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Book Review: SIZE MATTERS: How Height Affects the Health, Happiness, and Success of Boys — and the Men They Become.« Back to Volume 23, Issue 1, March 2007 - Table of Contents By Stephen S. Hall. Summary The book Size Matters is unique. Stephen Hall has presented his own autobiography in respect to his physiognomy, philosophy, and psychological maturation. In writing this book he has researched and synergized the best data available to understand the processes of physical and psychological growth. The intended audiences, in my opinion, are both the lay public and the professional medical community that serves children. He has shared his life story, and the data and experiences he has collected in this book demonstrate unequivocally that he is a masterful science writer. For potential readers, this book provides insight for all of us as parents and/or professionals. My personal opinion is that the book does not have to be completely or sequentially read in order for the reader to enjoy or benefit from the writing, although I suspect that most readers will find it so enlightening, informative, and entertaining that a significant majority will finish it quickly and completely. Hall has previously proven himself to be a masterful science writer. My introduction to his medical science books occurred when I read his book entitled Invisible Frontiers: The Race to Synthesize a Human Gene, which is the fascinating story of the identification of the structure of the human insulin gene–the attempts, failures, and eventual success of synthesizing the gene, and instigating the production of human insulin in large quantities for therapeutic use. I was captivated by the style of Hall’s work; specifically, the use of documented interviews of essentially all the participants in the story, and by the assimilation of political and scientific events that had transpired to make human insulin and, later on, human growth hormone (hGH) therapeutic agents. The period was 1975-1985; Hall published his book in 1987 and republished it in 2002 with a foreword by James Watson, of DNA fame. This book should be required reading for every endocrinologist of every specialty, as it portrays academic collegiality and competitiveness among and between professors, post-doctorate fellows, and their colleagues. It also opened my eyes to what scientific journalists could and should be creating. Review Why should pediatric endocrinologists and their patients want to read this book? Many reasons immediately come to mind; the first deals with the pertinence that size does matter–in multiple positive and negative ways. Hall has published an outstanding treatise on how and why it matters culturally, psychologically, politically, and influentially on how we act and think at every stage of our lives. No one has previously assimilated all these aspects and their interrelations in a single publication. The second deals with an introduction of the readers to how science writers can and should write in order to communicate with their audience. This is true whether the readers are pediatricians, psychologists, social workers, teachers, family practitioners, or the public. Hall’s publications are masterfully composed using personal contacts with patients, parents, and scientists in the medical field. Each of his books is written in an easy-to-read style that provides the reader with an intricate understanding of the medical feature about which he is writing. Size Matters is the epitomy of Hall’s scientific writings. He is an accomplished researcher, a sensitive interpreter of data, and an author whose work I believe should be read by all who deal professionally and personally with normal and/or abnormal growth in humans. The content which greets the readers is much more than textbook writing. Three important quotes are used to introduce the content of the book; one each by Cicero, Charles Darwin, and Dr. James Tanner, and all are appropriate for what follows. Exemplary is that of Cicero, “It matters greatly to the soul in what part of the body it is placed for there are many conditions of the body that sharpen the mind and many that blunt it.” The Introduction which follows is entitled “Squirt” and consists of 26 pages of self-analysis, and question-asking, which sets the stage to subsequently relate the physical and psychological perspectives that Hall has examined. Exemplary is Hall’s statement; “Pursuing a more idiosyncratic avenue of curiosity, I wondered if I could find any scientific support for my intuitive notion in line with Trudeau’s ‘inner shrimp’ idea that the experience of being short (or, for that matter, tall) in adolescence molds psychology and behavior.” Reading in this section of the self experiences of Hall, who was on the 1 st percentile of the Tanner height curve until his late teens, propels the reader into Part I of the major sections of this book. Part I deals with the control of both normal and abnormal growth in utero, infancy, and early childhood. The value and the charm of Hall’s writings is the prevalence of storytelling throughout the book. The stories that start this section deal with the historical and amazing development of the fetus, and how fetal measurements were attempted–successfully so in many respects–in the 1800s, and how refinement of these and other techniques has permitted an 8.6-ounce infant delivered in Chicago in 2004 to survive. Hall’s storytelling comes in different packages, some from research of literature and much from interviews with the people who made history. The latter is exemplified in this section also; specifically, the interview of David Barker whose research in England produced the concept and facts that there were correlations between fetal size and organic disease in adult life. This book is worth reading for the mental consumption of these stories alone, and they are just 2 of many. A remarkable component added to the book is the Notes section (pages 328-373). This is indexed to correlate page by page with the written text. The research Hall has done in obtaining his data is evident when one glances at the first section which covers Part I. The studies and explanations by Barker, Tanner, Fleming et al, Boas, and many others are recorded here. Hall has read, devoured, and transmitted to us the importance of their work. Part II is entitled “My, how you have grown...” The subsections are: (1) The Invention of Childhood, (2) The Bully Inside Me, and (3) Runts, Sneaks, and Dominators. The subtitles strongly indicate one of Hall’s orientations: specifically, the relationship between statural growth and the development of personality. The weaving of data published over many years by Tanner, Bayley, and others interested in physical growth, and that by Farrington and others interested in psychological observations of normal and abnormal growth is masterful. Multiple references are found in the Notes section. An abstraction from one paragraph (page 104) provides the reader with insight into Part II: “As someone who both bullied and was bullied, someone who knows firsthand and marrow-deep how profound an influence this kind of behavior has on childhood and adolescent development, I am dumb-founded that no solid national data on the prevalence of bullying in the United States existed prior to 2001. That is when researchers at NIH....published...a much discussed study....” which Hall has researched, and discussed for all of us. The example is just one of many that could be used. Part III, entitled “The Spurt” with subsections (1) To Grow Hairy, (2) Belittled, and (3) The Prussian Curse, deal with hormonal, structural, and psychological aspects of adolescence, including self doubting. Hall introduces part by a quote from Keats; “The imagination of a boy is healthy, and the mature imagination of a man is healthy, but there is a space of life between in which the soul is in a ferment, the character undecided, the way of life uncertain, and the ambition thick-sighted; thus proceeds mawkishness.” Puberty has always been a fascination in every way. Hall has covered nearly every aspect of its importance, including his own personal experiences trying to make the basketball team, but failing miserably and surviving. Also discussed is the work of Tanner in describing the stages of sexual development during adolescence, the work of Crowley in finding the gene(s) involved in sexual maturation, the work of Tremblay in determining hormonal factors in aggressive behavior. There is difficulty for me in selecting which part of the book I enjoyed most, but part III is high on the list. The 3 rd subsection, The Prussian Curse, is a detailed story of King Frederick William of Prussia who in the early 1700s worshiped the possession of tall men, collected them from many sources and by many different means, in order for them to be his grenadiers and drinking companions. Hall’s collection of historic stories about stature is unfathomable, and this is one of the best. Hall extends his research regarding data pertaining to tallness as an important fact in the generation of income as an adult. These data included the findings of Persico, Postlewaite, and Silverman in 2004. Part III is 56 pages, and I would have been disappointed with less. Part IV entitled “Timing” has 3 subsections: (1) Timing Is Everything, (2) ‘Man In His Imperfection’, and (3) The Emperor’s New Medicine Cabinet. The first 2 pertain to the various aspects of normal adolescent development and its variations, such as constitutional delay of adolescence and growth (which plagued Hall). I appreciated his presentation of these subsections which included valuable analysis and history of the extensive studies on the role of timing of appearance of adolescence, how often its delay causes self destruction on the teenager’s self image, and how these changes affect teen as well as adult behavior. The professional reader will have deducted rightly that the third subsection deals with the use of hGH to influence ultimate stature. In my opinion, this section is the climax in respect to the entire book. Hall has intensively concentrated on the positives and negatives of administering hGH to individuals with various types of short stature. The ethical considerations of treating individuals with idiopathic short stature are developed by relating personal interviews with many of the leading pediatric endocrinologists of our time. This subsection is an abbreviated history of the use of hGH on the past 2 decades, including its positive and negative uses in 2006 and 2007. Hall has wonderfully and fairly evaluated the dilemmas encountered by those prescribing hGH, particularly for those children with variations of normal growth. Of the major parts of Size Matters, Part V, entitled “Stature as a Metaphor,” is to me the most enjoyable to read and contemplate. The subsections are (1) College and Beyond, (2) The Tallest People On Earth, and (3) Final Height. This section of the book delves into multiple aspects of stature in the broadest perspective (historical, environmentally-induced, breeding, extinction of species, and others). For the reader who is not reading this book to seek answers to medical questions, but for other reasons, I suggest reading part V first. It truly provides a broad introduction to concepts of the world that most of us have not previously considered, all packaged in irresistible reading. Hall does focus briefly on himself. One summary paragraph is copied here to provide further insight into the philosophical breadth that Hall has acquired. From pages 277-278 of subsection (1) College and Beyond, “Like all children and adolescents with their landscapes of problems and challenges, I developed behavior that I carried into adulthood, clutching them like a bag lady defending her most proud possessions. Some have proved useful, some less so. Some are immensely helpful in certain circumstances, but nearly disastrous in others. All are a part of the person that I have become. Perhaps it is a cliché, and a cold hearted one at that, but if personality and character are tempered in the crucible of experience (especially difficult experiences), then resorting to a drug like hHG in non-medical circumstances strikes me a little like lowering the temperature of that tempering process. It might make adolescence easier, but it might make adulthood harder.” In the Epilogue, Hall presents runtism. He specifically he relates his experience visiting a hog breeding farm to determine if he could learn what makes the runt of the litter “the runt,” if the runt survives and, if so, how? His account and philosophical conclusion prompted this reader to smile broadly. Few researchers would have been so thorough or inquisitive. In the final section of text he relates seeking out the other very small boy, mentioned in the Introduction section, of his grade school class to learn how he had faired. His accounting is analytical and philosophical, as is his conclusion. He concludes that size does matters, just as genes matter to the growth of children, the development of boys, and the shaping of child psychology. Hall cites the thinking of Tremblay and others that it is not the genes in themselves–it is how the genes are suppressed or stimulated by the environment. I conclude that Hall’s belief is that nature and nurture work together in strange ways. Robert M. Blizzard, MD
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Volume 24 Number 1
May 2008
www.GGHjournal.com
ISSN 1932-9032
