Julie Silver: Medical journals must address gender bias

When women physicians and scientists face barriers to publication and journal leadership, the pace of discovery slows and critical perspectives are lost

Reports demonstrate gender bias in academic medicine, and an important subset of this evidence focuses on journal level disparities, for example the numbers of women as authors, reviewers, and editors. Notably, gender is not binary, but studies on publishing related disparities typically compare proportions of men and women, and there is a paucity of data for many people at risk of underrepresentation (e.g. individuals identifying as LGBTQ+ or ethnic or racial minorities). However, an abundance of research shows women in academia, inclusive of medicine, face more barriers to publishing than men. 

Barriers are wide ranging and multifactorial. Bias harms scientific discovery, and when it occurs at the journal level there are profound financial implications. For example, if a researcher faces barriers to publication this affects organisations that financially support her work (i.e. employer and grant funders), and their return on investment is not fully realised.

Journal owners, some of which are medical societies, have an obligation to address both conscious (explicit) and unconscious (implicit) bias. Firewalls exist between medical society owners and their journals. These are in place to avoid conflicts of interest and protect content selection. Firewalls do not prevent owners from ensuring their journals are fair and that they hold senior editors accountable for proactively uncovering and addressing gender bias in a scientific manner using established metrics.

Perpetuating gender bias is unethical and incompatible with a position of trust. The International Committee of Medical Journal Editors (ICMJE) has codified owner obligations, which include ensuring editors act in a manner that is compatible “with a position of trust.” For example, in the United States, gender equity among senior editors and on editorial boards is a long-standing and well-documented disparity, yet it is a straightforward and inexpensive issue to fix. A lack of equitable inclusion (i.e., a lower proportion of women editors as compared to their presence in the specialty or members of the society) is itself a disparity. Although one cannot assume equitable representation of women among editors or on editorial boards positively impacts other journal-level gender disparities; nevertheless, there is no reasonable justification for perpetuating an easily solvable inequity. 

Fortunately, there is good news to report. For example, recently the British Journal of Sports Medicine announced on Twitter it will “commit to at least half of the BJSM Ed board being women”—giving this reason: “Because the talent is there.” Even in a male-dominated specialty, parity on editorial boards is easy to achieve. Editors at the Journal of Hospital Medicine acknowledged “medical journals have an obligation to address unequal opportunities” and vowed as an initial step that they will “assess the current representation of women and racial and ethnic minorities in our journal community, including first and senior authors, invited expert contributors, reviewers, and editorial team members.” 

The Lancet’s editors recently published a special issue focused on women in medicine and discussed what they are doing about gender and diversity

They noted gaps are not due to a lack of qualified women, but rather the “supposed meritocracy is rigged against them, resulting in an unjustified and unacceptable masking of women’s contributions.” Their data also showed gaps in the representation of women authors and reviewers. They disclosed gaps in the representation of women as commentary authors, consistent with existing research in pediatrics and dermatology which showed that women in these specialties were not equitably represented as authors of opinion and perspective articles. This is a very important finding, because it essentially diminishes the voices of women in medicine, and a lack of diverse insights may negatively impact research and clinical care.

Journals depend on the privilege of publishing the best scientific work, and they need women’s research to be successful. As such, physicians and scientists (regardless of gender) can consider preferentially submitting to journals with a good track record on equity and inclusion. Before hitting “submit” women and allies might ask themselves, “Is there evidence that this journal is focused on treating women fairly?” 

Now is the time for all journals and their owners to address gender bias. When women physicians and scientists face barriers to publication and journal leadership, the pace of discovery slows and critical perspectives are lost. Patients may also be affected as they are relying on researchers with the brightest mindsmany of whom are womento advance the science that will help them overcome disease and disability. There is no doubt we need her science, and when science wins, everyone wins. 

Julie K. Silver is an associate professor and associate chair of the Department of Physical Medicine at Harvard Medical School. She developed the Be Ethical and Need Her Science Campaigns that are aimed at strategically addressing gender workforce disparities. Read the white paper and share the infographic. Follow these campaigns on Twitter at #BeEthical and #NeedHerScience

Twitter: @JulieSilverMD

Competing interests: JS reports no disclosures related to this perspective. Her work on disparities has been funded by the Arnold P. Gold Foundation and as an academic physician she receives royalties for books and honoraria for lectures related to her work. She personally supported the Be Ethical and Need Her Science Campaigns.