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Hardly a scientific endeavor, be it a journal publication, a university promotion application, or a research grant proposal, is devoid of the words peer review. Exactly who are the peers and what are they reviewing? To quote from The Shorter Oxford English Dictionary on Historical Principles,1 a peer is: “An equal in standing or rank; one's equal before the law” (p 1539). A review involves: “The act of looking over something (again), with a view to correction or improvement…an inspection, examination” (p 1821).

With this in mind, let's trace the story of peer review in the medical journal, and more particularly, the nuances to be applied to the dermatology periodical.

Background

  1. Top of page
  2. Background
  3. Current Status
  4. REFERENCES

When scientific publications began to appear in the seventeenth century, there was no peer review. It was the intention of the editor to report the endeavors of the scientists in the community (Figure 1). By 1731, The Royal Society of Edinburgh recognized responsibility for insuring that the printed word had some scientific validity, and so it embarked upon a peer review process, distributing the submissions to those “most versed in these matters” for recommendations.2 When The Royal Society of London assumed responsibility for Philosophical Transactions, the officers soon realized that they could not publish all the presented papers, and they instituted a selective process (ie, peer review).3

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Figure 1. The first Western scholarly publication appeared on January 5, 1665.

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Although medical journals currently utilize some type of outside peer review, such a process has only become standard in recent years. For example, before 1976, The Lancet considered a peer review process unnecessary, while The Journal of the American Medical Association used the in-house editors for manuscript review, only occasionally asking for outside opinions. Opposed to this, the British Medical Journal has sent every paper, other than editorials, for review since 1893. What occurred in dermatology journals is unknown; however, Howard Fox (Figure 2), editor of Archives of Dermatology and Syphilology, prided himself on thoroughly reading every paper published during his tenure (1936–1947).4

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Figure 2. Howard Fox (1873–1954) was the first president of the American Academy of Dermatology in 1938.

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Current Status

  1. Top of page
  2. Background
  3. Current Status
  4. REFERENCES

Nearly all biomedical journals today use some type of peer review. Whether because the subjects are too complex or the material too voluminous for one physician to read and make an appropriate judgment, the fact remains that other physicians, as well as other authorities, are consulted about the value of the submission. This would make a banner flagged across the cover of a journal announcing that it is peer reviewed redundant, if not silly.

Does this mean that the editor is bound by the recommendations of the reviewers? No, not at all. Accepting all the critiques of the reviewers has fatal flaws. Did the reviewers have sufficient knowledge of the subject?Has a bias been introduced? Was the presentation too verbose or too confusing so that an important message was lost? Were the reviewers jealous of the contributor?

Even with all of the safeguards put in place, problems can ensue. There have been instances of fraud that have passed rigorous review processes. The scientific method and/or the discussion seem sound; only later does it appear that there has been plagiarism and/or, even worse, outright cheating.5

At SKINmed, the submissions are reviewed without the reviewer knowing who the author(s) may be and from what institution(s) the paper has originated. When the comments are returned to the Editor in Chief, they are considered and put in perspective. A paper that does not meet the standards or the purposes of the journal would be rejected. If it appears the paper has some merit, then the author(s) would be given the opportunity to consider the critiques. Because the reviewers represent a microcosm of the readership, the author(s) should have the opportunity to address the issues raised. Perhaps the points made are not valid and should be discarded. The reviewers' recommendations should not be considered as cast in stone.

Elsewhere in this issue, a distinguished member of the editorial board offers his opinions of the peer review process.6 Peer reviewing is not infallible, but it represents the best we currently have, especially when put in perspective. As Jerome Kassirer, the distinguished Editor Emeritus of The New England Journal of Medicine, once wrote: “Although our understanding of peer review also remains crude, this fallible, poorly understood process has been indispensable for the progress of biomedical science.”7

REFERENCES

  1. Top of page
  2. Background
  3. Current Status
  4. REFERENCES