Women are
graduating from medical school in greater numbers than ever before. In 1970,
women made up under 10 percent of graduates. Today, it’s nearly 50 percent.
When it comes to who is getting published in top medical journals, though,
women are behind. Doctors say the gender gap in medical research isn’t just an
academic concern — it has implications for our health.
Most of
us don’t read academic journals for fun. Even fewer of us pay attention to
who’s the first author versus who’s second or third. But if you’ve been to the
movies, you know the names that flash first are hard to ignore.
In
academia, just like in the movies, name placement matters.
“It’s not
just a matter of pride, or not just a matter of ego,” says Dr. Carolyn Lam, a
cardiologist based in Singapore at the National Heart Center and Duke National
University of Singapore.
She says
the number of times you nab that “first author” spot on a publication matters
for your job – it affects everything from tenureship to pay.
“So this
is our livelihood; it’s important,” she says.
That’s
why Lam was upset when she heard about new research showing women are
under-represented among first authors in six of the world’s most prestigious
medical journals.
Dr.
Giovani Filardo and Briget da Graca, with Baylor Scott & White Health in
Dallas, co-authored the study that appeared in the journal BMJ. They
investigated the representation of women among the first authors of original
research articles published in the highest-ranked general medical journals over
a period of 20 years.
The
results show that while the representation of women among first authors was
significantly higher in 2014 than 20 years earlier, the numbers plateaued in
recent years and declined in some journals.
Here’s
the thing: authorship matters not just for the researchers who get a pat on the
back at the office. It matters for everyone’s health, especially women’s. Just
like in the movie business, when women are writers or directors, the
protagonists are more likely to be women, in the science world, research shows
that when women are first authors, you’re more likely to see women
participating in studies of new drugs or therapies.
The same
trickle-down effect applies to animal studies. Those rats, pigs and dogs being
studied in labs are usually male, da Graca says. This isn’t blatant sexism,
researchers say. It’s because male animals have less fluctuation in their
hormones.
“That is
a [fair] consideration,” da Graca says. “But when you get to the other end of
it you’re going to give that pharmaceutical agent to women who have
fluctuations in their hormone levels!”
In other
words, you don’t want to test a drug for multiple sclerosis or HIV exclusively
on men because what works for one half of the population simply might not be
right for the other. And yet, male-only studies continue, and part of the
problem, da Graca says, is that women aren’t leading the research.
Finding Time For Research
Is it
sexism?
Dr.
Deborah Diercks, first chair of the Department of Emergency Medicine at UT
Southwestern, says it’s probably not intentional.
But
Diercks has bumped up against a glass ceiling in her path to the top. She’s
reminded of that every time she looks at a framed note from her daughter on her
desk. Scribbled between bright bumblebees and flowers, it reads “Mommy, please
stay home. I don’t like it when you go on trips. I love you.”
“It just
reminds me whenever I go away I need to think about whether it’s worth it,”
Diercks says. “Because I’ve got someone who really wants me to be at home with
her.”
Diercks
says having kids meant she didn’t have as much time to apply for big funding grants
for research or to conduct the kind of research that could have been published
in top journals.
Another
concern is bias in the review process. In the top six medical journals,
reviewers know whether the authors of the submissions are men or women, and the
editors making decisions about who gets published are often men.
Da Graca
says it’s hard to know what happens when the editorial boards receive
manuscripts.
“It’s
like this big black box you send your manuscript into and hope it comes out the
right end,” she says.
She
believes there may be some unintentional bias, but suspects that there are also
fewer women submitting manuscripts.
Stepping Up
Gender
bias, intentional or not, is something Dr. Carolyn Lam thinks about often.
Just one
in five students in her medical school class in Singapore were women. After
graduation, Lam entered the especially male-dominated field of field of
cardiology. Still, she doesn’t fault the system for the gender gap in first
authors.
She
partially blames herself.
The last
time she was working with two male colleagues on a journal submission they
started talking about whose name should appear first, she stayed silent. Her
name went second.
“I
started examining myself a bit, why didn’t I ask to be first author? I began to
realize I’m to blame, too,” she says. “I think that sort of behavior is
pervasive in many, many fields. Some may be surprised that it’s even in
medicine where it may seem cut and dry, but it’s not.”
So, last
month, when Lam was finishing up another research article, again with two other
men, and the question of authorship came up, she didn’t stay quiet.
“My
colleague, whom I totally respect, he wrote himself as first author, our senior
colleague as last, and me as second,” she says. “I was about to shoot of an
email saying ‘OK, as long as our date gets published’ and I caught myself.”
She asked
to be first author; her colleague agreed.
There are
many reasons women aren’t publishing as much as men. Some underestimate
themselves. Some have trouble with funding. Others have family obligations.
Some point to a lack of mentors. Then there’s bias, intentional or not.
Lam says
it’s important for women step out of the shadows to talk about this. Experts
say that making things more equal in medical journals will make them more equal
in medicine and ultimately our health.
By Lauren
Silverman
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