Gilbert Martin, MD

Many years ago (March 1991), I wrote an editorial for the Journal of Perinatology entitled: Peer Review: Guerir Quelquefois Soulager Souvent, Consoler Toujours. This quotation thought to be from medieval times has had many definitions but basically is defined as “to cure sometimes, to relieve often, to comfort always.” In my monograph, I referenced David Horrobin (1939-2003), who was a longtime critic of the anonymous peer review system. In an article discussing the philosophical basis of peer review, he was concerned about the peer review system stifling creativity and innovation (1). He believed that the true aim of the peer review was the same as medicine: To cure sometimes, to relieve often, to comfort always. 

As physicians interested in an academic career, we are taught early that we had to “publish or perish.” This is an aphorism which puts pressure on academics to publish in scholarly journals as a condition for employment and career advancement. When our applications for employment or advanced ranking are reviewed, the bibliography is always scrutinized and can be the basis of success or failure. 

In the last few months with a great emphasis on needed information on Covid-19, there are have been several retracted articles, but most noteworthy, these pieces were retracted from The New England Journal of Medicine and the Lancet, two of the most respected international publications 

The number of articles retracted has increased in recent years. Research integrity has been questioned, and misconduct is often emphasized. It remains a question of whether the peer-review process has become flawed and too lenient. Are more cases occurring, or with the benefit of computerization, are we able to become justifiably more critical? It is difficult not to plagiarize minimally, and journal editors now have “plagiarism-detecting software” at their disposal. 

Peer-review functions as a mechanism to support quality, to provide a fertile breeding ground for dissension and improvement in the “final product.” This peer review assists the editorial board of a journal to decide whether or not the submission can be accepted, accepted with revisions, or rejected. Therefore this process needs to be objective and complete. After this degree of scrutiny, there should be no place for retraction of an article if the process was satisfied. 

In the early days of peer-review, the material was sent to anonymous reviewers, and a generous amount of time was allowed for this review. In today’s world, there are always comments by the reviewers, which can go back and forth between author and reviewer. In fact, some journals encourage the submitting authors to suggest reviewers for their material 

Am I surprised that retractions can occur?. Not at all….. for in order to present information to the public quickly, which can be important for health-care professionals, short-cuts and impediments to the full process are roadblocks to objectivity. 

The retraction of an article from a well- established, well respected medical journal should be considered a failure of the peer-review process. Journal editors must use reviewers who have credentials, are free of bias and can offer objective opinions 

One approach may be to use checklists and algorithms to make the process simpler. Questions with yes or no answers such as “Is the material well-organized?”; “are the facts accurate?”; “is the information up to date?”; and “is the style clear, informative, and readable?” will immediately simplify and shorten the entire process 

I hope that when I am asked to review an article, I am chosen because of my expertise in the field and not a colleague (friend or foe?). I often chuckle when the letter from the editor asks that I complete my review in a short period of time. The shorter the period of time allowed often results in an inferior review. 

In the future, the Guidelines for Contributing Author’s page may end up as an instruction manual. There will be confusion, frustration, and the work necessary to produce a manuscript will increase. Perhaps, then, the number of submissions will decrease, the workload to the referees will lessen, and the entire process will be improved. 

References: 

1. Horrobin DF. The philosophical basis of peer-review and the suppression of innovation. JAMA 1990; 263:1438-41.