14 Mar Women Are First Authors in About 1/3 Major Medical Journals

MedicalResearch.com Interview with:

Dr. Giovanni Filardo

Giovanni Filardo, PhD, MPH
Director of Epidemiology, Office of the CQO, Baylor Scott & White Health Briget da Graca, JD, MSSenior Medical Writer
Center for Clinical Effectiveness
Office of the CQO
Baylor Scott & White Health Dallas, Texas

MedicalResearch.com: What is the background for this study? What are the main findings?

Dr. Filardo: While there are readily available, up-to-date data on the proportion of medical school applicants, graduates, and member of faculty women constitute, no similar information is routinely collected and shared about women’s participation in and leadership of medical research studies. The previous studies looking at this issue were conducted in 2004, and were limited to investigating the proportion of women among the first authors with MD degrees and with institutional affiliations in the United States or United Kingdom. The time was therefore ripe for an updated, rigorous, and comprehensive examination of first authorship in high impact medical journals.

We examined female first authorship of original research articles published over the past 20 years in the 6 general medical journals with the highest impact factors: Annals of Internal Medicine (Annals), Archives of Internal Medicine (Archives), The BMJ (formerly the British Medical Journal), Journal of the American Medical Association, The Lancet, and New England Journal of Medicine (NEJM). After adjusting for differences over time and between journals related to different prioritisation of studies according to type, topic/specialty, country in which the research was conducted, or number of listed authors, we found that female first authorship increased overall from 27% in 1994 to 37% in 2014, but had plateaued – and in the cases of The BMJ and NEJM – declined in the last 5 years. Our results also revealed significant differences in female first authorship between journals.

MedicalResearch.com: What should clinicians and patients take away from your report?

Dr. Filardo: Our results are important for clinicians and patients because they give and receive care that is based on the evidence provided by published research studies. Lead authors are typically the people making key decisions about the studies – such as the hypothesis to be tested, design of the study, inclusion and exclusion criteria for the study subjects, the outcomes to be examined, follow-up procedures, and any assumptions made in the analysis and interpretation of the data. As such, they play a key role in determining what evidence reaches the medical community to inform clinical decisions and/or health policy. Whether the lead author on a single article is male or female may not make a substantial difference to the contents of that evidence base, but the cumulative effects are important to the care patients receive and, more importantly the outcomes they experience for the following reasons:

1. a) Although it may not be possible to resolve the question of whether women “do” science differently from men, studies looking at research conducted within the biological sciences do show important differences in factors such as women being more likely to include study subjects of both sexes, or females alone, while men make up the vast majority of researchers studying males alone. As such, greater representation of women among lead authors would likely help address the underrepresentation (or even exclusion) of female subjects from the animal and human studies that precede clinical trials, and the failure of many clinical trials to enroll sufficient women to analyse and report data by sex, that was brought into the spotlight by the 2014 report “Sex-specific Medical Research: Why Women’s Health Can’t Wait.” (http://www.brighamandwomens.org/Departments_and_Services/womenshealth/ConnorsCenter/Policy/ConnorsReportFINAL.pdf) As that report states “Medical research that is either sex- or gender-neutral or skewed to male physiology puts women at risk for missed opportunities for prevention, incorrect diagnoses, misinformed treatments, sickness, and even death.” (pg 8). We ran into an example of this when conducting the literature review for another research article (currently in press with Open Heart) that examines the differences in outcomes experienced by men and women following coronary artery bypass graft surgery: The American College of Cardiology/American Heart Association guidelines for coronary artery bypass graft surgery explicitly state that they extrapolate the evidence obtained in men to guide the care provided to women – even though other studies show that coronary heart disease manifests differently in women than men, including in ways that coronary artery bypass graft surgery does little to address.
2. b) Working from the assumption that men and women are equally represented among the “best and brightest” graduating from medical schools and doctoral programs in the biomedical sciences, the fact that women still constitute no more than 37% of the first authors of high impact research in the years that have followed them reaching/passing the mark of 50% of graduates with these degrees, suggests we are “missing” the contributions from approximately one quarter of the female half of that group – or, alternatively, that they are not receiving the credit they deserve for their contributions. While only the former might directly influence the research results being immediately added to the evidence base informing clinical and policy decisions, the latter has important implications for the production of future evidence, as individuals who feel their work is being undervalued may not continue to pursue a career in research.
   

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Dr. Filardo: Further research is needed to address the questions about whether women are less likely to submit their research to high impact journals (or to certain high impact journals) than men, and if so, why. We also need more data regarding the reviewer assignments and recommendations, and the editorial decisions for submitted papers. Studies published within the last 5 years show continued, but unintentional, biases in favour of men within the scientific community: when asked to review identical job applications or conference abstracts submitted under ostensibly male or female names, both men and women rated submissions associated with male names as demonstrating greater competence or scientific quality. (Knobloch-Westersick S, Glynn CJ, Huge M. The Matilda Effect in Science Communication: An experiment on gender bias in publication quality perceptions and collaboration interest. Science Communication. 2013;35:603-625; Moss-Racusin CA, Dovidio JF, Brescoll VL, Graham MJ, Handelsman J. Science faculty’s subtle gender biases favor male students. Proceedings of the National Academy of Sciences of the United States of America. 2012;109:16474-16479). As such, the effect of blinding reviewers to authors’ names, and decision-making editors to both authors’ and reviewers’ names, on their recommendations for and decisions regarding publication of submitted manuscripts need to be rigorously investigated. Or, where those options are not feasible within the journal’s manuscript processing system, the effect of having reviewers and editors participate in exercises similar to the studies described above to reveal any subconscious bias they may be harbouring and thus need to account for in their reviews or decisions.

Other related topics for future research include looking into why women and men show different patterns in applications for research funding (with women submitting fewer applications, and proposing shorter study periods and smaller budgets), and why women publish less during the early years of their careers, including investigating the underlying causes for influencing factors that research has identified to date, such as women being less likely to have a mentor with whom they collaborate after graduation, having less ability than men to control the time flexibility and pace of their work, and experiencing higher rates of exhaustion after entering the medical/medical research work force (Fridner A, Norell A, Akesson G, Gustafsson Senden M, Tevik Lovseth L, Schenck-Gustafsson K. Possible reasons why female physicians publish fewer scientific articles than male physicians – a cross-sectional study. BMC Medical Education. 2015;15:67).

MedicalResearch.com: Is there anything else you would like to add?

Dr. Filardo: Perhaps most importantly, we need to move past the idea that it “doesn’t matter” if the person conducting a research study is male or female. While it certainly shouldn’t matter to decisions about whether that study gets funded, or whether its results get published, we need the contributions from all perspectives within a diverse research community to meet the needs of the diverse clinical and patient populations it serves. Until women are making equal contributions to the published research most likely to inform future research and influence health care policies, and standards of practice, all these areas will continue to carry the bias implicit in women’s underrepresentation.

Citation:

Filardo Giovanni, da Graca Briget, SassDanielle M, Pollock Benjamin D, SmithEmma B, Martinez Melissa Ashley-Marie et al.Trends and comparison of female first authorship in high impact medical journals: observational study (1994-2014) BMJ 2016;352 :i847

Women Are First Authors in About 1/3 Major Medical Journals (2016). MedicalResearch.com

Last Updated on March 14, 2016 by Marie Benz MD FAAD