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Cracking under the pressure?

Peer review: how to work with a system that has been heavily criticised in recent years
Nut cracking

The practice of peer review is widely considered to be vital in ensuring the quality and credibility of the scientific record, and is arguably the most essential step in medical publishing. However, in recent years, peer review has received much criticism from editors, academics, industry and those working in medical education – the most frequently cited being lengthy review timelines, and unconstructive, irrelevant or biased comments.

Almost all of us will have at least one story to tell of a submission made unnecessarily painful by delayed reviews, requests for additional analyses that add little to the paper, or unhelpful feedback that demonstrates personal bias. Luckily, these experiences are relatively rare, with the majority of reviewers delivering well thought-out critiques that result in high-quality papers.

One limitation of the process stems from the difficulty in sourcing appropriate reviewers. In a world where transparency relating to authors' conflicts of interest  – their role in study planning, conduct, data analysis and interpretation, and drafting/critical review of the manuscript – is demanded, should there not be a similar emphasis on the suitability of peer reviewers? Could a set of criteria be developed and implemented to help journals source suitable candidates?

The comments should come from a peer who can challenge the authors and bring about real improvements, whereas at present, those that qualify are not always required to have the relevant level of expertise, or familiarity with the type of study/analysis conducted, but rather may have time available to review a manuscript. The practice of sending manuscripts out to reviewers who are simply free to undertake the work undermines the validity of the process. With an increasing number of submissions and pressure on editors to speed up review, it is likely that the situation will deteriorate in the near future.

With regard to conflict of interest, although we have to accept that few suitable peer reviewers are free from conflict, should the reader not be made aware of potential bias? Furthermore, it would be useful for the reader when assessing a piece of research, and would help stimulate scientific debate, if review reports were published in full alongside the final published article.

A system of open review would potentially discourage the submission of biased or unhelpful comments if reviewers knew that their names would be made known to the authors and, in some cases, that the review would be published on-line alongside the manuscript. Several journals have in recent years attempted to implement open review systems, with varying degrees of success, the most publicised being Nature's posting of articles for public comment in 2006.

Despite the evident weaknesses in the system, peer review continues to be a valuable and well-respected process, and will not be supplanted in the foreseeable future. Thus, we owe it to the authors we assist, and to our clients, to guide them successfully through any obstacles that may arise at peer review, ensuring that we actively address such issues during manuscript development, and by pushing back where necessary on comments received from seemingly biased or ill-equipped reviewers. It is also the responsibility of all stakeholders (be it academe or industry) to work closely with publishers to iron-out bad practice and bring about a real change in the way in which reviewers are recruited and their interests reported – ultimately building a stronger, more robust peer review system.


Leyna PrinceMedicus InternationalThe Author
Leyna Prince
, editorial director, Medicus International
Email her at:




29th March 2011


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