Elsevier

Social Science & Medicine

Volume 131, April 2015, Pages 305-312
Social Science & Medicine

Growth hormone, enhancement and the pharmaceuticalisation of short stature

https://doi.org/10.1016/j.socscimed.2014.10.015Get rights and content

Highlights

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    Takes human Growth Hormone (hGH) as a historical case study of human enhancement.

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    Investigates enhancement in terms of pharmaceutical and medicalising processes.

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    Demonstrates dynamic interaction between these processes in the case of hGH.

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    Challenges normatively-loaded bioethical concept of human enhancement.

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    Highlights academic medical research as a driver of pharmaceuticalisation.

Abstract

This paper takes the biological drug human Growth Hormone (hGH) as a case study to investigate processes of pharmaceuticalisation and medicalisation in configuring childhood short stature as a site for pharmaceutical intervention. Human growth hormone is considered to have legitimate applications in treating childhood growth hormone deficiency and short stature associated with other recognised conditions. It is also regarded by bioethicists and others as a form of human biomedical enhancement when applied to children with idiopathic or ‘normal’ short stature. The purpose of this study is not to evaluate whether treatment of idiopathic short stature is enhancement or not, but to evaluate how some applications of hGH in treating short stature have come to be accepted and stabilised as legitimate ‘therapies’ while others remain contested as ‘enhancements’. A comparative, historical approach is employed, drawing on approaches from medical sociology and Science and Technology Studies (STS) to set out a socio-technical history of hGH in the US and UK. Through this history the relative influence and interplay of drivers of pharmaceuticalisation, including industry marketing and networks of drug distribution, and processes of medicalisation will be employed to address this question and simultaneously query the value of enhancement as a sociological concept.

Section snippets

Pharmaceuticalisation, medicalisation and enhancement

Pharmaceuticalisation describes a process whereby ‘human conditions, capabilities and capacities’ are (re)configured as sites for intervention with pharmaceutical drugs (Williams et al., 2011, p711). Sociological interest in pharmaceutical use has been increasing in recent years, at least partly in response to significant increases in sales and application of pharmaceuticals since the 1980s (Busfield, 2003, Williams et al., 2008). This interest has manifested through transformations in

Methods

Drawing on the recommendations of Coveney et al. (2011), this study combines perspectives from medical sociology and Science and Technology Studies (STS) to investigate pharmaceuticalisation in the case of hGH. Following an STS perspective, technologies, including hGH, do not appear fully-formed to present ethical dilemmas about their use, but are shaped over the history of their creation, regulation and deployment. Accordingly, this investigation takes the form of a socio-technical history of

Making abnormal short stature

In order to investigate how a medical intervention for amelioration of short stature emerged, it is first necessary to ask how stature itself became an object of medical scrutiny. Human height and weight first came under the authority of public health during the nineteenth century, through the application of the normal distribution curve (Tanner, 1981). The normal curve allows individual height or weight measurements to be compared against a population mean value. Following the statistical

Conclusion

This socio-technical history of hGH has demonstrated that the development and subsequent expansion in use of a pharmaceutical can be usefully understood as a series of complex interactions between heterogeneous processes of pharmaceuticalisation and medicalisation. There is no one simple driver of these processes, but rather different drivers interact with each other at different times and in different spaces. Medicalisation of stature, driven by public health concerns, brought short stature

Acknowledgements

This article draws on original research funded by the Economic and Social Research Council (award number PTA-030-2004-00601).

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