Thoughts on the Second Sex: What the World Thinks of Women
I have lived a life of privilege in a society where my education and opportunities to contribute to others are respected and acknowledged. But most women in the world are not as fortunate: the horrendous injustices and abuses that the majority have experienced (and which are not only tolerated but perpetuated) have troubled me all my life. The actual spectrum of the inequities women suffer varies from the subtleties of how their medical care is often not informed by a clear understanding of their unique physiology to the horrors of rape, murder and enslavement of women by conquering invaders in wartime. Rape has always been an accepted weapon of war. What’s more heartbreaking is that women who manage to escape from their captors and abusers are often rejected when they try to return home—as are the children they bore during their enslavement.
The rights of women to own property, vote, drive cars and even to travel freely in some societies are all denied. They are compelled to conceal their entire bodies, including their faces, with voluminous clothing, as though personal beauty is an irresistible, fatal trap for men. They receive horrific punishment for violation of societal rules and customs in some countries, where they are stoned to death for alleged offenses like adultery. Honor killings of women by their own family members are tolerated and/or ignored. In the most sophisticated societies, we are still pointing out the different pay given to women compared to men for the same work. In the most primitive societies, the denial of nutrition, education and even rudimentary health care are the issues with which women have to deal with. In India, for example, doctors have confided to me that they are often reluctant to send a healthy, newborn baby girl home to her family because they are aware that the odds of that child surviving are not favorable. Sons, not daughters, are the favored sex for many Indian families.
The assumption that women are somehow the less valuable, less complex, less useful sex is reflected even in the scientific world: until recently, it was assumed that the unique features of the female child develop “by default” in the womb, whereas the development of the male child is an active process directed by testosterone! Molecular biologists have only recently begun to correct this notion: it is now apparent that the formation of the female is just as active a process as the male and involves a unique and gender-specific sequence of intrauterine activity.
Americans need not be smug about their enlightened treatment of women: this year, the United States made the list of the ten most dangerous countries for women in the world. Racism, poverty, malnutrition and inadequate education create women who at the least are disadvantaged, and at the most, murdered. The American College of Physicians has just told us that the rate of maternal mortality in the United States is the highest of all the developed countries and that black women suffer disproportionately from maternal deaths: 43.5 deaths in 100,000 compared with white women for whom the figure is 12.7 in 100,000.
Happily, women are finding the courage to move out of the shadows. Tokyo Medical University has just admitted responsibility for what has been termed the loss of a generation of brilliant women: women’s scores for admission examinations to medical school were arbitrarily reduced by 20% for at least seven years; 81 other Japanese medical schools have been asked to submit their admission data for inspection as a result of the emerging scandal. The numbers of women reporting sexual abuse by superiors in a position to destroy their careers are increasing.
The feminist movement, begun decades ago, was off to a slow, grindingly difficult start; the right of American women to vote has been established for less than a century. Finally, though, we find ourselves in an era of increasing transparency about the position women actually occupy in the world’s family. But we have miles to go to save the lives of the too often mortally threatened by abuses of all degrees: the savage, multifaceted disregard of society for so many women have produced a tremendous loss of talent from which we should all have been able to profit. The penalty for societies that ignore the importance of women’s well-being should be as draconian as governments can make it.
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.”