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From the Editor's Notebook |
rstanley{at}ajroffice.org
On one hand, Dr. Drummond Rennie, deputy editor of the Journal of the American Medical Association, stated in the article, "The more we look into it, the harder it is to prove it does good or bad" [1]. He proposed that "It would be lovely to start anew and to set up a trial of peer review against no peer review, but no journal is willing to risk it" [1].
On the other hand, Dr. Jeff Drazen, editor of the New England Journal of Medicine, cited in the same article, did not find that the system was broken and in need of overhaul and supported maintaining the review system, with the reviewers remaining anonymous and uncompensated for their efforts [1].
Over the weekend of September 17–18, the Fifth International Congress on Peer Review and Biomedical Publication was held in Chicago. An assortment of presentations covered such topics as bias and conflict of interest in reporting results, the value of open access for increasing the visibility of relatively obscure journals, and the effectiveness and mechanism of blinding in the review process. Several speakers at the Congress supported the notion that "blinded" reviewers, who do not know_the identity of the authors, are less likely to exhibit bias in their assessment of a study, than otherwise.
We recently surveyed the reviewers of the AJR to determine whether no blinding, single blinding (identity of the author is revealed to the reviewer), or double blinding (identities of authors and reviewers are withheld from each other) would be preferred. The double-blinding process was overwhelmingly preferred, and therefore no changes were made in the existing AJR peer review process.
No formal conclusions were reached at this Congress, since it was intended primarily for discussion of relevant topics rather than decision-making (log on to Web site listed in the second reference for a summary of the proceedings) [2]. However, discussions at the Congress along with issues raised in the Boston Globe article do raise some interesting questions and some interesting points, most importantly: What is the role of the peer review process?
Most might say that the role of the peer review process is primarily to determine appropriateness and relevance and to search for error and, secondarily, to detect fraud, conflict of interest, and plagiarism. I would agree with that, recognizing that home institutions are in a better position to and have a duty to oversee inappropriate behavior. We encourage our reviewers to be rigorous and diligent in their reviews [3], to use the Internet and on-line library resources liberally for checking references or scanning articles on the same topic, and to maintain their vigilance for the potential of conflict of interest, where a commercial interest is involved.
I also would argue that the peer review process is designed to allow thoughtful input from expert reviewers that promotes research and encourages scientific discussion. I encourage our reviewers to accept articles that discuss procedures and advances that may not be mainstream and that, though preliminary, could cause an impact on the practice of radiology. A good journal raises consciousness and, indeed, sometimes raises eyebrows, and I know when we've done both by the volume of letters to the editor we receive.
The peer review process also brings possible errors, plagiarism, and exaggeration to the attention of the editor and readers of the journal, along with the new ways of thinking about radiology and doing radiology.
Medicine is not a precise science. Looking back at the early issues of the AJR, one can find all sorts of statements that by current standards and knowledge are outrageously wrong. Because the accumulation of scientific knowledge is moving very fast, things that were considered correct just 10 years ago now are demonstrably erroneous. But that doesn't mean that the peer review system failed during that period of time. In fact, it probably succeeded on all points—serving as a gatekeeper to prevent the dissemination of truly egregious information while encouraging the debate necessary for moving our field of medicine forward.
References
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