No such luck for the tiny boy. He still battles stereotypes and a host of dire (if unproved) psychological predictions; tens of thousands of boys (and some girls) in this country receive injections of human growth hormone, the pituitary secretion pivotal to the complex hormonal cascade that mediates height.

The story of growth hormone contains many of the most painful object lessons of modern health care. First it was painstakingly harvested from cadavers, and the tiny supply was reserved for children with pituitary failure. But as we know now, human tissues make perilous drugs, and the recipients of cadaver hormone grew up under the hanging sword of the neurological condition Creutzfeldt-Jakob disease, transmitted by some of those shots.

Then, in 1985, new technology flooded the marketplace with synthetic human growth hormone, safe from infectious contaminants and made in quantities enough to treat not just the truly pituitary-deficient, but all small-comers.

The suddenly plentiful supply came with hard questions. The boundaries of “normal” height are hazy, and the drug’s performance is measured only in averages. Treated children grow, on average, one to two inches taller than predicted  but these predictions are inexact, and the growth for each individual child unknown. Psychologically, will children be helped more by the possibility of extra inches than they are hurt by the implication that they are defective, disappointments to their parents for failing to “perform biologically”? Is deciding against growth hormone for a child like deciding against a nose job, or is it like deciding against eyeglasses?

Meanwhile, the cost comes out to about $50,000 per putative inch gained, with eager drug manufacturers delighted to battle insurers on behalf of parents who might have their own personal definitions of normal.

One exasperated pediatrician, musing on whether outcome justified cost, suggested a clinical trial to settle the question: one group of tiny boys would get growth hormone and each boy in the other group would each get $100,000 cash. Who would be happier and healthier 20 years down the line?

That same experiment might well be wished for elsewhere in medicine, as we cast a critical eye over our spending habits in these days of budgetary introspection. “Normal at Any Cost” tells its own story with a pace and fluency sadly rare in medical journalism, and like the best in all literature, it illuminates the surrounding landscape as well.