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Things are looking up for women in clinical research. But the view may still be blocked by men standing on the shoulders of other men, to paraphrase Issac Newton.

According to a new study, the share of female first authors on papers in major medical journals rose from 27 percent to 37 percent between 1994 and 2014. That’s the good news, such as it is; the bad news is that the bulk of those gains occurred before 2009. After that point the trend plateaued, and even dropped in some publications  including the New England Journal of Medicine, perhaps the world’s most coveted medical periodical.

The study, which appears Wednesday in the BMJ, looked at nearly 3,900 articles in six of the most highly regarded journals: NEJM, Annals of Internal Medicine, the Lancet, Archives of Internal Medicine (now known as JAMA Internal Medicine), Journal of the American Medical Association, and the BMJ itself. For most of those articles, the researchers were able to determine the gender of the first author  who, in clinical medicine, is the senior researcher on the trial and typically gets the lion’s share of the credit for a publication. (The meaning of author order varies somewhat by scientific discipline.)


First authors on BMJ papers were about 30 percent more likely to be female than the average of the six journals. NEJM brought up the rear: Its authors were nearly 40 percent less often female than average, according to the researchers.

Why the plateau? Giovanni Filardo of Baylor Scott & White Health in Dallas, who is first author of the paper, attributes it to a number of potential factors. For example, Filardo tells STAT, even though the BMJ was at the top of the list, female first authorship there and at NEJM declined from 2009 to 2014. “Subtle and unconscious gender bias” may play a role, he and his coauthors write. And there may have been changes in how papers were reviewed during that time.


The findings are consistent with previous research. And they’re also consistent, broadly speaking, with other recent data on how well represented women are among senior medical school faculty in the United States. In 2013-14, about 1 in 5 full professors were women, which is up 7 percent from the previous decade, according to a survey from the Association of American Medical Colleges. But women are entering  and graduating  from medical school at the same rates as men, so there are leaks somewhere in the pipeline.

Although we’ve written (quite recently, in fact) about the overemphasis on publishing in science, it remains the yardstick by which scientists are measured, and so biases there are serious concerns. As Kathryn Rexrode, of Harvard Medical School, where 17 percent of full professors are women, wrote in an editorial accompanying the BMJ study, “Authorship is necessary for career progression and is also a symptom of success; it is the culmination of career development, mentorship, funding, and support. Gender inequity must therefore be tackled at the level of journals, universities and funding agencies …”

Specific solutions include blinding peer reviewers to the names of authors to eliminate not only gender bias but other subtle prejudices, such as those against authors with foreign-sounding surnames, for example. Some have suggested full anonymity for authors even after publication, too, which could address biases in who gets cited, although it might create other issues. And having more female editors on the mastheads likely would help. We’re getting there: Three of the world’s six leading medical journals  the Annals of Internal Medicine, the BMJ, and JAMA Internal Medicine  have women editors-in-chief. Of those six, only the Lancet has never had a female editor-in-chief.

Solving the problem will require more than changes at the top, however. To address the phenomenon neatly captured by the Tumblr “Congrats, you have an all male panel!” some conference organizers are looking at ways to increase gender diversity at meetings. It turns out, not surprisingly, that including women as session organizers is linked to having more women on panels.

These kinds of efforts could eventually nudge the needle on the number of female first authors of papers, which in turn could lead to more full professorships as women are rewarded for those authorships. But there may be a ceiling there, as long as authorship is the primary criterion by which success is judged. As Rexrode told STAT earlier this year, promotion committees should also reward mentorship, “which women often do to the detriment of their productivity in other areas.”

“Some people may ask whether we truly need diversity in authorship,” writes Rexrode in the BMJ. “Increasing the prominence of women and minority groups currently under-represented in medicine and research brings new perspectives that expand the scope of research and practice.”

For Rexrode, it’s personal: She’s planning to seek a promotion to full professor at Harvard. Perhaps being first author  sole author, in fact  of an editorial in one of the world’s leading medical journals will help.