Ignore the evidence and keep going wrong

EDITOR—We were surprised that in his editorial to our paper Saenger challenged our conclusions that most patients treated for growth hormone deficiency do not have this condition, and that controlled trials should be organised to evaluate the long term effects of growth hormone in most of the patients currently treated.1 Saenger supports the use of an integrated approach to diagnosing growth hormone deficiency and the wider use of IGF-1 measurements, as suggested by the Growth Hormone Research Society. However, his recent publications, as coauthor or senior author, do not reflect his plea.2 3 This contradiction reflects the widespread contrast between the recommendations in consensus guidelines and current practice or clinical research protocols.

In the absence of a gold standard, how can growth hormone deficiency be defined? We propose using long term results of treatment in comparison with spontaneous outcome. The results of our observational study indicate that most …