Medicine and Gender: How Men ... Video Transcript

Participants

, Marianne Legato MD, Benjamin H. Lewis MD, David R. Marks MD

Summary

That men and women have different bodies is news to no one. But with the advance of the medical sciences, more and more fascinating differences have been uncovered. Did you know, for example, that men and women often use different parts of their brain to accomplish the same task? Join our panel of experts as they discuss some of these gender differences and their implications for modern medicine.

Webcast Transcript

DAVID R. MARKS, MD: Welcome to our webcast. I'm Dr. David Marks. Men may be from Mars and women may be from Venus, but are they different medically? It's the age-old question. Joining me to help discuss this question are two guests. First is Dr. Marianne Legato. She is professor of clinical medicine and director of the Partnership for Women's Health at Columbia. Welcome.

Next to her is Dr. Benjamin Lewis. He is assistant professor of clinical medicine and a scholar at the Partnership for Women's Health, also at Columbia. Welcome.

Why do we have this question to begin with after all of these years?

MARIANNE LEGATO, MD: Ever since the 20th century began, we assumed that women were really small men and did research almost exclusively in men, partially as a desire to protect women from the consequences of clinical investigation, particularly women who were still in their reproductive years. That all changed with the advent of feminism after World War II, and finally Congress listened to the wishes of women to have more attention to their health and legislated in the early 1990s that women were to be included in federally funded research grants. To our amazement, we find that there are significant and important differences body-wide between men and women.

DAVID R. MARKS, MD: But this is all just recent information. So probably all of the results are not in, and we're going to find out even more down the road, I would think.

MARIANNE LEGATO, MD: That's right. But a significant number of interesting differences are already very much apparent.

DAVID R. MARKS, MD: Why don't you tell us, Dr. Lewis, about some of the differences that we're finding?

BENJAMIN LEWIS, MD: Some of the differences that are significant are, for example, how we test for coronary artery disease. The testing where we do the conventional stress testing with an EKG has a fairly good track record for reliability in men, but when you apply those same criteria to women, there are a number of false positives. That concept led to using nuclear scans for women that continue to have problems because of artifacts in the nuclear scan. As a result there became a bias against the truth, which was that women do get heart disease, and women really had to present with heart attacks or manifest heart disease before it was taken more seriously. I think now we understand that there are ways to look at the technology and find people earlier. One of the key advantages has been in terms of using ultrasound, using exercise echo.

So I think we've learned that there are clear differences. There are even differences, for example, in the normal heart size and heart mass per unit area between men and women. So there are a number of fundamental differences.

DAVID R. MARKS, MD: We hear about the fact that women and men think differently. I know that that's true. But is there a difference in the brain anatomically?

MARIANNE LEGATO, MD: Yes, indeed. There's a difference in every system, and the brain is probably one of the most interesting. It's called sexual dimorphism, different shapes of the brain, different sizes of the parts of the brain, between men and women, and even a difference in the number and complexity of connections between brain cells between men and women. The most interesting thing to illustrate how important it is is that if you and I had an identical task to perform, some problem to solve, different parts of your brain would light up with activity compared with mine. We might both solve it, but use different parts of our brain to do that.

DAVID R. MARKS, MD: Is this under hormonal control?

MARIANNE LEGATO, MD: Not altogether.