A double load of bad news this week: Sabrina Tavernese reported in the NY Times that the birth rate in our country has fallen for the fourth straight year. In fact, the decline in birth has been 15% since 2007. Whether it’s the result of economics, political turmoil or other reasons, an increasing number of young people are opting out of -or perhaps are physically unable to take on- parenthood. Apparently the only thing keeping our population numbers level is immigration.
The second depressing report comes from Joel Ashenbach, writing in The Washington Post, citing what he chillingly calls “the U.S. longevity reversal”: there has been a relative jump in death rates between 2010 and 2017 by a horrifying 29% among people ages 25 to 34. The demographics cut across all racial and ethnic groups. Apparently -and appallingly- it’s individuals generally regarded to be in their prime who are opting out of life. Steven Woolf, director emeritus of the Center on Society and Health at Virginia Commonwealth University who authored a report on the increase of deaths among young people commented that the increase in death is not only due to the obvious causes like the opioid epidemic, obesity and its complications, or driving accidents. He believes there is a deeper, “root cause” that is specifically affecting working class adults. Comments from experts who read the report speculate, like Ellen Mearn, Professor at the Dartmouth Institute for Health Policy and Clinical Practice, that people are increasingly more depressed, whatever the cause, about themselves and their futures. In fact, as Achenbach points out, the average life expectancy in this country fell behind that of other wealthy countries in 1998 and since then the gap has grown steadily. It’s so striking that it’s called the US health disadvantage.
One hopeful effort at combatting illness in the young is the report in Science that the US Centers for Disease Control and Prevention (the CDC) thinks that a synthetic form of Vitamin E oil added to many e-cigarettes may be at least one responsible agent for the deadly lung disease felling young vapers. The noxious substance was found in the lung fluid of all 29 patients who had suffered lung injuries. Vaping injured more than 2000 and killed at least 39 individuals since March.
Happily, this week’s issue of Science reports another weapon against premature death from another important killer: alcoholism. Dr. Bernd Schnabl, a gastroenterologist at the University of California has discovered an unexpected reason why heavy drinking affects some tipplers more than others. 30% of patients hospitalized with alcoholic liver disease harbored a toxic-making strain of the bacterium, Enterococcus faecalis, in their intestines. When mice experimentally infected with the deadly bug were treated with a virus that targeted E. faecalis, they had less severe disease than untreated animals. Clinical trials on treating humans with severe alcoholic liver disease with the virus will be the next step.
In short, the news of this week is bleak, but intense efforts to protect and defend human life, even for the millions afflicted by life styles and habits that are killing them in their prime, go on. It is an amazing fact that we can be recklessly abusive of our bodies, but science continues to find ways to help us survive in spite of ourselves. But the underlying reasons for the disturbing trends of a plunging birth rate and increasing death rates among young adults demand intense and focused consideration.
Marianne J. Legato, MD, Ph. D. (hon. c.), FACP is an internationally renowned academic, physician, author, lecturer, and pioneer in the field of gender-specific medicine. She is a Professor Emerita of Clinical Medicine at Columbia University College of Physicians & Surgeons and an Adjunct Professor of Medicine at Johns Hopkins Medical School. Dr. Legato is also the Director of the Foundation for Gender-Specific Medicine, which she founded in 2006 as a continuation of her work with The Partnership for Gender-Specific Medicine at Columbia University. She received an honorary PhD from the University of Panama in 2015 for her work on the differences between men and women.
At its core, gender-specific medicine is 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. Dr. Legato’s discoveries and those of her colleagues have led to a personalization of medicine that assists doctors worldwide in understanding the difference in normal function of men and women and in their sex-specific experiences of the same diseases.
She began her work in gender-specific medicine by authoring the first book on women and heart disease, The Female Heart: The Truth About Women and Coronary Artery Disease, which won the Blakeslee Award of the American Heart Association in 1992. Because of this research, the cardiovascular community began to include women in clinical trials affirming the fact that the risk factors, symptoms, and treatment of the same disease can be significantly different between the sexes. Convinced that the sex-specific differences in coronary artery disease were not unique, Dr. Legato began a wide-ranging survey of all medical specialties and in 2004, published the first textbook on gender-specific medicine, The Principles of Gender-Specific Medicine. The second edition appeared in 2010 and the third edition, dedicated to explaining how gender impacts biomedical investigation in the genomic era, won the PROSE Award in Clinical Medicine from the Association of American Publishers in 2018. A fourth edition is forthcoming.
She also founded the first scientific journals publishing new studies in the field, The Journal of Gender-Specific Medicine, and a newer version, Gender Medicine, both listed in the Index Medicus of the National Library of Medicine. She has founded a third peer-reviewed, open access journal, Gender and the Genome, which focuses on the impact of biological sex on technology and its effects on human life.
Dr. Legato is the author of multiple works, including: What Women Need to Know (Simon & Schuster, 1997), Eve’s Rib (Harmony Books, 2002), Why Men Never Remember and Women Never Forget (Rodale, 2005), Why Men Die First (Palgrave, 2008), The International Society for Gender Medicine: History and Highlights (Academic Press, 2017), and most recently, The Plasticity of Sex (Academic Press, 2020). Her books have been translated into 28 languages to date.
As an internationally respected authority on gender medicine, Dr. Legato has chaired symposia and made keynote addresses to world congresses in gender-specific medicine in Berlin, Israel, Italy, Japan, Panama, South Korea, Stockholm, and Vienna. In collaboration with the Menarini Foundation, she is co-chairing a symposium on epigenetics, Sex, Gender and Epigenetics: From Molecule to Bedside, to be held in Spring 2021 in Italy. She maintains one of the only gender-specific private practice in New York City, and she has earned recognition as one of the “Top Doctors in New York.”