Pens, Swords and Peer Review

Have you ever submitted a scientific paper to a journal?

If not, you may be surprised at how arduous the ‘no-holds-barred’ peer-review process can be. Although far from perfect, peer review is a vital cog in the machinery of scientific progress. The rigor of this challenging process makes the BCA’s libel accusations against Simon Singh seem laughable.

The ‘Quotable Quotes’ section of the Medical Journal of Australia is an excellent place to look fora insights into the Herculean labours of getting a paper published in a medical journal. Every year the journal prints anonymous excerpts from the written ripostes of authors and reviewers – unpublished writings that in many cases are far more interesting than the articles actually submitted and published.

Here are some of the nuggets I’ve panned.

First, you need a good title. Perhaps something like:

Adverse event reporting in clinical trials: regulatory tail wags the research ethics committee dog, distracting the latter from more useful activity

MJA 2003

Then you have to start your cover letter.  You might try the fearless approach:

I look forward to drawing swords against your referees.

MJA 2004

Or you might try to turn on the charm:

I have not been [to] your beautiful country yet, let my words visit it first.

MJA 2008

Don’t underestimate the (un)importance of the introduction:

“It is a romantic notion to think that we’d uncover stunning new insight into the past, by rummaging through attics and basements filled with relics of a bygone age. We’re more likely to find dust bunnies and Nan’s collection of vaudeville programmes than to uncover Macfarlane Burnet’s long-lost personal diaries.”

MJA 2007

As for the methods, take heed from this reviewer when describing your methodology:

Certainly the authors used both quantitative and qualitative approaches, but the mere conjunction of such approaches in the one study does not constitute a mixed-methods approach. By their demonstration, throwing flour, eggs and water in a bowl will produce pasta. Not unless some skill and care is applied, I’m afraid!

MJA 2008

Proofread carefully:

. . . patients [are] falling through the cracks in the Northern Territory

MJA 2005

Avoid speculation:

The whole paragraph is a case of malignant pharmacological speculation syndrome

MJA 2005

Don’t mince words trying to get your point across:

Cardiac arrest is more successfully treated in Chicago or Heathrow airport, or an American Airlines or Qantas jet, or in a Boston post office, than in the vestibules, corridors or general wards of Australia’s premier hospitals

MJA 2003

Be sure to end the paper strongly, so you don’t get a comment from a reviewer like this:

The conclusions end on a note that is remote from the key of the paper (to use a musical analogy)

MJA 2003

Don’t leave readers eating on the floor:

Reviewer: “In direct answer to your question about whether this submission has “legs”, I believe it’s safe to say that if this submission were a dinner table, the guests would be eating on the floor

MJA 2008

Most of all, try to be yourself when responding to reviewer suggestions:

Reviewer: “…Point 8. It would be useful to summarise the current . . . constraints . . . in a box so that non-Australian authors will understand what is being discussed.”
Author: “In 400 words, mate? Your sense of humour is even better than the editor’s.”

MJA 2004

Know when to quit:

“I’m well aware of the likely costs to me of publication of this letter, so on reflection I’ve decided that while I’m prepared to be hung for a sheep, it’s not worth it for a lamb (ie, a shorter letter). I would therefore like to withdraw my submission.”

MJA 2006

Hopefully none of this has put you off the idea of contributing to the world’s scientific and medical literature. Just in case, in order to make future paper submissions easier for you, I have reproduced a sample cover letter written by Roy F. Baumeister (originally from Dan Ariely’s Predictably Irrational website):

Today’s date

Dear Sir, Madam, or Other:

Enclosed is our latest version of MS# XX-XXX-XX-, that is, the re-re-re-revised revision of our paper.   Choke on it.   We have again rewritten the entire manuscript from start to finish.   We even changed the goddamn running head!   Hopefully we have suffered enough by now to satisfy even you and your bloodthirsty reviewers.

I shall skip the usual point-by-point description of every single change we made in response to the critiques.   After all, its fairly clear that your reviewers are less interested in details of scientific procedure than in working out their personality problems and sexual frustrations by seeking some kind of demented glee in the sadistic and arbitrary exercise of tyrannical power over hapless authors like ourselves who happen to fall into their clutches.   We do understand that, in view of the misanthropic psychopaths you have on your editorial board, you need to keep sending them papers, for if they weren’t reviewing manuscripts they’d probably be out mugging old ladies or clubbing baby seals to death. Still, from this batch of reviewers, C was clearly the most hostile, and we request that you not ask him or her to review this revision.   Indeed, we have mailed letter bombs to four or five people we suspected of being reviewer C, so if you send the manuscript back to them the review process could be unduly delayed.

Some of the reviewers’ comments we couldn’t do anything about.   For example, if (as reviewer C suggested) several of my recent ancestors were indeed drawn from other species, it is too late to change that.   Other suggestions were implemented, however, and the paper has improved and benefited.   Thus, you suggested that we shorten the manuscript by 5 pages, and we were able to accomplish this very effectively by altering the margins and printing the paper in a different font with a smaller typeface.  We agree with you that the paper is much better this way.

One perplexing problem was dealing with suggestions # 13-28 by Reviewer B. As you may recall (that is, if you even bother reading the reviews before doing your decision letter), that reviewer listed 16 works that he/she felt we should cite in this paper.   These were on a variety of different topics, none of which had any relevance to our work that we could see.   Indeed, one was an essay on the Spanish-American War from a high school literary magazine.   The only common thread was that all 16 were by the same author, presumably someone whom Reviewer B greatly admires and feels should be more widely cited.   To handle this, we have modified the Introduction and added, after the review of relevant literature, a subsection entitled “Review of Irrelevant Literature” that discusses these articles and also duly addresses some of the more asinine suggestions in the other reviews.

We hope that you will be pleased with this revision and will finally recognize how urgently deserving of publication this work is.   If not, then you are an unscrupulous, depraved monster with no shred of human decency. You ought to be in a cage.   May whatever heritage you come from be the butt of the next round of ethnic jokes.   If you do accept it, however, we wish to thank you for your patience and wisdom throughout this process and to express our appreciation of your scholarly insights.   To repay you, we would be happy to review some manuscripts for you; please send us the next manuscript that any of these reviewers submits to your journal.

Assuming you accept this paper, we would also like to add a footnote acknowledging your help with this manuscript and to point out that we liked the paper much better the way we originally wrote it, but you held the editorial shotgun to our heads and forced us chop, reshuffle, restate, hedge, expand, shorten, and in general convert a meaty paper into stir-fried vegetables.   We couldn’t or wouldn’t have done it without your input.


(your name here)

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of three amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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