Publication Bias

The appearance of an article in the pages ofTHE JOURNALis the result of a complex and lengthy process. Scores of people, acting as investigators, funding agents, members of institutional review boards, authors, reviewers, and editors, make decisions that influence what is published. Each decision may be subject to biases: the conscious and subconscious influences that interfere with impartial judgments. The editors are uncomfortably aware that, for reasons of space and timeliness, the good may often be turned down in favor of the best, but when the final product is published, all concerned like to imagine that their own decisions were free of institutional, hierarchical, political, sexist, racist, and other biases. It has been shown for one journal that these sorts of biases may be largely removed from the editorial process by having reviewers blinded to the names, positions, and institutions of the authors,1and an effort is