Peer Review: It Should Be an Honorary Process

As an editor of a major surgery journal “SURGERY” now for 22 years, when it comes to the topic of whether peer-reviews should be single-blinded, double-blinded, or fully open reviews, I fully acknowledge the stance of these 3 “reviewers” at their 3 different stages of their careers. Yes, each type of peer-review has its advantages, but each also has certain disadvantages that need to be considered as well. With all these considerations, ultimately, the final decision as to publication really depends on the editor—after all, that is his or her responsibility and his or her decision. I can assure you that as an editor of a top shelf, scientific journal, this topic has been debated in our editorial board meetings many times, but always with the same conclusion that I will address now. It is imperative as well as our responsibility as an editor to get to know our reviewers and have personally screened them in the past for any upfront bias and for the fairness of their reviews; thus we (should) have developed a confidence in their reviews and in their opinions. We must never forget that the reviewers give their time and expertise for free (what I call “academic citizenship”) which supports the academe of our profession. Quite frankly, we as editors are more concerned with the authors, many of whom we and our reviewers may not know, but also many of whom we do. The job of the reviewers and of the editor is to provide a nonbiased, fair, and usually comprehensive assessment of the work and to be supportive in every way possible to help the authors. And importantly, a good editor needs to uphold the reputation of both himself/herself as a nonpartisan editor and the reputation of the journal as being fair, open, and nonbiased. At some point, we as academicians need to place some faith in the time-honored system of peer-review. While some may and have argued that the double-blinded, peer-review system is the best, I will argue after 22 years of experience as an editor, that blinding the reviewers to the authors and their institution can be dangerous. A quick anecdote; when I was a very junior faculty, I was asked to be on the abstract review committee for the Society of Surgery of the Alimentary Track. After reviewing 250 abstracts, I was especially impressed with one that I gave the highest score because of the truly spectacular results. Luckily for me, the discussion of this abstract started with the committee member to my left and proceeded in clockwise fashion. It was immediately obvious that many of the older, more seasoned committee members knew the author to be dishonest, and after halfway around the table, this abstract was thrown out (to my utter amazement despite the senior author being an otherwise very well-known surgeon). This experience taught me an important lesson. As serious academic surgeons, many of us who have been in the game for a long time get to know our colleagues and their foibles. As I got older and more “experienced,” I was asked (about 20 yrs ago!) to review a paper submitted to a major, high impact journal on a new “treatment” for pancreatic cancer involving combined, intraoperative arterial, and retrograde portal venous infusion of high-dose chemotherapeutic agents in patients with far advanced, locally unresectable pancreatic cancer—the reported 3-year survival was (allegedly) 80% with little morbidity. Being my field, this was not believable and especially so, because the author also had the reputation of being dishonest and I was personally aware of prior episodes of academic impropriety-multiple simultaneous submissions, and simultaneously published articles that were exactly identical. If the reviewers are blinded to the authors, such nefarious activities like these 2 examples may very well go unnoticed, risking injury to patients or publication of false data. I have several other similar stories that I will not describe but were thwarted either by myself, my coeditors, or by the reviewers before any harm was done. Of course, such accusations need to be verified by objective documentation not just “opinion”! At some point we need to place faith in this system of honest, unbiased peer review, and considering the options, the current system with a good, experienced editor seems to me to be the best system, despite the (albeit rare) problems that in theory might arise with a partisan reviewer; this should be very very rare with a good editor. Thus, at SURGERY, we do a single-blinded peer review. Now let me address the concept of blinding of the authors and the readership to the reviewers. I admit that I am “a bit” different than most of our members of the editorial board of SURGERY and probably most reviewers as well, especially the younger reviewers whose opinions I fully acknowledge. When I was a research fellow in Keith Kelly's laboratory in 1979, my first research paper was sent to The American Journal of Physiology. I got back an excellent albeit critical review from a surgeon in Canada (Dr. Pierre Poitras). His review was fair, comprehensive, AND HE SIGNED HIS NAME AT THE END! I asked my mentor Keith Kelly why Dr. Poitras signed it, and looking a bit perplexed himself (having never seen that before), he responded “maybe because he wanted you to know who did the review.” So, I asked Dr. Kelly if I could call him, and he said “Sure why not” So I did! And we had a great discussion, Dr. Poitras supporting his criticisms (which were offered in a constructive fashion) and me sucking it all up enthusiastically—my conclusion was “this is the way science should be!” So, from then on these last 42 years, I have signed all my reviews with the phrase “I believe strongly that scientific reviews should be signed and request the editor to convey my name to the authors Michael G Sarr MD.” In doing so, I have made many friends, several authors have acknowledged me at the end of their paper, several have asked me to be an author (which of course I refused), and to the best of my knowledge, I have not been burned by anyone who was offended by my review. Yes, several authors have called and argued with my evaluation, but I made my arguments I think honestly, politely, and sincerely, and we agreed to differ. If I have been burned, then I have no respect for whoever burned me for my opinions, because, after all, science is science, and a peer reviewer should be able to say to the author in person what he/she wrote in the review. But in good faith, I will have to admit, there was 1 big name author (yes a surgeon) who hated me, because I wrote 2 papers that directly contradicted his findings (and indeed, he lumped together disparate patients that should have been analyzed separately). I since reviewed several more of his papers, but I did not sign these reviews for fear of unjust retribution. So my belief is that, yes, from a purely scientific standpoint, signing your name on a peer review does make sense and would be the best approach from a scientific standpoint. Our procedure at SURGERY currently is to include the name of the reviewer only if they wish it, but we respect the peer-reviewers who do not want their name to be conveyed to the authors.

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