Editorial Censorship is Today’s Hidden Gender Bias
by Dr. Jerilynn C Prior
CeMCOR, International Women’s Day, 2021
We have come a long way in equality for women during my lifetime. Internationally there are now women Chancellors and Vice Presidents, women scientists are sometimes now honoured; and over half of the medical students (since the mid-1970s) are women. But today a huge and unrecognized barrier is preventing progress in women’s reproductive and general health—the gagging of women clinician-scientists.
When I started medical school in 1965, there was a quota for the number of women allowed entry. I was one of six in a class of 82 (7%). We women medical students felt different. We were treated differently. And we were different than our women peers in having dared to attempt to become physicians. I was further different having grown up, gone to a one-room school in a fishing village in an educated but economically challenged home. Having worked summers on a forest fire lookout tower to support my education, I was living on $0.25/day for food. I had to save for a stamp to write to my family in Alaska. I bought flour and powdered skim milk in bulk and made sourdough bread; skim milk was my main protein. I felt privileged to afford chicken necks and backs to pressure cook into a bean-barley soup.
Women are now sometimes chosen as head of departments, dean of medical schools and occasionally achieve major medical research prizes. The University of British Columbia has women medical doctors as well as PhDs who are lecturers, assistant professors, associate professors and even professors. Women PhDs are trained as basic scientists and a few even run their own labs and receive consistent Tri-Council Canadian grant funding. Yes, we know that fewer female than male animals are studied1, and in most research on diseases affecting both sexes, fewer women than men are enrolled2. In addition, gender bias negatively affects assessments of medical students3 and women are less likely than men to be referred for coronary angiography4. Yet, still, as women today, we see opportunity and promise—most of society believes that the bed of women is rosy. Today, it seems to many that women’s equality is here.
It is true that the 50% of women first year medical students are not matched by the 22% of women full professors in the UBC Faculty of Medicine (UBC FoM personal communication in 2019, by then Executive Assistant Dean, Deborah Money). Progress against discrimination of all kinds is, at least, being discussed. UBC FoM now even has an office of Equity, Diversity and Inclusion (EDI) https://mednet.med.ubc.ca/ HR/Working-Environment/Equity-Diversity-Inclusion/Pages/Get-Involved.aspx.
What is unrecognized today is the extent of negative publication bias toward women scientists and innovative women’s health and physiology research results. As authorities have written, “editors are gatekeepers of science.”5 It has been the experience of Centre for Menstrual Cycle and Ovulation Research (CeMCOR) scientists that editors of the five high-ranked, general medical journals nearly universally reject new women’s health physiology results. So? Yes, they do reject over 85% of all submitted research. But almost always, these women’s health-related manuscripts are rejected without peer review.
Today CeMCOR submitted a data-based manuscript critiquing gendered editorial bias. We cited the sex of authors and research topics in research in the two general medical journal issues immediately following each’s editorial rejection of two population-based studies. These two manuscripts showed that 37% of over 3,000 regularly, spontaneously cycling women in a Norwegian county experienced serum progesterone-confirmed subclinical ovulatory disturbances6, and that teen women using combined hormonal contraceptives (CHC) in the Canadian Multicentre Osteoporosis Study experienced more negative hip bone changes than their non-CHC using peers7.
Editorial rejection also delayed for years the publication of a meta-analysis of international studies confirming that adolescent CHC use is associated with significant bone loss8. Rejection at the editorial desk has so far, for three years, prevented publication of our CIHR-funded, Canada-wide randomized placebo-controlled trial data showing that perimenopausal night sweats are significantly improved by oral micronized progesterone9. It is essential to share this publicly funded information given that progesterone is safe and accessible, that 23% of all North American women today are in perimenopause, and 10% have debilitating hot flushes/night sweats10. Progesterone treatment of perimenopausal night sweats could have improved the productivity, parenting and pleasure of millions of women.
Will we, a society purporting to value diversity, let editors reject new women’s health publications? Will we allow editors to censor women’s health physiology? women clinician-scientists?
1. Beery AK, Zucker I. Sex bias in neuroscience and biomedical research. Neurosci Biobehav Rev 2011;35(3):565-72. doi: 10.1016/j.neubiorev.2010.07.002 [published Online First: 2010/07/14]
2. Stewart DE, Cheung AMW, Layne D, et al. Are we there yet? The representation of women as subjects in clinical research. Annals RCPSC 2000;33:229-31.
3. Axelson RD, Solow CM, Ferguson KJ, et al. Assessing implicit gender bias in Medical Student Performance Evaluations. Eval Health Prof 2010;33(3):365-85. doi: 10.1177/0163278710375097 [published Online First: 2010/08/31]
4. Jaglal SB, Slaughter PM, Baigrie RS, et al. Good judgement or sex bias in the referral of patients for the diagnosis of coronary artery disease? An exploratory study. CMAJ 1995;152(6):873-80.
5. Heidari S, Babor TF, De Castro P, et al. Sex and Gender Equity in Research: rationale for the SAGER guidelines and recommended use. Res IntegrPeerRev 2016;1:2.
6. Prior JC, Naess M, Langhammer A, et al. Ovulation Prevalence in Women with Spontaneous Normal-Length Menstrual Cycles - A Population-Based Cohort from HUNT3, Norway. PLOS One 2015;10(8):e0134473.
7. Brajic TS, Berger C, Schlammerl K, et al. Combined hormonal contraceptives use and bone mineral density changes in adolescent and young women in a prospective population-based Canada-wide observational study. J Musculoskelet Neuronal Interact 2018;18:227-36.
8. Goshtasebi A, Subotic Brajic T, Scholes D, et al. Adolescent Use of Combined Hormonal Contraception and Peak Bone Mineral Density Accrual: a meta-analysis of international prospective controlled studies. Clin Endocrinol (Oxf) 2019 doi: 10.1111/cen.13932 [published Online First: 2019/01/08]
9. Prior JC, Cameron A, Hitchcock CL, et al. Oral Micronized Progesterone Beneficial for Perimenopausal Hot Flushes/Flashes and Night Sweats. Endocrine Reviews 2018;39(2)
10. Williams RE, Kalilani L, DiBenedetti DB, et al. Frequency and severity of vasomotor symptoms among peri- and postmenopausal women in the United States. Climacteric 2008;11(1):32-43.