Peer Review Matters: Research Quality and the Public Trust

Abstract

In an era of evidence-based medicine, peer review is an engine and protector of that evidence. Such evidence, vetted by and surviving the peer review process, serves to inform clinical decision-making, providing practitioners with the information to make diagnostic and therapeutic decisions. Unfortunately, there is recent and growing pressure to prioritize the speed of research dissemination, often at the expense of careful peer review. It is timely to remind readers and the public of the value brought by peer review, its benefits to patients, how much the public trust in science and medicine rests upon peer review, and how these have become vulnerable.Peer review has been the foundation of scholarly publishing and scientific communication since the 1665 publication of the Philosophical Transactions of the Royal Society. The benefits and advantages of peer review in scientific research, and particularly medical research, are manifold and manifest.1 Journals, editors, and peer reviewers hold serious responsibility as stewards of valid information, with accountability to the scientific community and an obligation to maintain the public trust. Anesthesiology states its aspiration and its responsibility on the cover of every issue: Trusted Evidence. Quality peer review (more specifically, closed or single-blind peer review, in which the identity of reviewers is confidential) is a foundational tenet of Anesthesiology.Peer review grounds the public trust in the scientific and medical research enterprise, as well as the substantial public investment in scientific research. Peer review affords patients some degree of comfort in placing their trust in practitioners, knowing that they should be informed by the best possible, vetted evidence.Quality peer review enriches and safeguards the scientific content, transparency, comprehensibility, and scientific integrity of published articles. It can enhance published research importance, originality, authenticity, scientific validity, adherence to experimental rigor, and correctness of results and interpretations and can identify errors in research execution. Peer review can help authors improve reporting quality, presentation clarity, and transparency, thereby enhancing comprehension and potential use by clinicians and scientists. Careful scrutiny can identify whether research has appropriate ethical principles, regulatory approvals, compliance, and equitable inclusion of both sexes. Peer review should consider the appropriateness of authorship and can detect duplicate publication, fabrication, falsification, plagiarism, and other misconduct.Peer review should serve as a tempering factor on overenthusiastic authors and overstated conclusions, unwarranted extrapolations, conflation of association with causality, unsupported clinical recommendations, and spin. Spin is a well known, unfortunately common, and often insidious bias in the presentation and interpretation of results that seeks to convince readers that the beneficial effect of an experimental treatment exceeds what has actually been found or that minimizes untoward effects.2–4Manuscripts often change substantially between the initial submission and the revised and improved published version. Improvement during the peer review process is not apparent to readers, who only see the final, published article, but is well known to authors, reviewers, and editors. Peer review is a defining difference in an era of proliferating predatory journals and other forms of research dissemination. Anesthesiology reviewers and editors devote considerable effort in service to helping authors improve their scientific communications, whether published in this journal or if ultimately elsewhere.In the domain of clinical research, peer review does not change the scientific premise of an investigation, the hypothesis, or the study design, although it frequently improves their communication. Peer review does not change clinical research data, although it often corrects, enhances, or strengthens the statistical analysis of those data and can markedly improve their presentation and clarity. More importantly, peer review can assess, correct, and improve the interpretation, meaning, importance, and communication of research results—and importantly, confirm that conclusions emanate strictly from those results. Peer review may occasionally fundamentally revise or even reverse clinical research interpretations and recommendations. Each of these many functions enhances reader understanding and should ultimately improve patient care.Peer review is not a guarantee of truth, and it can be imperfect. Medical history provides many examples of peer-reviewed research that was later found to be incorrect, typically through error or occasionally from misconduct. However, peer review certainly was and remains an essential initial check and quality control that has weeded out, or corrected before publication, innumerable reports of research of insufficient q