To the Editor,

Drs Law and Lo raise some intriguing points in their letter proposing a two-stage approach to peer review.1 Although there are most definitely some limitations with their proposed approach, I fully agree with the concept of assessing the validity of a manuscript (via its research question, hypothesis, methods, and baseline characteristics of its participants) separately from its results. Indeed, several journals have already established whole sections dedicated to accepting papers for publication even before the conduct of the experiments under the proviso that the authors have received an “in-principle acceptance” after peer review of their submitted study protocols from the journal.2

According to Law and Lo, one of the potential drawbacks of their proposal is that the impact factor of a particular journal may be affected (presumably negatively) if the journal elects to publish more negative studies. Implicit in this argument is the assumption that a negative study is somehow less citable than a positive study. It also assumes that the impact factor is an important quality metric, which is a highly debatable assertion. I believe the assumption of a negative study being less citable than a positive study is untrue. Indeed, in an era of worldwide fiscal austerity where healthcare cutbacks are occurring in virtually every country, negative studies - which can result in the disinvestment of wasteful practices or expensive but ineffective therapies3,4—have particular value and deserve even more citations so more healthcare providers are aware of the research.