Clinical review: Lessons learned from the hGH era

J Clin Endocrinol Metab. 2011 Oct;96(10):3042-7. doi: 10.1210/jc.2011-1739. Epub 2011 Aug 24.


Today, many medical interventions that begin as treatments for disease often expand into therapies that reduce disability, lessen disadvantage, or even confer advantage. Forces that propel profitable drugs, devices, and procedures dominate over considerations of efficient and equitable distribution of resources. This dominance is fueled by industry-physician collaborations often biased by prior assumptions, reliant on surrogate outcomes, and advantageous to marketing. Interventions are justified by "medicalization" of physiologic variations (e.g. short stature) as defects or disease, and nudged into "standard practice" by key opinion leaders. The story below of recombinant human growth hormone (hGH) treatment of short stature is one vivid example, but others (e.g. expansion of drug treatment to "optimize" cholesterol profiles, bone health, psychological well-being) can be found throughout medicine. In the new obesity era, lessons learned from the hGH era will be needed to keep the field of pediatric endocrinology empowered to make the key clinical decisions, and free of unintended consequences for patients and runaway health care inflation for society.

Publication types

  • Review

MeSH terms

  • Body Height / drug effects
  • Growth Hormone / adverse effects
  • Growth Hormone / pharmacology*
  • Growth Hormone / therapeutic use
  • Humans
  • Pituitary Gland / chemistry
  • Pituitary Gland / physiology
  • Recombinant Proteins / pharmacology
  • Recombinant Proteins / therapeutic use
  • Social Behavior


  • Recombinant Proteins
  • Growth Hormone