After an examination of research integrity in China, the journal Science concluded that there is a flourishing black market in publications (Hvistendahl 2013). For fees ranging from $1600 to $26,300 authorship in science citation index (SCI) journals is for sale. Shady companies are trading in SCI papers. Chinese regulatory agencies are concerned about global influence and the reputation of Chinese science. They have taken initiatives to cultivate research ethics through education and codes of conduct (Yang 2013). SCI papers are the basis of promotion in many universities; they also lead to privileges and financial rewards. In her study on bioethics governance in China, Zhang (2012) noticed that some Chinese scholars recall the impact factor of their publications but not the name of the journals in which they appeared.

This situation is not exceptional. It occurs in many other countries. One of the underlying mechanisms is the blind faith in quantitative measures for scientific output. Scientists are considered as ‘knowledge producers’; the more publications the better. The emphasis is also on individual researchers rather than institutional research teams, encouraging competition and rivalry. Now that research budgets are declining, and competition for grants is ferocious, scientific misconduct is rampant. But the holy grail of the impact factor is at least one factor that encourages misconduct. It can be argued that the use of the journal impact factor as indicator of scientific quality is contrary to the ethics of science. It suggests reputation and prestige while there are no experimental data supporting this suggestion (Moustafa 2015). What has been invented as a bibliographic tool for librarians and publishers is misused for the assessment of researchers and their research. It violates, as Moustafa argues, the ethical rules of scholarly citation since it does not primarily refer to original work. Review journals and articles have the highest impact factors. It also distorts editorial policies since editors may invite senior authors to submit ‘citable’ manuscripts that boost the impact of their journal. Furthermore, the myth of the journal impact factor also leads to universities ranking systems that use one biased criterion to compare heterogeneous systems. Finally, it distorts the research agenda, promoting preference for popular topics that might result in fast publications in high impact journals. The question therefore is: why is such an unscientific approach to measure scientific quality used? Why is it not more severely criticized from the point of view of science ethics?

Moving away from impact factors

In May 2013 scientists and scientific organizations published the San Francisco Declaration on Research Assessment. It advocates abandoning the use of journal impact factors to assess individual researchers or the quality of research articles. Its main recommendation is: “Do not use journal-based metrics, such as Journal Impact Factors, as a surrogate measure of the quality of individual research articles, to assess an individual scientist’s contribution, or in hiring, promotion, or funding decisions.” (DORA 2013: 2). The Declaration calls for a different approach in evaluating scientific research (Bladek 2014). At this moment, the initiative has been supported by hundreds of organizations and more than twelve thousand individuals. But it is curious that nowadays scientists have to reassert that the content of publications is more important than the journal in which it is published.

Peer review

The alternative approach to assessing the quality of research is peer review. This is not only used for review of unpublished material, but also for rating published work (for example in tenure-track decisions) and for assessing research proposals. The focus of this review is on the content of scientific work. Submitted manuscripts are evaluated by two or more outside reviewers. The underlying idea is that scientific progress in a specific discipline occurs through original scientific studies in peer-reviewed journals. In order to make sure that information can be trusted, that knowledge is new and based on sound methods, experts in the same field are asked to evaluate the manuscripts before publication. Peer reviewers actually have two functions. One is ‘filtering’; they make recommendations to assist the editors in deciding about publication. The other is quality assurance; they review the manuscripts following the standards of the field, provide comments and constructive criticism, and make suggestions for improvement.

However, peer review is not a scientific process. Reviewers often do not agree with each other; they make different recommendations. Whether or not decisions of journal editors are influenced by recommendations of peer reviewers depends on the type of recommendation. If reviewers agree that a manuscript should be rejected, their recommendation is generally followed by the editors (Kravitz et al. 2010; Sposato et al. 2014). For other recommendations, the degree of concordance is modest. Another finding in the literature is that the quality of reviews is often quite different. Some reviewers are tough, others are more lenient. Some reviewers are extremely tardy while others are swift and effective. Editors may know the style of the reviewer. Since editors tend to follow the most critical recommendations, they may influence the fate of a manuscript by the choice of particular reviewers. However, the final decision about a manuscript is not influenced by the quality of the review or the seniority of reviewers, at least according to a study of Vintzileos et al. (2014). Reviewers as well as editors might also be influenced by the so-called Dunning–Kruger effect (Huang 2013). This refers to the notorious Rumsfeldian “unknown unknowns.” Reviewers could be relatively ignorant about the topic; they might not be aware of their ignorance; they could act as if they were experts. Since disciplines are evolving rapidly and becoming more sub-specialized, it is safe to assume that reviewers have less knowledge about a particular topic than the authors of a manuscript. The same applies to editors. Careful approaches in inviting reviewers are therefore necessary; invited reviewers should decline invitations if the manuscript is not within their area of expertise; and editors should be more critical than reviewers. Some have concluded that if the same criteria are used as in evidence-based medicine, there is insufficient evidence to support the peer review system (Jefferson et al. 2007; Lortie et al. 2013).

Rejections

Scholars want to get published. But most submitted manuscripts are rejected. Reasons for rejection can be different: lack of originality, lack of focus, limited scientific value, flaws in methodology, inadequate literature survey, and writing deficiencies (Byrne 2000; Ali 2010). The first screening of submitted manuscripts is usually done by the editors. They determine whether the submission is within the scope of the journal and whether the packaging of the manuscript is appropriate. If the manuscript is not suitable it will be rejected before peer review has started. For authors rejection is a depressing message. However, if the reviews are adequate, they provide valuable comments to improve the manuscript. Most rejected manuscripts are eventually published. One can observe a curious phenomenon: rejection and subsequent revision actually improve manuscripts. Ironically, rejected manuscripts that are later published are eventually more cited than other papers. This has led some to conclude that more rejections are needed because that will improve the quality of scientific publications (Ball 2012).

The importance of publishing

The declaration of Helsinki (WMA 2013) requires that the results of research be published; this is an ethical obligation. Publishing has different purposes: it disseminates the results of academic work, it promotes discussion and debate, it encourages the formation of new ideas and views, it solicits feedback and comments. It demonstrates the basic value of science: sharing of knowledge and participating in a community of scholars. Science essentially is not an individual affair but a collaborative effort based on the global good of knowledge. It is therefore governed by scientists themselves as a global commons. Young scholars should therefore learn not only how to write articles and to get published but also how to deal with rejections and how to respond carefully and diplomatically to reviewers’ criticism (Jha 2014; Kotsis and Chung 2014; Song et al. 2014). Rejection and fear of rejection should not withhold authors to rewrite their manuscript. They should also know that manuscripts might be rejected because they present alternative and innovative views that are not compatible with dominant perspectives and paradigms. Truly innovative research might never pass the peer review system, as illustrated by Noble laureates who saw their publications rejected by prestigious journals (Editorial 2003).

This journal

Medicine, Health Care and Philosophy started as a journal in 1998. It was preceded by a Bulletin produced by the Secretariat of the European Society of Philosophy of Medicine and Healthcare (ESPMH), established in 1987. The annual conference of this Society brought together a growing group of scholars presenting their work and looking for venues to publish. Subscription to the journal is included in the membership of ESPMH but submissions are from across the world. After the journal received an impact factor in 2010, the number of submissions has increased dramatically. Google Scholar citation metrics ranks it in the category of bioethics at place 8, behind for example the Journal of Medical Ethics (place 1) but ahead of journals such as the Journal of Clinical Ethics (place 10), Theoretical Medicine and Bioethics (place 13), and the Cambridge Quarterly of Healthcare Ethics (place 15).Footnote 1 The Journal Citation Reports 2013 on the other hand are more ambiguous. The journal is not included in the Science edition (which is ranking 18 journals in the category of Medical Ethics). It is included in the Social Science edition in the category of Ethics (at rank 12 out of 50 journals) and in the category of History and Philosophy of Science (ranking 5th out of 42 journals) (JCR 2013). This ambiguity reflects the interdisciplinary nature of the journal. It is not an explicitly bioethics or medical ethics journal. It is not a history journal. Philosophy of medicine is not a separate category in the ranking system. It is not clear why the journal is not included in the sciences category. At the same time, the ranking queries indicate that the journal has a specific focus, filling a special niche among the other journals in the domain of philosophy, ethics and history of medicine and health care.

The attractiveness of the journal is manifested in the growing number of submissions. This trend is associated with a growing number of rejections. Of all submitted manuscripts since 2006, 49 % has been accepted, 46 % rejected, and 5 % withdrawn. The initial screening of manuscripts by the editors is important. An increasing number of manuscripts do not comply with the scope of the journal. The journal, as stated on its website, provides “a forum for international exchange of research data, theories, reports and opinions on bioethics, and the philosophy of medicine and health care in general” (http://www.springer.com/social+sciences/applied+ethics/journal/11019). The journal welcomes contributions form a wide range of discipline but it is “centered on a common object of reflection: health care, the human effort to deal with disease, illness, death as well as health, well-being and life” (Ibidem) Research reports or studies with mainly empirical data therefore are usually not suitable for the journal, as they tend to not elaborate and reflect sufficiently on the philosophical and ethical implications of the findings. Another reason for initial rejection is that instructions for authors are not followed meticulously. When a manuscript has passed the initial screening, it is sent to two reviewers. In general, two major criteria are used to assess the manuscript: contribution to the field, and sound methodology and argumentation. When the review reports have been received, the assigned editor will review the manuscript and the reports, and make a decision: accept (which is rare), minor revisions, major revisions or reject. In case of major revisions, the same reviewers usually review a revised and resubmitted manuscript again. Ultimately, all revised manuscripts will either be accepted or rejected. Decisions to reject are therefore heterogeneous. The following types can be distinguished: rejection without review (not within the scope of the journal); strong rejection (editor as well as two reviewers agree to reject); broad rejection (editor and one reviewer agree to reject, the other reviewer recommends major revision); light rejection (editor and one reviewer favor rejection, the second reviewer suggest minor revision); weak rejection (editor and one reviewer favor rejection, the second reviewer suggests to accept); and incomplete rejection (the editor decides on the basis of the negative recommendation of only one reviewer since there has not been a report of a second reviewer).

Transparency and appeal

With the Associate Editors a discussion is going on regarding increasing transparency about editorial decisions. The Committee on Publication Ethics has recommended that journals should have “a declared mechanism for authors to appeal against editorial decisions.” (COPE 2011: art. 3.5) Some journals do have an Appeals Committee or an Ombudsperson who can be contacted by authors. Questions to discuss are the conditions for appeal (for what type of rejection decisions?), the procedure for appeal, and the standards used.

The following appeal system seems reasonable. First, upon submission of a manuscript the editors will decide whether it is within the scope of the journal. A pre-review rejection is not open to appeal. Second, when a manuscript is taken into review it is reviewed by two reviewers. Each manuscript is also assessed by one of the Editors-in-Chief. If three persons agree that the manuscript should be rejected, the decision to reject is strong and cannot be appealed. Otherwise, while it is already difficult to engage reviewers, the review system will be overburdened. Third, a broad rejection is not based on a unanimous judgment. The manuscript is weak, but at least one reviewer will give the author the opportunity to improve the text. However, there is substantial risk that the revision will be rejected. Since this situation is close to the previous one, there will not be a possibility for appeal. Fourth, one reviewer has a much more positive view, suggesting minor revision while the other two assessments are negative, suggesting rejection. In this case there is more disagreement between reviewers. Rather than introducing a possibility for appeal, a preventative strategy of inviting another reviewer would save time. When this fourth assessment also advises ‘reject’ or ‘major revision’ the decision to reject might be better justified. Fifth, in case of a weak rejection, disagreement between reviewers is even stronger: two of them advise rejection while the third finds the manuscript acceptable. In this case, it should be standard practice to invite another reviewer. Only when this practice has not been followed, appeal is justified. Sixth, the decision to reject is based on incomplete review. For whatever reason, there is only the advice of one reviewer. In this case, appeal is justified.

Following this typology of decisions to reject a manuscript, a feasible appeal mechanism will be instituted that explains the reasons for rejecting. Authors can therefore always ask why their manuscripts have been rejected. In specific cases, they will be able to submit an appeal against the editors’ decision. If an appeal is made, it will usually result in another independent review of the manuscript. Transparency about the assessment of scientific work will not only lead to improved quality of publications in the journal but also enhance the fairness of the review system.