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Editorial   |    
Peer Review Has No Peer
Vernon T. Tolo, MD
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Copyright © 2014 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2014 Jan 01;96(1):1. doi: 10.2106/JBJS.M.01442
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On the cover of The Journal of Bone and Joint Surgery (JBJS) are the words “Excellence Through Peer Review.” The term peer review may mean different things to different people, but rigorous, blinded peer review has long been the cornerstone of high-quality scientific journals. The classic concept of peer review is now being reconsidered in some parts of medical publishing, leading to some confusion about exactly what peer review represents.
JBJS and I have constantly adhered to the principles of careful, blinded peer review. While a small number of manuscripts are not accepted after review by only a Deputy Editor and the Editor-in-Chief, the large majority of submissions are reviewed by two or three consultant reviewers with expertise in the subspecialty area into which the submitted manuscript fits. Many of the articles, particularly those with Level-I or II evidence, are also reviewed by a Deputy Editor for Methodology and Biostatistics as well as by the Deputy Editor assigned to manage the manuscripts and coordinate the reviews in a given subspecialty. If the reviewer comments favor publication, the manuscript is returned to the author for responses to the reviewer questions and comments through a revision of the initial manuscript. Further review and revision are done until the manuscript is deemed ready for publication, which occurs following a final review and editing by the Editor-in-Chief.
The JBJS peer-review process is rigorous and thorough and occurs completely pre-publication. In addition to the editorial and reviewer roles in validating and vetting of the data in the manuscript, consideration is given to the suitability for JBJS publication and our readers. If an article is published in a journal with a readership that has little interest in that article, there will be little scrutiny and commentary by the readers regarding its strengths or weaknesses.
It has been argued by some that the current form of peer review has substantial deficiencies. These include a delay in the time from submission to publication, various reviewer biases, and an inability to definitively validate the reported data without full access to the raw data on which the manuscript is based. Nonetheless, it is difficult to dispute that review of manuscripts by experts in that subject, with an opportunity for the authors to address questions and concerns of the primary clinical reviewers, has worked for years in providing trusted information to clinicians. The vast majority of our authors agree that rigorous, blinded peer review improves their manuscripts.
A few recent experiments in journal publishing, mainly among open-access journals, have led to the assertion that some or most peer review can occur after publication. While post-publication peer review is natural and inevitable, we do not agree that pre-publication peer review should be relaxed or oversimplified. If anything, the need to filter and refine information, while validating its quality and relevance, is more pertinent than ever. Yet, we also realize that some of the impetus for other approaches to peer review may arise from the current processes being taken for granted—that is, peer review has come to mean so many things that perhaps it has lost its point. We aim to sharpen the focus on it again.
Beginning with the current issue of JBJS, we will publish a “peer-review statement” that is intended to inform our readers of the rigorous review completed before publication of that article. To some, this may seem self-evident, but we believe that it will emphasize the commitment of JBJS to pre-publication peer review with validation and filtering of data. Our peer review process and statement will help ensure that the sought-after trusted source of information on which JBJS has built its reputation is maintained and can be used with confidence to optimize patient care.

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Accreditation Statement
These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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Thomas J. Blumenfeld, MD
Posted on January 04, 2014
Peer Review: Perspective of a Reviewer and Author
UC Davis, SMCS, Sacramento, CA, USA

I commend the Journal and you for commenting on the importance of peer review. As both a reviewer, and an author, the peer review process may be viewed as both critical, as well as cumbersome. The process is critical because insightful peer review is elemental to the creation of a final manuscript that both asks a question and reports an answer, supported by the scientific data derived in the investigation. The process is cumbersome for the simple reason that any author, having taken hours in manuscript preparation, must feel that perfection has been achieved in the initial submission.

The process is not without flaws, and as an author I have found at times that the reviewer did not review, but commented, often based on bias. Comments (e.g. “this has been reported” and “as an expert, this is not an infection”) without explanation do not yield peer review; perhaps peer ridicule is a more apt description. In my opinion a careful review should clearly show that the reviewer understood the question the author was asking, was able to interpret the results presented as being valid or not, and analyzed the discussion both for the data-driven insight that the author provided, and for relevance in the larger context of prior research in the area. A thoughtful review then describes back to the author areas of concern re: the manuscript and makes either general or specific suggestions for improvement, while avoiding demeaning or biased comments.

Any manuscript may be improved by the insight of a peer uninvolved in the science being reported. Peer review that adheres to understood guidelines allows for this blinded input. As a reviewer I am honored to provide this assistance. As an author although at times I find it burdensome this imperfect yet elemental process has only improved my manuscripts.

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