Healthy Skepticism Library item: 4578

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

Publication type: Journal Article

Wright J.
Hormone replacement therapy: an example of McKinlay's theory on the seven stages of medical innovation.
J Clin Nurs 2005 Oct; 14:(9):1090-7

Abstract:

AIM AND OBJECTIVES: The aim of this paper is to explain the history and use of hormone replacement therapy (HRT) using McKinlay’s theory of medical innovation. The paper will examine why a drug, HRT, was prescribed for mainly healthy women. It reflects on the controversies surrounding HRT and examines some of the possible reasons why, despite an almost complete lack of verifiable research, HRT became one of the most widely prescribed drugs of our time. BACKGROUND: Twenty-four years ago McKinlay published From ‘Promising Report’ to ‘Standard Procedure’: Seven Stages in the Career of a Medical Innovation. McKinlay argued that many, if not most, innovations in medicine undergo a process of which assessment of effectiveness is only a late stage placing many patients at risk of receiving treatments which are useless or malign. CONCLUSION: This paper argues that HRT was a medical innovation whose ‘career’ followed the seven stages describes by McKinlay. This suggests that the Nursing and Medical professions continue to accept innovation uncritically. RELEVANCE TO CLINICAL PRACTICE: This paper underlines the importance of critically assessing the research-based evidence for altering practice and introducing new treatments. It suggests that Nurse Prescribers and other clinicians question the assumed scientific basis of new innovations in clinical practice.

Keywords:
Attitude of Health Personnel Attitude to Health Decision Making Diffusion of Innovation* Drug Industry Estrogen Replacement Therapy*/adverse effects Estrogen Replacement Therapy*/trends Estrogen Replacement Therapy*/utilization Evidence-Based Medicine Female Great Britain Health Knowledge, Attitudes, Practice Humans Mass Media Menopause/drug effects Menopause/physiology Menopause/psychology North America Patient Selection Physician's Practice Patterns/trends* Prescriptions, Drug/statistics & numerical data* Public Opinion Randomized Controlled Trials Research Design Risk Factors Safety Women's Health