Editor's Note
October 30, 2023
Gender Equity in Clinical Trial Leadership—A Win-Win for Everyone
Grace Y. Zhang, Ishani Ganguli, Tracy Y. Wang
JAMA Intern Med. Published online October 30, 2023. doi:10.1001/jamainternmed.2023.5091
Gender disparity in clinical trial leadership has been described previously in fields such as cardiology.1 In this issue of JAMA Internal Medicine, Waldhorn et al2 demonstrate that this issue is more pervasive. They look across clinical trials of different medical specialties and report a persistent underrepresentation of women serving as principal investigators. This disparity was shown to exist in nearly every field other than rheumatology.
These findings have implications for gender inequity in academic medicine career success. Waldhorn et al2 found that trials led by women were less likely to be high-impact, practice-changing, or late-phase trials. This discrepancy limits women’s capacity to shape clinical practice and direct future research. It is not just about career progression, but also the power to steer scientific inquiry, which currently leans toward diseases predominantly affecting men. Additionally, clinical trials without woman leadership often face challenges in adequate representation of woman participants. As a consequence, clinical decisions about women patients are frequently based on data primarily from trials dominated by men participants.
The authors also found notable differences by specialty.2 Cardiology and hepatology trials had the lowest representation of woman leadership—both around only 20%. This disparity is striking considering the considerable effect of diseases from these fields on women. Heart disease remains the number 1 cause of death in women, and women have a higher risk than men of metabolic-associated steatohepatitis, which is a leading indication for liver transplant worldwide. Interestingly, rheumatology stood out with nearly equal gender representation in clinical trial leadership. This is a positive sign for patients with rheumatological diseases such as rheumatoid arthritis and systemic lupus erythematosus, which predominantly affect women.
On a hopeful note, Waldhorn et al2 demonstrated a rise in women leading clinical trials from 27% in 2005 to 40% in 2023. However, greater efforts to equitably distribute study leadership roles and promote broader transparency in reporting gender statistics for clinical trial leadership, beyond principal investigators, are still very much needed. Male leaders may ask what the cost to future male academic leaders is in the drive to increase woman leadership in clinical trials. But studies have shown that woman leaders often demonstrate more transformational leadership styles that do not compromise male leadership contributions.3 Collaborative problem-solving of study challenges may also be improved with a higher proportion of women on the study team. Prioritizing woman leadership in clinical trials is a win-win and crucial for academic and scientific equality, improving clinical care, and, ultimately, the welfare of patients.
