Reviewer's□report 
□Representation□of□women's□health□in□general□medical□versus□women's□health□specialty□journals:□A Title: 
content□analysis 
Authors: 
Jocalyn□P□Clark□( j.clark@utoronto.ca )
Georgina□D□Feldberg□( ginaf@yorku.ca )
Paula□A□Rochon□( paula.rochon@utoronto.ca )
□1□ □12□May□2002 Version: Date: 
□Ms□Tammy□Clifford Reviewer: 
□A□paper□of□considerable□general□medical□or□scientific□interest Level□of□interest: 
□Accept□after□discretionary□revisions Advice□on□publication: 
DISCRETIONARY□ 
1.□Background/2nd□paragraph/re:□statement□"Optimal□health□care□is□said□to□draw□upon□a□broad□definition□ 
of□women's□health..."□ 
Does□this□statement□refer□to□optimal□health□care□for□WOMEN□ONLY□or□is□it□believed□that,□by□drawing□ 
upon□a□broad□definition□of□women's□health,□health□care□can□be□optimized□for□ALL?□ 
2.□Methods/Sample□Selection/1st□paragraph.□It□is□noted□that□"original□investigations"□were□selected□for□ 
inclusion.□Could□the□authors□be□more□specific□here?□For□example,□were□research□letters□included?□What□ 
about□brief□reports?□Was□any□study□design□eligible?□(The□answer□to□this□latter□point□becomes□obvious□ 
later□in□the□article□but□it□would□be□helpful□to□state□this□up-front).□ 
3.□Methods/Sample□Selection/2nd□paragraph:□I□would□suggest□that□this□statement□requires□clarification,□ 
vis-a-vis□"leaving□a□TOTAL□of□514□GM□and□82□WS□articles."□I□found□the□word□"Total"□misleading□as□the□ 
final□sample□includes□99□GM□articles.□Perhaps□this□could□be□reworded□along□the□lines□of□"....were□ 
included,□PROVIDING□AN□INITIAL□sample□of□514□GM...."□ 
4.□Methods/Content□Analysis□of□Articles/final□paragraph:□ 
i)□The□authors□report□a□very□high□level□of□inter-rater□reliability.□Could□any□of□this□agreement□have□been□ expected□by□chance?□That□is,□would□a□kappa□statistic□be□more□appropriate□here?□ ii)□top□of□p8,□delete□the□square□bracket□ahead□of□(10,11).□ 
5.□Results□-□It□is□noted□that□"the□remaining□11□(11.1%)□were□of□mixed-SEX."□Would□the□term□ 
"mixed-gender"□be□more□appropriate?□ 
6.□Discussion/4th□paragraph:□The□authors□are□a□bit□hard□on□themselves□when□they□allude□that□articles□ 
higher□up□the□hierarchy□of□evidence□(RCTs)□tend□to□be□of□higher□quality□&□thus,□are□the□ones□to□get□ published□in□the□GM□journals□whereas□topics□less□amenable□to□RCT□design□end□up□in□non-GM□journals.□ This□is□especially□true□since□many□works,□including□those□by□Rochon□et□al□and□Moher□et□al,□have□shown□ 
that□many□reports□of□RCTs□are□less-than-optimal.□Furthermore,□it□is□as□easy□to□do□a□"bad"□RCT□as□it□is□to□ 
do□any□other□type□of□study□badly.□Perhaps□the□issue□lies□in□the□difficulty□assessing□reporting□quality□and□ 
how□to□interpret□measures□of□quality□when□moving□from□one□study□design□to□another.□I□was□pleased□to□ 
see□the□authors□comment□on□the□need□to□devote□further□energies□into□establishing□(or,□at□the□very□least,□ 
discussing)□issues□of□quality□-□particularly□across□types□of□journals.□ 
7.□Discussion/paragraph□1.□With□reference□to□the□observation□that□approximately□20%□of□GM□original□ 
investigations□were□devoted□to□women's□health,□the□authors□note□that□"this□is□encouraging...."□Has□this□ 
value□changed□over□time?□Are□there□any□previous□estimates?□ 
8.□Discussion/2nd□paragraph:□The□authors□correctly□note□that□JAMA□has□published□a□second□theme□ 
issue□on□women's□health□&□that□they□are□the□only□leading□GM□journal,□thus□far,□to□do□so.□The□Lancet,□too, 
has□recently□devoted□a□series□of□articles□to□"Violence□against□Women;"□I□am□sure□that□the□authors□are□ 
familiar□with□this□series□but□were□unable□to□include□them□in□this□paper□since□it□may□have□been□submitted□ 
prior□to□publication□of□The□Lancet□series.□If□it□is□not□too□much□trouble,□perhaps□the□authors□could□include□ 
a□comment□on□The□Lancet's□recent□work?□ 
9.□Conclusion□-□The□authors□note□that□"...leading□GM□journals□have□wide□impact..."□Could□this□statement□ 
be□made□more□precise?□That□is,□on□what,□exactly,□do□the□leading□GM□journals□have□an□impact?□On□the□ 
basis□of□impact□&□citation□factors,□yes,□but□there□are□issues□with□these□values.□Is□there□evidence□to□ 
suggest□that□these□journals□impact□on□the□practise□of□medicine,□policy,□research□priorities?□I□am□not□sure□ 
there□is□a□definitive□answer□to□this□question□-□by□all□the□leading□indicators□(impact,□citation,□immediacy,□ 
circulation),□this□statement□is□true□but□we□know□that□much□of□medicine□is□not□based□on□evidence.....□ 
COMPULSORY□ 
1.□Background/final□paragraph.□The□authors□indicate□the□objective□of□this□study□but□do□not□provide□a□ 
hypothesis.□Could□the□authors□indicate□what□they□expected□to□find,□a□priori?□ 
2.□Methods/Identification□of□Women's□Health□Articles:□ 
i)□Who□identified□all□88□articles□that□studies□women-only□samples?□(The□authors□indicate□in□the□3rd□line□ 
of□this□paragraph□that□"we"□identified□them).□ 
ii)□As□well,□were□the□authors□the□3□independent□reviewers□who□read□all□514□titles?□If□so,□could□this□be□ indicated□by□by□placing□each□of□the□three□authors'□initials□in□parentheses.□ 
iii)□Related□to□this□statement,□were□searches□for□keywords□restricted□to□the□titles□or□were□the□reviewers□ 
also□permitted□to□view□abstracts□&□keyword□lists?□ iV)□Who□performed□the□"more□detailed□review"□to□confirm□all□GM□&□WS□articles□were□relevant?□ v)□Who□were□the□two□independent□coders?□Again,□could□these□individuals□be□identified□by□placing□their□ 
initials□in□parentheses?□vi)□while□it□was□noted□that□discrepancies□were□resolved□by□consensus,□was□there 
ever□a□need□for□a□third□individual□to□"mediate"□or□"break"□the□tie?□ 
3.□Results/Representation□of□Women's□Health□Issues:□in□two□instances,□the□category□of□HIV/AIDS□needs 
to□be□supplemented□with□STDs□(i.e.,□HIV/AIDS/STDs),□as□per□tables.□ 
4.□Results/Representation□of□Women's□Health□Issues/final□paragraph□on□p10□(the□paragraph□referring□to□ 
Figure□1).□When□detailing□the□break-down□of□study□designs□used□in□the□GM□articles,□these□sum□to□97□not□ 
to□99.□ 
5.□References.□The□URL□for□Ref□#2□(Moore□et□al)□is□no□longer□available.□The□URL□for□Ref□#5□should□ 
include□a□hyphen□between□the□hc□and□sc□(i.e.,□wwwnfh.hc-sc.gc.ca.....)□ 
Competing□interests: 
None□declared.