Today, more and more parents of children (especially young boys) are told that they may want to consider human growth hormone to increase their children's height. Some critics may assume that this practice is primarily the result of pharmaceutical companies' marketing tactics while others may assume it reflects sound science. In contrast to these views, this dissertation shows that the actors and contexts that help create and normalize human growth hormone use are more complicated than either one of these explanations suggests. While ample attention and judgment has been given to so-called marketing campaigns of biomedical powerhouses, including Genentech's relationship with public health school programs during the 1990s and Eli Lilly's pursuit to convince the FDA to allow human growth hormone therapy for children with idiopathic short stature in the 2000s, these endeavors need to be contextualized. Such contemporary efforts are not the first attempts by medicine to treat short stature, nor are they solely examples of how the pharmaceutical industry profits from inventing maladies. This doctoral dissertation examines the relationship between the rise of the human growth hormone industry and the development of the modern notion of short stature, its stigmatization, and science's mission to quantify and fix it.
This dissertation begins with an analysis of the origins of the stigmatization of short stature in contemporary America. The doctoral student performing this research examines how late 19th and early 20th century anti-child labor campaigns, public health projects, anthropometry, school reform, and clinical guidelines for physicians all played notable roles in manufacturing the cultural perception of normal height and the perceived need for the medical treatment of short stature, especially in young boys. She also explores scientific endeavors to discover, isolate, use, and manufacture human growth hormone and examine the relationship between social anxieties over short stature and the supply of available human growth hormone.
Resources selected for this research project reflect the breadth of the dissertation as the list of archives includes collection material pertaining to growth surveys, federal attempts to establish population standards and clinical guidelines in regards to height, governmental efforts to regulate human growth hormone, and collaborations between the pharmaceutical industry, public health projects, scientific research, and academic ventures in establishing human growth hormone therapy. Taking into consideration the dynamic relationship between public health, scientific medicine, cultural norms, and pediatric care, this project answers why, when, and how height matters. The dissertation contributes to a growing body of work that examines the values that infuse scientific knowledge and practice. It adds, for example, to literatures in medical anthropology, medical sociology, and the history of science; such literatures critically investigate the creation and use of scientific categories to create standards for normal bodies.
Recently, a National Institutes of Health sponsored study concluded that over the past twenty years the U.S. experienced an almost 2:1 male to female ratio in pediatric patients receiving human growth hormone therapy. The lead researcher of the study suggested that "factors other than biology are at play" when children were treated for short stature and alluded to patients’ parents as possible culprits in the disparity of treatment between girls and boys (Grimberg 2008). Are parents really to blame? This dissertation provides a historical framework for the gender disparity in growth hormone therapy and reveals how it became synonymous with medically treating short boys in the hopes of making them tall. Resources selected for this project reflect the breadth of the dissertation as the list of archives include the Parke, Davis Research Laboratory Records at the National Museum of American History’s Archives Center; the Committee for the Evaluation of the National Pituitary Agency Central Files housed at the National Academy of Sciences Archives; the Scripps Research Institute Archive at the Mandeville Special Collections Library, University of California San Diego; the Baby Book Collection at the University of California Los Angeles’ Louise M. Darling Biomedical Library, and the Eugenics Record Office Records at the American Philosophical Society. The research conducted has allowed my dissertation to serve as a novel contribution to existing work on the history of the human growth hormone industry in the United States specifically and to a growing body of literature which critically investigates the creation and use of scientific categories to create standards for healthy bodies and the development of technology to normalize deviant ones. First, I demonstrate how pharmaceutical companies cannot be blamed as the sole culprits of framing short stature as a disease; rather its pathologization stretches back to the nineteenth century and reformers’ attempts to protect children from the dangers of modern capitalism. Public health reformers collected weight and height measurements from working children in order to demonstrate how substandard working conditions compromised their health and to encourage government regulation. Those engaged in anthropometry codified this anecdotal data by conducting large growth surveys of children. During the turn of the century, their statistics crept into private pediatric practice through the medium of growth charts. As the field of pediatrics professionalized, growth charts became less reflective of the series of varied measurements from growth studies and more in line with other diagnostic tools of the clinic. By the 1940s, short stature signaled poor living conditions at a population-level and ill health in need of medical intervention for the individual. Documents unearthed during this project revealed the legacy of early growth hormone therapeutics on GH therapy today. Even though we now know early growth hormone promoting therapy was ineffective, material from the Parke-Davis Collection reveal that many early twentieth century medical experts interpreted their results with GH as promising and it was their clinical experiments with growth promoting medical regimens, which brought growth hormone therapy and the medical treatment of short boys closer. After decades of mixed results, pediatric endocrinologists were ultimately forced to admit the ineffectiveness of GH pharmaceuticals and by the early 1950s specialists turned towards the male sex hormone testosterone as a viable therapy. Pediatric endocrinologists suggested this cure for short stature was an appropriate medical regimen for the majority of children who sought out medical attention, boys. Even once human growth hormone therapy finally developed in the late 1950s, the link between the male patient and growth promoting treatment remained unbroken. The National Pituitary Agency (a federal agency in charge of growth hormone therapy in the U.S.), the Human Growth Foundation (a parent-run organization of families with children with short stature), and medical experts strategically campaigned for Americans to donate their pituitary glands by advertising the success of boy patients who had grown in height due to cadaver human growth hormone [cHGH] therapy and were able to overcome the pitfalls of being short, according to internal memos found in the Scripps Research Institute archives. The message of short boys being saved by medicine reverberated in commercial cHGH advertisements in the early 1980s and continues to be a major theme in GH marketing campaigns today. While existing work on the history of human growth hormone industry highlights the dark side of GH and uses it to predict a dystopic future of medical technology, this dissertation examines the broader social, cultural, medical, and scientific contexts of the history of GH and is influenced by a wide range of scholarship, including the history of hormones, feminist scholarship on gender in medicine, men’s studies on hegemonic masculinity, and disability studies. Due to the extensive original research made possible by this grant, my dissertation reveals the history and inner-workings of an industry based on heightened expectations.
