SAO PAULO
J ""
:~::ED':
'le A L : ""; i.,0 ,1
ID 1\T
~ ;: :,::,
::,
; ':'lJ l\l't
~ '
Robert H. Fletcher
Inside medical journals
Harvard Medical School-
Boston, MA, USA
T ru stw o rth y in fo rm a tio n a b o u t a d v a n c e s in m e d ic a l c a re
is m a d e a v a ila b le in its m o st c o m p le te a n d b a la n c e d fo rm in
p e e r re v ie w e d m e d ic a l jo u rn a ls. T h e jo u rn a ls a re re sp e c te d b u t
p o o rly u n d e rsto o d . B o th a u th o rs a n d re a d e rs h a v e a sta k e in
u n d e rsta n d in g h o w p e e r re v ie w a n d e d ito ria l d e c isio n s a re d o n e
so th a t th e y c a n m a k e m o re e ffe c ti v e u se o f jo rn a ls.
S u z a n n e F le tc h e r a n d I h a v e e x p e rie n c e d jo u rn a ls a s a u
-th o rs a n d re a d e rs, a s e d ito rs o f A n n a ls o f In te rn a l M e d ic in e ,
th ro u g h o u r re se a rc h o n e d itin g p ra c tic e s, a n d b y m a n y d isc u
s-sio n s w ith o th e r e d ito rs. W h a t fo llo w s is g e n e ra lly in c o m m o n
w ith p e e r re v ie w e d jo u rn a ls th ro u g h o u t th e w o rld , th o u g h sp e
-c ifi-c p ra -c ti-c e s v a ry fro m jo u rn a l to jo u rn a l.
T h e p u rp o se o f p e e r re v ie w a n d e d itin g is to se le c t m a n u
s-c rip ts fo r p u b lis-c a tio n a n d to im p ro v e th e c o m p le te n e ss, b a la n c e
a n d c la rity o f th e p re se n ta tio n . R e v ie w is n o t a n e ffe c tiv e w a y
o f a ssu rin g th e a c c u ra c y o f th e d a ta . T h e tim e a n d e ffo rt in p e e r
re v ie w , b e y o n d w h a t w o u ld b e n e c e ssa ry to ju st p u b lish th e
m a n u sc rip t a s re c e iv e d , isju stifie d b y th e p o ssib ility o f m a k in g
th e re su lts m o re u se fu l a n d so re d u c in g th e tim e fro m re se a rc h
id e a to u se o f th e re su lts o f re se a rc h in p ra c tic e .
M a n u sc rip ts su b m itte d to jo u rn a ls a re se n t to e x te rn a l re
-v ie w e rs - ty p ic a lly tw o in a c a d e m ic p o sitio n s w h o sp e n d a n
a v e ra g e o f th re e h o u rs re v ie w in g th e m a n u sc rip t a n d a re n o t
p a id fo r th is w o rk . S o m e m a n u sc rip ts, w ith little c h a n c e o f su c
-c e ss, a re re je -c te d w ith o u t re v ie w , to sa v e a u th o rs' a n d re v ie w
-e rs' tim -e . R -e v i-e w -e rs a re c h o se n to h a v e c o m p le m e n ta ry e x p e
r-tise - fo r e x a m p le , o n e in c o n te n t a re a (su c h a s c o n g e stiv e
h e a rt fa ilu re o r a m o e b ia sis) a n d th e o th e r in th e m e th o d s (su c h
a s ra n d o m iz e d tria ls o r c a se -c o n tro l stu d ie s). R e v ie w e rs a n d
e d ito rs ju d g e m a n u sc rip ts o n se v e ra l d im e n sio n s: im p o rta n c e
o f th e q u e stio n , m a tc h w ith th e re a d e rs' in te re sts, sc ie n tific
stre n g th o f th e m e th o d s, a n d q u a lity o f th e w ritin g . R e v ie w e rs
a re a sk e d to p ro v id e c o n fid e n tia l c o m m e n ts fo r a n d e x te n siv e
su g g e stio n s fo r th e a u th o rs. T h e a c c e p ta n c e ra te d e p e n d s o n th e
n u m b e r o f m a n u sc rip ts re c e iv e d a n d th e sp a c e a v a ila b le in th e
jo u rn a l. F o r la rg e , h ig h ly c o m p e titiv e jo u rn a ls a c c e p ta n c e is 1 5
-2 0 % ; fo r th e m a jo rity o f th e w o rld 's jo u rn a ls, w ith c irc u la tio n
u n d e r 5 ,0 0 0 , it is h ig h e r. R e v ie w e rs c o m m o n ly d o n o t a g re e o n
th e ir re c o m m e n d a tio n s fo r o r a g a in st a c c e p ta n c e , w h ic h m ig h t
b e e x p e c te d sin c e th e y h a v e d iffe re n t p e rsp e c ti v e fro m e a c h o th e r
a n d fro m th e e d ito rs. F in a l d e c isio n s a re ju d g e m e n ts m a d e b y
e d ito rs a n d th e ir sta ff, n o t th e re su lt o f c o u n tin g re v ie w e rs' v o te s.
T h e in itia l re v ie w s ta k e 1 0 o r m o re w e e k s a n d u su a lly le a d to
su g g e stio n s fo r im p ro v e m e n t w h e th e r o r n o t th e m a n u sc rip t is
a c c e p te d .
H o w e ffe c tiv e is p e e r re v ie w a n d e d itin g ? M o st e d ito ria l
p ra c tic e s a re su p p o rte d b y tra d itio n a n d a rg u m e n t, n o t re se a rc h .
In a se rie s o f stu d ie s o f p e e r re v ie w a n d e d itin g , w e h a v e a
s-se ss-se d so m e c o m m o n p ra c tic e s. W e sh o w e d , in a ra n d o m iz e d
c o n tro lle d tria l, th a t "b lin d in g " re v ie w e rs to a u th o rs' n a m e s a n d
in stitu tio n s im p ro v e s th e q u a lity o f re v ie w s. R e v ie w e rs te n d e d
to b e b e tte r is th e y a re e a rly in th e ir c a re e r, a n o b se rv a tio n th a t
is su p p o rte d b y th e o n ly o th e r p u b lish e d stu d y o f th is q u e stio n
a n d is c o n tra ry to c o n v e n tio n a l w isd o m . In a stu d y o f h o w th e
q u a lity o f re p o rtin g c h a n g e s fro m re c e ip t o f m a n u sc rip ts to p u b
-lic a tio n , w e sh o w e d th a t n e a rly a ll a sp e c ts o f re p o rtin g im p ro v e ,
e sp e c ia lly d isc u ssio n o f lim ita tio n s a n d g e n e ra liz a b ility a n d th e
b a la n c e o f c o n c lu sio n s. R e a d in g le v e l fo r p u b lish e d a rtic le s w a s
d iffic u lt (a b o u t g ra d e 1 6 ); it w a s im p ro v e d a little b y re v ie w
a n d e d itin g .
