Objective.-To measure the effect of the peer review and editorial processes on the readability of original articles. Design.-Comparison of manuscripts before and after the peer review and editorial processes. Setting.-Annals of Internal Medicine between March 1 and November 30, 1992. Manuscripts.-One hundred one consecutive manuscripts reporting original research. Measurements.-Assessment of readability by means of two previously validated indexes: the Gunning fog index (units of readability in the fog index roughly correlate to years of education) and the Flesch reading ease score. Each manuscript was analyzed for readability and length on receipt and after it had passed through the peer review and editorial processes. Text and abstracts were analyzed similarly but separately. Mean readability scores were compared by two-tailed t tests for paired observations. Results.-Mean (+/-SD) initial readability scores of manuscripts and abstracts by the Gunning fog index were 17.16+/-1.55 and 16.65+/-2.80, respectively. At publication, scores were 16.85+/-1.42 and 15.64+/-2.42 (P=.0005 and P<.0001 for before-after differences, respectively). By comparison, studies of other print media showed scores of about 11 for the New York Times editorial page and about 18 for a typical legal contract. Similar changes were found for the Flesch scores. The median length. of the manuscripts increased by 2.6% and that of the abstracts by 4.2% during the processes. Conclusions.-The peer review and editorial processes slightly improved the readability of original articles and their abstracts, but both remained difficult to read at publication. Better readability scores may improve readership.
