Updated Guidance on Reporting Race and Ethnicity: Let’s Start With the Why

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Kim Penelton Campbell, BS, JAMA Network

I have used many adjectives to describe myself, but I’ve never referred to myself as other. When teachers called my name during morning attendance, I responded by saying “Here.” I never said, “Invisible.”

In medical literature, the failure to fairly and respectfully recognize and include individuals of all races and ethnicities can severely adversely affect patients’ lives and the quality of care they receive. It can misinform clinicians. It can compromise the credibility of a journal.

This means that race and ethnicity data should be reported in a way that encourages fairness, equity, consistency, and clarity in medical and science journals.1

Changing the b in Black and the w in White to uppercase lettering when describing race is not about mere political correctness—these changes are part of a conscientious movement toward equitable delivery of health care services to all people.

The objective of this post is to emphasize that updated guidance about the reporting of race and ethnicity is important, not because the AMA Manual of Style says so, but because inattentiveness to these changes can contribute to unconscious bias and ultimately affect how patients are treated or unintentionally mistreated.

Bias, when unintentional, is not mitigated—it remains bias all the same. Unintentional bias can occur simply because the writer or editor is removed from the patient’s life experience. When the writer or editor is unaware, they may not recognize how insensitive wording can affect the reader.

Example: “Adherence to the prescribed medication was higher among White patients than among Blacks.”

Consequence: Does this mean that if you are White you are a patient but if you are Black you are nothing? What is a Black?

When a person is called a Black instead of a Black patient or a patient who is Black, the wording detracts from that person’s humanity.

Likewise, use of lowercase lettering for Black and White, as well as referring to people as minorities instead of as members of a racial or ethnic minority group, also diminishes their humanity. Stating race or ethnicity in noun form can be interpreted pejoratively and is akin to labeling patients by their disease (eg, the blind, schizophrenics, epileptics) instead of putting the individual first (eg, a person with schizophrenia).2 Other things that can be interpreted pejoratively and should be avoided are using the term mixed race, which can carry negative connotations, instead of multiracial or multiethnic, merging race and ethnicity with a virgule (ie, race/ethnicity) rather than recognizing the numerous subcategories within race and ethnicity with the term race and ethnicity, and using abbreviations for racial and ethnic terms. Although the writer or manuscript editor may not have intended to negatively portray a group of people, the potential effect on readers remains unchanged.

  • To potential authors, the absence of a single word can indicate that a journal is insensitive to the health care needs of a population of patients.
  • To clinicians with the same racial or ethnic background as the one negatively represented, this can promote the inference that the journal has no diversity on its editorial board or staff.
  • To a practicing physician, this language can translate to offensive or insensitive communication when speaking with a patient or a patient’s family member.
  • To a patient, this wording can indicate that the medical community views individuals from their racial or ethnic group as nonpersons—unseen, unconsidered, and uncared for.
  • For all of these individuals, this can deepen a sense of mistrust.

Language that excludes a racial or ethnic group can subtly influence a medical trainee to “unsee” the humanity in people who are from a different background. If their research and educational sources are written or edited without intercultural competence, the medical trainee may unintentionally miscommunicate or make incorrect assumptions about patients from other backgrounds. This breach can interfere with a clinician’s understanding of the patient and, in response, impede the patient’s trust in the clinician.

Among some patients from communities that have been medically underserved or ignored, information about medical mistreatment can transcend generations. Past miscommunication can lead to mistrust, which can then lead to fear.

A family may never forget that Grandma never came home from the hospital and that no clinician took the time to explain why. Although this family was made to feel invisible because of miscommunication, it is quite possible that the clinician intended no disrespect and had no knowledge of how the family was affected. A patient with a historic burden of oppression can potentially interpret disrespectful communication as an initial step down the road to medical abuse.

My godfather once expressed such fear. He was Black, the clinicians were White, and he had grown up in Mississippi during the 1940s. Although I asked, he refused to ever repeat details of what was said by these physicians many years ago. But decades later, when I was a teenager and a novice driver, my godmother phoned and urgently asked that I come to their home immediately to rush him to our local VA hospital.

On my arrival, she exclaimed, “I think he had a heart attack while gardening in the back yard!” I said, “I’ll call 911. The ambulance will get him there faster.” Then, she stopped me. She pleaded that I drive him there myself. As I rushed to his aid, she continued by telling me that he would die of fear if an ambulance came to their home. She told me that I must speak for him when we arrived, remain by his side, and do everything in my power to keep him calm.

He cried like a baby during the entire ride. He was afraid. He was humiliated about expressing fear in my presence. I did not know what to say. I just kept driving. My heart was broken.

This brief story is an example of deep-seated fear that some Black people experience in a health care setting, a fear that can only begin to be abated with a conscientious effort to ensure that language humanizes Black patients and patients from all racial and ethnic backgrounds.

How does one address suboptimal reporting on race and ethnicity?

  • First, follow the guidelines.
  • Second, write and edit with a raised antenna. Look for what is unsaid in addition to what is written on the page.
  • Try to interpret as if you are a person from a racial or ethnic group unlike your own. Think about how you would you feel as the subject or nonsubject of the article.
  • Consider how wording can be misinterpreted.
  • Consider how inattentiveness to detail can affect the health, safety, or life of someone who is misrepresented.
  • Edit responsibly, but without fear of respectfully questioning the author.

Remember: no one is invisible, and no one is other.

“Not everything that is faced can be changed, but nothing can be changed unless it is faced.”3

James Baldwin

References

  1. Flanagin A, Frey T, Christiansen SL; AMA Manual of Style Committee. Updated guidance on the reporting of race and ethnicity in medical science journals. JAMA. 2021;326(7):621-627. doi:10.1001/jama.2021.13304
  2. Christiansen SL, Iverson C, Flanagin A, et al, eds. Correct and preferred usage. In: AMA Manual of Style: a Guide for Authors and Editors. 11th ed. Oxford University Press; 2020:547-548.
  3. Baldwin J. As much truth as one can bear. New York Times. January 14, 1962: Book review 1, 38. https://www.nytimes.com/1962/01/14/archives/as-much-truth-as-one-can-bear-to-speak-out-about-the-world-as-it-is.html

IQR You Serious?!

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Amanda Ehrhardt, MA, JAMA Network

Compared with navigating the treacherous waters of causal language, or throwing down the proverbial gauntlet against the terms renal and mutation, upholding AMA Manual of Style rules regarding abbreviations and when to expand them may seem like Not That Big of a Deal. If you had to plot the interquartile range for feelings surrounding this task, it may go something like this:

The median response toward expanding an abbreviation was “Meh” (interquartile range, “Yuck!” to “Yay!”).

However, one of the beautiful things about style rules is that they evolve and adapt with changes in cultural and societal outlooks and the editing process, and they occasionally throw you a colorful floatie while you’re swimming in copy.

That interquartile range that I’ve mentioned several times now? Well, check out the Common Abbreviations and Expansions table in the updated version of 13.11.

That’s right, it’s IQR! From beginning to end! No expansion necessary anymore!

So perhaps we should reassess that statement from the beginning?

The median response to learning that IQR no longer needs to be expanded was “Woohoo!” (IQR, “Cool.” to “Best thing ever!”).

Mxed Messages

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H Ford, they/them/theirs, Manuscript Editor, JAMA Network

There is a particular type of online pedant whose view of the English language has the effect of invalidating strangers’ sexual and gender identities. Much physical and digital ink has been spilled discussing the validity of the singular “they” when referring to a single gender-unknown subject of discussion and as an intentional personal pronoun.

I will not relitigate this issue here, but it should suffice that the AMA Manual of Style (sections 11.12.2 and 7.2.3.2, specifically) concurs with the Chicago Manual of Style, the AP Stylebook, and historical use (eg, Shakespeare and Emily Dickinson) in permitting the singular they.

Now with that said, let’s talk about respecting our queer friends, family, colleagues, and authors by using the honorific Mx! According to Merriam-Webster, the first use of the gender-neutral honorific Mx was in the 1970s, but its widespread use has only gained momentum within the past 5 to 10 years.

It can be helpful to compare Mx with Ms, another relatively recently developed honorific. Although the very first publication of the honorific Ms was in a 1901 article and was likely more focused on expediency of the address than the linguistic and sociopolitical ramifications of defining a woman by her social status, most people’s understanding of Ms is rooted in Gloria Steinem’s eponymous magazine (https://www.nytimes.com/2009/10/25/magazine/25FOB-onlanguage-t.html).

Mx is an honorific that affords the same respect to nonbinary and gender-nonconforming people that has traditionally been given to gender-conforming individuals who do not hold advanced degrees. As awareness grows of the existence of gender identities outside the male/female binary, more people every day feel comfortable publicly identifying as nonbinary, genderqueer, and agender.

The widespread use of Mx signals acknowledgment of and respect toward these individuals. Yet there is a broader application of the honorific Mx that we haven’t fully considered, one that is as practical as it is gender inclusive. Just as the title Ms allowed us to ask why a woman’s marital status affected how she was addressed, Mx should allow us to ask why a person’s gender should matter to any respectful form of address.

For these reasons, JAMA Network now offers Mx as a salutation for submissions to all of its journals!

As editors and writers, we occupy a unique position in the process of the legitimization of nascent linguistic terms. Let’s use that power for good!

Social Media: Dos and Don’ts

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Eman Hassaballa Aly, Social Media Manager; Reuben Rios, Social Media Coordinator; Deanna Bellandi, MPH, Manager, Media Relations (JAMA Network)

“All we want are the facts.”

Sgt Joe Friday, Dragnet

Social media is an important tool for promoting content published in JAMA and the JAMA Network family of journals to the research community, physicians and other health professionals, and lay audiences. Doing that means following a set of guidelines meant to ensure accurate and responsible social media posts.

JAMA Network Social Media Guidelines

  • Content published in social media sites is subject to the same norms, standards, and regulations as is all other published content.1
  • Be respectful.2
  • Use proper grammar, spelling, and capitalization.3
  • Abbreviations may be used provided they can be easily understood in context.
  • Avoid texting jargon, such as “U” for “you” or “L8” for “late.”3
  • Do not use sarcasm, irony, satire, or absurdities.4
  • Reflect diversity.4
  • Use language that is nondiscriminatory.5
  • Do not include negative comments directed at any person, group, or institution.
  • Do not use offensive content (including, but not limited to, racist, sexist, ageist, anti-LGBTQ, and antireligious.)6
  • Do not include sexually suggestive images or video (eg, genitalia, breasts, buttocks) or those that portray sexual assault/abuse.
  • Do not use language, images, or other content that reinforces stereotypes.5
  • Use individuals’ preferred pronouns when known; inclusive pronouns (they/them) are acceptable.4,5
  • When reporting the results of a study or describing a specific journal article, replace personal pronouns (I and we found) with reference to the study or the article type (eg, Viewpoint, Review).
  • When mentioning people/Twitter handles, do not editorialize or designate appellations (eg, do not say, “The great [@Twitter handle] discusses…”).
  • Do not use profanity or vulgarity.2,6
  • Do not include emojis based on gender or race.4
  • Do not include identifiable patient content without permission.1
  • Do not share confidential information.7
  • Do not share information that is embargoed or before publication date and time.
  • Do not include quotes, images, photos, or video from other social networking sites or third-party publications without permission and attribution to the source.8
  • Do not share others’ social media posts that do not follow these guidelines.
  • Correct posts with errors transparently and as soon as possible. For example, add a new post clarifying the correction, and include the word “correction.”

Posts that do not follow these guidelines may be removed.

Tweet Formatting

  • The basic format of a tweet consists of text, links, and hashtags handles with optional attached video and images (up to 4 images per tweet).
  • Length: the maximum length for JAMA Network tweets is 257 characters. Twitter limits to 280 characters, but because JAMA Network always includes a link, 23 characters are reserved for the link.
  • Hashtags should be limited to 3 per tweet.
  • Twitter handles should be included if there is room. Handles should be limited to authors and institutions directly related to the content of the tweet.
    • Example: Tweet text (including relevant @mentions and #hashtags), Link, Other @mentions (if not directly mentioned in the tweet), Other hashtags (if any, and if space permits).

References

  1. Christiansen C, Iverson C, Flanagin A, et al. 5.9.5. Social Media and 5.11.19 Social Media. In AMA Manual of Style: A Guide for Authors and Editors. Accessed March 24, 2021. https://www.amamanualofstyle.com/view/10.1093/jama/9780190246556.001.0001/med-9780190246556-chapter-5-div2-230
  2. Grossmont-Cuyamaca Community College District. Social Media Guidelines. Accessed April 2, 2021. https://www.gcccd.edu/marketing-communications/social-media-guidelines.html
  3. Christiansen C, Iverson C, Flanagin A, et al. 7.11. Grammar in Social Media. In AMA Manual of Style: A Guide for Authors and Editors. Accessed March 24, 2021. https://www.amamanualofstyle.com/view/10.1093/jama/9780190246556.001.0001/med-9780190246556-chapter-7-div1-138
  4. Sehl K. How to Create Effective Social Media Guidelines for Your Business. Hootsuite. Blog. February 3, 2020. Accessed April 2, 2021. https://blog.hootsuite.com/social-media-guidelines/
  5. United Nations. Guidelines for gender-inclusive language in English. Accessed April 2, 2021. https://www.un.org/en/gender-inclusive-language/guidelines.shtml
  6. CollegeGrad. 10 Things You Should Never Post on Social Media. Accessed April 2, 2021. https://collegegrad.com/blog/10-things-you-should-never-post-on-social-media
  7. Storey V. Social Media Guidelines or Policy?  Social Media Today. May 17, 2011. Accessed April 2, 2021. https://www.socialmediatoday.com/news/social-media-guidelines-or-policy/475646/
  8. Associated Press. Social Media Guidelines for AP Employees. Revised May 2013. Accessed March 24, 2021.  https://www.ap.org/assets/documents/social-media-guidelines_tcm28-9832.pdf

JAMA Network Guidance on Venn Diagrams

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Connie Manno, ELS, Director, Freelance Editing Unit, JAMA Network

Venn diagrams are simple pictorial representations of relationships that exist between 2 or more sets of things. Circles that overlap have commonality; circles that do not overlap do not share traits.1

Although Venn diagrams represent conceptual shared or unique traits between separate ideas or groups of things (Figure 1), they are not appropriate to visualize numerical (empirical) data.2

Figure 1. Conceptual Venn Diagram

Often, the separate sets are presented as identically sized circles—even if the quantities in each set and the overlapping and nonoverlapping segments are different—and the resulting illustration can be not only imprecise but also misleading (Figure 2).3

Figure 2. Venn Diagram of Identically Sized Circles That Represent Different Quantities

The identically sized circles obscure the different numbers of cohorts included in the referenced studies. From Sentenac et al.3

Like pie charts, which also compare relationships among component parts and are frequently used to depict data for a lay audience, Venn diagrams should be avoided in scientific publications.4(pp137-138)

One more precise way to present the data is to create a bar graph or component bar graph (Figure 3), which can present the relationships between 2 or more data sets while illustrating the size difference between the sets with bars of unequal lengths. A component bar graph additionally uses color and section length to highlight patterns in the data.2

Figure 3. Data as a Component Bar Graph

When the data from Figure 2 are presented as a component bar graph, the difference in cohort sizes is apparent from the bar lengths. In addition, bar sections that depict shared segments use the same color.

Another option is to present the data in a matrix: a tabular structure that uses numbers, short words (eg, no, yes), symbols (eg, bullets, check marks), or shading to depict relationships among items in columns and rows and to allow comparisons among entries.4(p114)

Depending on the complexity of the construction and the need for multiple colors or shading, a matrix may be presented as a table or figure (Figure 4).

A third option is to resize the circles to make them more proportional to the quantities they represent (Figure 5), but only if the circles and overlaps are precise and generated from statistical software.

Figure 5. Circles From Figure 2 Resized to More Accurately Represent the Sample Sizes

This option must use precisely sized circles and overlaps generated from statistical software to ensure that the figure’s elements are truly proportional.

Network figures that use nodes and connecting lines of varying sizes to illustrate the proportions of the compared items are also useful for depicting relationships among 2 or more sets of data (Figure 6).5

Figure 6. Network Figure Depicting Relationships Among 4 Data Sets

In this network map, the size of the nodes is proportional to the number of participants in each node, and the thickness of the connecting lines is proportional to the number of randomized clinical trials in each comparison. From Ferreyro et al.5

Although data can be displayed multiple ways, accuracy and audience, as well as the criteria of the final format (eg, scientific journal vs consumer publication), should govern the decision of which option to use.

References

  1. Kenton W. Venn diagram. Investopedia website. Updated January 17, 2020. Accessed February 1, 2021. https://www.investopedia.com/terms/v/venn-diagram.asp
  2. Harris RM. Bar plots as Venn diagram alternatives. Rayna M. Harris blog. May 7, 2019. Accessed February 1, 2021. https://www.raynamharris.com/blog/vennbar/
  3. Sentenac M, Boutron I, Draper ES, et al. Defining very preterm populations for systematic reviews with meta-analyses. JAMA Pediatr. 2020;174(10):997-999. doi:10.1001/jamapediatrics.2020.0956
  4. Tables, figures, and multimedia. In: Christiansen S, Iverson C, Flanagin A, et al. AMA Manual of Style: A Guide for Authors and Editors. 11th ed. Oxford University Press; 2020:113-169.
  5. Ferreyro BL, Angriman F, Munshi L, et al. Association of noninvasive oxygenation strategies with all-cause mortality in adults with acute hypoxemic respiratory failure: a systematic review and meta-analysis. JAMA. 2020;324(1):57-67. doi:10.1001/jama.2020.9524

Abbreviating the Pandemic

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If you’ve followed AMA style for at least the last several years, you may remember this big (welcome) announcement:

The companion abbreviation “AIDS” was given expansion-exempt status even before this with the 2007 publication of the 10th edition. It took some time for HIV to catch up.

Why did we decide that these 2 abbreviations no longer needed expansion? For one, they are ubiquitous, instantly recognizable (at least to English-reading audiences), and are long and cumbersome to write out in full.

After more than a year of publishing coronavirus-related content (JAMA’s first article was published in January 2020 by Fauci and colleagues), the AMA Manual committee has determined that COVID-19 and SARS-CoV-2 meet those same criteria to forgo expansion: ubiquity, familiarity, and cumbersome expansions.

  • Before: Protection against coronavirus disease 2019 (COVID-19) is mediated in large part by an immune response directed against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike protein.
  • After: Protection against COVID-19 is mediated in large part by an immune response directed against the SARS-CoV-2 spike protein.

While we all hope to soon have this pandemic in our collective rearview mirror, it is not likely that we will forget coronavirus disease 2019 or severe acute respiratory syndrome coronavirus 2.–Stacy Christiansen, Chair, AMA Manual of Style

Citing Online Journal Articles and Data from Repositories

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The new edition of the AMA Manual of Style is here, and it has nearly 200 more pages on everything from reference citations to the ethical and legal issues associated with medical publishing.

If the amount of new content seems overwhelming, may I suggest starting with the basics?

I dove in by reviewing the References chapter.

Online Journal References

According to section 3.11.4, “Online Journal Articles, Preprints, and Manuscripts,” the basic components of an online journal reference haven’t changed: authors’ surnames and initials, the title of the article, abbreviated name of the journal, publication year, pagination, the date the article was accessed, and the DOI or URL.

What has changed it that the date accessed should now be listed before the DOI or URL, and the URL is not followed by a period.

Data Repositories

I’ve also edited a few articles that included an analysis of data sets from a repository. Data repositories serve as archives for isolated data sets that allow data to be mined for secondary use in research. In a situation like this, the data set used and the original source for the data should be cited.

In the example shown below, the information for the original source for the data is listed first, followed by the name of depository, the date of data deposit, and the DOI for the data set.

DeLeon TT, Almquist D, Kipp BR, et al. Data from: Assessment of clinical outcomes with immune checkpoint inhibitor therapy in melanoma patients with CDKN2A and TP53 pathogenic mutations. Dryad Digital Repository. Deposited March 12, 2020. doi:10.5061/dryad.m0cfxpp0g

Accurate references are a critical element of any published article. The updated guidelines on references ensure that readers are directed to additional resources for more information.—Juliet Orellana

Common Mistakes in Submitted Images

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The production graphics team at JAMA Network reimagines author art following AMA style guidelines. Our department is a fantastic resource to assist editors and authors with submission of art and reassure them that, with only a bit of tweaking, images can be not only press ready, but also meet journal style guidelines.

Because there are limited ways to present medical data graphically, we tend to see the same issues with author-provided art occur over and over again. Here is a short list of common submission errors to watch out for as editors before relaying an author’s images to your publication’s graphics department.

  • Plotting odds ratios as arithmetic instead of logarithmic.

Odds ratios need to be graphed on log scales, because plotting odds ratios on a linear scale is misleading.

  • Log scales that use half numbers.

Using half numbers on a log scale does not meet AMA style guidelines.

  • Failure to include tick marks with numbers on the x and/or y axis.

Our department reproduces author-submitted art to conform to style guidelines, and when art is submitted without ticks, it is sometimes difficult to align it with our templates.

  • Not providing vector art for Kaplan-Meier plots, forest plots, dot pots, or other plotted data.
  • Low-resolution images provided for photographic imagery.
  • Providing photographic imagery with text, arrows, A/B designators, or other types of callouts in the image area of the art.
  • Providing dot plots, scatter plots, and other types of images with inappropriate symbols.
  • Plotting mean values as bar graphs.

Bar charts are not an acceptable format for mean values and may only be used for frequency data (counts) only.

Our team’s goal is to work with editorial staff to produce images that support an article, are visually appealing, and produce the best possible results at press. Hopefully this information can aid authors and editors in submitting art to obtain these goals!–Carolyn Hall

Transformation and Promoting Trust in the Peer Review Process

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Today is the start of Peer Review Week, an annual global event celebrating the essential role that peer review plays in maintaining scientific quality. This year’s focus is on trust in peer review, and this post addresses the evolving transformation of the peer review in scientific publication.

Peer review continues to develop, albeit slowly, in terms of models and methods, with increasing calls for openness and transparency. There are 3 common forms of peer review:

  • Double-blind review: Authors’ and reviewers’ identities are hidden from each other in an attempt to minimize bias.
  • Single-blind review: Authors identities are revealed to all, but reviewer identities are not revealed to authors (also known as anonymous review)
  • Open review: Author and reviewers are identified are revealed and various levels of the process and outputs may or may not be made public

Types of open review, with increasing levels of openness, include the following:

  • Level 1: Reviewer and author identities are revealed to each other during the peer review process
  • Level 2: Indication of editor and/or reviewer names on the article
  • Level 3: Posting of peer review comments with the article, signed or anonymous
  • Level 4: Publication of peer review comments (signed or anonymous) with authors’ and editors’ responses, decision letters, and submitted and revised manuscripts
  • Level 5: Publication of the submitted manuscript after a quality check and inviting public discussion from the community

A recent look at the types of peer review used by some top-ranked general medical and science journals shows that most journals use single-blind review, with some allowing reviewers to choose to sign their reviews. For example, JAMA has a single-blind review process and offers reviewers the option to sign their reviews that are shared with authors, and copies of reviews are shared with other reviewers.

JAMA also has an editorial collaborative process, called editorial review before revision, during which senior editors, a manuscript editor, and an editor with expertise in data display collaborate to provide guidance to the authors on all that is needed during revision to reach a favorable final decision.

However, these processes are not public. A short video that explains an inside view of the editorial and peer review process at JAMA is available.

JAMA Network

The BMJ has a fully open review process with the following published with all research articles: all versions of the manuscript, the report from the  manuscript committee meeting, reviewers’ signed comments, and authors’ responses to all comments from editors and reviewers. Nature publishes reviewer names and comments and author rebuttal letters; however, authors and reviewers can opt out of the open review process. And eLife has a mixed model with reviewers’ names revealed to each other during the review process; decision letters, anonymous reviewer comments, and author response letters published with the article; and an option for reviewers to sign their reviews.

One of the earliest demonstrations of open and collaborative peer review was launched in 2001 by Copernicus Publications, an open-access publisher of scientific journals. These journals use a 2-stage process:

“In the first stage, manuscripts that pass a streamlined access review are immediately posted as preprint in the respective discussion forum. They then undergo an interactive public discussion, during which the referees’ comments (anonymous or attributed), additional community comments by other members of the scientific community (attributed), and the authors’ replies are posted. In the second stage, the peer-review process is completed and, if accepted, the final revised papers are published in the journal.”1

Many studies have compared the quality of single-blind, double-blind, and open review. Early randomized trials2,3 found no differences in the quality of double-blind, single-blind, or open review. But some studies have found differences, such has higher quality for blinded review,4 higher quality for signed reviews,5 and higher quality for open review.6 And some studies7,8 have identified biases that may be better managed with double-blind review (eg, bias toward gender, geography, institutions, and celebrity authors).  However, no study has yet compared the quality of published articles that have undergone these different types of peer review.

Drummond Rennie, the founder of the International Congress on Peer Review and Scientific Publication, has been a vocal proponent of open peer review. Writing about freedom and responsibility in publication in 1998, Rennie commented,

“The predominant system of editorial review, where the names of the reviewers are unknown to the authors, is a perfect example of privilege and power (that of the reviewer over the fate of the author’s manuscript) being dislocated from accountability….to the fellow scientist who wrote the manuscript. For that reason alone, we must change our practices. ….The arguments for open peer review are both ethical and practical, and they are overwhelming.”9

There have also been numerous studies demonstrating the feasibility of each type of peer review. However, some studies have found that double-blind review is not always successful and have reported rates of failure to ensure blinding ranging from 10% to 40%. Other studies have found that reviewers who are asked to sign their reviews may be more courteous or positive in their recommendation, may take longer to complete their reviews, and may be more likely to decline invitations to review.

Support for open review, with options, continues to evolve. In a 2016 OpenAire survey of 3062 academic editors, publishers, and authors,10 60% indicated that open peer review (“including making reviewer and author identities open, publishing review reports and enabling greater participation in the peer review process”) should be common in scholarly practice, but they had some concerns. For example, 74% responded that reviewers should be able to choose to participate in open review, and 67% reported being less likely to review if open review was required.

The Nature journals have been experimenting with various models of peer review, and in 2016, Nature Communications announced that about 60% of its authors agreed to have their reviews published.11  In 2019 and 2020, Nature journals began offering “transparent peer review” with options for authors and reviewers to opt out.12

Elsevier conducted a pilot of open review from 2014 to 2017 in 5 journals, with reviews published.13 During this pilot, younger and nonacademic scholars were more willing to review and provided more positive and objective recommendations. There was no change in reviewer willingness to review, their recommendations, or turn-around times. But, only 8% of reviewers agreed to reveal their identities with the published reviews.

Thus, the key to successful transformation to open peer review and maintaining trust in the process may be offering options to authors and reviewers. Whichever model is used, journals should clearly and publicly describe their processes (eg, in Instructions for Authors) and continue to evaluate and test ways to improve the peer review process for authors, reviewers, and editors.–Annette Flanagin, Executive Managing Editor and Vice President, Editorial Operations, for JAMA and the JAMA Network, and Executive Director of the International Congress on Peer Review and Scientific Publication

*Note: Portions of this post have been presented at several meetings.

References:

  1. Copernicus Publications. Interactive peer review. Accessed August 23, 2020. https://publications.copernicus.org/services/public_peer_review.html
  2. Justice AC, Cho MK, Winker MA, Berlin JA, Rennie D; PEER Investigators. Does masking author identity improve peer review quality? a randomized controlled trial. JAMA. 1998;280(3):240–242. doi:10.1001/jama.280.3.240 https://jamanetwork.com/journals/jama/fullarticle/187758
  3. van Rooyen S, Godlee F, Evans S, Smith R, Black N. Effect of blinding and unmasking on the quality of peer review: a randomized trial. JAMA. 1998;280(3):234–237. doi:10.1001/jama.280.3.234 https://jamanetwork.com/journals/jama/fullarticle/187750
  4. McNutt RA, Evans AT, Fletcher RH, Fletcher SW. The effects of blinding on the quality of peer review: a randomized trial. JAMA. 1990;263(10):1371–1376. doi:10.1001/jama.1990.03440100079012 https://jamanetwork.com/journals/jama/fullarticle/380957
  5. Walsh E, Rooney M, Appleby L, Wilkinson G. Open peer review: a randomised controlled trial. Br J Psychiatry. 2000;176(1):47-51. doi:10.1192/bjp.176.1.47
  6. Bruce R, Chauvin A, Trinquart L, et al. Impact of interventions to improve the quality of peer review of biomedical journals: a systematic review and meta-analysis. BMC Medicine. 2016;14(85). https://doi.org/10.1186/s12916-016-0631-5
  7. Lerback J, Hanson B. Journals invite too few women to referee. Nature. 2017;541(7638):455–457. doi:10.1038/541455a
  8. McGillivray B, De Ranieri E. Uptake and outcome of manuscripts in Nature journals by review model and author characteristics. Res Integr Peer Rev. 2018; 3(5). https://doi.org/10.1186/s41073-018-0049-z
  9. Rennie D. Freedom and responsibility in medical publication: setting the balance right. JAMA. 1998;280(3):300–302. doi:10.1001/jama.280.3.300
  10. Ross-Hellauer T, Deppe A, Schmidt B. Survey on open peer review: attitudes and experience amongst editors, authors and reviewers. PLOS One. 2017;12(12): e0189311. https://doi.org/10.1371/journal.pone.0189311
  11. Transparent peer review one year on. Nat Commun. 2016; 7(13626). https://doi.org/10.1038/ncomms13626
  12. Peer review policy. Nature Journals. Accessed August 23, 2020. https://www.nature.com/nature-research/editorial-policies/peer-review#transparent-peer-review
  13. Bravo G, Grimaldo F, López-Iñesta E, et al. The effect of publishing peer review reports on referee behavior in five scholarly journals. Nat Commun. Published online Junary 18, 2019. https://doi.org/10.1038/s41467-018-08250-2

Preprints in the Time of COVID

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Fans of the 1985 Gabriel García Márquez novel Love in the Time of Cholera are all too familiar with the concept of pining over something long desired, but luckily for medical editors, the 11th edition of the AMA Manual of Style has been quick to provide necessary and accessible updates for editors to use during the time of coronavirus disease 2019 (COVID-19).

The worldwide effort to provide research on COVID-19 has led to a substantial emerging literature, and many study results and manuscripts have been posted on preprint servers prior to peer-reviewed publication. Thus, medical editors who are working with COVID-19 articles may find that more authors are citing sources from preprint servers, leading to references that are, just like Florentino Ariza’s love life, a bit…complicated.

However, medical editors will not need to inhabit a world of magical realism to solve this dilemma. They only have to refer to the recent update to chapter 3.11.4.1, Preprint and Publication of Unedited Manuscripts. In it, they’ll find that many of the things that made citing these sources cumbersome, such as duplicative ID numbers, have been removed and that the order of elements is similar to other, perhaps more familiar, references.

This update hopefully makes life easier for medical editors during a high-volume time. It may even leave more time for reading for pleasure! I can make a great book suggestion 😉–Amanda Ehrhardt