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Logo of emermedjEmergency Medical JournalVisit this articleSubmit a manuscriptReceive email alertsContact usBMJ
Emerg Med J. 2007 July; 24(7): 454.
PMCID: PMC2658385

Peer review

If a paper is published in a peer reviewed medical, biological or scientific journal there is a tacit assumption made by a significant proportion of readers, as well as many in the mainstream media, that it has survived a closely scrutinised, transparent and vigorous process of analysis and criticism from learned colleagues, before acceptance by the journal's editors. It must surely be a good paper and it must surely have something worthwhile to say, otherwise it will have been rejected. The reality is that the paper may have a worthwhile message, but it may not.

As Richard Smith, former editor of the BMJ, says, peer review is hard to define, its defects are easier to identify than its attributes, and until recently it has been unstudied. He adds that “if you persist long enough you can get anything published, no matter how terrible”.1

A paper submitted to the Emergency Medicine Journal (EMJ) must be done so electronically via Bench>Press on the EMJ website (Bench>Press being the manuscript handling software). The editors look at manuscript submissions online and either immediately reject, accept or allocate them to a fellow editor (or associate editor) to solicit reviews from a database of EMJ reviewers. Between 20–25% are rejected immediately without peer review on the grounds of priority, insufficient originality, flaws, or the absence of a message that is important to the readers of the journal.

We aim to have at least two reviews per paper but as we experience unreliable responses we build in some redundancy and normally approach at least three reviewers per paper, although sometimes we go to more than this. If all else fails we use the editorial board members as our “backstop”; they have a mutually agreed obligation to review at least 4–6 papers a year, and they come up trumps for us.

The reviews (generally of an excellent standard) help us to accept, reject or ask the author(s) for modifications. This exchange of opinions and responses may last several weeks but we try to keep it as brief as possible. In time the paper is accepted or rejected. If we cannot decide what to do, because of conflicting opinions from the reviewers, we refer the paper to the Hanging Committee (comprising the editors and associate editors), which then makes a decision after due discussion.

Reviewers are encouraged to reveal themselves to the author(s) when returning their reviews, an initiative started by the BMJ in 1999,2 but it is not mandatory, and they perform their tasks without any financial or material reward. Disclosure of the reviewer's name is known as open peer review and is not universally used in medical, biological and scientific publishing. It does not mean, however, that authors can contact reviewers directly; all queries must be directed through the editorial office.

The use of peers (when I first heard the term as a student I had a brief vision of ermine coated octogenarians writing to the editor in droves) and whether open or closed, but especially when closed, is slow and potentially biased. Trish Groves, a senior editor on the BMJ, says that “peer review is an art not a science; it is not a great system but it is what we have…there is great store set by peer review, which is a good reason to try and make it as good as possible. The reality is that it is all just a matter of opinion” (‐world‐review/features/2187722/road‐old‐peer‐show).

Open access, the creed that the world's scientific and medical literature should be freely available to be used and distributed in any way that the consumer wants, and defined following a meeting in Maryland in 2003 (˜peters/fos/bethesda.htm), has also recently started to experiment with open peer review so that it is completely transparent and the reviewers fully identified. Even the House of Commons gets in on the act, its Science and Technology Committee commenting that “the endeavours of publishers…to widen access to scientific publications are admirable and they are to be commended for the vigour with which they have pursued their aim”.

The American Public Library of Science (PLoS), a non‐profit organisation of scientists and physicians committed to open access (, has piloted open peer review but has been criticised for not being open enough, as the open peer review occurs after publication, with initial decisions being made by the editors.

The Directory of Open Access Journals is a useful resource for readers who are interested in accessing publications that follow these concepts ( As open access/sourcing via the internet becomes the norm in many activities of modern life (Youtube being a prime example) the trend of open access in publishing will bloom and in time become mainstream.

Meanwhile we continue to be most grateful to all our reviewers, both frequent and occassional, and ask them to decide for themselves if they wish to remain anonymous or not, but encouraging the latter.


Competing interests: None declared.


1. Smith R. The trouble with medical journals. London: Royal Society of Medicine Press, 2006 [PMC free article] [PubMed]
2. Smith R. Opening up peer review. BMJ 1999. 3184–5.5 [PMC free article] [PubMed]

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