Representation and Editorial Boards, Does it Affect the Science?

We’ve documented, as have numerous journals, the latest being The Journal of Bone and Joint Surgery, that editorial boards, surgeon society boards and, indeed, the membership of most orthopedic and surgeon societies do not match the gender, ethnic or racial characteristics of the patient populations they serve.

In addition, we’ve written extensively about the struggle to bring objective, non-biased scientific research to the practicing physician.

Medicine is a mission critical occupation—which is obvious, but unfortunately not so powerful a concept as to change medicine’s incentive structure which rewards publishers who reject 60% of all research submitted for publication and seems to push more dollars to the same labs year in and year out.

Perhaps it’s time to ask another simple question. What is the connection between lack of representation and the quality of the science being published in these journals or being included on programs at surgeon society meetings?

Is this yet another type of clinical study bias that can be defined and mapped? Maybe the answer is “yes,” because how you define a problem, particularly if it is based on your personal frame of reference, can affect how you articulate a “solution.” The answer may also be “no,” because the connection between gender, race and ethnicity, and the quality or rigor of orthopedic or spine research, does not have an immediately recognizable link.

Do we really think that only certain genders or ethnicities or races can do rigorous research? Hardly.

The newest study we’ve seen documents, again, the lack of racial/ethnic and gender representation on orthopedic journal editorial boards and found that it mirrors the lack of diversity and representation in academic orthopaedics overall. The study, “Racial/Ethnic and Gender Diversity of Orthopaedic Journal Editorial Boards,” appears in the March 6, 2024, edition of The Journal of Bone and Joint Surgery.

“In the current era of evidence-based medicine, scientific publications play a crucial role in guiding patient care,” said co-author, David Forsh, M.D., Chief of Orthopaedic Trauma, Associate Professor of Orthopaedics, Icahn School of Medicine, Mount Sinai Health System, to OTW. “While the lack of diversity among orthopaedic surgeons has been well documented, little is known about the diversity of orthopaedic journal editorial boards. The purpose of this study was to assess the racial/ethnic and gender diversity of U.S. orthopaedic journal editorial boards.”

The researchers included 876 editorial board members of 13 subspecialty and general orthopedic journals, using the 2021 journal impact factor to identify the most prominent U.S.-based journal in the field. Of the members of the editorial boards, 14.0% were Asian, 1.9% were Black, 1.9% were Hispanic, 2.4% were multiracial/other, and 79.7% were White.

They found no significant differences in minority representation between the different orthopedic subspecialties. The representation of racial/ethnic minority groups on journal editorial boards was similar to their representation in academic orthopedics (14.0% versus 14.1% for Asian, 1.9% versus 2.2% for Black, and 1.9% versus 2.1% for Hispanic). Asian representation was higher than that observed in the general U.S. population (6.0%), while Black and Hispanic representation was lower than that observed in the U.S. population (12.4% and 19.0%, respectively).

The overall representation of women was 7.9% (69 of 876). They determined that lower female representation was evident in adult reconstruction, spine, sports medicine, and trauma when compared with general orthopedics.

“In this study, the representation of racial/ethnic minorities and women on editorial boards was similar to their representation in academic orthopaedics,” said Dr. Forsh to OTW. “However, these values remain low in comparison with the population of patients treated by orthopaedic surgeons. Given the importance of scientific publications in the current era of evidence-based medicine, orthopaedic journals should continue working to diversify the membership of their editorial boards.”

In conclusion, this study along with several others, has established that editorial and surgeon society or foundation boards in orthopedics and spine do not have the same gender, ethnic or racial diversity profile as the patient populations they serve.

Is that a difference with a distinction or not? It’s time someone tackles that question, rigorously and objectively.