Clinical review: Lessons learned from the hGH era

Area of Science:

• Medical ethics
• Health economics
• Endocrinology

Background:

• Medical interventions frequently extend beyond treating disease to enhancing function or conferring advantage.
• Profitable drug, device, and procedure promotion often overshadows efficient resource allocation.
• Industry-physician collaborations, driven by marketing and surrogate outcomes, influence medical practice.

Purpose of the Study:

• To analyze the expansion of medical interventions beyond their original therapeutic scope.
• To examine the role of industry influence and "medicalization" in driving intervention adoption.
• To draw lessons from the recombinant human growth hormone (hGH) for short stature case to inform future pediatric endocrinology practice.

Main Methods:

• Qualitative analysis of historical trends in medical intervention expansion.
• Case study examination of recombinant human growth hormone (hGH) for short stature.
• Review of factors contributing to the "medicalization" of physiological variations.

Main Results:

• The expansion of interventions is often propelled by commercial interests rather than evidence of necessity or equitable benefit.
• "Medicalization" of normal variations, such as short stature, facilitates the adoption of new therapies.
• Key opinion leaders and biased collaborations accelerate the integration of interventions into standard practice.

Conclusions:

• The case of hGH for short stature exemplifies how profitable interventions can be normalized, potentially at societal cost.
• Lessons from this expansion are critical for navigating the "obesity era" in pediatric endocrinology.
• Maintaining clinical decision-making autonomy and avoiding unintended consequences are vital for patient well-being and healthcare sustainability.