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Irogers{at}ajroffice.org
"Blinding," of course, is shorthand for the withholding or deleting of all statements in a manuscript that refer to the authors, their previous work, and the institutions at which the research or clinical service was performed. Most reviewers of manuscripts in diagnostic radiology would be uncomfortable knowing the authors of manuscripts being reviewed. However, outside of radiology, blinding of manuscripts is rare.
Is blinding good for science or bad for science? Does blinding lessen the opportunities for bias? Does blinding improve the assessment of manuscripts?
Alas, I fear there is no right or wrong answer to this vexation: it comes down to a matter of opinion. Good parties, honest and true, will be found on both sides of the debate; some insist on blinding, and others will just as adamantly maintain that blinding is unnecessary.
While recognizing that the blinding of manuscripts is not a perfect system, the AJR comes down on the side of blinding in the belief that it is better for all concerned and easier for the reviewer not to know than to know the source of the manuscript being reviewed. In our judgment, knowing the source of the manuscript introduces a potential bias that is best avoided: such a bias actually lies beyond the validity of the information contained in the paper under review.
Those who oppose blinding say that it is unnecessary because the reviewer's knowing the names of authors or their institutions will have no impact on the reviewer's opinion of the manuscript. Frankly, I find that hard to believe. Knowing the names of authors and institutions cuts both ways, both positive and negative. First, such knowledge may cause reviewers to question their own judgment, particularly if the authors are well known and respected by the reviewer. After reading a manuscript, the reviewer could wind up in a quandary: "I don't really think much of this paper; however, the authors are well-known experts in this field." Or alternatively: "...but the paper comes from such a fine institution. Maybe it is just me. I must be wrong." Second, knowing the names of authors and institutions may arouse latent hostility due to former actual or perceived slights, such as: "I'll show them. I always wanted to get back at those jerks for rejecting my application for residency." Or alternatively: "...for not inviting me to be a visiting professor."
It is the information contained in a manuscript, not the source of the information, that should make the difference in a reviewer's assessment as well as the ultimate decision to accept or reject that manuscript for publication.
That said, it is not all that easy to ensure that nothing appears in a manuscript that might reveal its source. For a thorough discussion on this subject, go to the article by Katz et al. [1] in this issue. These authors reviewed a large series of articles submitted to—yes, believe it or not—Radiology and RadioGraphics to see if the identities of authors or institutions could be determined. Katz et al. were able to do so for roughly one third of the submissions. They conclude that all authors should give more attention to and take greater care with blinding manuscripts. I wholeheartedly agree.
Having said that, I am reasonably certain that most authors do not deliberately unblind their manuscripts but rather do so unwittingly, unmindful of and somewhat oblivious to the requirements for blinding. In the text of the original submission, authors should not state the name of the institution at which the work was performed, nor directly refer to their previous work, nor give initials of the authors, nor leave names of the institution on illustrations, nor write names of authors on labels on the back of illustrations. In the final revision of the manuscript, as it is prepared for final editorial acceptance, such references may be restored. Although there is no reason this information should not appear in the published paper, such information should never be included in a manuscript submitted for review.
Read the article by Katz et al. [1] and take greater care to blind your next manuscript. At the AJR, reviewers and editors will be glad that you did.
Speaking of blinding, your editor was absolutely blind-sided by the receipt of the manuscript from Katz et al. [1]. That is so because his coauthors were none other than Tony Proto, Editor in Chief of Radiology, and Bill Olmsted, Editor in Chief of RadioGraphics. These latter two gentlemen are long-time acquaintances and friends of mine, and Doug Katz is a fine reviewer for and contributor to the AJR. These authors had given no warning that we would receive such a manuscript: no letter, no phone call, no e-mail, no nothing. What were we to do? Dismissing the possibility that this might be a hoax, we sent the manuscript to two highly regarded reviewers: one a current editor and the other a former editor (but not of the AJR in either case). The reviewers (who, of course, were blinded to the author's identities) performed thorough, insightful reviews—so thorough, in fact, that the article was actually "RJRed," as we say here in Winston-Salem: rejected but with permission to resubmit (RJR) after extensive revision. The authors responded to the challenge, undertook the requested revision, and the revised manuscript was ultimately accepted.
The question arises, "Why on earth would these authors send their article to the AJR?" That is a fair question, but we never asked. We did, however, conjecture. Knowing them for the good men that they are, we concluded that they desired a fair and unbiased judgment of their work and that publication in a journal other than their own would give greater credibility to their work. That may well be true.
Sending the article to the AJR was a matter of trust and faith, evidence of the collegiality in our specialty. I am proud of them, proud of us, and proud of radiology. Is this a great specialty, or what? The contemplation of our good fortune only adds to the joys of the season.
The best to you and yours this holiday season!
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  D. S. Liebeskind, D. S. Katz, A. V. Proto, and W. W. Olmsted The Fallacy of Double-Blinded Peer Review Am. J. Roentgenol., November 1, 2003; 181 (5): 1422 - 1423. [Full Text] [PDF]
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