It may start as an idea, a hypothesis that turns into a research project, with publication of an article as the crowning achievement after a long search for scientific truth. Among other things, a published scientific article is an expression of the author’s level of knowledge, as well as his or her expertise, experience, erudition, sophistication and even personality.

Opening all of these personal attributes to criticism can be a daunting experience, one that may prevent some from even attempting to publish. Acceptance renders justification, but rejection can trigger doubt and even distrust. It can be difficult to look at a rejection or a request for revisions with emotional detachment and to accept that the critique was based solely on scientific merit. It is important, therefore, for the editor to provide an author with the best and most unbiased assessment of the submitted manuscript possible. To achieve this end, most scientific journals, including JADA, use a peer-review system.

After a manuscript is submitted to JADA, the editor makes an initial judgment as to the appropriateness and general quality of the submission, and decides whether the submission warrants further review. Unfortunately, some submissions are rejected outright. This occurs chiefly when there are major and obvious flaws with the scientific methodology or the statistical analysis, a lack of informed consent or the absence of an institutional review board approval. It also may occur when the manuscript does not conform to the types of articles suitable for JADA.

JADA has a registry of more than 1,800 reviewers selected on the basis of their demonstrated expertise in particular fields, including dental and general health care. A submitted manuscript generally is sent to a minimum of three reviewers. Depending on the complexity of the topic, six or even seven reviewers may be used. These "referees" are free to accept or decline participation in the review of a particular manuscript. JADA uses a single-blinded review process: reviewers know who the authors are, but the authors are not told the identities of the reviewers. A single-blinded review process can facilitate discovery of otherwise undeclared conflicts of interest and other potential biases—for example, if the same manuscript has been submitted to more than one journal or if similar articles already have been published by the same author. This single-blinded approach has few disadvantages, as studies have shown that double-blinded reviews, in which reviewers are not told the names of authors, have not been entirely successful in protecting the anonymity of authors.¹

Reviewers are asked to rate the submission based on several criteria and make a recommendation from four options: acceptance without changes; acceptance after minor changes; acceptance after major changes; rejection. If major changes are recommended, the freshly revised manuscript will be sent out for a second review.

The revised manuscript typically is returned to the same reviewers to determine whether the author has addressed the reviewers’ comments. In addition to making recommendations that are shared with the author, reviewers also can add confidential comments to the editor. As a rule, if an author cannot adequately address the reviewers’ comments after two or three revisions, the manuscript is rejected.

The peer-review process is meant to help ensure that published manuscripts meet the scientific rigor of The Journal and that they are appropriate for the readership. From an author’s perspective, peer review—a manuscript’s appraisal by numerous experts with different points of view, experience and levels of scholarship—may enhance the quality of the submission. Reviewers may identify errors and omissions, and suggest different methodologies for analyzing data. They may even broaden the appeal of the manuscript by providing a more forthright assessment of the scholarship in ways that may not have been available to the authors. In addition, reviewers sometimes can provide references to similar studies that the authors may have overlooked.

Despite all this effort, peer review has its limitations. Reviewers obviously bring their own experiences, skills and understanding of a topic to the task of reviewing a manuscript. Their opinions may not always be impartial or completely objective. On the other hand, authors do not have to agree with reviewers’ comments and are given an opportunity to present counter arguments. To facilitate this process, authors are asked to submit a separate document with their revised manuscript in which they address each and every point made by the reviewers.

Recent multiple cases of fraudulent research finding its way into the peer-reviewed literature have raised questions about the abilities (and responsibilities) of reviewers to detect intentionally falsified or fabricated material.² Even with the best scientific data, no single manuscript can cover every facet of the research on a given topic. Nor do reviewers have available to them original research notebooks or other data collection records. The responsibility to provide accurate, true and valid data rests with the authors. It is implied that all authors listed as having contributed to the submission have in fact made an intellectual contribution to the manuscript. This is something else reviewers cannot determine.

Authorship of scholarly articles is an essential part of academic promotion and tenure and is easily abused. There may be pressure on junior faculty members to add a senior faculty member, a director of a laboratory or a chairperson as a contributing author. Or a politically influential person may be added to enhance a submission’s chances of acceptance. Although there are guidelines detailing what constitutes proper authorship,³ this can be a contentious issue, sometimes to a preposterous degree. Consider the case in which authorship of an article was sold successfully on eBay!⁴

Another problem with peer review that has come to light recently centers on a reviewer’s recommended rejection of a contribution that negates his or her own findings or that competes for funding the reviewer seeks. Yet another predicament with peer review is the dearth of qualified reviewers. The best reviewers often are asked to review multiple submissions from many different journals, thus limiting the time they can offer any single publication. Obviously, a good reviewer must be knowledgeable about a particular subject, but there is more to it than that. He or she also must have the experience and ability to communicate constructive, written criticism in a way that is helpful, both to the author and to the editor.

Ultimately, the editor makes the final decision on the fate of each submission and, in doing so, must consider many factors beyond the reviewers’ recommendations, which are just that: recommendations.

Other considerations:

– Are similar manuscripts already accepted and awaiting publication?

– Are similar manuscripts in the pipeline of The Journal’s review process?

– Does The Journal have sufficient space available to accommodate the article?

– Is the article timely and right for The Journal’s readership?

– Have the authors published similar articles in other journals?

– Have related journals recently covered the topic?

Scientific, peer-reviewed journals have been around for more than 300 years. It should be noted, however, that some of history’s most revolutionary thinking was published without the benefit of peer review: Albert Einstein’s "Annus Mirabilis" articles in 1905, and Watson and Crick’s original 1951 contribution describing the structure of DNA. Unfortunately, there are many more examples of accepted peer-reviewed submissions that never should have been published.² Peer review is not perfect, but it has held up over time as an essential part of bringing new science to light.

At JADA, we have explored various options to reward our reviewers for what may seem, to some, a thankless task. In January 2007, we began awarding continuing dental education credits to reviewers whose evaluations demonstrated an especially conscientious attention to the reviewer’s role. It is a small sign of appreciation from us for the indispensable contribution our reviewers make to the American Dental Association’s Journal.

It also is our way of acknowledging that it is in part because of our superb cadre of reviewers that JADA holds the title of dentistry’s best-read peer-reviewed publication.