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another cause of publication bias

Lyons, Gordon

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European Journal of Anaesthesiology: September 2016 - Volume 33 - Issue 9 - p 620-621
doi: 10.1097/EJA.0000000000000469
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Some years ago I was researching the effects of gender on coagulation using the thromboelastograph.1 As a spin off, I explored the feasibility of studying the coagulation effects of female sex hormones by following changes during the menstrual cycle. The literature search was not encouraging, but there was a study in Russian that appeared to do just this. At some cost to our meagre funds I paid for a translation only to find that the cycle in question was not menstrual but lunar. I tell this story to illustrate that, outside the confines of our own language, we have no or little idea of what is out there. The scope of the undiscovered body of work written in languages other than English is unknown, as is its quality.

A Brazilian colleague once described Europe as ‘a melting pot of language’. Compared with the Americas, that is certainly true. The European Union recognises 24 official languages but there are, in addition, more than 60 regional and minority languages. More than half of Europe's citizens speak more than one language, and 38% speak English ( This must be a major factor limiting the penetration of journals that publish in English, but we can speculate that the figure might be higher among professional groups. The range of languages in which journals of anaesthesiology are published is probably smaller than the 24 recognised by the European Union as several national journals choose to publish in English, and not all countries produce a journal. Beyond Europe and North America, in the rest of the world, the situation is much the same.

For a European journal, it makes sense to publish in English as that is the most common second language spoken on the continent ( But proficiency in the spoken word and the ability to produce a document in English that meets the requirements of scientific writing and satisfies editors is another matter. It is easier to write up original research, particularly if there are studies on the subject already in the public domain. Methods and Results have a formulaic style and the wording can be copied from one to another. The Introduction and Discussion will, though, reveal any deficiency in language skill. Shaping an argument and phrasing a series of logical steps is a significant test of linguistic expertise. It can trouble primary speakers of English, let alone those who have adopted it as a second or third language. Reviews are the most difficult of all; without finesse in the written word they become little more than lists of facts. When most submissions to the European Journal of Anaesthesiology come from countries where the primary tongue is other than English, it is hardly surprising that reviews are few and far between. Potential authors with something to say, but lacking confidence in their linguistic skills, are unlikely to submit. Those who do, and are able to meet the scientific requirements but write inadequately, are likely to find that most journals will reject their work, sometimes out of hand.

Another source of bias arises from the literature search. When conducted in English, work in any other language is ignored. This particular problem is magnified in the writing of systematic reviews and the development of guidelines. A recent German guideline did conduct its search in two languages, English and German.2 Systematic reviews and guidelines feed into routine clinical practice and can have a significant impact on individual behaviour. Bias at this stage becomes deep-seated.

The European Journal of Anaesthesiology does not accept articles written in a language other than English. However, the editorial team recognises that, as their journal represents anaesthesiologists from a continent of many languages, a more accommodating approach is needed if potential authors are not to be discouraged. Any original research submitted, provided the science is sound and of sufficient interest to merit publication, will not be rejected on grounds of poor English alone. The journal has, within its editorial team, four editors whose job is to ensure that every accepted article meets the required standard of written English. These editors have had a career in anaesthesiology and have personal experience of publishing work in international journals. For most submissions this is a relatively simple matter of replacing vocabulary, correcting syntax and reorganising sentences. Sometimes whole sections require reorganising, and frequently, to resolve ambiguity and establish clarity, it is necessary to refer back to the author. Of necessity, editing of this nature is a word-by-word dissection that includes examination of tables and figures. From time to time the process uncovers numerical errors and problems with the science, but only very rarely do these prevent eventual publication.

What the journal does not do is offer a writing service to aspiring authors. On occasion, a submission that is written in language of a rudimentary nature, that meets the necessary scientific standard and satisfies the interest factor, will be rewritten in conjunction with the author. Reviews are difficult, but if an author is prepared to work patiently with an editor, even they can be refashioned. Professional translations of guidelines, for example, by agencies outside the discipline of anaesthesiology are probably going to be good enough to allow judgement on the scientific content. They will then require editing by someone with knowledge of our discipline. In this way the journal tries to meet its obligation to its international authors.

The question of bias remains unresolved as submissions to the journal that are not written in English are not considered. But there is improvement. Multiphonic authors will conduct literature searches for studies in English, their primary tongue and other languages in addition. It is common to see, in the bibliography of studies submitted, citations of publications in other languages. In this way science in languages other than English can find their way into the main stream. And by pursuing a policy of not rejecting submitted work on the grounds of poor writing alone, the journal makes a small step to reverse publication bias arising from inadequate language skills.

Acknowledgements relating to this article

Assistance with the editorial: none.

Financial support and sponsorship: none.

Conflicts of interest: none.

Comment from the Editor: this editorial was checked by the editors but was not sent for external peer-review. GL is one of four language and technical editors of the European Journal of Anaesthesiology.


1. Gorton H, Warren E, Simpson N, et al. Thromboelastography identifies gender related differences in coagulation. Anesth Analg 2000; 91:1279–1281.
2. Marx G, Schindler AW, Mosch C, et al. Intravascular volume therapy in adults: guidelines from the Association of the Scientific Medical Societies in Germany. Eur J Anaesthesiol 2016; 33:488–521.
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