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Peer Review: Always Room for Improvement.

In this issue of Obstetrics & Gynecology, Drs. Tvina, Spellecy, and Palatnik (see page 1081) achieve their goal of prompting a discussion of the peer review process in biomedical journals.1 I welcome the opportunity to further this discussion, as it is critical. Skepticism about science is increasing among patients, the general public, politicians, journalists, health care providers, and even among some scientists themselves. Having robust, nonbiased, and diverse voices in a transparent peer review system is one way for journals to convince the skeptics of the validity of the process. I share the concern expressed in the article about the need to use the best systems to improve research and, ultimately, patient care. At Obstetrics & Gynecology, we use the single-blind system, in which the authors are not told who the reviewers are but the reviewers are aware of the authors’ identity. Only the editors know all of the participants. In the double-blind system, neither the authors nor reviewers know the identity of one another. There are other variations to the peer review process, including triple-blind, in which the editors are also unaware of the authors and reviewers. At the opposite end of the spectrum, there is open peer review, in which everybody knows who the other members of the author, editing, and reviewing teams are. Taking it a step further, there is prepublication peer review, postpublication peer review, and transparent peer review. One of the many pleasant surprises for me when I started as Editor-inChief of Obstetrics & Gynecology is that there is a meeting every 4 years—the International Congress on Peer Review and Scientific Publication—at which I can join hundreds of other people interested in studying and discussing how to improve the integrity, validation, and understandable dissemination of scientific studies. I also have been privileged to be a member of the Committee on Publication Ethics (COPE) Council, the scope of which includes many aspects of the peer review process not only in biomedicine and science, but in the arts, humanities, and social sciences. There are frequent publications (including in journals with a focus on peer review and research integrity2) and gray literature commentaries on the process of peer review. The bottom line is that the model of peer review that a journal uses, whatever it is, is ultimately flawed, as no system is perfect. A change in the current system a journal uses should be based on clear evidence that a different system will produce higher-quality and less-biased reviews, without adding disproportionately to difficulties identifying willing highquality reviewers or the operational work of the journal. Chung et al3 report a pre-and-post study of the process after adopting a double-blind system at Plastic and Reconstructive Surgery. This study showed no statistical difference in the recommendations for manuscript disposition or manuscript ranking. The overall quality of the reviews was worse with doubleblind compared with single-blind reviews. They speculated that reviewers were spending so much time trying to figure out who the authors were, See related article on page 1081.