photo © Foundation for Gender Specific Medicine
“Women have a gift to give men that they can’t refuse.”
—DR. MARIANNE LEGATO, founder and director of the Foundation for Gender-Specific Medicine
“Remember,” Dr. Marianne Legato said when I interviewed her on May 17, 2019, “not only do we begin to ask—and answer—different questions about women’s health by specifically studying women, but we also ask different questions about men’s health as a result. For example, men, too, get breast cancer and suffer from osteoporosis—which most physicians didn’t consider in the past.”
I first met Marianne J. Legato, MD, PhD, FACP, an internationally renowned pioneer in the field of gender-specific medicine, two weeks earlier at an intimate gathering over brunch at the New York City home of Loreen Arbus who is, in her own right, a fearless pioneer and champion for the rights of the marginalized, particularly for women and people with disabilities. Also in attendance were a number of other powerful and philanthropic women, including Alice Walton, the daughter of the founder of Walmart and board member of the Walton Family Foundation; Penny Abeywardena, New York City’s commissioner for international affairs; Whitney W. Donhauser, president of the Museum of the City of New York; and Elizabeth Kabler, daughter of the late Leonore Annenberg, the former US chief of protocol for President Ronald Reagan.
I’d read all of these women’s impressive bios, and still it was Dr. Legato’s that caught my attention, due to her success and prominence as the founder of the Foundation for Gender-Specific Medicine, an organization she established to study gender differences to improve healthcare for everyone. A number of news outlets were then reporting on Caster Semenya, the South African transgender athlete who lost her case against the International Association of Athletics Federations when they ruled that she must take medication to lower her testosterone levels if she wanted to continue to compete in global running events. Since Women’s eNews was planning to publish an article on this topic, I was looking forward to asking Dr. Legato about her thoughts on this controversial issue. “I am actually writing a book about this right now,” she replied. I was not at all surprised, and immediately asked to schedule an interview with her.
On the cutting edge of all things related to gender differences in medicine, Dr. Legato’s previous best-selling books have included Why Men Never Remember and Women Never Forget, Eve’s Rib: The Groundbreaking Guide to Women’s Health, and Why Men Die First. It is through Dr. Legato’s pioneering research and discoveries, in fact, that doctors have come to understand the differences between how women and men experience the same diseases, including heart disease and stroke.
Yet, how Dr. Legato first came to dedicate her career to gender medicine was accidental, I later learned. The day of our interview, I was welcomed into her Upper East Side Manhattan practice by her office staff, and I noticed the mutual respect between them right away. As she introduced me, she commented on their extraordinary dedication to her center’s work. Proceeding into her private office immediately afterward, she did not sit behind her large wooden desk surrounded by stacks of medical books, but alongside me in one of two same-size chairs, with framed photos of her family and friends in the background. She wore a bright orange dress adorned by a simple gold necklace, and her shoulder-length, light-brown hair rested gently on her shoulders. Her eyes, beaming behind frameless oval glasses, were focused yet warm. After I thanked her for taking the time out of her busy schedule to meet with me, she replied, in a voice that was both gentle and purposeful, “I always say yes to every reasonable invitation.”
It turns out that this is exactly how Dr. Legato first came to focus on gender-specific medicine. “I was a molecular biologist doing research on the human heart for the American Heart Association when a journalist asked if I would conduct research about potential differences in women’s heart disease, which had caused her mother’s death,” Dr. Legato recalled. “I really thought there was no difference at the time. Wow, was I wrong!” The results of her research resulted in her prize-winning book, The Female Heart: The Truth About Women and Coronary Artery Disease, published in 1992. This caused her to wonder whether other female organs in the body were also different from those of men. She smiles when she recalls her revelation: “Maybe women and men really are different!”
This could not have been more surprising to her, since she had been trained in the medical tradition that proclaimed: “If we only studied men, there was no need to study women separately, because we assumed that, apart from their reproductive biology, they were functionally identical,” she said. The first studies on human physiology were originally compiled on men only because they were thought to be more stable (without the cyclic hormonal changes of women), were readily available in veterans’ hospitals following both world wars, and were always ready to volunteer for medical studies. “No one ever thought to suggest that we were making an intellectual mistake by only studying men,” Legato continued. “In a real sense, we exploited men, who were always willing to join clinical trials in spite of the possibility that they were at a certain amount of risk in doing so. Even though we concentrated on men, our questions often didn’t address their most fundamental vulnerabilities: Why did men die at significantly younger ages than women, for example?” It was originally thought that women suffered coronary artery disease when they were ten years older than the age at which men did due to the protection of estrogen. However, when men were given estrogen, it proved fatal in the doses chosen, and studies on preventing coronary artery disease in men were abandoned.” Legato said. “But there had been no previous research about the differences in the cardiac function of men and women that would have predicted this would happen.”
As much as Dr. Legato’s career in medicine led to tremendous gains in the medical community for women and men, it also resulted in some personal losses for her, due to her family’s deep-seated patriarchal beliefs. The only daughter of four children, she told me, “My father wanted his second son to become a physician, just like him. So, when I became the physician, instead of my brother, it created a permanent rift between us.” She persisted in spite of her father’s lack of support; he remained intransigent and refused to attend her medical school graduation. Her father told her brothers that she was no longer his daughter. “Yet, I do think he loved me; he was enchanted by me as a child,” she recalled. “It was only when it came time for me to oppose him and become a physician that he withdrew his support for me.” Her father required his entire family, including her mother, to join him in opposing her medical training, which they did, except for her youngest brother, Gerard.
Even though she grew up under such a misogynistic family structure, she did not allow these experiences of disappointment, rivalry, and loss to cause her to lead a life of anger and resentment. “I’ve come to understand that people do what they want—not what they should do, nor what we hope they will do,” she said. “If they’re fearful of being abandoned, or of a child surpassing what they have achieved, they may find those relationships difficult, and there’s nothing we can do about it.” And it was through understanding who her parents were—what frightened them, and what threatened them—that she ultimately forgave them. She said of her youngest brother, Gerard, “He has been invaluable in helping me understand the intricacies of my family’s relationships with one another, and helped me to accept that my parents were truly unaware of how hurtful they were to me.” She dedicated the prize-winning third edition of her textbook, The Principles of Gender-Specific Medicine, to her brother.
But Gerard was just one of the caring and compassionate individuals who lent their support to her life and career. While studying at Manhattanville College, the school’s dean often reiterated the motto: “Do the truth in charity.” Legato said, “That simple sentence taught me the twin values of justice and compassionate generosity in dealing with others.” Legato put this teaching into practice after her award-winning book, The Female Heart: The Truth About Women and Coronary Artery Disease, was published in 1992. “After winning the competition sponsored by the American Heart Association for the best book published for the lay public on heart disease, one of the judges called and asked me to become a consultant for Proctor & Gamble. He thought my input would be valuable as a consultant for products that would improve women’s health.” Instead, she told him she had a better idea. “Tell Proctor and Gamble that an alliance with Columbia University College of Physicians and Surgeons would be a much better idea than my individual contribution; it would give P&G access to all of the science in the world on this topic.” she recalled. They did just that and, as as a result, P&G ultimately funded Legato’s ongoing research to the tune of four million dollars. “This is an example of giving back in the best way that you can. I could have had a great job as a consultant for P&G, but this alliance was much better and broader.” The support of P&G allowed Legato to establish the Foundation for Gender-Specific Medicine, now in its twenty-third year.
Even now, as an internationally renowned academic physician, author, and lecturer, Legato does not, by any means, believe that she is “fully formed.” She told me, “I always have gaps to fill … to be more generous, to be more realistic, and to be more effective.” This is what she tells her students in her role as professor of clinical medicine at Columbia University College of Physicians and Surgeons. “I urge them to say yes to every opportunity, just as I do, and to try to be open-minded and open-hearted in their responses to challenges.”
“The trouble in life is that you can’t live it all over again once you’ve learned everything you need to know,” she told me at the end of our interview. “Too bad we can’t redo everything.” Yet what she has done in her career, by refusing to allow her patriarchal upbringing to limit her ambitions, or to lessen her compassion and generosity for others, has enabled her to develop an entirely new arena of medical research that has changed the lives—and saved the lives—of countless women and men.