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Medical journals must tackle gender bias

BMJ 2019; 367 doi: (Published 08 October 2019) Cite this as: BMJ 2019;367:l5888
  1. Julie K Silver, associate professor and associate chair
  1. Department of Physical Medicine, Harvard Medical School, USA
  1. Julie_Silver{at}
    Follow Julie on Twitter @JulieSilverMD

When women doctors and scientists face barriers to publication and journal leadership, the pace of discovery slows and critical perspectives are lost

Reports demonstrate gender bias in academic medicine, and an important subset of this evidence focuses on journal level disparities—for example, the numbers of women authors, reviewers, and editors. An abundance of research shows women in academia, including medicine, face more barriers to publishing than men.

Barriers are wide ranging and multifactorial. Bias harms scientific discovery, and when it occurs at a journal level there are also financial implications. If a researcher faces barriers to publication, this affects organisations that financially support her work (such as employers and grant funders), and their return on investment is not fully realised.

Journal owners, some of which are medical societies, have an obligation to tackle both conscious (explicit) and unconscious (implicit) bias. Firewalls exist between medical society owners and their journals. These are in place to avoid conflicts of interest but they do not prevent owners from ensuring their journals are fair and that senior editors are held accountable for proactively uncovering and tackling gender bias.

Perpetuating gender bias is unethical. The International Committee of Medical Journal Editors has codified owner obligations, which include ensuring editors act in a manner that is compatible “with a position of trust.” For example, in the US, gender equity among senior editors and on editorial boards is a long standing and well documented disparity, yet it is straightforward and inexpensive to fix. A lack of equitable inclusion—a lower proportion of women editors compared with their presence in the specialty or members of the society—is itself a disparity. Although one cannot assume that equitable representation of women among editors or on editorial boards positively impacts other journal level gender disparities, there is no justification for perpetuating an easily solvable inequity.

Fortunately, there is good news to report. Recently, as one example, the British Journal of Sports Medicine announced that it will “commit to at least half of the BJSM editorial board being women.” The reason given being, “Because the talent is there.” Even in a male dominated specialty, parity on editorial boards is easy to achieve. Editors at the Journal of Hospital Medicine acknowledged that “medical journals have an obligation to tackle unequal opportunities” and vowed to “assess the current representation of women and racial and ethnic minorities in our journal community, including first and senior authors, invited expert contributors, reviewers, and editorial team members.”

The Lancet’s editors recently published a special issue focused on women in medicine and discussed what they are doing about gender and diversity.

They noted that gaps are not because of a lack of qualified women, but rather the “supposed meritocracy is rigged against them, resulting in an unjustified and unacceptable masking of women’s contributions.” Their data showed disparities in the representation of women authors and reviewers. Gaps were also found in the representation of women as commentary authors, consistent with existing research in paediatrics and dermatology which showed that women in these specialties were not equitably represented as authors of opinion and perspective articles. This is an important finding, because it diminishes the voices of women in medicine, and a lack of diverse insights may negatively impact research and clinical care.

Journals depend on the privilege of publishing the best scientific work, and they need women’s research to be successful. As such, doctors and scientists (regardless of gender) can consider preferentially submitting to journals with a good track record on equity and inclusion. Before hitting “submit,” women and allies might ask themselves if there is evidence that the journal is focused on treating women fairly.

Now is the time for all journals and their owners to tackle gender bias. When women physicians and scientists face barriers to publication and journal leadership, the pace of discovery slows and critical perspectives are lost. Patients may also be affected as they are relying on researchers with the brightest minds—many of whom are women—to advance the science that will help them overcome disease and disability. There is no doubt we need her science, and when science wins, everyone wins.


  • Julie K Silver is an associate professor and associate chair of the Department of Physical Medicine at Harvard Medical School. She developed the Be Ethical and Need Her Science campaigns that are aimed at strategically tackling gender workforce disparities. Follow these campaigns on Twitter at #BeEthical and #NeedHerScience

  • Competing interests: JKS reports no disclosures related to this perspective. Her work on disparities has been funded by the Arnold P Gold Foundation and as an academic physician she receives royalties for books and honoraria for lectures related to her work. She personally supported the Be Ethical and Need Her Science campaigns.

  • Commissioned, not peer reviewed.