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Bias in medical research: Studies by women cited less often than those by men

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New research finds that medical research papers that women have authored get fewer citations than those by men.
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  • A new analysis of medical research articles in five major journals finds that research by women is cited significantly less often than research by men.
  • When both the lead author and senior author are men, articles receive almost twice as many citations as those with women as both the lead author and senior author.
  • As citations are an important signifier of recognition, the lack of citations stands in the way of women’s career advancement.

A new study from Perelman School of Medicine and the Leonard Davis Institute of Health Economics at the University of Pennsylvania in Philadelphia explores the influence of gender in the citation of high impact medical research articles.

The study finds that research articles with female authors are cited less often than those by male authors.

The study’s lead author, Paula Chatterjee, M.D., MPH, an assistant professor of General Internal Medicine at Penn Medicine, explains:

“The number of times a peer-reviewed article is cited by other researchers is commonly used as a metric for academic recognition [and] influence, as well as in professional evaluations and promotions.”

“Female academics already face a number of barriers to career advancement,” says Dr. Chatterjee, “and the disparity in citations only broadens the gap between them and their male peers.”

The article appears in JAMA Open Network.

The researchers performed a cross-sectional analysis of 5,554 original research articles that five important medical journals published in 2015–2018. These journals are The New England Journal of Medicine, JAMA, JAMA Internal Medicine, British Medical Journal, and Annals of Internal Medicine.

For each article, the researchers identified the gender of the lead and senior authors and tracked the number of citations the article received.

Overall, a woman was the lead author for 35.6% of the research articles and the senior author for 25.8% of the articles.

Research articles in which the lead author was female received an average of 36 citations, whereas papers with a male lead author received an average of 54 citations.

When the researchers looked at senior authors, they found a similar disparity.

Articles for which the senior author was a woman were cited an average of 37 times compared with an average of 51 citations for research with a man as the senior author.

For research articles where both the lead and senior authors were female, the gap was somewhat larger. Articles with male lead and senior authors were cited almost twice as often — 59 times vs. 33 times — than those with female lead and senior authors.

The researchers note that some of these journals specialize in internal medicine research, which is an area with a higher proportion of women. Due to this, the differences in citations in this study may actually underrepresent the disparity.

“What’s worse,” bioethicist L. Syd M Johnson of SUNY Upstate Medical University in Syracuse, New York, told Medical News Today, “research has shown that the gap is increasing rather than decreasing over time, even as these various fields diversify.”

The authors of the current study also analyzed the citations that commentary articles received, finding less of an imbalance.

The study’s authors cite several possible causes of the disparity in citations. They write that women typically have “smaller professional networks, smaller audiences, and narrower reach on virtual platforms,” limiting their amplification through social media. It may also be that women investigate topics of interest to smaller audiences than men.

However, Dr. Johnson said, “Several studies have shown that the driver of the gap is that male authors cite women less often than they cite other men.”

Dr. Johnson added:

“We may be seeing systemic bias being replicated and amplified by individuals in their citation practices. Or it may simply be individual implicit or explicit bias on the part of male authors who undervalue the work of their women peers.”

As more women are pursuing careers in medicine and academic medicine, disparities such as the one that this study revealed stand in the way of correcting the traditional gender imbalance in medicine and research.

The study’s senior author, Rachel Werner, M.D., Ph.D., executive director of the Leonard Davis Institute for Health Economics, says:

“Gender disparities in citations are just one way in which inequities in academic medicine should be examined. Our findings highlight that disparities stem in part from inequities in recognition and amplification of research.”

“This imbalance will not be solved through hiring and mentoring more women alone.”

According to Dr. Werner:

“We must also work to ensure that women already in academic medicine are equally valued and promoted for their contributions and their successes. From the journals publishing this work to academic institutions promoting articles once published, everyone should be invested in bridging this gender divide.”

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