Diversity, equity, and inclusion in ASH guidelines
Authors: Matthew D Seftel, Deirdra Terrell, Adam Cuker, Matthew Cheung, Menaka Pai
Journal: The Lancet Haematology (2024)

Jeremy W Jacobs and colleagues1Jacobs JW Martin AA Stephens LD et al.Gender composition and geographical representation of American Society of Hematology clinical practice guideline.Lancet Haematol. 2024; 11: e182-e183Summary Full Text Full Text PDF PubMed Scopus (0) Google Scholar question the representativeness of the American Society of Hematology (ASH) clinical practice guideline (CPG) authorship. ASH is committed to diversity, equity, and inclusion in all of its work; we support scrutiny of ASH guidelines to ensure that this commitment is upheld. However, several items in their paper merit clarification. Jacobs and colleagues conflate CPG authorship with panel membership. Panel members who meaningfully participate in the entire CPG process are offered authorship. Authorship also includes individuals from an externally sourced methodology team, the demographics of which ASH does not control. Consequently, panel membership, not final authorship, is a better reflection of ASH's efforts to facilitate demographic balance during the CPG process. ASH requests that panel members self-identify their gender. In contrast, Jacobs and colleagues infer gender from online gender specifications, photographs, and author names. Gender is based on one's own identity, presentation of self, and interaction with others. Established principles for measuring gender identity in health care emphasise respect for autonomy and recommend use of self-identification.2National Academies of Sciences, Engineering, and MedicineMeasuring sex, gender identity, and sexual orientation. The National Academies Press, Washington, DC2022Google Scholar Thus, perceived gender can be challenging and subject to classification bias. The panels of the analysed CPGs were assembled before the ASH Guideline Oversight Sub-Committee began collecting self-reported demographics in 2021, with the aim of enhancing panel diversity. Five CPG panels have since been constituted. Of the applicants for these panels, 213 (45%) of 477 were women. Ultimately, 72 (50%) of 143 panel members are women; this enrichment evidences ASH's efforts to support gender parity during panel vetting. We recognise that many ASH CPGs target North American end-users. At the outset, ASH's CPG initiative, constrained by available resources for production and dissemination, focused on high-resource settings. The scope of the initiative is expanding to meet the goal of global clinical relevance. The upcoming ASH CPG on aplastic anaemia has a deliberate international perspective, as aplastic anaemia is disproportionately encountered in low-resource settings. ASH also works with non-North American societies to ensure that CPGs are adapted for local relevance; one example is ASH's collaborative effort with 12 Latin American haematology societies to adapt guidelines on the management of venous thromboembolism for their region.3Neumann I Izcovich A Aguilar R et al.ASH, ABHH, ACHO, Grupo CAHT, Grupo CLAHT, SAH, SBHH, SHU, SOCHIHEM, SOMETH, Sociedad Panameña de Hematología, SPH, and SVH 2021 guidelines for management of venous thromboembolism in Latin America.Blood Adv. 2021; 5: 3032-3046Crossref PubMed Scopus (6) Google Scholar ASH has shown a sustained commitment to promoting diversity, equity, and inclusion, as evidenced by its Minority Recruitment Initiative, Health Equity Collective, and Women in Hematology Working Group. ASH's goal is to bring diverse, representative voices to every table, including CPG panels, to ensure that we capture a range of experiences and perspectives, serve the broader community, and combat inequities in our field. MDS, DT, AC, MC, and MP are all members of the American Society of Hematology (ASH) Guideline Oversight Sub-Committee. Diversity, equity, and inclusion in ASH guidelines – Authors' replyWe thank Matthew D Seftel and colleagues for their comments on our study assessing the gender composition of American Society of Hematology (ASH) clinical practice guideline (CPG) author positions.1 Full-Text PDF Gender composition and geographical representation of American Society of Hematology clinical practice guideline authorsClinical practice guidelines (CPGs) are often constructed, endorsed, and supported by professional medical societies. These publications influence how medicine is practiced, how care is delivered, and how resources are distributed. Despite an increasingly formal development process, there is mounting evidence that there is underrepresentation of both women experts (eg, in the CPGs from the American Academy of Neurology and pathology CPGs) and women physicians as CPG authors. Full-Text PDF