The door ritual went like this: heels tight against the wood, the ruler placed horizontally on her head, her mother's instructions to "stand up straight," the pencil moving back and forth.

"Look, Ellen! I think it's a little bit higher," her mother would say as the ritual continued.

"It looks the same," Ellen would answer.

"Well, I think it might be a little higher," her mother would offer hopefully.

But over the years, says Ellen Frankel, the pencil mark never got higher, only darker.

Frankel stopped growing at 4-foot-8 1/2 — her insistence on that extra 1/2 a telling detail. Height not only matters, it's also the source of a prejudice so ingrained that it's rarely noticed, says Frankel, the author of a new book called "Beyond Measure." Heightism, she says, is "the last acceptable prejudice." People are forever patting her on the head and saying things like, "I can't believe how short you are."

A determined tall person is often admired, Frankel points out, but "a determined short person is often said to have a 'Napoleon complex."'

It's no surprise, then, that parents of short children are tempted to get their doctors to prescribe synthetic human growth hormones, even for children who are not hormone deficient. In other words, Frankel says, the drugs are being prescribed for healthy children who happen to be short.

There will always be a certain percentage of children on the short end of the bell curve, even if the average height in America grows taller. So, hGH will be a "growth industry" for pharmaceutical companies, Frankel says, with a new batch of relatively short children providing a constant source of patients and profits.

In 2003, the Food and Drug Administration approved the use of hGH for healthy children with an expected adult height of less than 5-foot-3 for men and 4-foot-11 for women. It is also sometimes used "off-label" for other, taller children.

"I would never blame parents," Frankel said in a recent phone interview from her home in Massachusetts. "My point is that we're moving into a very dangerous area when the government sanctions a potentially dangerous treatment for a social prejudice." As she writes in her book: It's a journey that "starts with 'enhancement' and ends up with eugenics."

For children who are actually deficient in growth hormones, the drug can increase height by six inches, but for other short children, Frankel says, it only increases height by one or two inches, or causes children to grow faster but no taller than they would have without the drug. For these short children, the drug may also have dangerous side effects — including hypertension, kidney damage and leukemia — that doctors are not warning parents about, she says.

Up to half of the some 15,000 to 20,000 children currently being treated with hGH in the United States do not have classical growth-hormone deficiency, she says. With some insurance companies now covering the growth hormones for healthy children — which cost about $20,000 a year for an average of five years — Frankel wonders, "Is this where we want to use our scarce health care dollars?"

Frankel, who lives in Massachusetts and is an adviser to the board of the National Organization for Short Statured Adults, hopes to alert the nation about heightism. "My point I want to get across is that we're asking the wrong question: not how to make short kids taller but how to end height prejudice."

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