Selective oestrogen receptor modulation: HRT replacement therapy?

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

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.

Controversies regarding tamoxifen and uterine carcinoma

An increasing number of cases of endometrial cancer in women receiving tamoxifen have been reported but most are from non-randomized studies and case reports. In the last year, there have been no further results either confirming or disproving an association between tamoxifen and endometrial cancer from randomized controlled studies in breast cancer patients and those participating in chemopreventative trials with tamoxifen. Several papers have examined the possible mechanisms behind tamoxifen's endometrial effects.