Author + information
- ↵*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.
Editorials are a time-honored component of medical journals. They are analogous to the opinions expressed in the editorial pages of newspapers. Although such articles are nearly always authored by the editors themselves in the case of newspapers, in medical journals they are more typically written by experts in the field. Despite the well-established presence of editorials, little has been written either about their purpose or about the qualities that render them excellent. Therefore, I thought it might be of interest to present the opinion of the JACCeditors regarding the rationale for, the selection of, and the assessment of quality in the editorial comments.
In general, the decision to have an editorial accompany an article indicates that the editors judge there to be something noteworthy about the manuscript. However, this aspect may evoke praise, such as in detailing a major breakthrough, or prompt caution, as in the case of results that are inconclusive or may have been overinterpreted. Only rarely should an editorial be highly critical of an article, since serious faults would have been likely to result in rejection in the first place. Nevertheless, editorials span a wide range of postures regarding the articles discussed which reflect the spectrum of reasons for which they are solicited.
Editorials fulfill a number of purposes. One of the most common reasons the editors solicit an editorial is to deal with a topic that is particularly specialized or complex. As cardiovascular medicine becomes ever more specialized, the number of papers discussing issues unfamiliar to general readers is increasing. Moreover, the complexity of current scientific techniques is often not well understood by those outside the field. In such cases, an editorial serves the important purpose of providing background and perspective and putting findings into context. The goal of providing context is particularly important for some articles, but it is of significant value for all articles.
On occasion, the purpose of an editorial is to emphasize a breakthrough article of great clinical or research importance. The clinical multicenter randomized megatrials are classic examples, although many others exist. Editorials in such cases are expected to highlight the importance of the problem addressed, define the incremental value of the data and the issues that remain unresolved, and provide some guidance as to how the results should be incorporated into subsequent behavior. These types of papers lend themselves to editorials with the most specific recommendations.
From time to time a manuscript is accepted for publication in the face of reservations on the part of the reviewers or editors. Typically, such manuscripts have received conflicting evaluations from the reviewers, some expressing substantive concerns. Alternatively, all critiques may point to a single weakness of the work, such as the uncertain influence of a variable, a question about methodology, or disagreement about interpretation. In such cases the editors turn to an editorial to delineate the limitation of the study and the implications for the interpretation of the findings. Often the original manuscripts put forth new and interesting ideas, and although a study itself may not be perfect, we judge that it is important to air the concept. These editorials are among the most difficult to write, because they require a careful, objective delineation of the value and limitations of the work.
Similar to the foregoing, some manuscripts present very controversial findings. Such studies may report data that are totally unexpected or contrary to prior findings. Although they may lack any flaws that would discredit the results, such manuscripts nevertheless generate considerable doubt among reviewers and editors. Again, this represents a setting in which an editorial can make an important contribution by comparing and contrasting the findings with previous reports or expected results and by providing potential explanations.
Finally, some manuscripts are merely judged to be candidates for overall synthesis. In general these papers deal with established issues for which literature already exists. In these situations, the editors request an editorial in order to indicate why the new data are important, what they imply for current practice or research, and what additional data are required in the future. When we suspect that the title of a paper may lead readers to ask the question “why are they publishing this?”, an editorial will usually accompany.
Based on the above comments, the qualities that the editors believe make an excellent editorial should be apparent. An editorial should provide some background and perspective that will put the article into context. It should indicate why the issues addressed are important and what incremental information the new article provides. It should describe any weaknesses or limitations of the study and how these factors should influence the interpretation of data and the extrapolation into practice. For controversial articles, the editorial must carefully present the pros and cons of the report. Finally, every editorial should detail the significance of the questions asked, how the data should be incorporated into practice or investigation, and what additional information is needed for a definitive resolution of the issue.
What an editorial should not be
Perhaps equally important is what the editors think an editorial should not be. An editorial should not be a restatement of the article it is addressing. The editors are sometimes surprised to receive an editorial that is essentially a repetition of the methods, results, and conclusions of the original manuscript. In addition, an editorial should not be identical to the peer-review critique. The main message of an editorial can easily be lost in a highly detailed discussion of the specifics of the original manuscript. Finally, editorialists are generally selected for their expertise in and contributions to the subject matter under consideration. Nevertheless, the editorial should not be unduly weighted by a discussion of the prior work of the editorialist in the area.
Several other aspects of editorials seem worthy of discussion. Editorials are opinion pieces and, thereby, reflect the thinking of the authors. An editorialist's assessment of the importance, clinical implications, or any other aspect of an article may not be shared by others. For instance, the opinions expressed in a very critical review are obviously not shared by the authors of the paper. Nevertheless, in these opinion pieces, the editors allow writers very wide leeway. It should be remembered, therefore, that editorials do not necessarily carry the full endorsement of the editors and that a somewhat different interpretation and assessment of the work might be reached by another editorialist.
I believe that editorials entail a danger: that is, the risk that readers will accept the interpretation and evaluation of editorials without carefully considering the papers themselves. Many readers scan an article quickly and then turn to the editorial to see if there are any weaknesses and what the study means. In fact, some readers claim to read only the editorial. This is tragic, of course, and deprives readers of reaching their own conclusions. In addition, an editorial may convey to them an opinion—good or bad—that others might not share. In view of this potential misuse, I worry about providing too many editorials and about positioning them too far from the original article in the journal. In the final analysis, however, you cannot stop selling cars just because some people will drive while under the influence of alcohol and have accidents. We continue to solicit editorials for the good purposes they can serve, and we hope that readers will use them appropriately.
Editorials have been and probably always will be part of medical journals. Just like original articles, some are magnificent and enhance the articles they accompany, while some can be greatly improved. In any case, readers should first try to reach their own editorial conclusions before reading someone else's evaluation. Used in this fashion, editorials provide an excellent venue for transmitting important information to readers.
↵1 Editor-in-Chief, Journal of the American College of Cardiology
- American College of Cardiology Foundation