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Hormone replacement therapy: an example of McKinlay's theory on the seven stages of medical innovation


  • Jane Wright BSc (Hons), MSc, RNT, RGN

    1. Nurse Education Consultant, Beeches Management Centre, Nursing and Midwifery Education, Clady, Knockbracken Healthcare Park, Belfast, Northern Ireland
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Jane Wright
Beeches Management Centre
Nursing and Midwifery Education
Knockbracken Healthcare Park
301 Saintfield Road
Belfast, BT8 8BH UK
Telephone: 028 90561353


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.