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.
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.
*Correction: An earlier version of this story said Lam was one in five women in her medical school class, it has been corrected to say one in five students in her medical class were women.