To publish or not to publish? That is the question

"Published research is becoming a more and more significant factor in scientific dialogue. Physicians and other researchers are no longer the only readers of medical studies. Patients and their families and friends now regularly access medical literature. This makes the review process even more important," said study senior author William Tierney, M.D., a Regenstrief Institute investigator, Chancellor's Professor and professor of medicine at Indiana University-Purdue University Indianapolis.

"Peer review provides an important filtering function with the goal of insuring that only the highest quality research is published. Yet the results of our analysis suggest that reviewers agree on the disposition of manuscripts -- accept or reject -- at a rate barely exceeding what would be expected by chance. Nevertheless, editors' decisions appear to be significantly influenced by reviewer recommendations," said Dr. Tierney, who is the Joseph J. Mamlin Professor at the Indiana University School of Medicine.

A total of 2,264 manuscripts submitted to the Journal of General Internal Medicine (JGIM) were sent by the editors for external review to two or three reviewers each during the study period. These manuscripts received a total of 5,881 reviews provided by 2,916 reviewers. Twenty-eight percent of all reviews recommended rejection. However, the journal's overall rejection rate was much higher -- 48 percent overall and 88 percent when all reviewers for a manuscript agreed on rejection (which occurred with only 7 percent of manuscripts). The rejection rate was 20 percent even when all reviewers agreed that the manuscript should be accepted (which occurred with 48 percent of manuscripts).

"We need to better understand and improve the reliability of the peer-review process while helping editors, who make the ultimate publish or not publish decision, recognize the limitations of reviewers' recommendations," said Dr. Tierney, who served as JGIM co-editor-in-chief from 2004-2009.

JGIM is a publication of the Society of General Internal Medicine, which funded this study. The journal's editorial office is located at the Regenstrief Institute.

In addition to Dr. Tierney, co-authors of the study are Richard L. Kravitz, M.D., M.S.P.H. and Peter Franks, M.D., of the University of California, Davis; Mitchell D. Feldman, M.D., M.Phil., of the University of California, San Francisco; Martha Gerrity, M.D., Ph.D., of Oregon Health Sciences University and Portland VA Medical Center and Cindy Byrne of the IU School of Medicine and the Regenstrief Institute.