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.