Introduction: who should be a reviewer

The process of article revision can be conceptually likened to a soccer game, where the referee and linesmen uphold the rules to ensure a fair and rigorous scientific process. Reviewers bear the critical responsibility of evaluating articles impartially, identifying flaws in both their content and presentation. Typically, at least two reviewers assess each article. While reviewers provide recommendations, the editor-referee retains the ultimate authority to accept or reject these suggestions.

Reviewers are also tasked with identifying and reporting instances of potential scientific misconduct—such as plagiarism, redundant publication, methodological flaws, or data fabrication—whenever such issues are detected or reasonably suspected. Based on the reviewers’ input, the editor may decide to disregard unsubstantiated concerns or take appropriate corrective actions, ranging from issuing a “yellow card” as a warning to the authors, to imposing a “red card”, which could entail retracting the article and notifying the authors’ institution. A yellow card typically involves a formal warning aimed at preventing future occurrences, whereas a red card represents the gravest consequence for violations.

Both authors and reviewers are aware of these potential outcomes. However, reviewers’ roles can sometimes be misused to undermine scientific rivals. Editors, cognizant of the complexities of human behavior and motivations, strive to navigate these challenges judiciously to maintain the integrity of the peer-review process.

Indeed, being a Good Reviewer requires a range of virtues and skills, including knowledge, wisdom, balance, critical thinking, and the ability to evaluate the manuscript’s scientific innovation impact and methodological rigor. Moreover, Good Reviewers must be willing to make an altruistic use of their time, as there is no financial reward for this activity.

Despite the lack of tangible rewards, serving as a reviewer is a duty of researchers toward the scientific community [1]. By lending their time and expertise to evaluate the work of their peers, reviewers contribute to the quality and integrity of scientific literature. In turn, when they publish their work, they benefit from the constructive criticism and feedback of their peers, leading to improvements in the quality and impact of their research.

Therefore, Good Reviewers are essential for the success of the scientific publishing process, and their contributions to the scientific community are invaluable. It is important for researchers to recognize the importance of serving as reviewers and to strive to be fair, informed, and honest in their evaluations (Table 1).

Tough life of a reviewer

It is important to understand the challenges and limitations faced by reviewers. Reviewers are often overworked, and they are expected to provide thoughtful and constructive feedback within a very short timeframe. An average reasonably Good Reviewer serves at least once a week for all major (and sometimes minor) journals, and not infrequently the recommendation to the editor is overturned. The editor trusted you up to the point of asking you for an opinion, but not up to the point to follow your suggestion (Figure 1).

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Figure 1. 

The true agenda of an average reviewer in the first 6 months of 2006, with recommendations and the editorial decision

A Good Reviewer may receive up to 10 articles for review from only one journal [2], and up to 100 articles per year from all major journals. All this hard work is for free, although it is enough for the promise of a compact disk of classical music [3] or, more recently, of a modest honorarium of 100 euros offered by some journals for a fast-track review for a timely and high-quality review.

Real world and the land of bias

In the Oxford dictionary, bias is defined as “the inclination, leaning, bend, predisposition towards…”. Bias is sometimes unavoidable, often benign, but occasionally lethal for the integrity of the publication process. To minimize bias in the revision process, different operational models of peer review are used, from the most common (and preferred by Exploration of Cardiology) single-blind to double-blind, triple-blind, and open models. The features of each model are summarized in Table 2.

In theory, the open model is the most transparent, since the identities of all parties are known to all players, with the potential for direct and constructive interaction between author and reviewer. In practice, when your review is less than enthusiastic you will receive all forms of negative feedback from the author, who will become instantly your deadly lifetime enemy, and for sure will reject your next paper when serving as a reviewer.

Whatever the chosen model, bias exists. Like all human activities, there is the possibility of bias in the academic peer-review system, and several positive (pro-acceptance) and negative (pro-rejection) biases have been identified. For instance, in cardiology, French reviewers are 2-times more likely to accept French papers, and Italian reviewers are 2 times more likely to reject Italian papers [4]. Possibly, for Italy this is an extension of the well-known philosophy of Palio di Siena: it is not so important that I win the race, but my neighbor must lose it. Some other forms of bias are especially frequent but more difficult to quantify. They are summarized in Table 3.

True examples from the real life of an author-reviewer-editor can help to focus on some extra-scientific aspects of editorial decision-making. The take-home message is that your beautiful papers were rejected by all reviewers of almost all known journals of the Planet for a very simple reason, largely unrelated to the quality of submitted papers. Reviewers rejected your papers because they did not know you at the beginning, and because they did know you only too well at the end of your academic lifecycle.

Reviewer phenotype 1: the Good

Sometimes reviewers like the article, and this matchless and unexpected event leaves an unerasable mark in the memory of the submitting author. It is more unique than a rare event. If a reviewer says to the author that the article was beautiful, the devil will repeat this sentence in the ear of the author 10 times a day for the subsequent 20 years. For instance, in 1998, a reviewer of a top-notch cardiology journal described the article as follows: “The argumentation of the results and the statistical methods are elegant. The literary style is suggestive and enjoyable”, and suggested the acceptance without revision. The second reviewer evaluated the paper as “excellent work by one of the pioneers in the field. The study is well designed, well executed, and well written”. In general, the friendly reviewer also uses pre-cooked formulas, easy to adapt for any article on every subject in any journal: “The design of the study is appropriate. The presentation is clear. The conclusions well justified by the data presented”. If there are some terrible flaws that basically make the entire article uneatable, no problem: “The limitations of the study are honestly acknowledged by the authors in the discussion section on study limitations”. The sample size is ridiculously small, but the Good Reviewer gives a helping hand: “Although the sample size is limited, the authors must be commended because patients are carefully selected with stringent inclusion/exclusion criteria”. The article is full of typos, spelling mistake and syntax mistakes, making it impossible to understand unless you have the same native language as the author, typically an Italian reviewer revising a paper from an Italian author writing spaghetti-English: “The presentation is clear overall, with some minor typos that can be easily fixed by the authors with a common spell-check software”.

While positive reviews can be uplifting for authors, they should not be the sole focus of the revision process. Reviewers need to provide constructive criticism and suggestions for improvement, even if they overall like the article. This can help the author make their paper even stronger and more impactful. Additionally, editors have the responsibility to consider a range of opinions and make a decision that is in the best interest of the journal and its readership.

Unfortunately, the Good Reviewer is as rare as a white unicorn; some researchers reach the end of their careers without ever encountering one, leading them to question their very existence.

Reviewer phenotype 2: the Bad

The reviewer’s role is to provide constructive feedback to help improve the manuscript, not to hold it hostage and make unnecessary demands. Sometimes, the system fails and the author is captured in the hands of the reviewer who puts the loaded gun of pending acceptance on the head of the manuscript and forces the author to change the original manuscript to address the most insignificant, useless, and sometimes asinine suggestions of the reviewer with a considerable loss of time and impoverishment of the manuscript quality [5]. There are 2 basic reasons for this behaviour. First, a reviewer is also a human being, and for the author to meet a certain amount of sadistic or uncivilized persons is statistically unavoidable. Second, some reviewers simply have no idea of what they are criticizing and accepted to review simply to satisfy their ego, to please the editor (hoping for future acceptance of their papers), or simply because they have nothing better to do. The serial reviewer (poorly controlled by the inept editor-in-chief) tends to do this blackmail one, two, or three times every time changing the objections and trying to lead the author to desperation. Even more deleterious is the pattern of editorial malpractice of some editor-in-chief. They ask for substantial revisions which require time and work, and after revision—when the reviewers are happy and satisfied—they decide to reject the paper. It is important to note that this kind of behavior from a reviewer and editor-in-chief is not acceptable and goes against the principles of peer review [2]. Revisions leading to further revisions may erode the patience of the author and the credibility of the journal. Ultimately, the goal of peer review is to ensure the quality and integrity of published research, and this can only be achieved through a fair, and objective process. An example of the levels of sanguine bitterness and exasperation of the non-professional scientific writer is mirrored by this written comment from a senior, esteemed, head of an important cardiology division, also an amateur scientific writer [6]: In the life of a science writer, the reviewer of scientific papers submitted for publication in prestigious journals plays an overwhelming, excessive, extraordinarily pathogenic role, often a source of bitterness and unspeakable crises. This can drive the beleaguered scientist to suicidal impulses or, conversely, to the delirious idea of premeditated murder, perhaps through a mail bomb. However, this esteemed cardiologist was not original in his idea of carpet bombing some hostile reviewers. A famous psychologist, Roy Baumeister of the Case Western Reserve University, wrote beautifully what many submitting authors think: I shall skip the usual point-by-point description of every single change we made in response to the critiques. After all, it is fairly clear that your reviewers are less interested in details of scientific procedure than in working out their personality problems and sexual frustrations by seeking some kind of demented glee in the sadistic and arbitrary exercise of tyrannical power over hapless authors like ourselves who happen to fall into their clutches. We do understand that, in view of the misanthropic psychopaths you have on your Editorial Board, you need to keep sending them papers, for if they weren’t reviewing manuscripts they’d probably be out mugging old ladies or clubbing baby seals to death. Still, from this batch of reviewers, C was clearly the most hostile, and we request that you do not ask him or her to review this revision. Indeed, we have mailed letter bombs to four or five people we suspected of being reviewer C, so if you send the manuscript back to them the review process could be unduly delayed [7]. The task of judging other people’s work should generate humbleness, not arrogance.

In recent years, a paper was submitted in 2020 to a major cardiology US journal. The 2 reviewers were very positive. Reviewer 1 commented that: The authors are expert in the field and should be commended for presenting an original and attractive new way to fully profit from the semiology of the technique.

Reviewer 2 found the article well-written and persuasive. The editors thought the article was of interest but best suited for a subspecialty imaging journal. The associate editor was the same for the cardiology journal and the sister’s cardiac imaging journal. The very same paper was transferred to the imaging journal and the additional reviewer found the paper “In its present form, the manuscript is unreadable. It is poorly constructed, verbose, illogical, and at times ridiculous”. The editor asked for revisions, diligently compiled by the author, but at the end the associate editor decided to reject the paper. The integrity and quality of the Editor is essentially to grant the quality of the journal, and also the quality of the Reviewers plays a major role, but there is no cure for laziness, intellectual arrogance, and gaming with reviewers and authors. Indeed, criticisms are always a gift to the author [8], but sometimes criticisms smell of prejudice and arrogance, and it is wise not to waste your time following destructive efforts by the reviewers. When a rejection is felt by the author to be unjustified, the best retaliation is to publish the same paper in a better journal.

Reviewer phenotype 3: the Ugly

The Ugly Reviewer appears with unsettling regularity—at least once a month. They believe your article is truly terrible, and often, they are right. The Ugly Reviewer, though harsh, is no fool. Their critiques are brutal and unforgiving, yet accurate. Years later, you may find yourself grateful to them for preventing you from publishing work that, in hindsight, would have irreparably tarnished your already modest scientific reputation. When you submit the article, the general rule is that the higher the impact factor of the journal, the higher the density of Ugly Reviewers.

The examples from the literature of corrosive revisions are abundant, and someone collected them in a horror gallery, with frightening examples such as [9]: Right now, there are zero rationales for the study and zero reasons to read the study.

Or, even worse: If the editor somehow decides to accept this paper, they risk permanently destroying the credibility of this journal and its entire editorial board, as well as every author who has published in this journal or will do so in the future.

Negative reviews can be hurtful, but they can also help improve the quality of your work. It is important to take the feedback constructively and try to improve the paper accordingly. Hostile reviewers will lower the chances of publication of the paper in a specific journal but are more likely to improve the quality of the manuscript.

Being a reviewer

The inclusion/exclusion criteria for being a reviewer for Exploration of Cardiology are simple. The reviewer must meet 2 inclusion criteria:

• 1.

  Has a different affiliation with the authors.

• 2.

  Has not published articles together with any author in the recent five years.

Exclusion criteria are that they did not accept previous requests of revision for the journal, or their performance did not meet the time deadline or quality criteria according to the judgment of the editor-in-chief. The editorial office knows of each reviewer the response rate, and the time required for each revision. The review quality may be also scored by the editorial office.

These criteria may vary between journals and editors, as each may have its set of standards and requirements for potential reviewers. Additionally, while having a high H-index is one way to demonstrate expertise in a field, it may not be the only measure of a reviewer’s qualifications. Other factors such as the recent publication record, expertise in a specific topic, and experience as a reviewer may also be considered. Ultimately, the reviewer selection process aims to identify individuals who can provide fair and constructive feedback on submitted manuscripts. Reviewers are essential for the quality of the editorial process, and the author can view their work as the manuscript’s best friend. Taking criticism as a gift and not as a personal offense can help you improve the quality of your work and ultimately make it more impactful [10].

The main recommendations to write a useful reviewer’s report are summarized in Table 4.

Conclusions

In essence, Good Reviewers should read the paper before reviewing it. Admit their inadequate expertise in the field before accepting the position. Write the review in respectful language. Meet the deadline as a sign of respect for the author and the journal. Judge the paper, not the authors’ list. Do the review in the same way as you wish to be reviewed with your own paper. In a fast, honest, and constructive way.

Conversely, an inept reviewer nitpicks on details or rewrites sentences: you are a reviewer, not an author. Ask for additional data that the author cannot have. Reject the paper without reading it. Accept the paper to tell the author you were the reviewer. Decide the rejection because your paper was not referenced. Decide the acceptance because your paper was referenced. Use derogatory language or personal attacks in your review. Delay your review without any explanation or communication with the editor. Plagiarize from the manuscript you are reviewing. Use the manuscript to advance your research or personal interests. Ignore conflicts of interest or bias in your review and decision-making process.