Defining the Future
The story behind the landmark women's health study that is creating exciting breakthroughs
Marilyn Swope, 75, of Zanesville, Ohio, has worn many hats in her life: first-grade teacher, union president, city mayor, quilt shop owner, and great-grandmother. But one of her most cherished roles was guinea pig. A decade ago, Swope saw an article in the newspaper seeking participants for the Women's Health Initiative, a massive federal effort to study the major causes of death, disease, and disability in older women. She felt a responsibility to sign up immediately. Zanesville, about 55miles east of Columbus, had such high incidences of cancer and heart disease, "people always think there is something wrong with the water," says Swope. But she suspected it was more than that. "We are habituated to eating a lot more than what we really need."Swope agreed to enroll in a trial testing the health effects of a low-fat diet and committed the next 10 years of her life to eating in a radically different way. "Maybe it's not going to help you," says Swope. "I was doing it for my family, for my daughters."
Swope probably didn't know it at the time, but that pledge put her smack dab in the middle of a new kind of women's movement. With more than 160,000 participants, the Women's Health Initiative is the largest government trial of its time and is perhaps the most dramatic and ambitious act in a long-running debate on women's health. The study aimed to enroll 1 out of every 200 women ages 50 to 79 and track her for the next seven to 12 years. With its sheer size and scope, as well as an eventual $725 million in funding, the WHI made a defiant statement against scientific trials that excluded women and challenged long-held medical beliefs. "By far and away, it's the largest and most comprehensive longitudinal investigation of women's health issues that's ever been undertaken," says Duncan Thomas, codirector of the Division of Biostatistics at the University of Southern California Keck School of Medicine.
Shock wave. One thing's for sure: The WHI has certainly made a mark. In 2002 and again in 2004, the WHI abruptly halted its two hormone therapy trials, rocking the world of medicine by casting doubt on what most experts thought was a proven tool in preventing heart disease and prompting women everywhere to toss out their estrogen pills. Now new studies are re-examining the role of hormones for younger, premenopausal women (story, Page 66). Earlier in February, the initiative caused another shock wave when researchers announced that in spite of a national obsession with fat-free products, a low-fat diet alone has little effect on cancer. And all the vitamin D and calcium supplements that women were taking don't seem to prevent bone fractures.
Some critics fault the findings on the low-fat diet and vitamin supplements: A lot of money was spent to prove something wrong. Others disagree. "It's very good to put theories to the test--some work, and some don't,"says David Freedman, a statistics professor at the University of California-Berkeley. "It's a big study, but expense is kind of relative given the public health costs of giving wrong advice."