MSexism take two: The Mystery of the Missing Authors

Recently this blog featured an eye-opening article written by our guest blogger Rachel, about gender inequality in the world of multiple sclerosis, from a patient’s point of view. It’s well worth a read. She also outlines just how few women feature on academic panels. And this investigation has now been taken further, with an analysis of authors on academic papers.

This post is a rewriting of an abstract from the investigating team.

The ubiquitous glass ceiling seems to be firmly and unsmashably installed in medicine across most fields, but particularly in academic roles (as opposed to clinical roles). As neurology is considered one of the more academic medical disciplines, we weren’t holding out much hope for a balanced distribution of paper authors.

The team working on this decided to look at who authored papers relating to phase 3 of clinical trials for drugs treating MS. Between 1993 and 2016, they found 197 authors from 26 eligible studies. But what exactly is an ‘author’ when you’re talking about trials? They defined an author as someone listed on PubMed, or members of the Writing Committee in the manuscript. And it’s important to note that clinical trial authors are chosen by the sponsor of the trial, usually a pharmaceutical company.

From 197 authors, they identified the gender of 195 of them by searching online bios, official institution profile pages, images or news articles. If these were unavailable, they inferred from photos or first names.

150 (77%) were male, and 45 (23%) were female. Of the 25 authors who were each named in three or more clinical trials, only four (16%) were women. Of the ten authors named in six or more clinical trials, only one (10%) was a woman (and she was not named as first or last author).

There is a clear disparity, but it’s interesting that it becomes starker amongst the select group repeatedly asked by pharmaceutical companies to lead the writing committee of these trials. This result is in line with the gender inequality found across scientific research generally, with studies finding that under 30% of all academic, scientific paper authors are women.

In academic papers, it’s the first and last author positions that are the most important. The first author is the person who undertook the most work with relation to the study and the writing of the paper. The last author is the one with the most senior position, who will sometimes take responsibility for the paper (so says this source, explaining author positions to someone like me, outside of academia).

Unsurprisingly, but disappointingly, women are also underrepresented in the first and last author position across academic writing, and this holds true for MS too.

The next question we come to, is why? The team acknowledge that they found the numbers, but not the reasons behind them. But they posit some pretty sound ideas:

Gender distribution of trial authors may simply mirror that of all academic neurologists. In 2018, McDermott et al. found that in 29 top ranked US academic neurology programs only 30.8% of neurologists were female.
There are still fewer women choosing science, technology, engineering and mathematics (STEM) careers in general, despite girls outperforming boys in STEM subjects at school. Here’s a recent article from a programming agency highlighting this.

Women are leaving academia sooner than men; therefore there are fewer women in senior academic positions. As clinical trial publications are authored by individuals with appropriately high expertise, generally authors hold senior academic positions. So fewer female senior academics = fewer female clinical trial publication authors.

As to why women are leaving academia, there are many reasons that interweave through the fabric of our society. Some possibilities are that academic careers are difficult or even incompatible with having and raising children; people’s biases obstruct the career progression of women; and the vicious circle of women being deterred from continuing by lack of female role models (and even women in senior positions not hiring other women).

It’s unbelievable to me that in 2018 we are at the very beginning of sorting out this issue. It has been identified and quantified. But what is to be done about it?

The team behind this investigation poses a solution of a programme, to support and create gender equality in academic neurology. In the same way that democratic societies legislate against discrimination, academic neurology needs incentives, rules, and education to promote cultural and attitude changes that are long overdue.

One expert who was asked to comment (and wishes to remain anonymous) pointed out that this investigation, and the resulting publication, was carried out entirely by men and that all credited academic authors of the letter are men. Another reminder of how far we have to go.

Another asked me to consider “the importance of male networks, which is still very difficult for women to gain entry to … These networks are asked for example by Pharma to join academic panels – everybody knows everybody from the networks. The same is true for grant review boards and so on. The same speakers at each conference as the chairs who invite the speakers know each other and return the favour.”

She goes on to say, “In my senior author papers, I paid for the work and the first authors (students) executed the projects I designed. Trial papers from big companies are often written by the company and not the first or senior authors! … Food for thought!”

We’d love to hear your thoughts.

About the author

Rachel Horne


  • The scientific career structure in the UK is just generally archaic & somewhat cutthroat. The constant cycling of temporary posts and chasing grants is soul-destroying and demeaning. I think guys tend to be a bit more bohemian about the matter and more happy to move around and make sacrifices like not having a family to get up the career ladder. Women less so. Both myself and my other half work in academia; I took a permanent post a couple of years ago because my health can’t take the stress and insecurity of chasing publications, my new post is more managerial/teaching orientated, the salaries better, I could take time off for health/maternity without criticism and its actually more rewarding, but I haven’t really published since (apparently fourth author doesn’t counts). The other half is currently scrambling around trying to get another fellowship application together (half of which he cant apply for because they only accept applications from women) and is just too stubborn/passionate to give in and accept a job outside of academia…. I don’t think we should make this about gender, institutions should do more to treat all their staff like professionals, opposed to like summer staff that can be disposed of. The French system is much better.

    • I second your comments. Neurology clinical and academic positions have always been male dominated. I haven’t seen this change much in my career. It’s just the women work much harder than ever before to reach these goals, which gives a false impression that a status quo may be achieved in the near future (this was pointed out to me by a COO who also happens to be male). This is reflective more of current society than anything else and their thoughts around highly competitive fields.

  • Everyone wants to be #1. Maybe be thankful to research and not a patient like these 2. ALS and MS both have 1 in 1000 lifetime risk.

    Richard K. Olney, MD, founding director of the ALS Treatment and Research Center at UCSF and a pioneer in clinical research on amyotrophic lateral sclerosis (ALS), has died at age 64, following his own eight-year battle with the disease.

    "Lucky you!..That used to be our life," she said. "We used to fly all over the world talking about A.L.S. Now we have it."

    MD/Phd ALS researcher 40y/o diagnosed ALS
    "I have lost my faith in god. I can’t believe that a loving being would ever do something so cruel."

By Rachel Horne



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