Heightened Expectations: The Rise of the Human Growth Hormone Industry in America by Aimee Medeiros (review)

Aimee Medeiros has produced a nuanced and persuasive examination of the origins and evolution of human growth hormone industry in America. Its wider implications for historians of medicine, especially those examining the role of the pharmaceutical industry, are profound. Medeiros shows that the attitudes and interventions toward short stature in boys predated the pharmaceutical interest and development of human growth hormones. Only decades later would the pharmaceutical industry add its voice to the health effects of short stature. Medeiros makes a persuasive case that stigmatization of short stature among boys had its origins long before the application of growth hormone therapy. It was not, she demonstrates, driven by the pharmaceutical industry. The book has three main “themes.” First, as discussed above, “the pharmaceutical companies cannot be considered the sole culprits in framing short stature as a disease” (p. 3). Rather she points to the role of the development of the rise of pediatric specialty and its growing reliance surveys and height charts as “diagnostic tools” which set “standards” for “normal” child growth and development.

A second theme focuses on the “origins of growth hormone therapy in the United States, and in doing so resets the beginning of the GH (growth hormone) industry to the early twentieth century” (p. 3). Here Medeiros examines the period preceding the reliance on cadaver-based human growth hormone and traces the history its ineffective application and the substitution in the 1950s of the male sex hormone, testosterone.

Her third theme “focuses on how, in the twentieth century, changing sociological notions about gender and masculinity influenced the development of medical treatment of children with short stature” (p. 4). For Medeiros “the history of the rise of the human growth hormone industry is a poignant example of the creation of a ‘desire machine,’ demonstrating how anxieties processes of production, and desires get grafted on to one another” (p. 5). Drawing on the work of Georges Canguilhem, she revisits scientific notions of what constitutes the normal and the pathological, as well as more recent work on what constitutes disability. A wide range of scholarship informs this study, “including the history of hormones, feminist scholarship on gender in medicine, men’s studies on hegemonic masculinity, and disability studies” (p. 9).

Medeiros draws on a wide variety of popular sources including film, photography, and popular music. She uncovers the roots of these policies and attitudes in such diverse places as Barnum and Bailey Circus and in the munchkins of L. Frank Baum’s, Wizard of Oz film, and the seven “dwarfs” in the Disney film Snow White. Its late nineteenth- and early twentieth-century origins can be traced to the Progressive concerns with the health effects of child labor. She provides elaborate discussion of the progressive photographer, Lewis Hine to illustrate that short stature among boys was used as evidence of the harmful effects of child labor. Nevertheless, in these early years interventions were ineffective, despite the ubiquity of school height charts which established “normal” versus “abnormal.” Medeiros examines how changes in attitudes toward gender and normality affected attitudes toward short stature. Only later would the development of human hormone interventions insert itself in these long-held attitudes and practices. This is the historical perspective in which Medeiros examines the rise of what would become a billion-dollar industry that reinforced the messages of the need to intervene against what was labelled as short stature, and, more widely, as a threat to the health and development of short stature children.

In a series of chapters she examines the evolution of short stature as a problem as an issue of masculinity, the medicalization of midgets, the early and unfulfilled promise of growth hormone, news coverage of GH, and how this failure impacted those with short stature. With a medical diagnosis, but without an effective treatment, those of short stature continued to be stigmatized. Medeiros examines the...