February 26 - March 4, 2000

This Year’s Women’s Health Dialogues featured Dr. Marianne Legato, professor of clinical medicine, Columbia College of Physicians & Surgeons, founder and director of Columbia’s Partnership for Women’s Health and founder of the Journal of ender-Specific Medicine. Dr. Legato has written extensively on coronary artery disease in women and is a leading figure in the movement toward gender-specific clinical practice.

The aim of the Dialogues, which are funded each year by the American Physician’s Fellowship (APF), is to bring the latest developments and research in the field of women’s health to the attention of Israeli policymakers, practitioners and consumers and to stimulate discussion and exchange of information. This year, we were challenged by the provocative and revolutionary message of our remarkable guest lecturer to rethink goals and strategies for the coming years. "Women’s health," she cautioned, "need no longer be presented as a political or feminist issue. It is a scientific and clinical issue with invaluable benefits for understanding and improving health care for all… We need to focus equally on men and women and explore more fully the ways in which normal human function and pathology vary depending on sex and gender."

Among the more salient gender differences that were highlighted are the following:

• Men have larger brains; women have more brain cells.
• There are significant differences in the brain activity of men and women.
• Food takes twice as long to pass through the digestive system of women compared with that of men.
• Men have larger hearts; women’s hearts beat faster.
• Heart disease presents differently in men and women: men feel a crashing pain in their chest; women experience fleeting pain in the upper abdomen, shortness of breath, and sweating.

From left to right: Hinda Gross, Dr. Neri Laufer, Dr. Amy avgar, shoshana Israeli, Marianne Legato, Suzanne Brown

Despite these and other differences, Legato observed, two-thirds of all research on diseases that affect men and women have been carried out on men. Women have been treated as "small men" and their own medical "stories" have yet to be told in full. Much more work is needed in order to document differences in illness, risk factors, effective diagnostic techniques and the response to treatment.

According to Legato, physicians perceive women differently than they do men and this gender bias leads to different clinical decisions and, often, less aggressive treatment. Moreover, the "bikini" view of women’s health, which has focused on reproduction to the exclusion of other systems, has resulted in an isolation of the field of women’s health from mainstream medicine. Service delivery has been fragmented, uncoordinated and based on the notion of "compliance" rather than "collaboration" between women and their doctors.

Dr. Legato called for a shift away from women’s health and the commercialization of women’s health centers toward a new science and gender-specific medicine that would study and treat men and women side by side according to their gender needs. She addressed this call to academicians at Ben Gurion University in the Negev, health professionals and volunteers at Hadassah Hospital in Jerusalem, the Knesset Committee on the Status of Women, members of the newly established National Council on Women’s Health, the Council of Women’s Organizations, Arab physicians and nurses at the English Hospital in Nazareth and colleagues from the Women’s Heart Center in Ashkelon.

Dr. Legato also met extensively with IAAWH and Hadassah-Israel board members and staff and with participants in the joint Advocacy Training Course. She enriched us all, professionally and personally, and will undoubtedly become an important member of our international network of colleagues and friends. Upon her return to America, she wrote: "I can’t tell you how many times I’ve reviewed the details of the uniquely wonderful trip I had with all of you in Israel. I found the trip profoundly gratifying and I know it will enrich all of my medical work and experiences in the future. You are heroes doing wonderful deeds against formidable odds in an environment that is more challenging than any I have seen. I hope to continue to collaborate with you in any way that I can."

From the newsletter "Women’s Health Matters" by The Israel Association for the Advancement of Women’s Health (Spring 2000, Issue No. 4)