In 1985, approval of recombinant human growth hormone (rhGH) made available a virtually unlimited resource to replace human pituitary–derived GH, which had been withdrawn for safety concerns. During the ensuing 2 decades, clinical trials spearheaded by pediatric endocrinologists and supported primarily by manufacturers of rhGH strived to show that rhGH treatment could improve growth rates and eventual height in children without growth hormone deficiency (GHD) who are short as a result of (sequentially) Turner syndrome (TS), chronic renal insufficiency (CRI), small for gestational age (SGA), Prader-Willi syndrome (PWS), or idiopathic short stature (ISS). Approval of these new indications validated the notion, first proposed in 1990, that if rhGH treatment is effective at increasing height in non-GHD children, then the etiology of short stature is not morally relevant in deciding who is entitled to treatment. These children all share a central and seemingly valid concern: “I am short and I...

You do not currently have access to this content.