 Okay. Now I'm getting feedback. You want that. Okay, so in the spring of 2008 I had written an article actually about the methodology that was being used for newborn screening for cystic fibrosis. So, the methodology what you have to know is that the, the first gene that was really identified the Delta F508 was sort of the beginning of really newborn screening genetics and as well as really genetics and many parts of our modern medical precision medicine. And what was interesting is that you could test for newborn screening either using IRT and immunoreactive trypsinogen, or you could use a DNA test, and it turned out that half the states would use one and half the states would use the other. What was interesting is that the Delta F508 which was the only genetic mutation that had been originally discovered is very, very common in those of European ancestry and very, very rare in all other racial and ethnic groups. So using the DNA test, you're going to identify children of European ancestry of having CF, but you're going to miss a lot of minoritized children. You use the IRT method, you have to do it twice. And so that means you have to bring people back in. And so you can have disparities in that way as well. But you're also it turns out you're going to pick up a lot more false positives, particularly in the black community. Because which is the right way to do it. Do you do the IRT or you do the DNA test. And so I wrote this whole editorial about looking at the pros and cons and looking at it from a disparities perspective, and really felt that you needed to be focusing on the IRT method at that time, because to be fair, if a child of European ancestry came to the emergency room failing to thrive, everybody's first thought in pediatrics is always CF. But child of a minoritized community comes to the emergency room with failure to thrive that might not be the first disease on the differential. And so I thought it was really important that we picked up children of minoritized communities. So I wrote this as a grand round you have to write a report and tell them why you're going to do it and they approved it and so I wrote it and it got peer reviewed and it was accepted. And then I got a call a week before the publication was going to come out that they had decided to publish it as a, why am I not getting basic. They decided to publish it as a commentary so I called them up and I said why this was a grand round and they said, Oh, because it's about ethics and ethics is about opinions and opinions belong in commentaries. And so I said, please withdraw my article. And they said, excuse me, I said, I'm not interested in it being a commentary. This is really a very important medical disparities issue that needs to be as a grand round. And so I attempted to withdraw it and instead what I did was I got a call from Bill Ballester who actually just stepped down of running the, the journal of pediatrics after over 30 years. And what he said was, we had a whole discussion I explained to him why I thought it was a grand rounds and at the end of it he looked me he goes, Well, you're right, it really should have been a grand rounds, but we're actually already printed it we're actually about to mail it out. And it would be really hard to withdraw it. So I have an idea. He says I have a win win solution I said what's that he said let's publish it as a commentary. And I go on the editorial board so nobody will ever make that mistake again at the journal of pediatrics. And I said, mmm, that sounds like a lose lose. He said, excuse me. I said, so instead of being a grand rounds it's a commentary, and you're asking me to work for free. Anyway, I did join the editorial board and it's been an incredible 13 years I do want to thank Bill for having contacted me and coming up with his solution, although I'm still not sure whether it's a win win or lose lose. One of the beauties of being a member of the journal of pediatrics is that I get to go to the editorial board meetings which is always the the Thursday, the Thursday night in May before the PAS. So it's actually Thursday night, not Friday and then all day Friday we have a meeting where we hear all about the issues that are going on in journals and of course we all know that everything's really moved electronically and that's been really hard on a lot of journals. I've been hearing about this now for the past 15 years. And at that meeting they always train us on how to do peer review properly and things of that sort now you have to know about the journal of pediatrics like many medical journals, it's a single blind right so you put your name on the publication but you don't know what the viewers are and that will become important in my talk, but so they were giving training for all of us who are on the editorial board who become guest editors from anywhere from five to 40 articles a year that will get published, and we'll take it through the process. So we're having experience, as well as to add diversity to the editorial team. And so we're at this implicit bias training, and it was the worst implicit bias training, I will ever go to. And one of the things the speaker said is that they would not allow three female reviewers for a manuscript. He said wait, wait is this bias pediatrics is two thirds female. So if you do the math for just one for all pediatricians two thirds times two thirds times two thirds is 827 or one third of the time women three women should be randomly selected to be journal editors to be three reviewers. I raised my hand and explain the math to this person who just sort of ignored me. And so then I said would you allow three male reviewers. And the response by this speaker was it would never happen. And the answer is one third one third one third or should happen about 3% of the time, although when you think about it. We don't just pick randomly from pediatricians we often pick more senior people. So it would probably be higher than that. But anyway. When you look at who the board members were who were sitting in this implicit bias training with me, it was clear it was going to be more than 3% of the time. So, I kept asking questions, and by the end of the meeting. There were a lot of people who are as upset as I was but I just kept asking questions very calmly. And when asked why I stayed as calm as I did my answer was Laney's motto, don't get mad, get data. And the fact was is that on Monday after the Friday, Michael Fishman was coming to my office and he needed a project to do for his second year medical school time off to do research and I didn't have one. And now I had found one. So, fish needs a project. The first thing that we decided to do was to examine the gender of authors of original research and three high impact pediatric journals, between 2001 and 2016, given the importance of publishing on academic promotion and to compare authorship gender with the percentage of women on editorial boards and with amc faculty composition. The first one was we assess the prevalence of a female first, who's usually a junior colleague, as well as collected the data of the last author who's usually a senior colleague. And we looked at it in these three journals and we did it by both a computer algorithm but also then hand by hand when the computer outcome said that it didn't have a high enough confidence. And so as I said we picked four years between 2001 2016 every five years. We looked for the if it was articles by a study group only with no listed authors we didn't include it. We, again, we did identify gender if we couldn't find the gender through our computer algorithm we did searches on Google we did searches on PubMed we took pictures. And basically, eventually we got down to having less than 3% unknowns articles were double coded by two individuals to ensure accuracy of the assignment. And then we all looked at the editorial boards for these three different journals. And what you're going to see the initial plan was to compare women authorship and editorship with double amc data. And at that time I happened to be interviewing a student who had graduated Hopkins was looking to take a gap year. And he was looking to be an RA for a totally different project, but I was so excited about this project that I was doing with fish that I was telling him about our data and that at this point had just been accepted for publication. And he said to me, you're comparing it to double amc data, but that only is us physicians what about the women who are international. And I looked at him I said, oh my God, you are so right, but I'm going to bet that it's probably less than 10% will just consider that in the error bar. I said to him so you start counting the countries that people come from from Peds and J Peds, and I'll look at the other journal jamapede and we'll count and we'll see what's going on. And the answer was it was more than one third of all the publications came into nationally. So at this point the paper had been accepted and it was a clear error. So I called up the journal and I said, I'm doing two things I'm violating one is we're going to send in totally new data with the revision and second we're adding an author because the author spent the weekend before it actually hired him for the other project, going through and counting and distinguishing between those who are US versus those who are international. And so I'm going to show you both sets of data because I think they're interesting. So here is first this is overall so this includes both US and international data, and you can see both from all three journals and then each of the journals individually. What you'll see is that the blue is first author, and so that's much higher than the number of women as senior authors which is the red line, and the green is the editorial board so there are a couple of things to point out about that. One, for example, is that the rate of rise of junior faculty is much greater than the rate of rise of senior faculty. And that is by 2016 women on editorial board actually mirrors women as senior authors, which is what you would expect since most editorial boards are usually more senior faculty. So that was one thing we took away. Then when I went to compare against double AMC data so now I'm going to with remove all the data about international women. In terms of ownership then the differences can be explained by the percent of women faculty because what you're seeing here is that blue and red are the two lines to look at what are the percentage of junior faculty by the double AMC and what is the percentage of women authors, and then the purple are senior authors as well as senior faculty. And so you can see that particularly for the senior faculty they dovetail exactly right on top of each other for the junior faculty that trending in the same exact way. What it doesn't explain though is the low number of senior women that drop off if you look at instructors were between those years it was 64 to 74% and by the time you get to full professors you're down to 22 to 33%. So are women dropping out are women just not being promoted. I don't have an answer for that but that is one of the most dramatic things about that first slide. And as I said I was wrong about the implicit bias training when I raised my hand it wasn't two thirds times two thirds times two thirds you could say it was should have been closer to women make up 55% of the faculty or 40% of the senior faculty. So the review team should have been a little bit lower how often it should have been all female, but that also meant that it would be much more frequently how often it would be an all male review team. This becomes important it's eventually I'm going to get to look behind the curtain and we'll get to that. This was also an interesting data we looked at how often do you have a female first author with a female senior author and how often do you have a female first author with a senior male author. And what you can see is that there's a tendency for women to publish with women, although both of them are increasing again going along with just the increasing number of women entering the field. So whether the takeaways women are more likely to have a female mentor. Although the women are fewer in number, but they are more likely to be publishing with a woman first author than they are male first author. And again because they're both going up because of the increasing number of women coming into the field. There's two kinds with each the I laughed at fish and what for two males working on this project with me I said that the data show that you get better mentor, you get better sponsorship from having a male senior author a male mentor because they have more opportunities to give you, and here they're working with me sort of rather different than what the data we're going to show. But the real reason I got them was not to look at the data that was publicly available what I really wanted after that bias training was to look behind the curtain what I really wanted to do, was I wanted to look at the data at JP's and I wanted to look at who were the reviewers by gender, who were the editors by gender because member it's not just the, the editor in chief and the associate editors it's all of us to become guest editors, and I wanted to look. Was there a difference in acceptance rate by papers by female ML authors, depending on the gender of the reviewers or the percentage of editors. And so that was the project and not only did they give me the data they gave me the data with no strings attached. I said to them you know after they handed me the data I said you know I'm going to publish this. And they said yes we do know that and I said you know I'm not asking permission they said yes we know that. But they were very very confident that I wasn't going to find anything. So, as I said we had unrestricted access. What was different though is that for articles they reject they only keep track of the corresponding author, because they never take it further. And so rather than being able to look at first and last authors the only thing I could look at is corresponding author. And so then we just did a quick peek to see so who are the corresponding authors, and it's actually very different in the US it'll almost always be the first or last author. In some of Europe and some of Asia it could be a middle author and I don't exactly know why, but that is the only date I could compare so I'm going to compare apples to apples I'm only going to look at corresponding authors for both papers that are accepted, as well as papers that are rejected. We asked for the data from 2015 and 16 we ended up asking for about four months of 2014 to see articles that had started down the pathway but didn't get accepted into 2015 and then to see what had finally happened in 2017. So this is this is the peer review process and if it looks complicated. It really isn't I mean so an author submits a manuscript, and then it is. It's, it goes to the Journal of Pediatrics and then the editor in chief can either decide to desk rejected or he can send it to one of the other editors so he could be one of the editors or he can send it to one of his associates, or he can send it to a guest editor, and any one of them can be a guest rejected. After the, if it doesn't go to guest rejection then it's going to go to reviewers, and you people are always asking about five edit reviewers. It was very interesting to hear whether people actually use those suggestions or if they don't use it use many people will use a combination of people that you may have suggested, but also other people, and yet sometimes three or four or five people are invited and then the, the managing editors so the people who work behind the scenes at the Journal of Pediatrics would just look for people who might be in the bibliography and would invite them as well. So that's an important detail because that might mean that all of the people who were reviewers weren't actually picked by the editor. And then at that point you could either have a paper accepted as is you could have except with revision or reject, and as long as it wasn't rejected it would keep going through the pipeline, until we got either an accept reject. In the end. And so that was how we were going to follow we're going to look at each time what the, the genders of all the reviewers and editor work, and then we also decided we would also look at editorials, because those are invited. Virtually 100% are accepted, but they have to be invited and so the question is, what with the gender of the people who are being invited to write editorials. So of note, as I mentioned it's a single blind review. And here are our data. So what we found was that the first thing we did in 2016 the editorial board was 40% female, compared to 15.6% in 2001 so they had been a big change, particularly at JP's. And in first authors 57% of the time women were 35% senior authors, but now looking at corresponding authors what you're going to see is that it was about 54% were female. So again, mostly first authors but sometimes authors in different locations. So we have 54% of corresponding authors of female 40% of the editors are female. 34% of the guest editors are female, and the primary reviewers are about 37% female, which is much lower than one would expect given the demographics of the pediatric faculty and so one question is are women not being asked to review. Are they being asked to review and refusing or are they. I mean, I don't know because all I have is the data of the people who did the reviews. So what I noticed then was we, what we now did is we looked at who the editors were and did the paper get accepted or rejected. What you're going to see is that the p values are not significant for any. So it doesn't matter whether you have a female or male editor, and it doesn't matter. So male editors were as likely to reject the paper by a male author as they were likely to reject a paper by a female author, female editors likewise as likely to reject the paper and by a male. And as they were a female, interestingly, though, if you compare the female editors did a lot more desk rejection. So I jokingly when I presented this data to JP said so the next time I submit my paper I'm going to specifically ask for a male editor. Yeah, they sort of had that nervous giggle also and so one of the things that we talked about is why might that be why might female editors do more desk rejection and I was given several possibilities one might be the fields in which women were the editors that those might be fields where there was less quality or for example, there might have been more case reports and infectious diseases and journal pediatrics doesn't accept case reports. That was one possibility you know the possibility was that unbeknownst to bill he might have been sending articles to the female editors that were of lower quality. These are all questions I can't answer, because I didn't have full access for example to all the reviews and I didn't sit in at the meetings where he was deciding which editor to get it to. So clearly more work needs to be done, but it was obvious that the women editors were more likely to do a desk rejection. And then we looked at the reviewers. And again it didn't matter, you can see the p values are totally not significant didn't matter whether your reviewers were male or female equal rejection rates. But women were much less likely to complete primary views, and that is something to think about it. They just saying that they're too busy. They're not being given the opportunity. When I'm asked by junior faculty is it worth my time to do it. I actually think there's a lot of learning that can be done. When you get to look at somebody else's paper, and you can be critical of it then you can sort of put the mirror to your own work and realize some of the same weaknesses that you might have. And so I do think there is a value of a real learning curve and doing good reviews. And then we looked again at looking at the teams right so the female editor and the female reviewers and the male editors and the male reviewers and again there's no difference. So we editors are equally likely to choose men to review for their papers as they were to have women to review for their papers. And yet, as I said, the takeaway is there were a lot more all male teams and that bias trainer was telling me about, but in the end it in a sense didn't matter. I actually was expecting to be honest I thought there might be some disparities. And I was going to suggest that we should move to a double blind. Because I didn't find any disparities doesn't mean we shouldn't move to a double blind because again I can't. I can't account or, or sort of correct my data for the quality of the papers right I can only look at, we have parody, but that if parody is good if the quality of the papers are the same. And that's something that I can't answer with these data. I can say that males are overrepresented as reviewers and finally, looking again at this time looking it doesn't matter where the editor is female or male and relationship to author gender. So nothing mattered, except for the fact that women were more likely to do desk rejections. And so here's another just view of how the process went and all of the numbers in our data so that it was a really large data set. Yeah, JP should have padded themselves on the back. Lainey given full access couldn't find any equity issues in this whole process. Until I looked at the editorials. 107 editorials were written commenting on 121 original articles. Now the corresponding authors for those articles were 52% were female which is comparable with the percentage of published by female authors in the paper so again, no, no disparity there, but women were invited to write editorials less frequently than men. In fact what you would find is that they were only making up about 29%. And it didn't matter whether the editor was male or female, both men and women were inviting female colleagues to write editorials less than would have been expected to look at the percent of women who were senior authors. And when I showed that data to JP's at one of our editorial board meetings, the policy now is that at every time that they make an invitation for someone to write an editorial they actually go through and say have we thought about people of different demographics and so that has actually become quite strategic in their mind, but that was the only thing so I was pretty impressed. In writing up the discussion I actually went and found an article in 1994 written by then editor-in-chief George Lundberg and his colleagues at JAMA they had actually done the same process. And they also found no gender bias and outcomes of manuscript from corresponding authors based on editor or reviewer gender. And note that JAMA just like JP's is a single blind review process. They also found that female editors rejected manuscripts more than male counterparts. So maybe that comment. Yes, Deb. That the reviewers don't know who the author is so they don't know whether you're male or female. Right. So when you submit a paper that says Deb Burnett. I make an assumption that Deb is a female name and so I know now that I'm reading a paper by a woman and whether that has any unconscious bias. You don't know who the reviewers are. So in our study women receive only 40% of invitations to review although they only completed 37% and given these numbers that was actually statistically significant. But they also refuse receive fewer invitations to write editorials. I mean I've been talking about the limits the whole time we don't know about the quality of the papers Lundberg who as editor-in-chief would have had access to the quality of the reviews and stuff didn't didn't do that in his paper either so none of us have that information. So what are the remaining questions from that study was while the data found that male and female authors have the same likelihood of success. If they found for the quality of the submissions, what if female author papers were better than one should expect them to be accepted at a higher rate likewise if they were worse they should be accepted at a lower rate. Why do female editors reject manuscripts at a higher rate. I don't know. And as I said, we've had a couple of people make suggestions at JP's I still don't know what the right answer is. But then there was COVID. Right. And so, and we all know it had a far reaching a global implications and at the time that I started this next project we were dealing with 54 million confirmed cases and 1.3 million deaths worldwide. What we decided to do is so what happened now you had read we read all the time that women were being disproportionately harmed by COVID. In the STEM fields and there were lots of papers that were coming out saying that, but they were often looking at papers that were being published in May and June of 2020, which we all know what the review process is papers that are getting published in May and June, were probably submitted back in November and December, got reviewed in January went back for a second round of revisions came back in March or around March and then gets published in June. And so it was very early for people to be doing that. And, nevertheless, people were showing points for example that there was a 7% reduction and women as corresponding authors for drama surgery in April May 2020 with April May 2019. I still think that was too early. So I don't know why they were seeing that drop off but it couldn't have just been cold. The policies though published articles concerning coven also found that a smaller proportion of women then expected. So if you just looked at papers that started so those were often fast track papers right they were the ones who got reviews in 48 hours we were all really proud of it then we started with all the retraction so we became less proud of it, but those are papers that would at least being fast track and there you were seeing men taking better advantage of coven 19 and women on from a research perspective. And everyone had all their theories but the question was, was that really true and Pete. So we looked at the same data and we looked at it, comparing January and February of 2019 and January February of 2020. So all of that should have been pre coven should have no impact, and looking again at that same data from JP in April May 2019 and 2020. So you can see lots of non significant p values I circled the two that were significant. You did see that there was a difference in a decrease of female authors between April May 2019 and April May 2020, but all of the difference comes in the international authors that men and women, pediatricians in the US were equally affected that's the point nine right and that's important, because what what it says. So the question is why were us men and women equally affected. So it may be something different about men who go into pediatrics it's one possibility, or it could just be the whole way that the field is I don't know. What we saw was that for men and women there was no difference in being affected in the US, although it was so significant internationally that internationally. International women had been more likely to publish in JP's and international men, and after coven those numbers actually flipped and men have become the primary first and last authors at the Journal of Pediatrics. So then we looked at final disposition of all articles as I said, specifically looking in table three at coven papers and you can see they're very few so we're not going to be able to really do any good statistics. But because very few papers JP to publish very few papers on coven as early as April and May, but yet it didn't seem that there was any gender difference here either. What was interesting about being on a journal like JP's is that the number of articles that were being submitted was like 33% more and I called all my friends who worked at different pediatric journals, and everybody was seeing about a 33% increase in the number of papers being submitted to journals. So what are the hypotheses about that we were all told to go home and to work from home. So we were clearing off by desks of all these papers that we might have had that we wanted to just get off of our desk that's one possibility. I don't know what the other possibilities are, but it has been fascinating the number of articles still is much, much higher since the pandemic, and before the pandemic. The editors are always worrying about what they call salamis science where people are just taking small little fractions of what they find, or they're showing in the first month, 10 cases and then next two months later they're showing 20 cases because they just adding on, and we're really not getting much quote new research. We found that JP's at only one quarter of the increase in the article submitted was actually based on coven itself. And so a lot of this was just all other types of research. Although the submissions had increased globally as I mentioned already international men had the greatest increase in submissions. And again, mostly not due to coven and here was the numbers that us men and us women as corresponding authors increased by 34 and 32% not statistically different, but the international men increased the number of papers submitted by 117% and women only 51. So, when I say the international female or harm they were still less harmed than both us male and female corresponding editors. It was a fascinating time to try to figure out why the rest of the world was publishing in a much more a much more prodigious rate than we were here in the United States. The studies have found similar data. So this was a study by a Brahmo that just came out last year. They looked at pre print repositories right so getting earlier papers. This is pre print so it's before peer reviewed and they looked up through 31 May 2021 so a year into the pandemic and here's what they wrote contrary to what most people might expect and early studies have announced that female scientists are hurt more by pandemic due to the increase in family care workload. We could observe that the plunge in production is not more severe from women than for men. They said only in the far East women experiencing a worse decrease in depositions with respect to men. And in fact they said that both in Europe and North America the share of women among corresponding authors of pre print showed a significant increase after 2020. And in fact that the country level they showed some differences right so then us in China, the level of female and male scholarship reduced equal amount, but in some countries women were hurt more than men and others men were hurt more than women and some there was no difference. And so, but again the earliest reports were all about that women were being harmed, and at least in the US, my data were about pediatric this is a study now looking more globally and not finding that same reduction Another paper that came out just just coming out because it's still, it's still just online only was a paper by Ryan and colleagues looking at gender specific effects of COVID-19 lockdowns on scientific publishing productivity, and this was published in social science and medicine. And they, this was specifically looking in Australia and they looked at 120,000 published articles from all journals all over as long as it had an Australian author. And they, again found Australian women have been incredibly resilient to the challenges faced by the lockdowns. There was an increase in the number of published articles submitted in 2020 that was equally due to women as men. However, what they did notice was that women were slower to start publishing about COVID. And so their only point was their question was will women just slower to sort of regroup and change their focus of research or was this a caregiving issue but by the by 2021 women are now publishing more than men on the topic of COVID. And so their conclusion was that the data suggests that women from Victoria were less able to rapidly transition to new research early in the pandemic, but again showing equal amount of harm both to men and women overall. So what are the next steps while many but not all studies have showed women in stem fell behind during coven. Our data showed the losses greater for women in pediatrics outside of the US and not as much for women in pediatrics comparatively speaking so they had the same impact as did the male pediatricians. And as I pointed out these two articles show the same there are lots of articles that show different. And so I think that the jury is still out. I wanted to then get behind the scenes because just what the publishing doesn't tell you how many people are submitting articles right so if men if women may be hurt it may be the men are submitting much much more commonly now. And so I would need to know that by looking at the rejection rate. There was a change in management and so I was not given access although there's been change in management again I've been told that I will be able to get access to it, because I do think it's important to really try to understand. It's not just about who gets accepted because that again might have something to do with quality of papers, it would be really interesting to see who's actually doing the submissions. So covid's not going away. What's happening now to an almost three years into the covid pandemic. So we decided to repeat study that we started with fish, looking at those papers. And so just to add this was the same graphs but now I'm adding in the data. And what you can see there are a couple of really interesting things about the data, looking at this is the double amc data. And what's really interesting is when you look at instructors that women now make up 78% and I just want to point out that if you look at pediatric residencies, women only make up 73%, which suggests that this is for the first time women are entering academic pediatrics, more than you would expect just from their percentage in the training pool. So that's one really interesting piece of data, as we would expect also you're seeing that the number of women are full professors and associate professors we still have this gap, but you have that gap with men as well, but full professors now women make up 40% and now 54% of associate. I point out the history of pediatric residencies which has been relatively flat over the past two decade. So women have made up about 73% because one reason you could argue why we have fewer associate and full professors is just that there wasn't the pipeline, but the pipeline has been there for at least 20 years. Since 2010 the percentage of pediatric residents is flat since 2016 as I mentioned women are entering pediatric faculty as instructors greater than their percentage in residency. And finally what you can see in 2016 to 2021 it's the biggest jump in women as full professors. And that's still not clear if the low percentage of women as full professors is due to women not being promoted or dropping out issues that clearly need to be evaluated. So this is repeating this study looking at first and last authors of just what's publicly available. And what you can see, if you look at the first slide the overall that first authors continues to rise at the rate of basically women entering into the pediatric field, and that the number of women who are senior authors and our editorial boards really overlap. And so again suggesting that they has achieved some degree of parity, although there are differences within the journals. So here is another way of looking at this paper, which is that women were historically if you look at the slide the overall slide on the, on the left what you see is that women were historically underrepresented as pediatric first authors right in 2001. First authors women only made up 40% and if you just looked at where they were as assistant and instructors, you would have expected to be closer to 60%. And versus what you would have expected for senior authorship, again, associate and full professors and somewhere between 22 and 37% and that's exactly what you see. So you're seeing that as first authors women are finally coming up to being proportional to their numbers in the AMC faculty for junior authorship but in senior authorship, they're increasing at the same rate as they're increasing just in the population of associate and full professors. So the gap is shrinking but women are still underrepresented as first authors. Although for last authors it's been comparable over the whole 20 year period. Other studies are also optimistic in pediatrics there was a study by Bomi et al, again from 2022 looking at gender disparities in pediatric research. And they did a descriptive bibliometric on scientific authorship and what they found was 46% of all authorship and pediatric research were held by female authors. There's relatively more first authorship and at higher arts for first authorship compared to men, going along with the fact that women entering individuals entering the field from training are more likely to be female than men at almost a two to one ratio. But then they pointed out that the prestige index of negative 0.13 indicated an under representation of female authors at prestigious first and last authorship so that women were often in the middle. The presentation rates they found were not affected by the gender of the first to last authors, and then they looked at the country level they found pronounced gender related differences with much better results for example in the US for women. And then they said with their time trend that they predicted that by 2023 that there would be a female dominated prestige index of 0.05 so that women were making great strides in pediatric research. The conclusion then was the integration of women in pediatric research as advanced opportunities for female authors differ at the country level but overall women are lacking in leadership positions, improving career opportunities for women and pediatric research can be expected in the coming years. So we've come a long way baby, but we're not there yet. These are the data from the double AMC from 2020. And what you can see is that the women in pediatrics are much more likely to have a hold up position of professorship or associate professorship compared to all women in all academic fields. At all levels and again the residents though for women in pediatrics 73% and overall about 45%. And so one question is, you know why, why are all these differences outside of pediatrics and whether pediatrics is really different. Or if pediatrics is just because it is so female dominated that we're seeing the changes in pediatrics first. But even impedes there are disparity gaps that persist so this is the paper by Conan colleagues, looking at it from the Association of Medical School Pediatric Department chairs it's known as amps for that. And it's looking at pediatric chair turnover and demographics, and what you can see so remember women make up 73% of the residents, make up 40% of the senior full professors, but we make up only 26% of all pediatric chairs. And again to and those other numbers are 39% of all full professors 60% of all faculty 72% of all trainees. So clearly under representation is pediatric chairs. We also hold fewer endowed chairs. This was a paper that just looked at professors from 27 top granted funded institutions, and then among all full professors they found that only 23% of women, 23% of the endowed chairs were held by women. Men were more likely to hold an endowed chair and a multivariate analysis that adjusted for degree number of publications and funding the odd ratio for holding an endowed chair was 0.8 for women compared with men. So clearly, still some barriers that we need to get past. So, to conclude, I think that the data show at least in pediatrics continue significant progress of women and academic pediatrics over the past 20 years. The data are not generalizable to other fields pediatrics is different in many other ways. Just because we're reaching those some degree of parity doesn't prove that there is or is not bias again, I don't have access to the quality of the papers, as well as a better feeling for what's going on behind the scenes other than that one glimpse that I had four years ago. The concern might be that women and men may differ on what they consider meritable research women and men may be invited to editorial boards with different degrees of merit, just because we're at their percentage one would expect that doesn't mean that. Again, it might be a merit that it either should be higher or lower and I can't answer that question. It's no better time to be a female academic pediatrician. I've appreciated my 28 years here at the University of Chicago, and hope to continue that type of success in Rochester. Thank you very much. I just want to thank all the students, many of whom are now faculty as well as well as Diane Lauderdale and Denise Goodman to faculty members who worked with me, and I'm supposed to again put the CME code. Okay, yeah. So, any questions from the room. Yeah, yeah, that's. Yeah, so the question is how would you. How would you quantify quality if I were actually given full access to all of the articles and things. And boy, you would need a whole team of people to really look at that. One hint might be what the reviews say, right and I so Lundberg really had that chance in 1994 because he had access and even commented on the paper that he had accessed the reviews but chose not to look at them. But I think that would be a really hard thing. One of the ways that JP's looks at quality is that we look at actually a presented papers that we reject, we look to see where they end up getting published. Right. And so if they get published in a here equivalent did we make a mistake, they get published in a lesser journal, we don't care. They get published in doing the journal. We're very worried right so, and in general, we're seeing more that they're getting published in a lower quality so we're feeling that we're doing a decent job in quality. It's a proxy it's not a it's a surrogate market it's not perfect. Any questions from the zoom chat just to it's kind of on the same topic and it's asking about middle authors so in regards to the middle authors. Is there any way to tell any information about that specifically are the medical students residents statisticians research nurses pharmacists or other non pre physician or physician roles. So yeah so the question about what about I have not looked at the middle author so I really can't make any comment. There's one kind of question from back earlier in your talk about the lose lose or win win situation. It's interesting that it was thought there's a lose lose of editorial board offer how did you decide to go ahead and join the board when this is how you felt at the time. Well, I really so I had. I had two roles at that time I was also on the AAP committee on bioethics, and one of the things that actually I was on the section of bioethics at that time and the section is occasional arm of the section which our policy and the sections are the education, and we had tried to contact the editors of JP's Peds and Jamma Peds to try to get them to have a section on ethics. And so we that we had made that as part of our project and the only people who bought at the time was actually pediatrics and review let us have a series for one year. So we were trying to figure out how could we sort of mainstream ethics into the pediatric literature. And so it was at that time that I was given this offer, and I was sort of like well this is our shot to get into JP's. I then spent the next decade trying to get that. So now I'm an edit on the editorial board but I don't have a section that's focused on ethics, and it took a decade of arguing at every single board meeting, why we needed the section. We actually have since 2019 reach which is reflections on ethics and advocacy and child health. We publish four times a year, anywhere from three to nine papers. We have a call that comes out every four months if you're interested send me an email or just on the JP's website. So we pick topics such as transplant and pediatrics we've done issues on LGBTQ issues in pediatrics we've done. We're currently doing one on precision medicine and pediatrics and things of that sort. So we pick topics and then we send out abstracts and then we invite the people who write abstracts to submit full papers. And with the idea that just having one article the way people read journals is so changed over the past 25 years we used to get it at home. We'd read articles we'd rip a few out keep them to read at another time. Now that people just do sort of searches for the topics they're interested in. We thought if we could sort of lump them together in the journal we might get more reading more feedback from it and so that's why we picked rather than just having it. We wanted to have one article and pediatrics to lump them every four months and so if you're thinking about a topic and you see one article and it sends you to the next article and to the next article, it might actually increase the readership of articles about ethics and advocacy and child health. It took a decade but I finally did get it, but I was being pressured by my peers that we had to get into all the journals, of course journal of PD journal, comic pediatrics, then also started the ethics rounds. Never did make great progress on jammapede so though again each of the journals now have at least one person interested in ethics on their editorial boards. So that I had and it has to do with the concept of volunteerism there's some data that, you know, females, especially academics are more volunteerism and like roles that maybe wouldn't promote them but they do some of that work and I was trying to wrap my head around reviewers and you know reviewers have some academic benefit but it is a little bit of volunteerism and I'm just wondering if you can comment on that. Yeah, so I was surprised because we always talk about the quote the female tax I expected women to be reviewing more, and they're not and they're being asked and they're saying no. So that I had the data for. So I was intrigued by that and so is it because they're being asked in so many other places that that's why they decided to say no. So in my career, how much benefit do I get from reviewing I don't know I think I still do because I get to see how people are presenting data I get to see some of the new science even if it gets rejected with areas of interest and things of that sort. So I continue to volunteer but it is a volunteer right we don't get paid there has been a whole discussion. And frankly it's really getting hard to get reviewers during coven. And part of that was because everyone was so busy publishing. I mean, you. The journals got 30 every journal including jam and doing the journal but even some of the really weak journals, everybody just saw this influx and it hasn't stopped. The question really is about the quality of this, such a high increase in the number of journals that people are fatigued that we're accepting now just two reviewers at JPs, rather than historically having three reviewers. Yes. But, but you can't just control for the number right you need the quality and I can't do the quality so I can't answer that question, right. The question was, you know, is there still a gap in the promotion if we're seeing, you know, improvement in the publishing and the answer is, unless we can, you know, it's, we're told it's not the number of publications it's a number times the quality. Right so knowing the journal papers can be worth a lot more than almost all the other papers combined so I don't know. I'm just looking at one specific journal. I don't know the AMT data. What is. So why are women yeah so well, so what's interesting is, are they so they're, they're, they're entering as instructors, but when you look at them coming in as assistant professors, they're at 67% compared to 72. So one question is, are men getting introduced, starting as instructors or are they coming in starting as assistant professors right. So I don't know about that, but it is interesting that women are more likely to be instructors now than what you would expect just from their percentage in residency and fellowship. Yeah, we're doing better right so if you look at the yellow lines you can see that we're making progress from from, you know, it's hard because it's always shifting and years are going, but the interesting thing though is that the pediatric kind of women in pediatrics has been, it's in the six, it's in the 60s in the 90s it gets up to 70 in 2003 but it's been stable now for 12 years and 72 to 73%. And I had more than I just wanted to show a couple of data points and not to make it a total mess but so my point is relatively stable so at this point, 10 or 15 years from now, if I'm healthy enough to redo this study. So will we stop seeing this slide, right, and because we're now at a steady state, and I don't know. Yeah, so the, so Dr Rora has assigned herself to understand what whether women are coming in as instructors, more than as assistant professors and so she's going to take this on thank you for doing that Dr Rora. Okay, there's one other question here from a dermatologist I'm working on a project in my some specialty that is looking at similar metrics I was wondering if you had any feedback or pushback in using the names or profiles as proxies for gender when you published your research on this. So we didn't back in 2016. So much more. And in fact, as I also said, one of the things we did we looked at pictures, right and we're making assumptions. And so I acknowledge that we're making assumptions. We're probably making assumptions. I'm hoping that our assumptions are equally problematic in both directions, but I can't say that but no I haven't had pushback but I do hear that that has become an issue that didn't exist when I first started the studies. Yeah. Some people want to see your face so they want me to stop sharing. Okay, so that they can see you on zoom. I don't know if that makes it better I think you have to look at the speaker view. Okay. I haven't changed. Oh, I see they want to see you down here. Okay. Sorry, we should have turned it on earlier. You know they're looking at these on the screen. Okay, so here's another question. Basically like our reviews truly blind. I'm sent articles to review they're blind I don't have the author's names I feel I'm able to look at what sided and how to determine the author of course I may be wrong, but effectively blinding me take more than redacting the author's names. That's a really good point I actually I have an anecdote about that I had two reviewers in my life who. And it's publicly available so I'll use names so I Bob truth had written a paper. Why doctor this for your child. What would you do and he wrote a paper why you shouldn't answer that question. And so I wrote an article saying why you should answer that question. And I got this review and I sent it to the journal where he had published, and I got three reviews and one of them it was so clear it was Bob. I said I know it's blind that I know I'm not supposed to know but it's obvious that you can we talk. And one of the interesting thing is Bob is a intensivist, and I'm a generalist so very different places and relationships with families and the intensity and I don't care but longitudinal relationship that I have as a general pediatrician, and after a great conversation. What we decided to do is I called Journal of clinical ethics which is now being run out through here the McLean Center, but I called up Norm quest and I said, what I'd like to do is I'd like to write. I'm going to revise this article based on a lot of comments that Bob made, but then I'd like to submit it here, but I'd like it to be done with with other people commenting on it. So, it turned out that Bill Ruddick had written a philosopher at NYU had written a paper about why parents shouldn't ask the question. So my paper was why, why parents should ask and why doctors should answer. And if you're interested you can contact me but it was a whole series then the Journal of clinical ethics published my article Bob was one of the commentators, as well as Bill Ruddick as well as several other people so that was fun. I wrote another paper. And this will, I hope I can do this without tears. The paper that Tracy Kugler and I published lethal language legal lethal decisions was actually we had submitted it, and it had gotten rejected. And I realized that one of the reviewers was Ben Wilfand. And I called up and he goes, funny you should call me I said well Ben it was obvious you would wrote the review. You know, I was actually writing a similar paper. And I said yeah and so we talked. And what we decided to do was actually to co author, and then submitted it to a different journal. And so if you ever look at that paper Tracy Kugler's first author, then his middle author and I'm last author. So you can figure out who your reviewers are. I've used it for positives. I'm trying not to do it except those two are just way too obvious. But even when you do have a double blind like they'll put like your paper, but they'll take out the author so you still know what the title is and if you're want to you can cheat right and you can look up the paper and the authors I mean the point is you're not supposed to. You know the data from the music world right the whole point of double blind really comes that why were orchestras so male predominant and one of the things was that they realized that there was a bias in the music world and so they started doing it behind the curtain and that there was still bias, and they realized that one of the reasons was when you walked in they could hear the difference of the women's shoes and the click click of heels versus the men's shoes. They were carpeting and now when you look at orchestras they're very 5050. So there is a value in doing double blind. Again, it doesn't explain whether our differences are due to quality or because of bias and I can't answer that question, but if we all switch to double blind would it change things. And one of the other things about double blind is when you get a paper by somebody who's like a Nobel Prize winner. It's not rejecting it takes a lot of courage type of thing and sometimes. So we've had some people have won some fancy awards who submitted papers that aren't of high quality but everyone wants to give a break and so there might be a real value in double blind even if I can't show any bias. So actually that answered this last question so I'm just going to read the question we'll have to end but it said, do editors tend to factor in the authors prior publications how many which journals and their decision to publish another one of his or her articles so you kind of just talk about I mean so we tried not to but that that would be the type of thing where we shouldn't give a very prominent author paper to a junior editor. Right. That should be at the level of the editor in chief, because that's a person, you know, of the highest stature versus the highest actor type thing. So, and that's what we do with the journal with pediatrics if there's somebody really well known that they'll do that. That's final round of applause. Thank you very much. Please join us next week. I'm hearing came we'll be talking about gender equity and research. And now we'll have the ethics fellows come down to this lower down here to have a more informal discussion. Great. Thank you very much everybody. Thank you.