Diversity, equity, and inclusion in ASH guidelines – Authors’ reply
Authors: Jeremy W Jacobs, Garrett S Booth, Julie K Silver
Journal: The Lancet Haematology (2024)

We 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.1Jacobs JW Martin AA Stephens LD et al.Gender composition and geographical representation of American Society of Hematology clinical practice guideline authors.Lancet Haematol. 2024; 11: e182-e183Summary Full Text Full Text PDF PubMed Scopus (0) Google Scholar The authors stated that we "conflate CPG authorship with panel membership." To conflate is to combine two or more ideas or datasets into one or to confuse or not properly differentiate them, potentially generating erroneous conclusions. We used only one dataset—CPG author positions. The term "panel" or any variation was not used in our report, thus we did not conflate authorship with panel membership. A 2018 report demonstrated under-representation of women as CPG authors,2Merman E Pincus D Bell C et al.Differences in clinical practice guideline authorship by gender.Lancet. 2018; 392: 1626-1628Summary Full Text Full Text PDF PubMed Scopus (43) Google Scholar and numerous studies have since used this metric. Nevertheless, the authors assert that panel membership is a better metric. They explain the ASH Guideline Oversight Sub-Committee began collecting self-reported demographics in 2021, with five CPG panels convened since, comprising 50% women. Panelists who "meaningfully participate" are offered authorship. We do not know whether CPGs have been published with 50% women panelists, but in 2022, women held 64 (41%) of 155 CPG authorship positions, and in 2023, women held 12 (34%) of 35 such positions. Research shows that women are credited less than men in science, which is partly attributed to a paucity of acknowledgment of their contributions.3Ross MB Glennon BM Murciano-Goroff R Berkes EG Weinberg BA Lane JI Women are credited less in science than men.Nature. 2022; 608: 135-145Crossref PubMed Scopus (128) Google Scholar A list of panelist contributors was not available. The authors question the gender-coding method used in workforce equity studies,4Jagsi R Chapman CH Silver JK Determining identity in medical research.BMJ. 2023; 3832410Google Scholar suggesting it is subject to bias, but self-identification is limited by response rates and also has potential bias.4Jagsi R Chapman CH Silver JK Determining identity in medical research.BMJ. 2023; 3832410Google Scholar ASH denied our formal request for de-identified self-identification data, stating they were performing a similar internal assessment. Peer researchers are crucial for ensuring accountability, and refusal of information by ASH because of the desire to publish internally contradicts the authors' assertion that ASH supports scrutiny of guidelines. We applaud ASH's equity efforts. Future analyses should include comparisons of both panelists and authors, and greater transparency with equity researchers. JKS has no disclosures related to this Correspondence; unrelated to this Correspondence, she reports participating in research funded by the Binational Scientific Foundation and community programming from the Cummings Foundation, and is an advisor to Simplifed and a venture partner at Third Culture Capital. All other authors report no competing interests. Diversity, equity, and inclusion in ASH guidelinesJeremy W Jacobs and colleagues1 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. 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