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- ↵*Address correspondence to:
Anthony N. DeMaria, MD, MACC, Editor-in-Chief, Journal of the American College of Cardiology, 3655 Nobel Drive, Suite 400, San Diego, California 92122, USA.
This Editor's Page is being written as the month of June 2003 comes to an end. July will mark an anniversary of sorts, since it was one year ago that the first issue of the Journalwas published under the auspices of the San Diego editorial office. In fact, most manuscripts for even that issue had been processed by Bill Parmley and associates. Although the time has gone by quickly, it has been a period of intense learning for myself and the Associate Editors. I thought you might be interested in my impressions from the first year—especially some of the bigger surprises.
My first impression in editing the Journal, is that, like so many things, it takes longer to process a submission than we thought it would. When we assumed responsibility for the Journal, one of our major goals was to make the interval required for peer review and decision as short as possible. It seemed simple enough, just log in the manuscript, obtain the opinion of reviewers, make a decision, and inform the authors. However, the actual implementation has involved more steps and time. This became clear when we conducted “autopsies” on several submissions that required more than 60 days for the initial decision. The manuscript first went to me to assign an Associate Editor, who then obtained reviewers, who then performed the evaluation, which then awaited discussion at our weekly meeting. Each step required time. Delays could occur at any point, but the most frequent was at the reviewer interface. Some potential reviewers simply never responded to our solicitation, and it was often necessary to contact 10 or more individuals to secure two referees. Most reviewers were prompt, thoughtful, and of great assistance. However, some reviewers (often with stellar reputations) held an article for 60 days and then declared that they could not perform the evaluation. We have now implemented a number of steps to eliminate delays, such as withdrawing reviewers after 40 days. In addition, we are constantly tracking the progress of manuscripts as they go through the peer-review process, which currently averages 27 days. However, even with all the planning and tracking and exhortations, I am still amazed at the time required to process a paper—much longer than I would have thought.
The large number of international submissions to JACChas been commented on previously in these pages. In fact, the quantity and quality of these submissions have been a pleasant surprise in adding important contributions and participating investigators to the Journal. Likewise, I have found the community of editors of cardiovascular journals to be a valuable resource. These colleagues have always been ready and willing to discuss unusual problems or to recount their approach to a variety of issues.
Interacting with authors has proven to be more pleasant than I would have guessed. Most authors produce only a few manuscripts per year, if that many, and regard their work with pride. The thought and effort of the authors has given birth to the article, and they have usually considered every detail in great depth. The editors, on the other hand, are dealing with 70 new manuscripts per week, on average, and are challenged by the sheer task of maintaining the flow. I have often used the analogy of the famous video clip of Lucille Ball trying to keep up with a rapidly moving candy production line conveyor belt. After several minutes she feverishly stuffs candies in her mouth and her pockets just to keep things from backing up. Nevertheless, the editors have made it our highest priority to approach each manuscript with the respect we would want accorded to our own. However, sometimes delays and decisions which are not precisely explained do occur. One of the truly unexpected and great surprises of the first year has been how understanding and accepting the authors are of the issues we face as editors. This is especially welcome since, as discussed in the rest of this essay, the process of peer review is imperfect and subject to a number of variables.
We began our term as editors with the philosophy that there are two fundamental variables in the evaluation of any manuscript: the article itself and the reviewers. We believed our job was to synthesize the two variables and adjudicate differences. However, we have discovered that the variables exist to a greater degree than anticipated, often making the acceptance of manuscripts complicated and a bit fortuitous.
Although we fully anticipated that individual reviewers might differ in their assessment of a given manuscript, I for one have been very surprised at the magnitude of the variability. In fact, so often and so greatly did reviewers of the same manuscript disagree with one another, I decided to study this phenomenon systematically. We therefore examined the grades given by the first two reviewers for 2,400 manuscripts that completed a full initial evaluation in 2002. Using our A, B, C, D, and F grade scheme of overall priority for publication, there was a difference of two grades or more (e.g., from B to D) for 45% of the papers. Using our recommended action scheme of accept as is, minor revision, major revision, or reject, at least one reviewer recommended rejection of 59% of the manuscripts. Of greatest surprise, an article rejected by one reviewer was assigned a grade of A or B by the other in 24% of the cases examined. Needless to say, the Associate Editor may have yet again a different opinion. In such circumstances we often used a third critique as a tie-breaker, and thankfully the third reviewer usually came down firmly on one side or the other. Nevertheless, that two experts in an area can review an article and come to such diametrically opposite conclusions gives some idea of the element of chance inherent in the peer-review system. The sometimes contradictory critiques often confuse authors who are trying to understand why we reached the decision we did and how to revise a manuscript for submission to another journal. The lack of concordance in reviews also illustrates the challenges confronting the editors in deciding which assessment is most accurate, not to mention what the priority for publication should be relative to other articles.
Once a manuscript arrives on the agenda of our weekly meeting, the editors must decide how it rates in priority for the limited number pages able to be published. Typically there are a number of papers with acceptable priority scores but some significant limitation either in originality, methods, presentation, or clinical relevance. We first prioritize the paper according to the highest scores. As we reach the quota we can accept for the week, we choose among papers of generally comparable score based on number of pages available, diversity of subject matter, perceived interest to the readers, and other criteria. We sometimes hold a paper for another week (or two at most) if it falls slightly short of making the cut for that week.
Thus, the chances that any submission will be accepted for publication depend not only on its priority grades but also on the number, quality, and subject matter of competing papers considered that week. We trust (and we hope and pray) that we don't reject any really excellent papers, but we do decline to publish many that are very acceptable and of considerable merit. It is not surprising, therefore, that after receiving decision letters and reviews, authors sometimes contact us, perplexed at why their paper has been rejected. Nevertheless, when we explain our constraints in the number of pages, the process we follow, and how we reached our decisions, virtually all authors have been quite gracious in accepting our decision. For this we are extremely grateful.
As time goes by, we hope to use the experience of this first year to help us do a better job. We now know where all the potential delays are in the peer-review system. We are using this knowledge to progressively reduce our time to decision and to eliminate the trapping of manuscripts in long periods of delay. We are gradually getting a sense of who are the “hard” reviewers and who are the more forgiving ones. This helps us factor out some of the variability in the review process. We are also feeling more comfortable in our interaction with authors, so that we can be of more value to them in revising their papers. I'm sure we will continue to learn things that will make us better editors as time goes by. For the moment, perhaps the most important things I learned this past year are that our peer-review process is not perfect, that our decision-making is not infallible, and that nobody expected either.
↵1 Editor-in-Chief, Journal of the American College of Cardiology
- American College of Cardiology Foundation