Peer review Toward improving the integrity of the process

Peer review, that maze through which medical manuscripts pass and are ultimately accepted for publication or rejected, is a complicated and flawed process, poorly understood by many in the medical field. There are published data showing much of which has been published in the past is untrue.(1) Gradually, perhaps glacially, the process has been evolving in a favorable manner but much remains to be done to ensure that what enters the medical literature is correct. Understanding the peer review process is crucial to critically examining the literature and utilizing it appropriately. Ten years ago, the International Committee of Medical Journal Editors announced that participating journals would only publish randomized controlled trials (RCTs) that had been prospectively registered in approved clinical trial registries (such as Clinicaltrials.gov).(2) The purpose was to help eliminate publication bias, which can occur by selective reporting of trial results, nonpublication of trial results, and suppression of negative results. Registering a clinical trial before the enrollment of any participants and declaring prespecified endpoints before initiating the trial can be effective in mitigating such bias.