness) is not completely mysterious (see the Landsburg link for a clever experiment to find the path from height to income). Still, I can think of reasons to doubt the cost/benefit analysis in favor of HGH treatment.

Even if the drug had some measure of proven benefit, other factors, such as the possibility of untested long-term effects for new treatments, have to be weighed in these decisions. Also most families don’t have $100,000 to blow; perhaps an equal amount of money put towards good college, a decent home, or something bearing interest for this wee lad would be a wiser investment than 1 inch of height.

Related: Tall Tale, How Much Taller?, Taller ~ Richer, On Height, Medieval Height, Asian Height Gaps.

Addendum from Razib: There is book, it is called Worldwide Variation in Human Growth, and it is searchable via Amazon and Google Print. This book has tables, it reports on studies. These tables and reports transmit facts. Facts are important, and many would contend, as would I, that they should precede opinions, rather than being rendered unnecessary by the presence of an opinion. One need not read the book above, one might even make recourse to a website called google, where one can find facts. If one has an allergy to facts, or lacks the cognitive aptitude toward the manipulation and deployment of facts, one should retreat from the plain of discourse. We aren't here to play Risk, some intellectual stakes are on the table....