Editorial Balance: Men More Likely Than Women to Author Invited Commentaries

Women are more than 20% less likely than men to author invited commentaries across a wide range of both medical and cardiology-specific journals, according to a new analysis. Notably, this disparity increases with researcher experience.

Describing this as a “really large gap,” lead author Emma G. Thomas, MSc, MA (Harvard T.H. Chan School of Public Health, Boston, MA), told TCTMD that in the past she had “subscribe[d] to that general belief that if we just wait long enough for more women to progress through the scientific pipeline and get to the top of their careers, then things like invited commentary authorship will be more equal because there will be as many female experts as male.”

However, she continued, “our study seems to show that that probably won't be the case. That did surprise me and depressed me as a young female scientist.”

The gender gap in medicine, and specifically within cardiology, is now widely discussed and researched. One study showed that female mentors play a role in increasing the presence of female corresponding authors, the American Medical Association has pledged to decrease the wage gap, and most recently the editorial board of The Lancet adopted a new diversity pledge eschewing “manels.” Despite these and other efforts, the gender imbalance in medicine remains a hot topic.

When it comes to invited commentaries within medical journals specifically, Thomas speculated that what’s happening is that editors “rely on their professional networks and on their social networks and on their previous interactions with people when they decide who to extend an invitation to write a commentary. There is already evidence from previous papers that there is this same-gender preference in peer reviews, so male editors tend to prefer male authors and female editors also prefer female authors, but there are just way more male editors. So, what you end up with is a strong preference for men.”

To TCTMD, Joseph Hill, MD, PhD (UT Southwestern Medical Center, Dallas, TX), who has served as the editor of the cardiology journal Circulation for the last 3 years, said “this is yet another example of a situation in academic medicine where men and women are treated differently, and the solution to this problem in my view requires a concerted effort where diversity is front of mind in all of these types of decisions.”

The solution to this problem in my view requires a concerted effort where diversity is front of mind in all of these types of decisions. Joseph Hill

While Circulation does not have a formal policy to encourage more female editorialists, Hill described himself as “quite proud” of the diversity within the journal’s editorial board, something he said he strongly encouraged upon stepping into his leadership position. “Very often the people you reach out to for editorials come from the people who [already] did a particularly good review, and so it starts with a team of individuals that is focused on diversity and that leads to the next step in this particular conversation of a diverse group of reviewers and then subsequently hopefully a diverse group of editorialists,” commented Hill.

Men at an Advantage

For the study, which was published online this week in JAMA Network Open, Thomas and colleagues used natural language processing, a technology that helps computers understand human language, to profile the expertise of the individuals who authored all medical invited commentaries published in English-language medical and multidisciplinary journals between 2013 and 2017. The investigators also used the website genderize.io to predict each authors’ gender based on country of origin and first name. Among 46,235 articles published in 2,549 journals, 26.6% of the 34,047 unique authors were women.

After adjusting for field of expertise, author h-index, and total number of publications, women were consistently less likely than men to author invited commentaries throughout a range of experience levels, with lowest odds seen in those with the longest careers.

Odds of Authoring Invited Commentary: Women vs Men

Once someone is asked to write a commentary, he or she will likely be tapped again for a similar opportunity in the future, Thomas said, explaining that while there may be a smaller gender gap among early-career researchers, “over time that can accumulate. . . . At the early stage of their career, men have that small advantage and then they get invited to write more and more commentaries.” Hence, the growing disparity.

In subgroup analyses by journal topic, male authors were favored over female authors in 38 of 48 topics (79%), including cardiology and cardiovascular medicine (OR 0.78; 95% CI 0.73-0.85), which made up the largest number of individual articles (n = 7,637) of all the subspecialties studied.

Lastly, the odds of men being invited commentary authors over women went down with journal CiteScore—a measure of journal notoriety based on the mean number of citations—yet men were statistically favored at all CiteScore values. “What we think is happening is that there has been a concerted push among [certain high-profile] journals to improve the gender balance,” Thomas said. “That's really important because it shows that it is possible and there are some journals that are leading the way. We hope that that is some motivation for other journals to follow suit.”

Diversity in voices and in thoughts is really important, because that's one of the things that drives innovation. Emma Thomas

There are two main reasons all of this matters, according to Thomas. First, “writing invited commentaries can be a career boost for people. It really increases their visibility, and it allows them to make connections with journal editors. We don't want women losing out on that opportunity, especially when they're already at a disadvantage in so many other ways,” she said.

Second, “if we have an imbalance in the literature where men are writing more commentaries than women, women's voices aren't being heard as often as men's,” Thomas commented. “In terms of the progress of science, we think diversity in voices and in thoughts is really important, because that's one of the things that drives innovation. Also, if you have that imbalance, we can have a dominance of men's ideas over women's and that can be problematic.”

Data Over Anecdotes

In an accompanying editorial, Elizabeth Loder, MD, MPH, and Rebecca Burch, MD (both Brigham and Women’s Hospital, Boston, MA), argue that data like these are important. “Anecdotes regarding the barriers faced by women in academic medicine and publishing abound, but anecdotes are not high-level evidence,” they write. “It is easy to generate plausible explanations for why an individual woman physician is infrequently or never invited to write editorials. It takes research like that of Thomas and colleagues, looking at large samples across a range of disciplines, to demonstrate that this a systemic and not an individual problem.”

When women are excluded from academic medical discourse, “everyone loses,” the editorialists continue. “Their absence reinforces stereotypes and implies that there are no qualified women whose opinions are worth hearing. . . . The marginalization and neglect of the expertise and opinion of women is demoralizing for other women and may discourage them from pursuing or continuing medical careers. It also harms those excluded. Authoring a high-profile editorial confers expertise and authority, can lead to speaking opportunities and media exposure, and facilitates the accumulation of many other credentials needed for academic promotion. The compounded disadvantage of many professional snubs can have a serious and negative cumulative effect on a woman’s career.”

The compounded disadvantage of many professional snubs can have a serious and negative cumulative effect on a woman’s career. Elizabeth Loder and Rebecca Burch

Hill agrees. Being asked to author an invited commentary “is a sign of recognition, it's a sign of respect that you're considered a thought leader and you are someone who can put a particular study in perspective,” he said. “It's important for women to be recognized that way.”

The key message for journal leaders is to be aware of the issue, Hill argued. “[When] we send a paper out for peer review, we come up with a list of at least six or eight names and we start at the top and run down the list. Ensuring that there are women included in that list is part of our workflow. Whether someone will accept that ask to serve as a peer reviewer is something that obviously we don't control.”

Acknowledging that there is more work to be done overall, he commented that “some other journals in the cardiovascular field [are] shockingly absent of diversity. . . . There are journals out there that have not done a good job in my view of addressing that.”

As Loder and Burch write, “Because the problem is not the women, it must be the process.” Thus, they say, the questions journal leaders must now scrutinize are: “How are experts identified? Who decides whom to invite? How often do those invited accept an invitation? Of those, how many successfully complete the task?”

Thomas suggested that some journals might use the same natural language processing used for this study to identify new voices. “We have this huge wealth of bibliometric data, everyone's published abstracts, and you can use that to search for people who are writing about the topics that might be relevant to your invited commentary,” she said. “That's one of the reasons that we think looking at invited commentaries is really interesting because the journals have somewhat more of an ability to manipulate the gender ratios in the authors of those invited commentaries than they would for other types of articles where people are submitting them.”

“Medical science thrives when there is vigorous dissent, discussion, and debate,” Loder and Burch conclude. “It is vital that women experts are able to play a full and active role in this process. Women physicians should insist on being heard, and medical journal editors and other gatekeepers must work to identify and dismantle the systems that stand in the way of their full participation.”