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J R Coll Physicians Edinb 2019; 49: 99–100 | doi: 10.4997/JRCPE.2019.201 EDITORIAL

Peer review in academic : threats and challenges Durga Prasanna Misra1, Vinod Ravindran2

EditorialFinancial and Competing Interests: VR is the Editor-in-Chief of the Journal of the Royal Correspondence to: College of Physicians of Edinburgh. This paper has undergone peer review in accordance Vinod Ravindran with JRCPE’s policies. VR is also Emeritus Editor of the Indian Journal of Rheumatology Centre for Rheumatology and an editorial board member of Rheumatology Advances in Practice (Oxford). DPM is Calicut an Associate Editor of Rheumatology International and Indian Journal of Rheumatology, Kerala and an editorial board member of Mediterranean Journal of Rheumatology and Archives of India Rheumatology Email: [email protected]

Peer review refers to the evaluation of the appropriateness with the submission to journals. This absolves and validity of scientifi c by one’s own peers. the journal of the burden of soliciting reviewers; however, From its origins in seventeenth-century Europe, when the this method may not be free of confl icts of interests, in the need to evaluate work submitted to scientifi c journals by light of payments involved to the commercial agency as well colleagues in the fi eld fi rst became recognised,1 the fi eld as peer reviewers.3 Often, peer review has been considered of peer review has evolved and grown, as well as developed to be sympathetic to ‘positive’ studies, as opposed to its own peculiar issues. In this editorial, we shall discuss those studies that may report a lack of attainment of the the types of peer review, discuss emerging issues in peer hypothesised effect or difference between study groups. review and hope to enlighten readers as well as prospective This has resulted in the concept of results-free review, reviewers about the nuances of this critical gatekeeping of whereby authors submit their manuscript at the stage of scientifi c publishing. planning the study, written up to the section, which is peer reviewed, and, if successfully clears this Broadly, peer review can be either blinded, when there is step, the study is published after completion in the said an attempt to conceal the identity of reviewers, authors or journal, irrespective of the results.4 Increasingly, complex both, or open, when the identity of reviewers and authors statistical tests are used in manuscripts, and these may are revealed to each other. Furthermore, blinded peer further require a separate expert statistical review.1 review can be single blind, where the identity of authors is revealed to the reviewers (who remain blinded), or double The International Committee of Medical Journal Editors blind, when both reviewers and authors remain anonymous (ICMJE), which is one of the core bodies recommending to each other during the peer review process. Blinded ethical practices in , lays out ethical peer review has its advantages, with the ability to shield guidelines for peer reviewers. It recommends that reviewers the manuscript in question from either the scepticism should consider potential confl icts of interest (COIs) that associated with a junior author’s work, or the privilege they may have when they review a manuscript, and refuse associated with work from a known group of authors in the to review in the presence of such COIs. Furthermore, specialty. This especially holds true in areas of the world reviewers should attempt to be as timely as possible while where senior researchers may have signifi cant authority, submitting their reviews, and attempt to be professional in such that an early career researcher would hesitate to their criticism of the said manuscript. Such reviewers should be named as a referee when evaluating such a senior maintain strict confi dentiality regarding the manuscript and peer’s work for fear of later retribution in case of rejection its contents until publication, and should refrain from using or negative comments. However, many journals have now this privileged information for designing or conducting their adopted , with transparent publication own studies in the meantime. At this stage, it must be of named peer review reports, available along with the emphasised that the ICMJE guidelines clearly state that published manuscript (or provided to the authors in the reviewers can only recommend their decision to the editor, case of a rejected manuscript).1,2 Another type of peer who is solely responsible for taking the fi nal decision about review that has been proposed is peer review for hire, acceptance or rejection of a manuscript, and editors can whereby authors submit their work to a commercial agency make such decisions even without seeking external review that solicits paid peer reviews and includes the reviews comments.5

1Assistant , Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical (SGPGIMS), Lucknow, India; 2Consultant Rheumatologist, Centre for Rheumatology, Calicut, Kerala, India

JUNE 2019 VOLUME 49 ISSUE 2 JOURNAL OF THE ROYAL COLLEGE OF PHYSICIANS OF EDINBURGH 99 DP Misra, V Ravindran J R Coll Physicians Edinb 2019; 49: 101–2 | doi: 10.4997/JRCPE.2019.202 EDITORIAL

Figure 1 Dangers that may compromise the peer review system in the present day Nowadays, scientifi c fraud is being increasingly recognised, and peer review is not immune to misconduct.10 Reviewing Burnout and work– balance: getting when one has COIs, whether positive or negative, is inappropriate, also so is seeking inappropriate citations personal to one’s own work or to the work of one’s colleagues Clare Bostock1 while suggesting revisions for a manuscript.5 Similarly, providing adversarial review comments and identifying new criticisms at every round of revision, when authors have already addressed the previous concerns satisfactorily, EditorialFinancial and Competing Interests: No confl ict of interests declared Correspondence to: is uncalled for.11 A recent worrying trend has been the Clare Bostock identification of peer review fraud, wherein authors Aberdeen Royal Infi rmary submit recommended reviewers, using genuine names Foresterhill Health Campus in the concerned area of research, but with false email Foresterhill Road Aberdeen AB25 2ZN addresses that are operated by the authors themselves. UK The ensuing favourable reviews manage to get one’s paper

Peer reviewing is mostly a thankless, rarely publicly published, but also has resulted in large-scale retractions Email: acknowledged job, driven by the passion of to and public shaming of such authors, once such peer [email protected] serve as gatekeepers for . This has resulted in an review fraud has been identifi ed. Instances exist of peer increasing diffi culty in obtaining the help of peer reviewers reviewers directly contacting authors of a manuscript to provide comments for manuscripts.6 Recent initiatives and demanding authorship in revised future submissions have attempted to address this imbalance. is an of the same manuscript. Experienced editors will recall Will you share your burnout story with me? There is a this that we should realise the balance is wrong and that we that enables logging and verifi cation of one’s peer reviewers who may have stalled manuscripts with repeated, signifi cant chance that you have one. The General Medical do have a choice. How often do we put too much pressure on reviews anonymously, in a format that can be downloaded unnecessary comments, while themselves initiating and Council’s survey showed that 24% of trainees and 21% ourselves? No one had ever told me that I must work every and presented at the time of job interviews or academic completing work on the hypothesis proposed by the same of trainers in the UK feel burnt out to a high or very-high evening; so how had I slipped into this routine? promotions.7 Similarly, numerous journals and publishers have manuscript.8 Needless to say, the careless peer reviewer, degree because of their work.1 Global studies indicate begun to award their best reviewers, in the form of reviewer who is impressed by the fl ow of that expounds that approximately one-third of physicians are experiencing I made a choice at that time – to stop working in the evenings certificates, or published acknowledgements in journals. what can only be described as nonsense, is no less a burnout at any given time.2 A more recent and to take more exercise. I also chose to speak to my line Others provide fi nancial incentives, such as discounts on danger (Figure 1). found that there was marked variation in the defi nition of manger, and I discovered that I could take some parental purchased scientifi c literature.6 The Open Researcher and burnout and that the prevalence of burnout in physicians leave. Paradoxically, I began to achieve more at work and Contributor ID (ORCID) is another initiative. ORCID provide a To conclude, the landscape of peer review in scientific ranged from 0 to 80%.3 at home. unique identifi er, an ORCID number, which can be used to publishing is undergoing a sea of change in recent times. What showcase one’s publication and review record by quoting this was once a behind-the-scenes, purely voluntary contribution There is no doubt in my that as healthcare professionals But work–life balance is not about having children, or being number while reviewing or publishing articles. ORCID has to science is now able to be catalogued and archived through we are at risk of burnout. The combination of a caring female, or working less than full-time. We all have different the dual advantage of being able to verify reviewer identities, initiatives like ORCID and Publons. Prospective reviewers, and tendencies towards selfl essness and perfectionism are a roles to balance: doctor and partner; academic and clinician; something that has gained traction in the light of recent authors and editors should be aware of the principles of perfect recipe for burnout: ‘overwhelming exhaustion, feelings physician and educator; care giver, homemaker and marathon instances of reviewer identity fraud, as discussed below.8 ethical peer review. Those who serve as gatekeepers of of cynicism and detachment from the job, and a sense of runner (insert other hobby here). How we choose to balance Since traditional courses teach little, if at all, about how science, including reviewers, editors and editorial staff should ineffectiveness and lack of accomplishment’.4 these roles is personal: there often is not a simple dichotomy to peer review manuscripts, online initiatives, such as the remember to avoid misusing their privileges, while doing their and many of you will prefer to live in shades of grey rather Publons academy7 or mentorship programmes by professional best to ensure that submitted manuscripts are provided their So, you are likely to have a burnout story but are you than black or white. For me, when it comes to work–life societies,9 can help train prospective early career reviewers. just rewards. comfortable sharing your personal tale? Firstly, you would balance I prefer the black–white approach: work is for work need to take off your superhero eye mask and cape, and (not booking the car for a service) and home is for home (not climb down from ‘Healthcare Heights’. And are there not more checking work email, and keeping mentally and physically fi t). exciting and heroic tales to tell? – of lives saved, spectacular References feats accomplished during a night shift, of running the busiest It is easy to blame ‘the organisation’, ‘the profession’ or ‘the 1 Tennant JP, Dugan JM, Graziotin D et al. A multi-disciplinary 7 Rajpert-De Meyts E, Losito S, Carrell DT. Rewarding peer-review clinic single handed … And what about the stigma and loss culture’ for our wellbeing – or lack thereof – to the extent that perspective on emergent and future innovations in peer review. work: the Publons initiative. Andrology 2016; 4: 985–6. of face by sharing your weakness? – it is not really very fi tting ‘resilience’ can even become a ‘dirty word’.5 But I believe that F1000Res 2017; 6: 1151. 8 Misra DP, Ravindran V, Agarwal V. Integrity of authorship and of a physician, is it? we have some personal responsibility for our wellness. This 2 How to perform a peer review. https://authorservices.wiley. peer review practices: challenges and opportunities for com/Reviewers/journal-reviewers/how-to-perform-a-peer- improvement. J Korean Med Sci 2018; 33: e287. responsibility is not because we are healthcare professionals, review/index.html (accessed 01/04/19). 9 Rodriguez-Carrio J, Putrik P, Sepriano A et al. Improving the So, I’ll tell you one of my burnout stories – I’m not proud. I but because we are human and we have a responsibility 3 Company offers portable peer review. https://www.nature. peer review skills of young rheumatologists and researchers in was sharing what should have been a precious bedtime story to ourselves. I believe that healthy work–life balance is key com/news/company-offers-portable-peer-review-1.12418 rheumatology: the EMEUNET Peer Review Mentoring Program. with my two young children, yet I felt incensed because they to avoiding burnout. And I believe that burnout is one of (accessed 15/07/18). RMD Open 2018; 4: e000619. were not going to quickly enough. Why was I angry? the biggest threats to ourselves, our profession and to the 4 Horbach S, Halffman WW. The changing forms and 10 When reviewing goes wrong: the ugly side of peer review. expectations of peer review. Res Integr Peer Rev 2018; 3: 8. https://www.elsevier.com/connect/editors-update/when- – because all I wanted to do was check my email and get sustainability of patient care. However, to improve your work– 5 International Committee of Medical Journal Editors. http:// reviewing-goes-wrong-the-ugly-side-of-peer-review (accessed on with some work. The anger melted and was replaced by life balance you must identify both a need and a desire for www.icmje.org (accessed 04/04/19). 01/04/19). overwhelming sobs and fl oods of tears, and I realised what a improvement. I am not claiming that this is easy. Further 6 Gasparyan AY. Peer review in scholarly biomedical journals: a 11 Cormode G. How NOT to review a paper: the tools and terrible position I had found myself in. It is at moments like reading would tell you that this is not a problem with a single few things that make a big difference. J Korean Med Sci 2013; techniques of the adversarial reviewer. SIGMOD Record 2008; 28: 970–1. 37: 100–4.

1Consultant Geriatrician, NHS Grampian, Aberdeen, UK

100 JOURNAL OF THE ROYAL COLLEGE OF PHYSICIANS OF EDINBURGH VOLUME 49 ISSUE 2 JUNE 2019