Reviewers of research manuscripts do not produce better reports if they are blinded to the authors' identity and institution, according to research presented by investigators from the London School of Hygiene and Tropical Medicine and the BMJ in Prague last week.
The study contradicts the suspicion common among authors and editors that reviewers' opinions of a paper may be biased according to the renown of its authors or the prestige of the research institution.
In a randomised controlled trial of 487 papers submitted to the BMJ, reviewers were randomly allocated a blinded or unblinded copy of papers. Reviewers were also randomly assigned, whether or not they would be asked to allow their signed reviews to be passed to another reviewer. Independent evaluation of each review found no significant difference between blinded and unblinded reviewers in the overall quality, recommendation about publication, or time taken to complete the review. There was also no difference in the quality of the review between reviewers whose reports were sent to another reviewer and those whose reviews were not passed on.
Similar conclusions were reached by a multicentre randomised trial from Cleveland in the United States. Based at five leading US medical journals including JAMA and the Annals of Internal Medicine, Dr Amy Justice and colleagues also allocated blinded or unblinded manuscripts to reviewers. Among the 58% of papers for which both reviews were returned, the researchers found no significant difference in the quality of review between the two groups of reviewers. But this study also showed that blinding is not always possible. Checks to ensure the efficacy of the blinding procedure showed that a significant number of reviewers were able to guess the authors' identity. This was a particular problem for specialist journals representing small research communities, in which researchers are more likely to know one another
Dr Fiona Godlee, one of the authors of the BMJ study, said: "Taken together, the two studies sugget that there is little to be gained from blind peer review especially if there is a bias towards better known authors being easier to identify."
But the New England Journal of Medicine's editor, Marcia Angell, said that the experiments violated the Nuremberg Code and the Declaration of Helsinki, which called for the best standard of care and not the local standard.
In a joint statement the Centers for Disease Control and Prevention and the National Institutes of Health responded that the zidovudine regimen used in the US "is not feasible for poorer nations" and that the studies offer the best hope of finding a safe and affordable alternative.
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