Letters to the Editor: defining utility and pertinence

Medical journals such as Hepatology convey novel information and knowledge across the research spectrum of discovery, translation, and application. Manuscripts are subjected to peer review with a focus on mechanistic, diagnostic, or therapeutic insights, the robustness and rigor of the experimental design, the impact of the study, and relevance to the readership. The blinded peer-review process invariably leads to an improved manuscript, often asking for clarity of the experimental design, challenging interpretation of the data, asking for additional data and/or data analysis, requesting additional references, and calling for a more global discussion of the study findings and limitations. After peer review, only a small fraction of submitted manuscripts are ultimately prioritized for publication (~10%).

Peer and editorial reviews are imperfect; however, as busy professionals with content expertise may not be available to review a specific paper, and, if available, may not be au fait with all the nuances and complexities of the innumerable technical approaches used nor the sophisticated data analysis. Indeed, it is an unusual reviewer who has a deep working knowledge of all facets of a study, and in a sea of data with multiple panels per figure (including unlimited supplemental data) reviewers can become fatigued. Hence, even well-reviewed, carefully vetted published manuscripts may have deficiencies. In this context, letters to the editor are a valuable form of postpublication peer review.¹ These letters not only help maintain the standards for quality publication, but in part, also hold reviewers and editors accountable for the published papers. If letters to the editor highlight deficiencies in the experimental approach or ask for the clarity of methodological approaches and data analysis, they serve as a check and balance system for the peer-review process. In this regard, Hepatology encourages and publishes numerous letters to the editor (181 letters to the editor were accepted in 2022).

Despite the critical role of letters to the editor, we have noticed an insidious abuse of this process. We have received innumerable letters to the editor within a short time span by small teams of coauthors, often rotating the senior author position role to avoid recognition of the repetitive nature of the submissions. Indeed, such a team submitted 9 letters in a 2-month period in 2022. Often the letters only serve to note obvious limitations, frame larger questions that cannot be addressed in an appropriately focused manuscript or ask for unrealistic expectations of the study. They do not ask for the clarity of approaches, additional data analysis, nor do these letters ask focused answerable questions. The letters are submitted from a very limited number of geographic locations and usually pertain to clinical studies suggesting a secondary gain for the authors if the letter to the editor is published. Letters to the editor which, if accepted, appear on search engines as publications (eg, Pubmed), likely provide academic gain for the authors within their academic structures, and hence the motivation to submit and hopefully publish large numbers of letters. These letters do not advance the discourse of the manuscript as it relates to scientific validity or insight, and accordingly we no longer accept letters to the editor with these characteristics.

Another example of attempting to enhance an author’s notoriety is publishing letters to the editor regarding manuscripts published in journals other than Hepatology. Such letters do not impact the checks and balances system for the Hepatology editorial process. Obviously, with an expanding universe of journals and published papers, the letters that could be written regarding papers in other journals approach infinity and would be overwhelming for the editorial team, journal office, and publisher. Such letters should be appropriately directed to the journal publishing the manuscript.

Another example of an unsound practice is the submission of letters to the editor with limited, original data to help substantiate the claims of the authors. These letters to the editor either hope to disprove the work of a published paper or support its conclusion. However, letters to the editor do not have methods sections and hence cannot be subjected to rigorous peer review; the veracity, rigor, and robustness of the original data cannot be examined, and, therefore, these data are unsubstantiated and potentially misleading. We agree with the policy established by our predecessor, Dr. David Cohen, and his editorial team that original data cannot be included in a letter to the editor.

>Another subcategory of letters to the editor falls under the category of proclaiming an author’s expertise (promoting the “brand” of the author). The content of such letters is often laudatory of the published work; and written largely as a disquisition to highlight similar work by the author. Such letters to the editor are written to bring attention to their work as well. Another tactic of letters in this category is to highlight future directions, which they deem to be most relevant and are being pursued by the author of the letter in an attempt to claim primacy. Simply stated, letters to the editor in this category do not advance the scientific discussion regarding the authenticity or limitations of a published data set but rather serve to publicize and broadcast the authors’ expertise and authority in the field of study.

Given these observations, it is appropriate for Hepatology to review the utility and pertinence of letters to the editor. Letters to the editor, if published, add to the workload of the journal’s office staff and the publisher, and require long-term archiving, and hence are resource intensive. Indeed, Hepatology publishes letters to the editor online not only to reduce the paper publication efforts but also to ensure archiving and accessibility for the readers. Given the resources involved, journals need to prioritize letters to the editor for publication as they do manuscripts. The current Editors prioritize letters to the editor, which are focused and ask answerable questions of a recently published manuscript in Hepatology (Table 1). Letters to the editor that are unfocused, lack relevance to our journal, seek to publish original data, or are written to enhance the academic stature of the author will not be prioritized for publication. We owe our readership this selectivity.

TABLE 1 - Letters to the editor: categorization and prioritization for publication

Prioritized
Categorization	Subject Matter
Focused	Desire clarity of experimental approach and data analysis
	Offer alternative interpretation of the data
Unprioritized
Categorization	Subject Matter
Unfocused	Ask unrealistic questions, ask no questions, highlight obvious, and generic limitations of a paper
Lack relevance to Hepatology	Subject matter is a manuscript published in another journal
Contain original data	Original data cannot be published without peer review
Proclaiming expertise and primacy of work	Written to enhance notoriety of the author