Woman Editors-in-Chief of English-Language Medical Journals Published by the Japanese Professional Medical Associations

Gender inequality matters in the academic field globally, but Japan still lags behind the global movement; for example, the proportion of women medical doctors in Japan was a mere 21.8% in 2018, the lowest among the 34 countries belonging to the Organization for Economic Co-operation and Development . To further evaluate women participation and their contribution to the medical endeavor in Japan, we investigated the proportion of women Editors-in-Chief (EICs) in English-language medical journals published by Japanese professional medical associations (PMAs) as an indicator because their decisions on publication directly influence the value and trend of academic fields, especially when published in English for global readers .


Introduction
Gender inequality matters in the academic field globally, but Japan still lags behind the global movement; for example, the proportion of women medical doctors in Japan was a mere 21.8% in 2018, the lowest among the 34 countries belonging to the Organization for Economic Co-operation and Development (1) .
To further evaluate women participation and their contribution to the medical endeavor in Japan, we investigated the proportion of women Editors-in-Chief (EICs) in English-language medical journals published by Japanese professional medical associations (PMAs) as an indicator because their decisions on publication directly influence the value and trend of academic fields, especially when published in English for global readers (2) .

Methods
We identified EICs of English academic journals published by Japanese PMAs registered in the University Hospital Medical Information Network (UMIN), Japan's largest public research and education network. We subsequently collected data on their name, gender, institution, location, occupation, and specialty from each journal's website and their officially affiliated websites. Regarding gender, we made a comprehensive judgement based on name conformities and photos listed on the websites and the physician registry website by the Ministry of Health, Labour and Welfare. Also, we focused on the specialty of EICs instead of that of journals. We also confirmed accuracy of the data by contacting journal editorial offices when necessary. All data collection was conducted from April 2019 to August 2020.
Then, we conducted descriptive analyses of the obtained data. All the data analysis was done not on a journal basis, but on an EIC basis. Concretely, we first calculated a proportion of women in each EIC subcategory stratified based on occupation, affiliation, and specialty of EICs. Second, we compared the proportion of women who were medical doctor EICs and non-medical doctor EICs in the entire population and groups stratified with their affiliations. Ethical approval was obtained through the Ethics Committee of the Medical Governance Research Institution (approval number: MG2020-04-20200607).

Variable Editor-in-Chief Woman (N [%])
All 351 20 ( a Other professors include the assistant professor, associate professor, clinical professor, emeritus professor, specially appointed professor, and visiting professor. b This represents specialties of the Editors-in-Chief considered, instead of fields of medical journals. Consequently, in total, 122 Editors-in-Chief worked for journals with specialties that differ from the fields of journals. c Other includes rehabilitation, oriental medicine, environmental ecology, nursing, otorhinolaryngology, iPS and regenerative medicine, genetic medicine, plastic surgery, preventive medicine, urology, clinical laboratory, sports medicine, medical safety, medical ethics, palliative care, and health science. DOI: 10.31662/jmaj.2021-0008 JMA Journal: Volume 5, Issue 1 https://www.jmaj.jp/

Discussion
Only 6.2% of English medical journals in Japan had women EICs, which is considerably smaller than 12%-18% of similar studies reported from western countries (3), (4) . Particularly, there was only 2.9% of women among medical doctor EICs. There are two possible reasons. First, the presence of mentors can be associated with a successful career development, but women are less likely to have same-gender mentors and role models in the academic societies of Japan. This is because the absolute number of woman researchers, especially highranked medical doctors, is extremely low among the upper generation (5) . Second, sexual and gender discrimination or harassment have impaired the careers of Japanese women medical doctors and researchers. Particularly, a recent scandal illustrates the problem, where entrance examination scores of women applicants for medical schools were manipulated to be lower than those of men to restrict their entrance (6) .
As a study limitation, we could not elucidate the proportion of women members of each PMA, but it would also likely be very low considering the patriarchal nature of Japanese society. Still, our findings show that the Japanese academic society has a striking gender inequality regardless of specialties. It would not resolve in the foreseeable future without the implementation of a countermeasure. To improve women participation in the academic fields of Japan, creating better conditions is crucial by assigning women to higher positions in accordance with their skills. Further, considering lessons learned from experiences in leading countries in gender equality, policy-level interventions and activities by advocacy groups are both important to mitigate a dismal situation in the country (7) .

Conflicts of Interest
Dr. Ozaki received personal fees from Medical Network Systems outside the scope of the submitted work; Dr. Tanimoto received personal fees from Medical Network Systems and Bionics Co. Ltd. outside the scope of the submitted work.