Arresting Development

By William Saletan
Sunday, January 21, 2007

Once upon a time, there was a little girl named Ashley. And she stayed little forever.

It's a true story. You can read it on her parents' blog, http://ashleytreatment.spaces. Ashley's brain stopped developing when she was 3 months old. Nobody knows why. She never learned how to roll over, sit up or walk.

But Ashley's body kept growing. It was hard work lifting her and moving her around. When she was 6, her parents discovered something amazing. "We learned that attenuating growth is feasible through high-dose estrogen therapy," her mom writes. "This treatment was performed on teenage girls starting in the 60's and 70's, when it wasn't desirable for girls to be tall, with no negative or long-term side effects."

Eureka. Ashley didn't have to reach her natural adult size. She could be "attenuated."

So Ashley's doctors reshaped her. Her parents call it the "Ashley Treatment." They lay it out in three steps on their Web site: First, limit final height using high-dose estrogen therapy. Second, avoid menstruation and cramps by removing the uterus (hysterectomy). Third, limit growth of the breasts by removing the early breast buds.

The first step alone can reduce a child's adult size by two feet and 100 pounds, according to Ashley's doctors. Other parents are already asking for the same treatment. We don't have to make the world fit people anymore. We can shrink people to fit the world.

Is this a good idea? Ashley's parents think so. The less she weighs, the more she can be "held in our arms" and transported to stimulating activities, they argue. Without treatment, she would exceed her stroller's weight limit and "stop fitting in a standard size bathtub." And breasts would get in the way of her wheelchair straps.

That isn't the way Americans have traditionally dealt with size problems. We've made bigger stuff to fit bigger people. The average height of American men has increased by 2 1/2 inches since the Civil War. The height of Chinese children has increased by nearly the same amount since 1975. Cars and houses have grown with us. A decade ago, the standard height of a ground-floor ceiling in a new house in the United States was eight feet. Now it's nine. Wheelchairs have widened, as have hospital beds and doorways.

In the long run, however, economic and ecological forces are going Ashley's way. Smaller people consume fewer resources, live longer and are cheaper to transport. They can fit in a Hyundai. Forty-five years ago, if you were six feet tall, you couldn't fly in a NASA space capsule. Now you can barely fly coach. Blessed are the short, for they shall inherit the Earth.

We've already shrunk people -- not to fit technology, but to fit our image of what a certain kind of person should look like. That's the second rationale offered by Ashley's parents: A prepubescent body fits her mental age. They call her "sweet," "pure" and "innocent" -- their "pillow angel." The curious thing about these terms is that they're not cognitive. They're moral. Indeed, the parents had Ashley's breast buds removed in part because "large breasts could 'sexualize' Ashley towards her caregiver, especially when they are touched while she is being moved or handled, inviting the possibility of abuse."

It's equally curious that the parents were inspired by the shortening of tall girls in the 1960s and 1970s. Half the nation's pediatric endocrinologists participated in that fad. They changed bodies to match a feminine ideal. Some parents shortened their daughters to fit the physical requirements of flight attendants or ballerinas. Most did it to fit the culture. When the culture shifted, size modification shifted with it. Three years ago, the Food and Drug Administration approved the use of growth hormones to make short kids taller.

Everywhere you turn, people are engineering their bodies to fit in. Chinese are lengthening their legs with surgery to raise their status and career prospects. American men are bulking up on steroids to look good at the gym. In the United States, 300,000 women receive breast implants each year. Some are having toes trimmed to fit fashionable shoes. Sexual development, too, is under arrest. The FDA is considering an implant to delay puberty in girls. The number of Americans having laser hair removal each year has surpassed 1.4 million. Many women are undergoing "revirgination" surgery to restore their hymens.

Ashley's parents say that her treatment, unlike cosmetic procedures, offers important medical benefits. It prevents menstrual cramps and breast discomfort, as well as breast or uterine cancer and other diseases. "Ashley has no need for her uterus since she will not be bearing children," they write. "Ashley has no need for developed breasts since she will not breast feed."

But if those are good arguments for shrinking people, or at least for removing some of their tissue, why stop with Ashley? We're facing an epidemic of patients who are physically and cognitively incapacitated, hard to lift, cancer-prone, extremely uncomfortable and incapable of bearing children. They're called old people.

Today, 7 percent of aging Americans have severe cognitive impairments. Fifteen million Americans have become caregivers for their parents. Most people with Alzheimer's disease live at home with help from family and friends. The age group most affected by Alzheimer's, 85 and older, is the nation's fastest-growing bracket. Their reproductive organs are useless and dangerous. By age 75, most men develop preliminary prostate cancer. By age 80, one in 10 women has breast cancer.

Ashley's parents aren't trying to mutilate old folks. They're trying to help them. That's why they want to make Ashley easier to bear. "The only additional care givers entrusted to Ashley's care are her two Grandmothers, who find Ashley's weight even more difficult to manage," the parents plead. But once you start changing people's bodies to make them easier to bear, it's that much easier to look at their caregivers the same way. So the bearers became burdens, and we lightened them. And they lived happily ever after.

William Saletan covers science and technology for Slate, the online magazine at

© 2007 The Washington Post Company