The New Sun
Dr. Legato's Dynamic Discoveries
Marianne Legato, M.D., founded the Partnership for Women's Health at Columbia University in 1997. It is the first collaboration between academic medicine and the private sector focused solely on gender-specific medicine: the science of how normal human biology differs between men and women and how the diagnosis and treatment of disease differs as a function of gender.
Lese Dunton This unique collaboration that you're doing, how did you make that happen? Did it take years?
Marianne Legato: It took three years and I really was asked to be a consultant to Procter and Gamble for women's health. I said I thought I had a better idea and that was an across the board collaboration between a corporate leader, like Procter and Gamble, and an academic medical center like mine. I thought that being just a consultant for them -- if they really wanted to do a credible women's health program -- was not enough. And that's how it began.
LD: This idea about assuming the research done for men was the same for women -- how did you hit upon that? When did it come to you?
ML: It came to me when I was working on women and coronary disease. It was such a different experience for women that it occurred to me that perhaps other things were different for women than for men. I found that two thirds of all diseases studied that affect both men and women had only been studied in men. I just began to look through the literature and I found that there were indeed astonishing difference reported in the literature already, but that no one had pulled them all together in a coherent whole. So that's how I got started.
LD: From studying that further, what else did you discover?
ML: Well I'm publishing a book this spring which summarizes all the differences that I think are most important between men and women. It turns out that there are differences in every system of the body, both in normal function and in the way disease is experienced -- not just the incidence of disease but the course of disease and how patients experience it is definitely a function of their sex. Drugs are metabolized differently in many cases, between men and women.
LD: Therefore, the treatment would be perhaps different.
ML: Exactly. So, it's become a whole discipline now and I think I've contributed a little to it. I must say I think it's the most important work I've done and I'm very lucky to have been able to do it. The Institute of Medicine has been meaning to define Gender Specific Biology as a real discipline and they're going to publish their monograph very soon. It's a great new advance for medicine.
LD: How will this help women? How will it change their life?
ML: Well I think it will help us, first of all, concentrate on women who have definitely been cared for less aggressively than men, and who have not been studied directly. It has been assumed that they're "small men" and that what we find out in men is also good for them. So I think it will teach them to be aware of the fact that there are not only differences, but their impression that their bodies are different, in many cases, especially in terms of reactions to medications, is absolutely accurate. They're not just dreaming that.
So that's number one. We're also going to be able to develop much more focused therapy for women, and for men, because as we ask these important questions we will be asking about pre-existing models of illness which were really founded on just the basis of one sex.
When you find out, for example, that diabetes makes a woman four to six times more vulnerable to coronary disease than a man who has diabetes, you begin to rethink your model of diabetes. How does it work and why should being a female make a woman so vulnerable? What is it about diabetes that I haven't understood or factored? The better you understand the disease, the more you can do to prevent and to cure it. So I think it will lead to a whole new era to more focused and more effective therapy.
LD: Do you conduct symposiums?
ML: Yes. What we do each year now is to review, across the board, the biologic differences and try to educate physicians to the importance of considering the sex of the patient as they diagnose them and as they treat them.
While about half of men are optimally treated, in terms of their serum cholesterol -- and doctors try to drive that down to acceptable limits when they have coronary disease -- only 16 percent of women are treated that aggressively. One has to ask: why the difference? What have been the consequences for women? I think until the death rates for women start decreasing from cardiovascular disease the way they have for men, we still have more work to do.
I have a book out which is called, What Women Need to Know, and there will be a book coming out in the Spring of 2001 written by me for the lay public, published by Crown. There is a Journal of Gender Specific Medicine, which I founded and is now in its third year.
LD: Explain more about Procter and Gamble's contribution.
ML: They do a great deal to support our educational programs to the lay public. They help us with educational programs for the professional community. We also have major support from other corporations now. At least seven of them. They include Wyeth-Ayers, Aventis, Pfizer, Nike. And smaller corporation of which you haven't heard. We're very excited about the support we're getting.
LD: What keeps you determined and positive? What keeps you going?
ML: Being a woman, being a mother, being a scientist. I really feel that we've neglected the opportunity to use gender or sex as a variable in the research that we do. To me, as a scientist primarily, it's important to look at the fact that we've made the unwarranted assumption that what's true about males has to also be true about females -- on all levels, not just on the human level but even in animal experiments and tissue culture.
I once found dermatologists who were testing cosmetics for efficacy in tissue culture and they were using the cells from the foreskin of baby boys who had been circumcised. I said, "You know these cosmetics are intended for females and yet you're testing them in a tissue preparation obtained from males." They said, "Well that doesn't bother us" and I said, "Well it bothers me."
LD: Good for you. That's great.
ML: So those sorts of fun things make it very exciting, and I like it because there is something new all the time. You know it's like striking gold in a mine that everyone thought wasn't worth buying.
LD: How do you relax with all this activity?
ML: Good question. I love reading on planes. I'm on them a lot. I really enjoy reading and thinking about my next creative project. And I have a wonderful family.
See her website: Partnership for Women's Health at Columbia University College of Physicians and Surgeons.