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Addressing conflicts of interest and clouding of objectivity: BJSM’s “Peer review: fair review” section
  1. Karim M Khan1,
  2. Steven D Stovitz2,
  3. Babette Pluim3,
  4. Jill L Cook4,
  5. Roald Bahr5,
  6. Elizabeth A Arendt6,
  7. Timothy D Noakes7
  1. 1
    Centre for Hip Health and Musculoskeletal Research and Department of Family Practice, University of British Columbia, Vancouver, Canada
  2. 2
    Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota, USA
  3. 3
    Royal Netherlands Lawn Tennis Association (KNLTB), Amersfoort, The Netherlands
  4. 4
    School of Exercise and Nutrition Sciences, Deakin University, Burwood, Australia
  5. 5
    Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
  6. 6
    Department of Orthopaedics, University of Minnesota, Minneapolis, Minnesota, USA
  7. 7
    MRC/UCT Research Unit for Exercise Science and Sports Medicine, Sports Science Institute of South Africa, Newlands, South Africa

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    You know that feeling. You have spent months raising the funds for your research study, writing the protocol and having it approved by your ethics committee. Then you spent a year or more completing the research and writing up your results. Then finally you press “send” and your sacred manuscript is winging its way across cyberspace to the journal of your choice. Your feeling of relief is immense and for a short time you turn your mind to other pursuits.

    Then with what appears to be quite rude alacrity, you receive the email from the journal. Your heart sinks as you assimilate the rejection. The editor informs you that your manuscript has been reviewed by two or more of the world’s most eminent authorities on the topic. Unfortunately none sees value in your study which is “too speculative” and does not fit with what “is already known about the topic”. Then to add further insult, the editor states that your study is in any case of too low an impact to be of any interest to the readers of the journal.

    But when you review the experts’ comments your disappointment turns to anger. For the “prominent world authorities” have failed to read your article. Or else they are simply reluctant to afford it a fair review. They are so committed to their own paradigm or model that they are unable to see that you have interpreted your data according to a different model. You dared to challenge the “status quo”. You empathise with Galileo Galilei, Gregor Mendel and 2005 Nobel Laureates Robin Warren and Barry Marshall; all of them had their manuscripts rejected in the first instance.

    Warren and Marshall’s study of peptic ulcers provides us a classic contemporary example of failed peer review. In the early 1980s, the existing dogma was that Helicobacter pylori was commensal in the stomach. The “experts” (gastroenterologists, pathologists, peer-reviewers) “knew” that ulcers were caused by stress and gastric acid; treatment was antacids and if that failed—surgery. Challenging this view, pathologist Warren and clinician Marshall observed that curved gastric bacteria were associated with peptic ulcer disease. This led to an entirely novel treatment regimen (antibiotics) and to an entirely new research area into possible infective triggers of common diseases. Was their innovative discovery greeted with excitement by their peers? Apparently not. “Dear Dr Marshall, I regret that your research paper was not accepted for presentation. For this meeting 67 abstracts were submitted and we could only accept 56”.1 In 2005, the same research was awarded the Nobel Prize.

    We acknowledge that biases exist in sports and exercise medicine as they do in all areas of medicine and science. You might feel that your research will be blocked by certain reviewers either because the reviewer has a strong commercial conflict of interest through contacts with the pharmaceutical or other industry. Or else, perhaps the reviewer has spent 30 years in a career promoting the very idea that your data disprove. Richard Smith, former editor of the BMJ, is author of the provocative monograph The trouble with medical journals.2 Chapter 11 is called “Conflicts of interest: how money clouds objectivity”. Smith argues that health professionals and scientists are not different from those in the “venal worlds of commerce, politics or journalism”. “We are exposed to conflicts of interest like everybody else. Our response should not be to pretend they don’t exist but rather to acknowledge and disclose them always, and sometimes to accept that they are so extreme that the doctor should not treat a particular patient or an author write an editorial in a medical journal.”2 To this we add that conflicts of interest should exclude some reviewers from reviewing certain submissions.

    As authors, we have all suffered the experience we outline at the beginning of this Warm up. Thus, as editors, we strive to offer you a transparent, fair system. When you submit your article to this special section of the journal, we will assure you that however outrageous your theory, it will receive a fair review from those who have no conflict of interest in this review. We will listen to your suggestion of reviewers who will gain no benefit from either the publication or the rejection of your valued contribution.

    The British Journal of Sports Medicine is proud of the independence of its review process, which we believe to be as fair as can be found in the exercise sciences and sports medicine. But we want to do more to ensure that your controversial and challenging work is not buried simply because it is too challenging and too controversial. So, if you believe your idea is being suppressed by an unfair peer-review process, this is the section of the journal for you.

    Submit your manuscript with a cover note directing it to the “peer-review: fair review” section. You may confidentially list names of reviewers who you feel are unsuitable. We commit BJSM to encouraging debate and providing a “safe place” for ideas that are supported by evidence but considered “too radical” elsewhere. We want to be certain that if we tell you that BJSM cannot publish your work, it is not because a conflict of interest is sabotaging the peer-review system.


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