Papers

Babes and boobs? Analysis of JAMA cover art

Commentary: An inconclusive study

Babes and boobs? Analysis of JAMA cover art

Jocalyn P Clark. 

Correspondence to: J P Clark, Centre for Research in Women's Health, Toronto, Canada M5G 1N8 j.clark{at}utoronto.ca

	Abstract

Top Abstract Introduction Methods and results Conclusions References

Objective: To determine the representation of the sexes in JAMA cover art.
Design: Review of 50 consecutive issues.
Setting: JAMA, March 1997-March 1998.
Main outcome measures: Numbers and nature of covers portraying men and women.
Results: Of the 50 covers, 34 depicted humans. 15 depicted women, 13 men, and 6 were of mixed or indeterminate sex. 11 pictures of women included a child and five included nudity. One cover showed a man with a child (not as a father) and none depicted nudity. Men were depicted exclusively in authoritative roles.
Conclusions: Much of the cover art gives strong messages about sexual stereotypes that are inappropriate in modern society. JAMA should consider reviewing its policy for choosing cover art.

We invited JAMA to comment, but Dr Therese Southgate, who is responsible for JAMA's covers, declined to respond.

	Introduction

Top Abstract Introduction Methods and results Conclusions References

Since the 1960s JAMA, the journal of the American Medical Association, has featured various pieces of art rather than the conventional table of contents on its front page. "Cover art" distinguishes JAMA from the leading international general medical journals with which it strategically competes for market share. Medical journals have been urged to "preserve the basic elements that make them credible, even as many of the specific practices and the external appearance of these journals change,"¹ and the use of fine art provides an interesting example of how JAMA attempts to draw attention to itself and to "emphasize the humanities in medicine."² But are there other messages conveyed by cover art? Given that fine art is not just aesthetically moving butlike literature, music, the media, and other cultural productsmakes statements that are often social, cultural, and political in nature, cover art demands a critical gaze.

	Methods and results

Top Abstract Introduction Methods and results Conclusions References

I reviewed 50 consecutive JAMA issues (one year), starting with 19 March 1997. Of these 50 issues, 34 (68%) covers depicted human images; 15 presented female subjects, 13 presented male subjects, and six presented subjects of mixed or unknown sex. Of the 34 covers depicting humans, 25 (74%) presented stereotyped sex imagesthat is, women were predominantly positioned as "objects" (of desire) and men as (powerful, strong) "subjects." Five covers portrayed women working in traditional roles such as carers or cleaners and eight presented women with soft or white imagery as virginal, angelic, or sexualised figures. Women were depicted as submissive, with their eyes averted or gazing down, in 13 covers. Men, on the other hand, were depicted almost exclusively in authoritative roles, as religious,⁴ scholarly⁵, or military³ figures, with their eyes directly facing the viewer.

Of the 15 covers depicting women, 12 included babies and six showed nudity. In contrast, only one male image included a child and none contained nudity. In the cover depicting a man with a child, the man is not the child's father but its doctor. Babes and boobs were featured in 12 of the 50 covers.

View larger version (77K): [in this window] [in a new window]   Candidate for a JAMA cover? The main scene is based on Edouard Manet's Déjeuner sur l'herbe (1863). That painting has a naked woman in the foreground, but her position is now occupied by Michelangelo's Adam from the Sistine Chapel. In addition to the transposition of figures, there is an interesting transposition of faces: the face of Manet's missing déjeuneriste will be found on the right, and the woman's face that has replaced the man's on the left belongs to the token American by the name of Katherine Stembridge Greene, originally painted by John Copley (1738-1815) in 1760. Further tasty flesh is visible in the forms of the man leaning against the tree, and the inspiration for the young men wrestling in the background comes from Frédéric Bazille's (1841-1870) Scène d'été painted in 1869. This unfinished painting is thought to be by the little known London artist Malcolm Willett (b 1960)

	Conclusions

Top Abstract Introduction Methods and results Conclusions References

Visual imagery associated with medical journals shapes our understanding of health and the human body. Images of babes and boobs in cover art emphasise women's sexual and domestic roles, representing women in traditional and stereotypical ways that undermine contemporary beliefs in the equality, autonomy, and status of women. ^{3 4} These representations do not reflect women's contributions to the domains of science, medicine, and academia, which are frequently the focus of scientific reporting in the leading medical journals. Although O'Kelly's review of Western art history books showed sexual stereotypes in fine art throughout the Gothic, Renaissance, Baroque, and Modern art periods, 70% of fine art depicted male subjects.⁵

JAMA's traditional representation of women in cover art is in sharp contrast to its coverage of issues relating to women's health, which in this sample of 50 issues amounted to 29 original contributions, five editorials, and seven letters. Furthermore, seven items in these issues discussed domestic violence and its implications for health and medical care. The proportion of women graduates from medical schools is approaching 50%,⁶ and the profile of sex and inequity issues in medicine is increasing. ^{7 8} Critical discussion of the physician-patient relationship is also burgeoning, ^{9 10} and medical journals have broadened their mandates and scientific and editorial content to include social and political dimensions of health.^11-13

The stereotypical representations of the sexes in this one year sample of JAMA covers seems to detract from the stated social responsibility of medical journals. Although it is said that you cannot "judge a book by its cover," cover art seems to provide provocative visual imagery each week for JAMA's diverse and international readership. JAMA is widely circulated to a diverse readership and its promotion of scientific excellence implies a critical review of all material published in its pages. It would be of benefit to see a more thoughtful and balanced representation of women on the front page, reflecting growing scientific coverage of and concern with women's health and social issues.

	Acknowledgments

This report was originally submitted to JAMA as a letter to the editor. After nine months of evaluation and peer review it was rejected.

I thank Professor Patricia McKeever for valuable discussion and insight.

Contributors: JPC initiated the project, collected data, conducted the data analysis, wrote the manuscript, and is the guarantor of the paper.

	Footnotes

Funding: JPC is a doctoral fellow of the National Health Research and Development Program, Health Canada.

Competing interests: None declared.

	References

Top Abstract Introduction Methods and results Conclusions References

1.	Fletcher RH, Fletcher SW. The future of medical journals in the western world. Lancet 1998; 352: SII30-3.
2.	Lundberg GD. The art of JAMA is now available. Science News Update 1996 October 30:1.
3.	Gamman L, Marshment M. The female gaze: women as viewers of popular culture. Seattle: Real Comet Press, 1989.
4.	Itzin C. Media images of women: the social construction of ageism and sexism. In: Wilkinson S, ed. Feminist social psychology. Philadelphia: Open University Press, 1986.
5.	O'Kelly C. Gender role stereotypes in fine art: a content analysis of art history books. Qual Soc 1983; 6: 136-148.
6.	Waalen J. Women in medicine: bringing gender issues to the fore. JAMA 1997; 277: 1404[Medline].
7.	Bickel J. Gender stereotypes and misconceptions: unresolved issues in physicians' professional development. JAMA 1997; 277: 1405-1407[Medline].
8.	Fried LP, Francomano CA, MacDonald SM, Wagner EM, Stokes EJ, Carbone KM, et al. Career development for women in academic medicine: multiple interventions in a department of medicine. JAMA 1996; 276: 898-905[Abstract/Free Full Text].
9.	Meryn S. Improving doctor-patient communicationnot an option, but a necessity. BMJ 1998; 316: 1922[Free Full Text].
10.	Smith R. Renegotiating medicine's contract with patientsthe GMC is leading the way. BMJ 1998; 316: 1622-1623[Free Full Text].
11.	Kassirer JP. Should medical journals try to influence political debates? N Engl J Med 1999; 340: 466-467[Free Full Text].
12.	Kandela P. Medical journals and human rights. Lancet 1998; 352: SII7-11.
13.	Haines A, Smith R. Working together to reduce poverty's damage. BMJ 1997; 314: 529-530[Free Full Text].

Commentary: An inconclusive study

Elaine Showalter, professor of English. 

Department of English, Princeton University, Princeton, NJ 08544, USA

elaines{at}princeton.edu

In the 1960s, after more than 80 years of placing the table of contents on its cover, JAMA began featuring various works of art on its cover. In the 1970s Therese Southgate, the JAMA deputy editor, acquired the task of choosing the cover art and writing an accompanying essay about the artist and the work. Dr Southgate wrote: "As distant as the two notionsmedicine and artmay at first seem, they do share a common goal; the goal of completing what nature has not. Each is an attempt to reach the ideal, to complete what is incomplete, to restore what is lost."¹ Since 1974, Southgate has chosen the art for more than 1000 JAMA covers and has written more than 500 essays and supervised another 350. JAMA's former editor, George Lundberg, wrote that one of the journal's objectives is to "inform readers about nonclinical aspects of medicine and public health, including the political, philosophic, ethical, legal, environmental, economic, historical, and cultural. Our JAMA art covers and cover stories help us meet that objective every week. In fact, they formed the beginning of our whole JAMA initiative to emphasize the humanities in medicine, and we now include essays, poems, and historical accounts nearly every week."¹

The idea of furthering the humanities in medicine is the ideology elucidated by the cover art; the pictures do not imply a political or a social commentary. Certainly, the Japanese woodblock print titled "Lady" (August 1998)an elaborate, beautiful print of a Japanese geishadoes not imply that JAMA is a proponent of professional courtesans. The essays contextualising each cover picture do not support Clark's allegation that women are represented in "traditional and stereotypical ways that undermine contemporary beliefs in the equality, autonomy, and status of women." Dieric Bouts' "Mater Dolorosa" (20 January 1999) is a painting of a weeping Madonnait is difficult to criticise this selection for emphasising women's sexual and domestic roles. Similarly, it seems hypercritical to disapprove of placing Raffaello's masterpiece "The School of Athens" on the cover because it presents men like Plato and Aristotle as dominant and scholarly figures of authority.

Perhaps the author should examine what criteria are used when cover art is selected by JAMA and make specific recommendations for evaluation. The statistics would have much more credibility if a larger base of examples (perhaps starting with the 1960s) was used, particularly if some type of trend was noticed.

The terminology of the paper could be better definedwhat specifically are "stereotyped sex images"? What would be a good or healthy ratio of such stereotyped images? (The paper cites 74% of the cover art depicting humans as presenting stereotyped sex images.) I would also recommend using pejorative adjectives only when each one conveys something significant and different and can be specifically evidenced.

	References

1.	The art of JAMA. Science News Update. 1996 Oct 30.