No More 'Good Girl'

That's it. I'm not going to be a Good Girl any more. The latest headlines from the Women's Health Initiative (WHI) have put me over the edge. A low-fat diet -- overrated for cancer protection! Calcium supplements -- in doubt for maintaining bones! How the mighty dictums have fallen.

We women are the Good Girls of medicine. We make the health decisions for our families. We drag our children to the dentist. We take butter away from the men we love and nag them to get a colonoscopy. We gorge on blueberries for our brains and stretch our bodies with Pilates. (Well, at least we know we should eat fruit and veggies and get our 30 minutes of physical activity a day -- and we feel guilty when we don't.)

We believe in pills. The older we are, the more medicine we consume. We spend more out-of-pocket than men for prescription drugs. We scan the labels of over-the-counter anti-aging remedies to enhance our immune system, strengthen our bones and boost our memory. We devour women's magazines for tips on physical correctness (and looking younger). We watch for health news and go weak in the knees whenever we hear the magic phrase "proven by clinical studies."

We've made the Good Girl bargain: If we do everything we're told to do -- according to clinical studies -- we and our families will thrive forever. I pick up my bottle of Os-Cal calcium supplements, manufactured by GlaxoSmithKline. "Do More, Feel Better and Live Longer" -- that's the company motto. One little tablet, twice a day. Of course I want to do more, feel better and live longer!

The seduction is smooth. Os-Cal boasts that this calcium supplement is "most doctor recommended" and "proven effective in more clinicals." What's more, it was "used in the prestigious Women's Health Initiative Landmark Study."

Oops! Now this prestigious landmark study has found that calcium supplements do not significantly reduce the risk of broken bones in a large population of women aged 50 to 79. This comes as a shock to many women. To be sure, the WHI study is controversial, and experts will be arguing for years over the results. "Headlines can be misleading," cautioned Lori Lukus, a communications manager for Glaxo. "We believe this study supports the need for and benefits of calcium." But overall the study offered scant evidence to support a blanket endorsement of calcium supplements to prevent fractures.

The bottom line in this and other recent studies is that popular health strategies thought to have a clear-cut significant benefit have been knocked off their pedestal. On the battlefield of clinical studies, the Good Girl has become a Woman Scorned.

I wake up in the morning and feel the soreness in my finger joints. Just last month, a study dashed hopes for glucosamine and chondroitin as over-the-counter fixes for osteoarthritis, which affects more women than men. According to a report in the New England Journal of Medicine, these popular supplements failed to show a benefit in people with mild arthritis of the knee.

Prescription drugs have also led to heartbreak. The blockbuster arthritis drug Vioxx was taken off the market more than a year ago because of side effects. Left in the ashes is the bitter memory of those Vioxx testimonials by former Olympic skater Dorothy Hamill and the promise of triumph over pain.

This downward slide began with earlier findings of the Women's Health Initiative, which showed that hormone replacement therapy (HRT) did more harm than good. All those years of feminine-forever mystique and the promise of a pill to reduce the risks of heart disease, bone loss, memory lapses, sexual problems, skin wrinkling, hair thinning, general fatigue, aging itself! And then, boom! After the report came out, some women threw away their pills. The era of long-term HRT was over.

Then again, maybe not: A new study suggests that HRT does not increase heart disease risk in women in their fifties. What will the next study suggest?

We Good Girls lurch from study to study. This has become hazardous to peace of mind. We have to change. Not that I'm going to turn into a bad girl and stay in bed all day, swilling brandy Alexanders (brandy and crème de cacao -- now there's a source of calcium) and smoking a cigarillo.

More like: smart women, smart choices. That means giving up the fantasy of a magic fix and getting real about clinical studies. Some are more significant than others. Most deal with a very broad population or a very specific group of people, and may -- or may not -- be relevant to me. I have to chart my own course. Researchers don't have all the answers -- science proceeds in incremental steps over many years -- and physicians are too busy to sort it out. Being smart means dealing with uncertainty. It also means resisting advertisements and health promotion campaigns that promise Mr. Right in a diet or tablet form.

I'll hang on to the goal to "do more, feel better, live longer" because that's the imperative of longevity, and it goes way beyond medicine to the larger spheres of loving and working, playing and praying.

Meanwhile, I'll keep exercising and eating yogurt. (Because I feel better when I do.)

And I'll wait for the next findings. Just last week, a study showed that eating chocolate may lower blood pressure and reduce the risk of death. I can live with that -- even though the research involved Dutch men over 65 and probably doesn't apply to me at all. ·

Comments: mytime@washpost.com.