A 'kitemark' that identifies randomized-controlled trials reviewed by specially trained peer reviewers would improve public trust in the robustness of clinical trials, according to an opinion piece in the open access journal BMC Medicine. Jigisha Patel, BioMed Central's Medical Editor argues that peer review should be recognized as a professional skill in the clinical medical field. The article was openly peer reviewed and the reports published alongside, as is the case for all BMC Medicine articles.
Peer review and its effectiveness is the subject of much heated debate within medical and scientific communities at the moment. This is coupled with the ongoing public discussion about the need for greater openness and the transparency in how clinical trials are conducted.
Jigisha Patel's opinion piece discusses her experiences as a junior doctor, and how she took for granted that when research was published in a medical journal that editors selected the best qualified people to review clinical trials. However, there is often disagreement over what peer review is, and there is variation in instructions for peer reviewers from journal to journal and on who is eligible to be a peer reviewer.
Jigisha Patel says: "While innovations in trial reporting and the peer review process have increased transparency, there has been little progress in defining the aims and effects or improving the quality of peer review itself. There is vast volume of health information available to the lay person with little or no guidance on its quality or trustworthiness."
This opinion piece underwent open peer review - as is the case with all BMC series clinical journals – which means the authors and reviewers identities are known to each other. In addition, the reports will be published alongside the article, which provides more transparency for the reader.
One of the peer reviewers, Doug Altman, Director of Centre for Statistics in Medicine at Oxford University, said in his report: "The issues raised [in this article] are of major importance to the integrity and value of the medical research literature. The problems identified are well known of course, and in my view not amenable to easy resolution….The main problem though is that nobody has the power to change the system and it is the system that is the problem….But we should try to make progress and this paper offers one way forward."
Jigisha Patel proposes a possible solution: "Peer review of randomized controlled trials should be recognized as a professional skill. Peer reviewers could be taught to spot fundamental flaws and be periodically evaluated to make sure they do, in the same way that any other knowledge or skill that affects patient care is. Every randomized controlled trial, and its peer review reports if made public, whether published online, on paper, open access or subscription only, with open or closed peer review, or peer reviewed before or after publication could then have a searchable 'quality assurance' symbol"