The elixir of youthBMJ 1995; 310 doi: https://doi.org/10.1136/bmj.310.6979.607a (Published 04 March 1995) Cite this as: BMJ 1995;310:607
- C G D Brook
You want your children to be taller and yourself to be leaner, fitter, and sexually more active? You need growth hormone every night, if you listen to siren voices. Adam Bullmore, the director of “Too Big Too Soon,” did a good job balancing the loonier assertions (the BBC trailer called them “compelling anecdotal evidence”) with the consumer view represented by the American consumer activist, Jeremy Rifkin. It was a pity not to report the randomised double blind placebo controlled trials of growth hormone, but that's not a story.
Growth hormone has been with us in supplies limited only by cost for nearly 10 years and it is looking for a market; it is highly effective for the treatment of growth hormone insufficiency in adults and children. There may be other indications, but they need rigorous evaluation and this takes time. Because of its powerful anabolic effects, especially in the short term, growth hormone attracts abuse by doctors and others.
The film, the title of which I still have not fathomed, begins with normal short children. Michael Preece (professor of child health and growth at the Institute of Child Health) gives a disarmingly frank (“I published too soon …”) account of his own work. Cut to an extraordinary tale of suburban Virginia where a normal small boy persecuted at school grows nine inches in 18 months on the wonder drug at a cost of $20 000 a year. His physician “believes that he has a chance of benefiting”—as if this and predicting adult height were a matter of guesswork. Come on, scientists deal in facts.
Professor Peter Sonksen, of St Thomas's Hospital, had the advantage of a Thames view to give gravitas to his account of studies in adults deficient in growth hormone. The cleancut doctor from Virginia talking about the elderly (for whom growth hormone is actually no more effective than fitness training in promoting exercise tolerance) and the shaggy doctor treating people with AIDS in San Francisco provided a splendid contrast.
Because of its anabolic effects, growth hormone probably has a part to play in the treatment of catabolic states (burns, sepsis, ventilator dependency, etc), but the visual impact would be difficult to show. In the case of AIDS, the voice over promised that growth hormone “might soon be licensed for this indication.” What neither physicians nor pharmaceutical companies seem to recognise is that a licence is not an instruction to prescribers. You can prescribe anything you like for ingrowing toenails; a licence simply allows a pharmaceutical company to promote a medicine as efficacious for a condition.
Last and funniest, if it was not so tragic, was the claim of Harold Turney, founder of the “El Dorado” clinics for rejuvenation, that taking growth hormone every night has changed his life. He seeks to enrol older people to share his wellbeing. Included among them was a woman I guess to be in her 30s, who told in her best southern drawl that “it's like my bones feel stronger.” Rifkin came back, appropriately framed by the US Congress building, to restore focus.
Adam Bullmore's film was excellent televisual entertainment: it gave a balanced view of the state of the art. Maybe you had to know something about the art to appreciate the balance, but it was there.—C G D BROOK, professor of paediatric endocrinology, the Middlesex and Great Ormond Street Hospitals