Introduction

Over the last 30 to 40 years the achievements required to achieve promotion have changed for career dental teachers, or dental academics as they are now known. A significant part of this change has been the requirement to publish scholarly and research articles in the dental press. Furthermore, institutional reputations and funding have also become dependent on this research output. As a result, the number of journals has increased, competition for space in these journals has increased and a form of quality control has been introduced – peer review – by which, in theory, the scientific integrity of these publications is checked and guaranteed.

There are a number of stakeholders whose interests depend on the proper functioning of the system that has developed – the journal proprietors, their editors and staff, authors wishing to publish in the journals and the readers. Responsibility for the credibility of the system rests principally with the journals and the academics submitting articles for publication. A system of peer review can only work if properly instituted by the journals and supported by the contributing academics.

The system of peer review

But first: what do we mean by peer review? It is a system whereby a paper submitted for publication is reviewed by two or more people of equal standing in the field to the author to ensure that the work in question meets ethical and scientific standards. This places responsibilities on journals to ensure that proper systems are in place and on academics to agree to review and be reviewed. At present it can be argued that both are failing in their responsibilities.

Journals must be clear regarding subjects that they are interested in publishing and more importantly the type of study in which they have no interest especially when the subject matter would seem to be within the journal's scope. If allegedly academic journals are only interested in trendy topics they should make this clear to potential authors either before submission or as quickly as possible after submission: a delay of several months is not acceptable.

Confidentiality

Traditionally peer review was supposed to be confidential: the reviewer not knowing who the author was and vice versa. Now there are a variety of combinations practiced by different journals. Some tell the reviewers who the authors are, some just reveal only the name of the corresponding author, and some still try to keep to the bilateral confidentiality rule. Few, if any, tell the authors who the reviewers are. In some cases the current system appears to work but may give reviewers a false sense of confidentiality, which they may abuse, stepping over the line of acceptable criticism. However, in national journals and specialist journals confidentiality is almost unachievable because it is nearly always possible for the reviewers and authors to identify each other if they try hard enough, because editors necessarily select reviewers who have expertise in the field in question. Nevertheless there is still an element of guesswork involved which may result in both author and reviewer being wrong about who they suspect is involved.

The reviewer

Several problems arise from the choice of reviewers. Generally, editors find it hard to recruit academics in appropriate fields with sufficient expertise. A particular problem is that those who are prepared to be reviewers may have ulterior motives or may just be susceptible to human weakness; some may see it as a career or CV enhancing move. Their task is to judge the scientific integrity of the article in question, but too often other factors come into play. In this author's experience a common complaint of reviewers is that their own previously published work related to, but not necessarily relevant to the article in question, has not been sufficiently glorified. Another common complaint occurs when the article in question overlaps with a previously published article of the reviewer's. The criticism then is that this work has already been published whereas in reality there is very little overlap and the paper under review is much more comprehensive in breadth and depth of investigation. Further problems arise when publishing the results of surveys. If reviewers don't like the results on the basis of the way they may impact on them or their own schools, or if by chance they were non-respondents to the survey in question then their opinions may be negative and less than honest. Reviewers must resist the temptation to be arrogant and bigoted. One recent reviewer stated 'I object to the phrase prosthetic dentistry'. This is hard to accept when your job title is professor of prosthetic dentistry. A comment that removable prosthodontics is a more modern term would have sufficed. Fortunately, the experience of the author is that editors have the final say and are prepared to overrule the worst excesses of rogue referees.

Conclusion

Many of these problems would not occur if the whole process of peer review were to be open and above board and not clouded in secrecy. The goal of confidentiality should be abandoned. Without the assumed cloak of secrecy, the worst abuses of the system would not occur. Referees would be more careful before making unjustified derogatory remarks. At the same time, academics involved in publishing should do their share of reviewing as a quid pro quo for having their own papers reviewed and should do so within a reasonable timeframe. Then the system would revert to its original purpose: to ensure the scientific integrity of the published work.