Aristoteles Giagounidis, MD
Head of the Department of Oncology, Hematology, and Palliative Care at Marien Hospital
in Düsseldorf, Germany
In 1912, Albert Einstein was working hard on his theory of general relativity. To finalize his efforts, he needed some additional insight into elliptic or Riemannian geometry. His friend and colleague at the University of Zurich, Marcel Grossmann, provided this invaluable assistance. Einstein also contacted the Greek mathematician Constantin Carathéodory for clarifications on the Hamilton-Jacobi equation and canonical transformations. Today, while just about everyone knows who Einstein is, very few people have heard of Grossmann or Carathéodory. This calls into question how we value peer reviewers – those key people who critically review scientific work and improve our intellectual achievements. Based on my experience, peer reviewers aren’t valued highly enough, and the systems that are in place to recognize reviewers are insufficient. Change is in order.
A couple of months ago, I was asked to review a manuscript for The New England Journal of Medicine. It was a nice paper detailing a massive, long-lasting scientific effort, and it had an author list that read like a “who’s who” of the field. Although I was impressed with the data and the overall message, I wasn’t entirely happy with the way some data were presented, and I spent a lot of time trying to make it more concise and understandable to a wider audience. To complete my review, I spoke with the authors for hours, searched current literature, and reviewed molecular biology and genetics. I recommended that the paper be revised. The paper was eventually published – in another prestigious journal – and the authors had taken into account all my recommendations. The published paper was clear, concise, and easier to read than the original I had first reviewed.
Despite this result, I didn’t receive anything in return for my effort, apart from three American Medical Association Physician’s Recognition Award (AMA PRA) Category 1 credits, which are not recognized in Germany. This is not an uncommon experience for physicians in hematology who do this type of work.
In addition to AMA PRA credits, I have previously been offered recognition by Publons, a website that summarizes a researcher’s scholarly impact as an author, editor, and peer reviewer. Although I like the website and its functionality, the advantages I derive from being listed there are modest at best. I have suggested to journal editors that a subscription to their publication might be a sensible reward for volunteering my time to improve the research they publish, but this hasn’t materialized. I propose another option for recognizing reviewers: include them in the list of authors.
Including peer reviewers in the list of authors – unless they wish to remain anonymous – would be warranted, given that they invest considerable time and effort to improve the manuscript. Reviewers could be listed in the middle of the author list with a special letter or abbreviation that identifies them as a reviewer; for example, em, for the Latin emendatio, which means improvement.
This would have a multitude of benefits. In Germany, for example, a score is assigned to each scientific paper (usually equivalent to the journal impact factor). This score is awarded in full to the first and the last authors, who typically put the most work into the paper, and then at 50% to any other author. If a reviewer were assigned a position in the author list, he or she could also receive a value for their efforts, be it 25%, 50%, 75%, or 100% of the impact factor equivalent. This reward system would also provide a higher incentive for reviewing manuscripts by increasing the reviewers’ visibility in a relevant way. In addition, authors (and editors) could grade the impact that the review had on improving the manuscript, and those reviewers who meet a threshold score could be added to the author list.
There are many arguments against the practice of including reviewers in the author list, but most are not well substantiated. For example, the International Committee of Medical Journal Editors (ICMJE) requires four independent factors for inclusion on the author list:
- Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work
- Drafting the work or revising it critically for important intellectual content
- Final approval of the version to be published
- Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved
I propose that this is a mere convention that could easily be changed. For example, a fifth requirement could be added: “or serving as a reviewer of a manuscript that has been submitted for publication whose review has been assigned high value by the authors or journal editors.”
Some may argue that this could incentivize a reviewer to try to pass an article into a high-ranking journal, but there are several reasons I don’t think this would happen. First, reviewers of high-ranking journals are usually very experienced and advanced in their careers, so they are unlikely to be subject to this kind of bribery. Second, if one gives a bad paper a pass, he or she would be exposed with their names as referees – which is probably the biggest deterrent. Third, most journals already ask authors to suggest potential reviewers, which can be seen as a source of bias. Finally, some may say that if a manuscript is rejected, the editor of the next journal to which it is submitted will not know how many people’s input it has taken to improve the paper. True, but then again, that is bad luck. All the flaws will not be resolved at once!
I am not sure whether these suggestions will result in a fundamental change to the way we reward reviewers, but it is time to make reviewing manuscripts more attractive. The time and effort of the anonymous crowd doing this major work needs to be valued at last.
Ari Giagounidis, MD