Editorial: The Process Is the Outcome—And it All Starts With CORR’s Wonderful Peer Reviewers : Clinical Orthopaedics and Related Research®

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Editorial: The Process Is the Outcome—And it All Starts With CORR’s Wonderful Peer Reviewers

Leopold, Seth S. MD1

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Clinical Orthopaedics and Related Research: December 2022 - Volume 480 - Issue 12 - p 2281-2283
doi: 10.1097/CORR.0000000000002454
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As a glass-half-full kind of guy, most days I can find lots to be excited about. Here at Clinical Orthopaedics and Related Research®, especially, it’s been another great year. Nearly 1700 author groups considered CORR® their journal of choice and sent their work here, and this was the first pandemic year in which all of CORR’s affiliated societies hosted sufficiently large meetings to publish a selected proceedings issue with us. We’re just now wrapping up a large symposium on the topic of diversity and healthcare disparities in partnership with the Ruth Jackson Orthopaedic Society and the JR Gladden Orthopaedic Society, and in it there are several papers that should genuinely transform how we think about those problems and how we perform, evaluate, and publish research on those topics. Stay tuned: This don’t-miss symposium will appear in the February issue of CORR.

Given all this good stuff, it’s no surprise that CORR’s readers continue be avid consumers of the content we publish; 2022 again delivered historic highs in terms of full-text downloads, social media engagement, and Impact Factor.

But there are undercurrents in scholarly publishing that trouble me, and I wish they received the soberminded treatment from more journals—and readers—that they deserve.

The most important of these, in terms of the potential to cause human harm, seems to be preprint servers. During the pandemic, they’ve increasingly been treated by journalists [5] and even the United States federal government [8, 15] as sources of actionable biomedical information. This is a mistake. It’s not just that preprints are unreviewed at the moment they’re made publicly available, the problem is that most never get reviewed at all. One recent estimate suggests that 9 of 10 preprints receive no comments whatsoever, and of those that do, 60% get only a single comment, oftentimes (31%) coming from the authors themselves [6]. Even preprint advocates have suggested—in a preprint posted 3 years ago that, as far as I can tell, still has not been published—that the largest percentage of comments come in the form of tweets [13]. If we can agree on one thing, let it be that a single tweet or comment by the authors themselves is not the same thing as several in-depth, expert reviews, along with the close editing that follows the highest standards of scientific reporting, which is what you can expect a paper published in a good journal to have received.

Three years ago, CORR—along with The Journal of Bone and Joint Surgery, The Bone and Joint Journal, and The Journal of Orthopaedic Research—asserted that using preprints as evidence would cause harm to patients [4]. As it turns out, we underestimated how damaging that would be. Both the ivermectin [10] and hydroxychloroquine [1] disasters during the COVID-19 pandemic, which resulted in needless illness and death, had important origin stories on preprint servers. So did countless examples of harmful misinformation; one such suggested that COVID-19 was bioengineered [9]. An information economy that values the amplification of the sensational resulted in that bit of bunk achieving the highest Altmetric score ever recorded [16]. It continues to be covered (without warnings like this one) even today. Journals in other specialties should follow the lead set by CORR, JBJS, BJJ, and JOR and not publish clinical research that was posted to a preprint server [4], and journalists shouldn’t use preprint servers as news sources [5]. But for the moment at least, that view seems not to be widely shared across the field of scholarly publishing.

The most financially impactful of the negative undercurrents in scholarly publishing probably will turn out to be a recent directive from the US Office of Science and Technology Policy, which mandated open access publication of federally funded research from the moment of publication, eliminating what had been a 12-month embargo period [7]. This somewhat breathless pronouncement—the authors titled it “Breakthroughs for All: Delivering Equitable Access to America’s Research”—is a breakthrough only in the depths of its naïveté. It startles me that sophisticated players like these claim to believe that “open” somehow will turn into “equitable” or “free” [11, 14]. The only sustainable open access models thus far depend on article processing fees that run into the thousands of dollars; the article processing charge at Nature—a sought-after journal for federally funded researchers—is in the neighborhood of USD 10,000 [2]. Back here on earth, which is to say in orthopaedic journals that readers of this essay might shoot for when they publish their own work, those publication charges still run in the range of several thousand bucks, more than the typical researcher can find among the couch cushions.

This is not going to democratize science or increase “equity.” Rather, this new federal requirement is likely on one end of things to concentrate market share among the already-dominant large publishers (some of which now boast profit margins that would make rock stars blush), while validating the concept behind a pay-to-play open access junk bin on the other. Although Clarivate (the company that calculates the Impact Factor) lists 86 orthopaedic journals in its most recent report, a broader look finds that the number is many times that large; Scimago, for example, lists 294, more than one-third of which are open access publications [12]. In my conversations with the large publishers, they’re consistent in saying that the only new journals they’ll consider starting now will be open access. This is a risk-reward proposition for them, and it’s a no-brainer from their viewpoint. From your vantage point, though, know this: It now takes little more than a credit card number to enable a paper that has been rejected from four or five robust journals to crawl out and tan under light. This makes you—and by extension, your patients—the real victims here, as it becomes harder for you to pull a vanishing amount of signal from an ever-intensifying background of noise. CORR supports authors’ right to choose whether or not they would like their work published open access. To keep things fair, the editors making the decisions about each paper are not made aware of the authors’ choice (open access or subscription-model publication) so as not to create any incentives favoring one approach over the other.

By standing athwart these problematic trends in publishing, CORR hopes to remain a trusted intermediary on which readers and the patients to whom they’re responsible can depend [3]. And a key part of what makes CORR a trustworthy source is our skillful, expert, generous corps of peer reviewers.

Last year, 830 peer reviewers volunteered their time here; their names are listed beginning on page 2476. I hope they will accept my sincerest appreciation for the essential service they provided. And the elite of the elite are CORR’s Top Reviewers. This year, only 6% of those who reviewed received this designation, which required completing at least four reviews (though many who volunteered did more than that) and consistently receiving top-tier reviewer scores. The names of these superstars are listed beginning on page 2475. As always, we offer each of these contributors a 1-year electronic subscription to CORR, and (if they will permit me) a personalized note to their department chairs and/or hospital leadership.

Notwithstanding the undercurrents I mentioned, with the kind of engagement we saw again this year—from CORR’s authors, readers, and peer reviewers—it’s impossible not to feel optimistic. Happy 2023 to you.


1. Axfors C, Schmitt AM, Janiaud P, et al. Mortality outcomes with hydroxychloroquine and chloroquine in COVID-19 from an international collaborative meta-analysis of randomized trials. Nat Commun. 2021;12:2349.
2. Else H. Nature journals reveal terms of landmark open-access option. Available at: https://www.nature.com/articles/d41586-020-03324-y. Accessed August 30, 2022.
3. Leopold SS. Editorial: Can journals, as trusted intermediaries, cut through the signal-to-noise problem in medical publishing? Clin Orthop Relat Res. 2021;479:1409-1412.
4. Leopold SS, Haddad FS, Sandell LJ, Swiontkowski M. Editorial: Clinical Orthopaedics and Related Research, The Bone & Joint Journal, The Journal of Orthopaedic Research, and The Journal of Bone and Joint Surgery will not accept clinical research manuscripts previously posted to preprint servers. Clin Orthop Relat Res. 2019;477:1-4.
5. Leopold SS. Opinion: the dangers of undercooked science and a hungry public. Available at: https://www.seattletimes.com/opinion/the-dangers-of-undercooked-science-and-a-hungry-public/. Accessed August 30, 2022.
6. Malički M, Costello J, Alperin JP, Maggio LA. Analysis of single comments left for bioRxiv preprints till September 2019. Biochem Med (Zagreb). 2021;31:020201.
7. Marcum CS, Donohue R. Breakthroughs for all: delivering equitable access to America’s research. Available at: https://www.whitehouse.gov/ostp/news-updates/2022/08/25/breakthroughs-for-alldelivering-equitable-access-to-americas-research/. Accessed August 30, 2022.
8. National Library of Medicine. NIH preprint pilot. Available at: https://www.ncbi.nlm.nih.gov/pmc/about/nihpreprints/. Accessed August 30, 2022.
9. Pradhan P, Pandey AK, Mishra A, et al. Uncanny similarity of unique inserts in the 2019-nCoV spike protein to HIV-1 gp120 and Gag. Withdrawn in: bioRxiv. 2020. 01.30.927871. DOI: https://doi.org/10.1101/2020.01.30.927871.
10. Romo V. Poison Control Centers are fielding a surge of ivermectin overdose calls. Available at: https://www.npr.org/sections/coronavirus-live-updates/2021/09/04/1034217306/ivermectin-overdose-exposure-cases-poison-control-centers. Accessed August 30, 2022.
11. Rouhi S, Beard R, Brundy C. Left in the cold: the failure of APC waiver programs to provide author equity. Sci Ed. 2022;45:5-13.
12. Scimago SJR. Journal & country rank, orthopaedics and sports medicine. Available at: https://www.scimagojr.com/journalrank.php?order=h&ord=asc&category=2732. Accessed September 19, 2022.
13. Sever R, Roeder T, Hindle S, et al. bioRxiv: the preprint server for biology. Available at: https://www.biorxiv.org/content/10.1101/833400v1. Accessed August 30, 2022.
14. Smith AC, Merz L, Borden JB, Gulick CK, Kshirsagar AR, Bruna EM. Assessing the effect of article processing charges on the geographic diversity of authors using Elsevier’s “Mirror Journal” system. Quant Sci Studies. 2021;2:1123-1143.
15. Stobbe M. CDC director announces shake-up, citing COVID mistakes. Available at: https://apnews.com/article/covid-science-health-public-rochelle-walensky-843cd83bf1d616846ff455f7f5f0d30d. Accessed August 30, 2022.
16. West JD, Bergstrom CT. Misinformation in and about science. Proc Natl Acad Sci U S A. 2021;118:e1912444117.
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