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Big Think Interview With Marianne Legato

Marianne Legato: My name is Dr. Marianne J. Legato. I’m a professor of clinical medicine at Columbia University.

Question: Are men more prone to diseases?

Marianne Legato: In spite of their obvious increased physical strength compared to women, men are more vulnerable biologically than women are. The vulnerability begins in the womb. Far fewer male embryos make it to delivery compared with females. Even at birth, boys are developmentally behind their sisters and are prey to developmental disabilities and respiratory problems among others in the weeks immediately after birth. This vulnerability continues during the course of their life. One of the most important health problems of men is the early onset of coronary artery disease which begins to be symptomatic in many men in the mid thirties. And those men who have coronary disease are usually dead before the age of sixty-five. I think this is one of the most compelling health problems that men face and something on which we should really be concentrating.

Question: Are men also more prone to developmental disabilities?

Marianne Legato: Developmental disabilities are four to six times more frequent in males than in females. We don’t really know why this is correct but a very interesting theory has developed in which it was pointed out by some neo-natal experts. That the brains of boys are larger than those of their sisters and at the same time their metabolic rate is lower so that the demands of the bigger brain are really not met as efficiently by the low metabolic rate which doesn’t deliver enough oxygen and blood to the brain as is the case with their sisters who have smaller and probably more efficient systems of providing the brain with blood and oxygen.

Question: Is there an age where men are particularly vulnerable?

Marianne Legato: One of the most vulnerable periods for men, or males, is during adolescence. There is a lag time in the development in the systems in the brain that have to do with risk assessment and judgment. At the same time, the surge of testosterone makes them prone to idealistic, impulsive and risk-taking behavior so that suicide and violent death is far more common in the male adolescent than it is in the female adolescent. We really capitalize on this, sadly, by sending eighteen year olds to war. A very smart man had said to me, who was in the military, that if you ask an 18 year old to take a well-defended objective, he’ll say “when?” If you ask a thirty-year-old to take the same objective, he’ll say “how?” And if you ask a forty-year-old man, he’ll say “why?”

Question: What steps should we be taking to help men lead healthier lives?

Marianne Legato: I think there are definite steps we should be taking, and taking immediately, to ensure better and longer lives for men. In the first place, we should stop regarding them as the “stronger sex.” They’re biologically much less hardy in many ways than are women. In particular, we should be concentrating, in my opinion, on the early onset of coronary disease which takes such a terrible toll of men. And I think the American Heart Association should have a program called Go Blue for men, the way it does Go Red for women. I think heart disease in its early and devastating onset in men is one of the most important health problems that we face.

Question: Is the Y chromosome prone to mutations?

Marianne Legato: The Y chromosome is definitely unique among all the chromosomes. Over most of its extent, it can’t exchange with its partner the X chromosome to repair its deficiencies or mutations in DNA. It’s learned to repair itself in an interesting and unique way. The issues with the Y chromosome are that they are exposed to environmental toxins because they are housed outside the body in the scrotal sack. Many millions are produced every day and, therefore, mutations are far more frequent in the Y chromosome than in the X or indeed in any of the other chromosomes. So the male drives evolutionary development because of this extraordinary proliferation of mutations that are characteristic of sperm and the Y chromosome.

Question: Are men less prone to depression as women?

Marianne Legato: The generally accepted statistic is that women are twice as likely to suffer from depression as men. I don’t think this is correct. I think that the signs and symptoms of depression in men are very different than those in women. In spite of great sadness and pessimism, men tend not to communicate their distress. They go it alone as they do in so many areas of their lives and they turn to self medication sometimes with excessive TV, excessive sexual activity, or excessive drinking as symptoms of their distress.

Marianne Legato: There’s no question that depression can be fatal in both sexes including, obviously, in men. People lose their appetite. They can’t sleep. They don’t take action against threats in the environment. And I think that there’s no question that depression, which by the way also depresses the action of the immune system and makes people prone to infection, is a very serious warning that a fatal outcome is a possibility. So depression should never be underestimated.

Marianne Legato: A very interesting thing about depression was commented on, in fact, by my father who was a physician years ago. When he said that the time to be most on guard against suicide is in the partially treated, depressed patient, he pointed out that when they’re profoundly depressed, they can’t take action even to end their own lives. But as they improve, they begin to see ways to carry out their very sad objective. And I think that that’s reflected in many of the warnings on some of our antidepressants, when we start to give them, result in the suicide of patients unexpectedly. And I think it may be to this general principle that the depressed patient in treatment has to be very carefully watched because there’s this time of special vulnerability.

Recorded on: November 4, 2009

 

 

A conversation with the professor of clinical medicine at Columbia University.

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The psychological scars a traumatic experience can leave behind may have a more profound effect on a person than the original traumatic experience. Long after an acute emergency is resolved, victims of post-traumatic stress disorder (PTSD) continue to suffer its consequences.

In the U.S. some 30 million patients are annually treated in emergency departments (EDs) for a range of traumatic injuries. Add to that urgent admissions to the ED with the onset of COVID-19 symptoms. Health experts predict that some 10 percent to 15 percent of these people will develop long-lasting PTSD within a year of the initial incident. While there are interventions that can help individuals avoid PTSD, there's been no reliable way to identify those most likely to need it.

That may now have changed. A multi-disciplinary team of researchers has developed a method for predicting who is most likely to develop PTSD after a traumatic emergency-room experience. Their study is published in the journal Nature Medicine.

70 data points and machine learning

nurse wrapping patient's arm

Image source: Creators Collective/Unsplash

Study lead author Katharina Schultebraucks of Columbia University's Department Vagelos College of Physicians and Surgeons says:

"For many trauma patients, the ED visit is often their sole contact with the health care system. The time immediately after a traumatic injury is a critical window for identifying people at risk for PTSD and arranging appropriate follow-up treatment. The earlier we can treat those at risk, the better the likely outcomes."

The new PTSD test uses machine learning and 70 clinical data points plus a clinical stress-level assessment to develop a PTSD score for an individual that identifies their risk of acquiring the condition.

Among the 70 data points are stress hormone levels, inflammatory signals, high blood pressure, and an anxiety-level assessment. Says Schultebraucks, "We selected measures that are routinely collected in the ED and logged in the electronic medical record, plus answers to a few short questions about the psychological stress response. The idea was to create a tool that would be universally available and would add little burden to ED personnel."

Researchers used data from adult trauma survivors in Atlanta, Georgia (377 individuals) and New York City (221 individuals) to test their system.

Of this cohort, 90 percent of those predicted to be at high risk developed long-lasting PTSD symptoms within a year of the initial traumatic event — just 5 percent of people who never developed PTSD symptoms had been erroneously identified as being at risk.

On the other side of the coin, 29 percent of individuals were 'false negatives," tagged by the algorithm as not being at risk of PTSD, but then developing symptoms.

Going forward

person leaning their head on another's shoulder

Image source: Külli Kittus/Unsplash

Schultebraucks looks forward to more testing as the researchers continue to refine their algorithm and to instill confidence in the approach among ED clinicians: "Because previous models for predicting PTSD risk have not been validated in independent samples like our model, they haven't been adopted in clinical practice." She expects that, "Testing and validation of our model in larger samples will be necessary for the algorithm to be ready-to-use in the general population."

"Currently only 7% of level-1 trauma centers routinely screen for PTSD," notes Schultebraucks. "We hope that the algorithm will provide ED clinicians with a rapid, automatic readout that they could use for discharge planning and the prevention of PTSD." She envisions the algorithm being implemented in the future as a feature of electronic medical records.

The researchers also plan to test their algorithm at predicting PTSD in people whose traumatic experiences come in the form of health events such as heart attacks and strokes, as opposed to visits to the emergency department.

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