There are fads and fashions in what the lay public accepts about medical information. One of the most alarming at the moment is the resistance to vaccination, including the one we are dispensing at the moment against influenza. Persuading patients to get a flu shot, even when it’s free at their local pharmacy, is not easy. “I never get sick” is one answer. “Last time I got a flu shot; I got the flu” is another stock reply. Many don’t have a reason they’re willing to share with me; the answer is a flat: “No. I don’t want one”. And yet the weekly report from the New York State Department of Health shows the rate of infection spreading relentlessly, particularly in heavily populated areas like Manhattan even though it’s only the beginning of the flu season. The increase of homeless people crowded into shelters or who sleep in subways makes contagion, particularly in freezing weather, more likely. The virus spreads through the air in droplets coughed out by infected people and can contaminate shared surfaces like computer keyboards, restaurant counters or shared telephones.
Most fundamentally healthy and relatively young people survive the disease with a great deal of misery but recover without treatment in a week or two. But influenza can be a fatal infection, particularly for vulnerable populations. People over 65 and/or those with significant chronic diseases like diabetes or heart disease are at special risk. At the other end of the susceptibility spectrum are children under five-particularly those in the first 12 months of life. Pregnant women in the last two trimesters of pregnancy and for several weeks after delivery, when their immune systems are muted in an accommodation for the developing fetus, are also a target population for the virus.
The vaccine is made up differently each year in an effort to protect against the strains of influenza viruses most likely to be abroad; the immunization generally proves to protect most of the population. Even so, doctors dread the development of a mutant strain we can’t contain, like the “Spanish Flu” that decimated the world’s population in 1918. (Downton Abbey fans will remember the poignant death of one of the youngest women of the household from the flu). That particular virus, which had begun infecting humans in about 1910, picked up some genetic material from birds with influenza and mutated into the most lethal version we’ve ever seen: it attacked a third of the planet’s population, killing 20 to 50 million individuals in the process. Various explanations have been offered for why those who died were often young people in the prime of life –a very different profile than that of current flu viruses, which takes the biggest toll among the elderly, infirm or very young. It is thought that the havoc caused by the 1918 version was due to the perfect storm of young people having been previously infected with another virus that made their immune systems unable to mount a defense against the 1918 “Spanish flu” infection.
If you are one of the holdouts who refuses the flu shot at least take simple precautions to avoid infection: wash your hands frequently, avoid crowds and if you find yourself ill, contain your sneezing and coughing with a mask or handkerchief. Don’t brave an infection by going to work in spite of it; it’s not fair to your co-workers. Warning signs of a sore throat and dry cough, combined with generalized muscle aches and fever, should prompt you to contact your doctor early. You might stop influenza’s progression by taking 75 mgm capsules of TamiFlu (oseltamivir) twice daily for 5 days if you catch the infection within the first 24-48 hours. The far better idea is to get vaccinated; you’ll have done all you can to avoid an illness that is massively unpleasant to endure and in the worst cases, can be fatal.
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.”