Ethnicity and gender trends of UK authors in The British Medical Journal and the Lancet over the past two decades: a comprehensive longitudinal analysis.

Background: While gender equity among academic authors has been extensively investigated, there is a significant gap in our understanding of racial/ethnic authorship trends, despite the recognition of barriers to authorship along both ethnic and gender lines. Leveraging the meta-data for all articles published in The British Medical Journal (The BMJ) and the Lancet and between 2002 and 2022 (inclusive), we explore demographic trends among UK academic medicine authors in two of the world's leading British medical journals. Methods: We systematically searched PubMed's MEDLINE for all articles published in The BMJ and Lancet between January 1st 2002 and December 31st 2022. Filtering for articles with a UK affiliation, we predicted gender using a publicly-validated name-to-gender dictionary, while data was analysed to explore and investigate ethnicity using the Consumer Data Research Centre's (CDRC) Ethnicity Estimator. Data was analysed to explore and investigate: (a) the proportion of female/male author publications, (b) the proportion of the various UK author ethnicity groups, and (c) the overlap/intersection between gender and ethnic identities among first and last authors. This comprehensive longitudinal analysis was conducted on 82,143 articles (51,209 from The BMJ and 30,934 from the Lancet) which represents >97% of all published articles between 2002 and 2022. As we sought to understand how academic authorship reflects the diversity of the UK population, we limited our analysis to first and last authors who had a UK affiliation and excluded "news" and "comments" pieces (16,736 articles for The BMJ and 4678 articles from the Lancet). The main outcome measures were the trends in first and last authorship demographics of academic medicine, focusing on the proportion of female/male authors, ethnicity and their intersectionality. Findings: Our findings show that, while women have made substantial headway towards equity among first and last authorship in The BMJ (peaking at 42% and 43%), they remain under-represented in the Lancet (35% and 27%). In both The BMJ and Lancet, Black authors have remained severely under-represented as both first and last authors (below 1% for most of the two decades), while Asian authors have increased proportionally to match their fraction in the general population (ranging from 2 to 10%). Interpretation: Analysis over the past two decades has shown that the gender author gap is decreasing quickly in The BMJ and Lancet. However, despite the two journals' growing focus on structural inequalities in medical academia, little progress has been made in rectifying the large gap between White British authors and other ethnic groups, especially Black authors. Without more awareness, diversity initiatives which have resulted in positive gains for White women do not seem to translate well for authors of colour. Funding: None.

The Under-representation and Stagnation of Female, Black, and Hispanic Authorship in the Journal of the American Medical Association and the New England Journal of Medicine.

Publication in leading medical journals is critical to knowledge dissemination and academic advancement alike. Leveraging a novel dataset comprised of nearly all articles published in JAMA and NEJM from 1990 to 2020, along with established reference works for name identification, we explore changing authorship demographics in two of the world's leading medical journals. Our main outcomes are the annual proportion of male and female authors and the proportion of racial/ethnic identities in junior and senior authorship positions for articles published in JAMA and NEJM since 1990. We found that women remain under-represented in research authorship in both JAMA (at its peak, 38.1% of articles had a female first author in 2011) and NEJM (peaking at 28.2% in 2002). The rate of increase is so slow that it will take more than a century for both journals to reach gender parity. Black and Hispanic researchers have likewise remained under-represented as first and last authors in both journals, even using the best-case scenario. Their appearance as authors has remained stagnant for three decades, despite attention to structural inequalities in medical academia. Thus, analysis of authorship demographics in JAMA and NEJM over the past three decades reveals the existence of inequalities in high-impact medical journal authorship. Gender and racial/ethnic disparities in authorship may both reflect and further contribute to disparities in academic advancement.

Insights from full-text analyses of the Journal of the American Medical Association and the New England Journal of Medicine.

Analysis of the content of medical journals enables us to frame the shifting scientific, material, ethical, and epistemic underpinnings of medicine over time, including today. Leveraging a dataset comprised of nearly half-a-million articles published in the Journal of the American Medical Association (JAMA) and the New England Journal of Medicine (NEJM) over the past 200 years, we (a) highlight the evolution of medical language, and its manifestations in shifts of usage and meaning, (b) examine traces of the medical profession's changing self-identity over time, reflected in its shifting ethical and epistemic underpinnings, (c) analyze medicine's material underpinnings and how we describe where medicine is practiced, (d) demonstrate how the occurrence of specific disease terms within the journals reflects the changing burden of disease itself over time and the interests and perspectives of authors and editors, and (e) showcase how this dataset can allow us to explore the evolution of modern medical ideas and further our understanding of how modern disease concepts came to be, and of the retained legacies of prior embedded values.

William A. Hinton (1883-1959): Diagnosing and Confronting Racism in the Medical Profession.

Racism impacts every aspect of medicine, including the careers and lives of Black physicians. The story of William Augustus Hinton (1883-1959), who invented the Hinton Test for syphilis before becoming the first African American full professor at Harvard University in 1949, offers an instructive perspective on the intersection of interpersonal and systemic racism, and personal determination, just over our historical horizon. Yet there are sobering and instructive lessons throughout this history. Hinton had to navigate prejudice throughout his career. Indeed, while there is much to be inspired by in the telling of Hinton's story, the forms of racism faced by Hinton and his contemporaries remain persisting features of academic medicine. This article focuses on encounters with racism that affect the course of medical careers and scientific innovation. Hinton's story holds important implications for many health professionals in the twenty-first century and provides unique insights into the history and impact of interpersonal and systemic racism alike in academic medicine.

An Awkward Fit: Antimicrobial Resistance and the Evolution of International Health Politics (1945-2022).

Despite being acknowledged as a major global health challenge, growing levels of antimicrobial resistance (AMR) in pathogenic and commensal organisms have proven an awkward fit for international health frameworks. This article surveys the history of attempts to coordinate international responses to AMR alongside the origins and evolution of the current international health regulations (IHR). It argues that AMR, which encompasses a vast range of microbial properties and ecological reservoirs, is an awkward fit for the 'organismal' philosophies that centre on the rapid control of individual pathogens that have characterised international policy-making since the 19th century.

Oliver Wendell Holmes, Racism, and Remembrance.

Oliver Wendell Holmes Sr. has long been a celebrated figure at Harvard Medical School (HMS) and in the history of medicine more generally. And yet in part on account of Holmes's putative link to eugenics, but especially on account of his role as dean in the dismissal of the first three African American students at HMS in 1850, his name has recently become associated with systemic racism as well. In October 2020, the Oliver Wendell Holmes Society at HMS (one of the society "homes" to which students are assigned at admission) was renamed the William Augustus Hinton Society, in honor of the pioneering African American syphilologist. This paper examines the shifting depiction of Holmes as well as Holmes's considerations of hereditary determinism and race over the course of his long career in the nineteenth century as a test case concerning the evolving evaluation of historical figures in the history of medicine.

Waves of attention: patterns and themes of international antimicrobial resistance reports, 1945-2020.

This article uses quantitative and qualitative approaches to review 75 years of international policy reports on antimicrobial resistance (AMR). Our review of 248 policy reports and expert consultation revealed waves of political attention and repeated reframings of AMR as a policy object. AMR emerged as an object of international policy-making during the 1990s. Until then, AMR was primarily defined as a challenge of human and agricultural domains within the Global North that could be overcome via 'rational' drug use and selective restrictions. While a growing number of reports jointly addressed human and agricultural AMR selection, international organisations (IOs) initially focused on whistleblowing and reviewing data. Since 2000, there has been a marked shift in the ecological and geographic focus of AMR risk scenarios. The Global South and One Health (OH) emerged as foci of AMR reports. Using the deterritorialised language of OH to frame AMR as a Southern risk made global stewardship meaningful to donors and legitimised pressure on low-income and middle-income countries to adopt Northern stewardship and surveillance frameworks. It also enabled IOs to move from whistleblowing to managing governance frameworks for antibiotic stewardship. Although the environmental OH domain remains neglected, realisation of the complexity of necessary interventions has increased the range of topics targeted by international action plans. Investment nonetheless continues to focus on biomedical innovation and tends to leave aside broader socioeconomic issues. Better knowledge of how AMR framings have evolved is key to broadening participation in international stewardship going forward.