Suhardja A (2004) Mechanisms of Disease: roles of nitric oxide and endothelin-1 in delayed cerebral vasospasm produced by aneurysmal subarachnoid hemorrhage. Nat Clin Pract Cardiovasc Med 1: 110–116 doi:10.1038/ncpcardio0046

I was a peer-reviewer for the manuscript “Mechanisms of Disease: roles of nitric oxide and endothelin-1 in delayed cerebral vasospasm produced by aneurysmal subarachnoid hemorrhage” by Agustinus Suhardja, published in the December 2004 issue.1 At the time of peer review, there were two authors on the paper, Robert Furchgott (a Nobel prize winner) as senior author and Dr Suhardja. In my comments I mentioned to the Editor that Furchgott's name added to the basic value of an otherwise quite mediocre manuscript. I also added “because of the anticipated increased interest among scientists in the field of vascular research that this paper could evoke, I strongly believe that this review should provide not only accurate up-to-date information but also avoid omissions and misleading statements, and should clarify the reasons why past efforts did not succeed.” I suggested the possibility of an Editorial to accompany the paper addressing my concerns, but the journal currently has no capacity for such articles. I also offered my help to make the paper suitable for publication, suggesting that, if the authors decided to incorporate all or most of my proposed changes, I would be happy and honored to work with them to do so. The journal's in-house Editor duly passed this information on to Dr Suhardja.

In good faith I provided detailed information, including references and a figure, on the following items: the difference between delayed vasospasm and clinical vasospasm or delayed ischemic deficits, which the authors did not address (the possibility of there being a different mechanism for these two entities); the existence of a cortical spreading ischemia of which the authors were not aware; mechanisms of disease that, in my opinion, the authors misinterpreted (early vasospasm, stop-flow phenomenon); and the pathophysiology of decreased nitric oxide availability, which was overlooked by the authors.

Some time after peer review I was contacted by the journal's in-house Editor, who informed me that, while the paper was being prepared for printing, Dr Suhardja had requested that Dr Furchgott's name be removed from the paper and that a few days later he had contacted the journal again to request that the paper be withdrawn because he had incorporated much of the material I had provided without consulting me. At this point the journal had already been printed. I was angered and dismayed by this author's admission, for two reasons: first, the main cause of my support for the paper and the reason for my effort during the review process was Dr Furchgott's role as senior author; and second, because the offer of help to the authors had not been taken up. Unfortunately, these matters were raised with the journal when it was too late to stop production. Had I been aware at an earlier stage of the change in authorship, I would most likely have recommended that the paper be rejected.