By Emma Regan and Jordan Maxwell Ridgway
Medical publishing has proven not to be as progressive as expected recently, thanks to studies that have shown a lack of diversity when it comes to publications in the top academic journals.
If you aren’t already aware, medical publishing is a collection of continually updated evidence-based review articles, encompassing major medical and surgical specialities written by a teams of experts. Many of these review articles can be found in medical journals. Medical journals are published frequently to communicate new research to scientists, clinicians and other healthcare workers. Examples of these journals include the New England Journal of Medicine (NEJM), the Journal of the American Medical Association (JAMA), and the British Medical Journal (BMJ), to name a few.
The BMJ reported two weeks ago that the NEJM, JAMA and The Lancet – all acclaimed medical journals used widely across the world – lack diversity, as white male authors still dominate its publications. This was discovered due to the Lancet editors calling for action to “explore inequalities against women in medicine and science” in 2017.
The study was led by A. Laurie Shroyer and faculty colleagues at the Renaissance School of Medicine at Stony Brook University and was published in PLOS ONE, a peer-reviewed open access scientific journal. The study randomly sampled 1060 original publications that were published between 2002-2019 and extracted the author’s gender and ethnicity. This was done by using internet-based biographies, pronouns, first names and photographs. The faculty also tested for first, second and third author disparities. The results found a “gender disparity chasm” within the journals; the first author women’s publication rate in these journals was lower than the rate of U.S. full-time women medical faculty. Women were also under-represented in the second and last author roles.
Moustafa Abdalla, a Harvard Medical School student, led a similar study that further affirms the thesis that women and people of colour are under-represented in this kind of authorship. Since the emergence of the Black Lives Matter movement, there have been greater calls for diversity in a variety of industries, publishing included. Yet data still suggests that not enough progress is being made.
Historically, data pertaining to the gender and ethnicity of these authors has not been collected. Abdalla, whose background in computational systems helped him to collect the data required for his study, admits the limit of his own technique, as it still focuses on a gender divide between men and women rather than including other gender identities. The data had to exclude gender-ambiguous names, for example, leading some to question the numbers. Determining an author’s race proved to be even more difficult unless authors openly self-identified, and census data was required as a comparison. Even if not all medical practitioners are fully convinced by the numbers, there is an appreciation that this kind of research is being carried out to shine a light on the importance of diversity in a field that affects us all. What speaks volumes is the repeated lack of surprise from those in the medical community at these findings.
It is important to note that publishing articles in the top medical research journals around the world can help influence the author’s promotions, salary, job prospects and even grant funding, so having white male authors dominate medical publishing is a massive disadvantage for all gender and ethnic minorities.
The lack of progress could be attributed to the systemic and nebulous nature of academic medical publishing. The slowness to respond may be a result of gaps in data only being realised now. As mentioned previously, journals have not historically collected this kind of data, and it is only in recent years that people have taken it upon themselves to form these databases. It is an issue in which many layers of the system need to be addressed.
It is an issue that affects not only lead authors, but those at a researcher level too. Some practitioners have noted it is rare for women or people of colour to lead studies that will become published. Some have gone as far to say that women and people of colour are shut out from the process from the get-go. For example, JAMA and NEJM actively reach out to researchers they know rather than passively accepting content. If marginalised researchers don’t already have a seat at the table, it seems even more unlikely that they’ll get to these senior positions.
In the future, researchers may have to accept submitting answers to questions pertaining to this kind of data collection as a norm, even when they review and edit, but this is not concrete.
If we cannot celebrate the reality of progress just yet, perhaps we can rejoice and recognise the efforts made by those who are trying to shine a light on diversity, who are bringing that reality ever closer.