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John Lantos, MD; Mark Siegler, MD; Leona Cuttler, MD

JAMA. 1989;261(7):1020-1024.

Abstract
Pediatricians face clinical and ethical dilemmas about therapy to augment growth in short children who do not meet classic criteria for growth hormone (GH) deficiency. Biologic norms of health are unhelpful because of the uncertain relationship between stature, GH secretion, health, and disease. Instead, we suggest that GH therapy be evaluated from the perspective of cultural norms. We compare GH therapy for short normal children with currently accepted therapies for non-life-threatening pediatric conditions such as well-child care, cosmetic therapy, treatment of psychological problems, and invasive outpatient therapy for chronic conditions. Based on this analysis, we argue that the burdens of therapy, the uncertainty about long-term risks and benefits, the unclear therapeutic end point, and the implications for child health policy place routine GH therapy for children without documented deficiency of GH secretion outside current pediatric ethical norms. Such therapy is properly administered within a comprehensive clinical research protocol.

(JAMA 1989;461:1020-1024)

Author Affiliations
From the Center for Clinical Medical Ethics (Drs Lantos and Siegler), the Sections of Pediatric Chronic Disease (Dr Lantos) and Pediatric Endocrinology (Dr Cuttler), Department of Pediatrics, and the Section of General Medicine (Dr Siegler), University of Chicago Pritzker School of Medicine.

Footnotes
Reprint requests to Department of Pediatrics, University of Chicago Pritzker School of Medicine, 5841 S Maryland Ave, Chicago, IL 60637 (Dr Cuttler).

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