Dr. Marianne J. Legato, associate professor of clinical medicine and director of the Partnership for Women's Health at Columbia

Columbia University and Procter & Gamble have joined forces to advance gender-specific medicine, a new approach to health care based on insights into biological differences between women and men. The University announced the formation of the Partnership for Women's Health at Columbia in February 1997. An unrestricted $1 million grant from Procter & Gamble funds the center's work. Procter & Gamble also committed $450,000 in startup capital for each of the partnership's first three years.

Columbia contributes a substantial team of experts, led by Dr. Marianne J. Legato, associate professor of clinical medicine. She has dedicated most of her academic career to the study of the structure and function of heart cells.

She is the author of the first book on gender differences in coronary artery disease, "The Female Heart: The Truth About Women and Coronary Heart Disease," which won the American Heart Association's 1992 Blakeslee Prize as the best book of the year about heart health for the lay public. Her newest book, "What Women Need to Know," answers a variety of questions women have asked about health. She also recently completed "Gender-Specific Aspects of Human Biology for the Practicing Physician," a book that discusses gender-based differences in human physiology and the pathophysiology of disease. As director of the Partnership for Women's Health, she leads a world-class group of P&S scholar-researchers who are experts in many aspects of women's health.

Procter & Gamble, with headquarters in Cincinnati, is a leading developer of consumer products worldwide, including a broad range of health care products designed to improve the lives of the world's consumers. Procter & Gamble will contribute its expertise on consumer behavior to develop education programs to prevent or eradicate disease; support research and development that will lead to products and treatments that meet women's needs as defined by the partnership; and serve as a catalyst in bringing together private organizations to support the work of the partnership.
As partners, P&S and P&G will work together to identify gaps in knowledge about women and chart useful directions for the future. As the first collaboration between an academic medical center and the private sector to focus on gender-specific medicine, the union meets a real need. "Historically, medical research has been conducted primarily in males, leaving us with an insufficient, largely male model of biology and disease that's been applied to treat women without modification," explains Dr. Legato. Because of the lack of gender-specific information, the medical community has often thought of women as small men.

In other instances, also because of a lack of information, the medical community has overlooked biological similarities. More than half of all women in a 1997 survey say their doctor has never talked with them about heart disease or reducing their risk of heart attack. And a surprising 50 percent say their doctor doesn't check cholesterol, an important coronary artery disease indicator. "The partnership's goal of building and sharing gender-specific knowledge is critical to optimizing women's health care around the world in years to come," says Dr. Legato. The partnership will go beyond the obvious reproductive differences to quantify gender differences throughout the body. Recognizing those differences is essential to the practice of good medicine.

The partnership's first projects take a closer look at gender-specific differences in heart function and bone metabolism. Future research will try to determine why some diseases are more common in women than in men and why some drugs are less effective in women than in men or, in other cases, why some drugs that are safe for men are fatal to women. Explains Dr. Michael R. Rosen, Gustavus A. Pfeiffer Professor of Pharmacology, professor of pediatrics, and a partnership associate director, "By understanding why this occurs, we can attempt to develop drugs that better meet the physiological needs of female biology."

Because researchers will observe and compare women with men to create an accurate model of normal human function, the partnership will not neglect men's health. For example, "We need to understand the basis for osteoporosis in men, which may provide additional clues to the different susceptibilities and mechanisms of bone loss between the genders," says Dr. John Bilezikian, professor of medicine and of pharmacology and a partnership associate director. Once researchers understand why osteoporosis is less common in men, they can begin to work on therapeutic approaches that will help women. Drs. Rosen and Bilezikian are also investigating the influence of sexual hormones on the electrical behavior of the heart and on bone metabolism. Ultimately, the partnership will establish a database called GenCite, which will provide a comprehensive and up-to-date summary of information on gender-specific biology.

Once partnership researchers have acquired new information, they will use it for the foundation of innovative educational programs for women and their doctors, through professional symposia, position papers, and medical and consumer books. Partnership staff are creating easy-to-understand, disease-specific educational tools to help women access the best care and ask doctors the right questions.

Like CPMC, the partnership will be an inspiring example of the power of collected expertise. Not only is this partnership the first of its kind between an academic medical center and the private sector, it also has issued a call to complementary programs from all sectors--women's advocacy groups such as the Society for the Advancement of Women's Health Research; government entities such as the National Institutes of Health, and foundations. Already, researchers at Harvard and Yale have expressed interest in the partnership, as have multidisciplinary representatives of the health community who will serve on the board. Says John Pepper, chairman and chief executive officer of Procter & Gamble: "The challenge we face is too large, and the consequences are too great, to make this effort exclusionary. We need the best thinking from the best minds to accelerate our understanding of gender-specific medicine and women's health. A partnership involving companies large and small, universities around the world, foundations with diverse interests, and, most important, women themselves is the best way to access and maximize such thinking. Our vision is to create a partnership without walls."

To learn more about the Partnership for Women's Health at Columbia and women's health at P&S, visit http://www.pg.com/docWomenshealth/ and http://cpmcnet.columbia.edu/dept/cwh/ on the World Wide Web.

Gathered Intelligence: Describing Male and Female Biologies

The Partnership for Women's Health at Columbia is creating GenCite, a database on biological differences and similarities between men and women. Among the knowledge acquired so far:
The Heart
Women's hearts are two-thirds the size of men's, and women have smaller coronary arteries.

Women's heart rates are higher than men's, even during sleep.

Aspirin use reduces the risk of stroke in men with high blood pressure but not in women.

The Immune System
Women have higher immunoglobulin levels than men, which give them better virus-fighting powers.

Most autoimmune diseases, such as multiple sclerosis, lupus, and rheumatoid arthritis, are more common in women than in men.

The Brain
Women's brains have more neurons.

Women experience depression two to three times more often than men.

15 percent to 17 percent of women have migraine headaches, compared with only 3 percent to 6 percent of men.

Metabolism
Women and men metabolize drugs differently, among them benzodiazepines, aspirin, and alcohol.

Estrogen and oral contraceptives have a significant impact on the metabolism of many drugs.

Bone
Women have lower bone mass at peak maturity than men do.
80 percent of the roughly 210,000 hip fractures each year occur in women.

Skin
As estrogen levels drop in postmenopausal women, the epidermis becomes thinner.