Debate: idiopathic short stature should be treated with growth hormone

In this paper we outline the case for and against the treatment of idiopathic short stature with growth hormone. Drs Ambler and Fairchild argue that many of those with 'idiopathic' short stature are not 'short, normal children' and will ultimately receive molecular diagnoses. They also argue that there is a subset of children who suffer negative psychosocial consequences of their stature for whom growth hormone therapy is effective. Growth hormone has a very good safety record and is likely to be as cost-effective in idiopathic short-stature as in some other conditions that are currently funded. Dr Wilkinson counters that short stature is not associated with physical or psychological illness, and that there is no evidence that growth hormone improves psychological or physical wellbeing. Moreover, growth hormone for idiopathic short stature represents a form of enhancement rather than treatment, and is not a fair use of resources. Socially mediated disadvantage should be treated by attention to prejudice and not by hormone treatment.

Disease mongering: expanding the boundaries of treatable disease

Traditionally, the promotional activities of medical industries have been product specific. In recent years, however, there have been examples where companies have worked through partnerships, which have included clinicians, to expand the boundaries of treatable disorders. The main motivation appears to be to increase sales of commercial products. The term 'disease mongering' has been applied to these activities. Whereas some disease awareness programmes may bring benefits in the form of improved recognition and management of disorders, the presence of strong commercial interests probably distorts the traditional processes by which treatable diseases have been defined. This can result in individual patients being exposed to potential harms, with little expectation of benefit and will place an unwarranted burden on the publicly funded health-care system. None of this can happen without the collaboration of the medical profession that needs to be aware of the risks of becoming involved in commercially supported 'consensus' groups that are reviewing the definition and management of diseases.