A Reader and Author Respond to "The End of Peer Review and Traditional Publishing as We Know It"

Val Jones, MD; Peter Frishauf, MS


January 16, 2009

To the Editor:

I think that Peter's approach to peer review for scientific articles is interesting but incomplete.[1] As with all "user-generated content," one must always consider the motivational forces driving engagement. If the user requirements are high, and the personal gain is unclear, participation will be low. Those who will make the effort to do the work are likely to be biased in some way; otherwise the value proposition wouldn't work for them. Good peer review is difficult; it takes focused effort from knowledgeable and well-trained individuals, and it's critically important for the advancement of science.

Now, if Peter had suggested a mechanism to control for this bias and offered users a tangible benefit, other than the honor of being a participant, I would have been all ears. For example, why not design a peer review process in which a large pool of qualified reviewers could receive CME [continuing medical education] credit for their work? This approach might be an improvement over our current "clubby, biased, and incomplete" method. I like the idea of expanding participants in the peer review process, but we must not throw open the doors to all comers. If someone asked me to review an aerospace engineering research article, I can tell you (with all honesty and humility) that my contributions would be fairly worthless. Let's avoid doing something similar in medicine.

Val Jones, MD
CEO, Better Health, LLC

  1. Frishauf P. The end of peer review and traditional publishing as we know it. Medscape J Med. 2008;10:267. Available at: Accessed November 30, 2008.

Author's Response

To the Editor:

My thanks to Dr. Val Jones and the many others who have commented on my Medscape Video Editorial. A few points I made merit repeating:

  • I did not state that Wikipedia in its present form is a substitute for a traditional peer-reviewed publication. I called for "a variant of Wikipedia." I said "the future will look a lot like Wikipedia (emphasis added)," not that the future would be the English-language Wikipedia most readers know.

  • I fully support the need for peer review of articles. I want a better, faster process than what we have today. I want peer review to occur both before and after publication. Most peer review now is capricious: An editor can make up his or her own rules, and doesn't even have to tell readers what they are. It's slow, secretive, and clubby. I want a system in which editor(s) or a trusted board of editors decide quickly whether an article should be posted, and then invites comments or corrections from readers (again, reviewed prior to posting) published after the article is posted.

  • I agree with Val Jones' views: "Motivational forces" of reviewers should be considered; "good peer review is difficult," and requires "focused effort from knowledgeable and well-trained individuals." So what exactly do traditional peer-reviewed journals do to meet these healthy goals? Do they publish peer review rules? Who sees to it that they are followed? Do we hear dissenting views? The process I advocate would be transparent, ie, every reviewer would publish a profile that would accrue "trust points" that are based both on their credentials and affiliation, what they contribute to the work, and continually ranked by readers whose own profiles would be built. Dr. Jones' excellent idea ("why not design a peer review process in which a large pool of qualified reviewers could receive CME credit for their work?") suggests that she is largely onboard with this concept. Just as eBay invented an effective system to establish trust among buyers and sellers, medical publishing could design a reputation system that could validate published findings as new knowledge and understanding are brought to the topic of an article.

  • I was surprised by the dearth of comments on the benefit of reading one living article that is constantly updated, expanded, and improved, rather than the static article format (really a "snapshot in time") that dominates today. Constant updating is one of the hallmarks of the Wikipedia approach. Aren't defenders of the status quo concerned with the built-in obsolescence of every article they read? How many times have you read something that is out of date by the time you get to it? Isn't this something that should worry publishers and audiences of traditional journals? Doesn't this hurt patient care as well as waste time, energy, money, and resources? One commenter writes that "the advantage of peer-reviewed print media is that it is not a short-lived phenomenon. It is there for reference, examination and digestion. Wikipedia (sic), by its very nature, is none of these." Although this is a virtue of print, it should be noted that another part of the Wikipedia method is to maintain a complete history of every version and every change to an article made once it is first published. A reader or researcher can examine every version of an article and easily compare it with others.

Peter Frishauf, MS
Founder, Medscape
New York, NY
Independent Consultant
PFKC Ltd. Corp
New York, NY
Silverado Health Partners, LLC
Newtown, Pennsylvania

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