late 2000 and early 2001, the New York Times carried three articles
about aspects of the debate over early puberty in American girls,
The first was an article in the New York Times Magazine by Lisa
Belkin on 24 December 2000, "The Making of an 8-Year-Old
on an independent web page]. The following two were both
written by science reporter Gina Kolata: Doubters Fault Theory
Finding Earlier Puberty (20 February 2001) and 2 Endocrinology
Groups Raise Doubt on Earlier Onset of Girls' Puberty (3 March
article puts a human face on the landmark
paper by Marcia Herman-Giddens and colleagues that reports sexual
development is occurring earlier in American girls than in the past.
In particular, Belkin explors a diversity of plausible causes that
scientists have identified as possibly contributing to shifts in
the timing of sexual development, including hormones in milk, contamination
in food, increases in obesity, and social factors, including family
circumstances that might cause stress.
quotes one researcher, Bruce Ellis: "It appears that the quality
of the father-daughter relationship is the most important aspect
of early family environment in relationship to subsequent puberty."
Ellis goes on to say that the "absence of a biological father
in a daughter's early life is associated with early puberty and
that thte presence of an unrelated male in a household, no matter
how consistent, may speed it even more." Belkin also interviews
scientists studying the possible involvement of obesity. Other possible
causes, including contamination, receive less attention.
Belkin's article does not do, however, is challenge Herman-Giddens'
original result. In contrast, Kolata's two articles raise issues
both about the reliability of Herman-Giddens' finding and the use
of them in medical practice.
principal focus of her writing is on the latter: whether pediatric
standards should be changed to regard earlier development as "normal."
Both articles are based principally upon exchanges in the medical
literature, in particular two letters published by groups of Pediatrics,
(October 1999) recommending a change in standards of what is considered
normal timing in development, and then a second
letter (September 2000) challenging that recommendation.
their October 1999 letter, Kaplowitz
et al. recommended that pediatricians redefine the normal age
range of puberty downward to reflect Herman-Giddens' findings: They
conclude that (1) the prior standard that breast development before
age 8 is precocious is based on outdated studies and (2) that instead
of evaluating girls if they show either breast development or pubic
hair by age 8 or earlier, this age be lowered to 7.
et al., it should be noted, did not propose to change the
standards, but instead were more concerned about what factors--environmental
or sociological--might be causing the change. They regarded the
change as anything but normal. Their paper discusses several
possible causes of the trend, such as contamination and obesity,
none of which could be construed as "normal" nor a reason
to ignore early development. If anything, Herman-Giddens shines
a spotlight on the need to find out what is happening.
the second letter (September 2000), Rosenfield
et al. focus on two concerns: First, they argue that it is "premature
to conclude that the normal age of puberty is occurring earlier."
Second, they point to methodological problems in Herman-Giddens
et al. that weaken the strengths of its conclusions. Their first
point is not directed at Herman-Giddens but instead at what Kaplowitz
et al. recommend to do about it. They are particularly concerned
that a change in what is expected as normal would lead some young
girls to not be evaluated (and possibly treated) if they were showing
signs of early puberty at the age of 7-8. This is a legitimate concern,
in agreement with Herman-Giddens but directly in contradiction to
Kaplowitz et al.
respect to methodological weaknesses in Herman-Giddens et al., Rosenfield
et al. observe that the 17,000 children in the study were not randomly
chosen but instead children brought to see pediatricians, some for
illnesses, some for normal check-ups. Herman-Giddens et al. respond
to this criticism in a reply in the same issue of Pediatrics that
"the large number of girls in their study would make it unlikely
that they were different from the population as a whole." They
also acknowledge the value of replicating their work with an unquestionably
representative sample of comparable size. They also comment "we
agree that puberty at an early age may not be "normal"
even though a large proportion of girls are experiencing it because
factors that may be contributing are not yet understood."
an observer of this debate, two things would appear obvious:
at the causes of why such a significant percentage of young
girls are showing signs of sexual development by age 7-8 is
an important issue, whether or not the average age of puberty
standards for what is considered "normal" in the pattern
of sexual development is at best premature. Not only
would make it likely that young girls might not receive needed
medical attention but it would also discourage a larger investigation
of why, if the age of puberty has changed, this is happening.
factors affect the rate of sexual development?