Blinded vs Open Peer Review: What’s it Gonna Be?

The goal of any change in peer review is to improve the quality of review. Whether your journal conducts single-blinded, double-blinded or open peer review, it’s never a bad idea to take a step back and assess the review process. Are your reviewers productive and efficient? Notice any articles getting stuck in the review process? Authors eagerly (and perhaps impatiently) awaiting approval for publication?

So which should it be? Let’s take a brief look at the review types most often seen:

  • Single-blinded review – reviewers know the identity of the author, but reviewers remain anonymous
  • Double-blinded review – both reviewers and authors remain anonymous
  • Open review – both reviewers and authors are known to one another

We currently offer single-blinded review at Cureus, but we’re open to whatever results in the best possible process. What are the pros and cons of blinded and open review? Well, single-blinded reviewers don’t have to hold back when it comes to criticism.

We recently polled the Cureus community, looking for insight into the review process. Roughly 60% of respondents indicated they’d be less likely to levy harsh criticisms if participating in open peer review. OK, so then the answer must be blinded review, right? Well, not so fast – there’s also the question of review motivation. Now this problem is nothing new – indeed, most every journal has difficulty getting their reviewers to, well, review. Making the review process public could serve as a way to recognize reviewers for their contributions, while also bolstering their profiles with publicly recorded reviews.


So which is the right style for your journal? Unfortunately, there is no clearly defined right answer. How about giving reviewers the option? Would you choose blinded or open if given the chance?

A Mother’s Death and the World of Medical “Care”

My mom died.

Almost three weeks ago, Anita Koerner Adler, nearly 83 years old, moved on, and in doing so, left me both grieving and deeply troubled by the current and future state of US healthcare.  Of course, death is no stranger to anyone who has lived a long and productive life, but the years of suffering my mom endured at the end is what deeply troubles me now.

For more than three years, my mom complained of a growing constellation of symptoms, the cause of which sent her to more than a dozen board certified internists and specialists at multiple hospitals countless times for answers. Almost every few months she would return from a doctor visit with yet another oftentimes peculiar (from my neurosurgical perspective) diagnosis, and yet another medication. Yes, she had a primary care doc, two of them in fact, who would spend the requisite ten minute visit, and perhaps a generous extra five or ten minutes if I were in attendance. They “listened” and wrote notes and filled out scripts, before passing Mom on to yet another physician.

Given our current healthcare system, each of these doctors had conscientiously completed their MOC (maintenance of certification), filed the appropriate paperwork in a HIPAA (Health Insurance Portability and Accountability Act) compliant fashion using the latest ICD9 (International Classification of Diseases) coding (before implementing ICD10 codes) and increasingly demonstrating “meaningful” use of their new EMR (electronic medical record) and perhaps meeting some new “quality standard” created by a sundry committees commissioned by CMS (Center for Medicare Services) before ultimately submitting time consuming bills that complied with the most arcane Medicare requirements. Despite following accepted healthcare processes, not one physician seemed motivated to connect all of the (now in retrospect) flashing neon dots to make a proper diagnosis, (or at least refer her to someone who could) even in the face of mom’s obvious relentless deterioration. Heck, maybe she was simply old? In a last ditch effort, and without seeking permission from her medical team, I insisted that mom go to a big time medical center. I dragged dear mom to UPenn, not so much because they had expertise with complex and more obscure diseases, but mostly because I knew that Anita Adler might finally encounter a physician who cared about HER, her medical resident granddaughter, and my progeny, Brit Adler.

Although the holidays and my daughter’s junior status at UPenn compromised the efficiency of the inpatient work up, it took a little over a week to finally diagnose Mom with T-cell lymphoma, an unusual but hardly rare disease. After three years of fruitless, yet very expensive (clearly more than $100,000, if not three times that), outpatient and inpatient medical work-ups from so many faceless specialists, mom and the family could finally put a face on the enemy. As luck would have it, there was a promising new, highly targeted, fairly non-toxic “experimental” therapy for her condition. In the end, it all proved to be a little too late. Less than 6 weeks from first treatment and three weeks after returning to the care of her longstanding and largely anonymous medical team, mom died of presumed sepsis (my diagnosis). Presumably from her doctor’s perspective, another old lady simply died?

As I conduct my post mortem of Anita Adler’s illness, I am haunted by the belief that the only physicians who ever really “cared” about her throughout her three year odyssey were me, her son (and in this case, a worthless neurosurgeon), and her clearly much smarter granddaughter. More importantly, I am forced to conclude that as a result of such careless indifference, my mother (like so many other “moms” out there) suffered needlessly for three years and at great expense to society. In resigning myself to this outcome, I am also forced to conclude that in all likelihood the “system” healthcare towards which our society is currently racing was “accountable” for significantly shortening Anita Adler’s life. As in life, and so now in death, mom teaches me yet again. What I learned in such a personal and painful fashion is that I don’t want a healthcare “system” with elaborate quality checks and processes dreamed up by academic whiz kids from think tanks who have long ago left the trenches of medicine, to direct the care for me or my family. When it comes to protecting my loved ones, as well as myself, from death and disability, I want medical care anchored by “a” physician who cares almost as much about my loved ones as I care about them.

When I am faced with illness, I want for me the very doctor that I always aspired to be to my patients. Truthfully, it is a lot to ask. Because the all-encompassing 24/7 life of such a doctor is intrinsically so difficult, I want to make the rest of my doctor’s life as easy as possible. The doctor I want for me should be an esteemed member of our society with no financial worries whatsoever and should be freed of all mindless clerical tasks and endless quality processes so that my doctor can do what a doctor is suppose to do, truly care for me and protect me from death and disability like he/she would want for themselves and with NO excuses whatsoever; ironically that means “my” doctor may need to increasingly protect me from the “healthcare system” itself, which too often provides neither “health” nor “care.”

Beyond the still raw grief of my mother’s death, seeing firsthand how far away our “system” of healthcare has mindlessly drifted from the idealized physician advocacy I desire (and patients deserve), my sadness is turning to despondence. I now find myself praying that my wish to live and work in a world of medical “care” does not die alongside my mother. Goodbye mom.

Reviewers Need Love Too!

Far too often, peer reviewers are left on the sidelines when it comes time to award credit for an article’s publication. Yes, peer review is oftentimes a blind process (and in the case of Cureus, always a blind process), but let’s not forget that without reviewers that article wouldn’t be published in the first place. We’ve all been a part of peer review at some point in the past, whether it was years ago in school or more recently in the academic or medical worlds – it can be a thankless task, we know. That’s why Cureus wants to recognize the efforts of our peer reviewers. Over the coming months, we’ll be using this space to recognize the invaluable contributions of our wide array of reviewers. You might also eventually see us recognize our reviewers across our website, so stay tuned and keep an eye out for more reviewer recognition in the future!

While we utilize a blind review process, that doesn’t mean we can’t call attention to our reviewers without tying them directly to the articles they’ve reviewed, and lo and behold, that’s exactly what we’re going to do. The reviewers highlighted below are just a few in the Cureus community – click the names to find out more about some of the folks who make publication with Cureus possible!

Click here to join the Cureus community – you can publish, review, rate and discuss articles and it’s absolutely free!

Congratulations – you’ve published! Now what?

The medical science community, indeed all scientific research communities, are often so wrapped up in the seemingly insurmountable task of getting published that it has become increasingly rare to stop and think about what comes next.

At Cureus, we’re working hard to ensure that your journey doesn’t end at publication. That’s why we greatly value post-publication review in the form of SIQ (Scholarly Impact Quotient). The review process should never stop when it comes to ensuring the best possible science is available to the publScreen Shot 2014-02-26 at 3.18.08 PMic. Why limit the review period to a few weeks prior to publication? Doesn’t it make sense to allow for further evaluation as more eyes see an article? Of course we value the efforts of our reviewers, but the huge jump in sample size from half a dozen reviewers to a thousand interested readers shouldn’t be ignored. With our SIQ system in place, any reader can quickly and easily rate an article across five different categories. Will this result in the occasional uninformed review? Perhaps, but we feel strongly that, over time, the wisdom of many will outweigh the errors of a few readers, resulting in a dynamic evaluation of every article within the Cureus journal.

We want readers to engage with your research through assigning SIQ scores and entering into discussions, and we’re more than happy to promote your article across social media in the days and weeks following publication. With Cureus, you don’t need to worry about your article being buried and forgotten as soon as it’s published. Publication is just the beginning of the journey here at Cureus. Remember – publishing and reviewing articles at Cureus is entirely free, so stop by today and have a look around. Cureus could be the place for you to launch your research into the social stratosphere!