Masking, Blinding, and Peer Review: The Blind Leading the Blinded

For some 300 years, peer review, with all its strengths (there are many) and its flaws (there are also many), has been a key element in the vexing process of getting to the truth. Despite its importance, the peer review process itself has until recently not been subject to the same intense scrutiny as the content of scholarly work [1]. It is a healthy sign, therefore, that peer review is now getting the serious attention it deserves, as was abundantly apparent at the International Congress on Biomedical Peer Review and Global Communications held in Prague in September 1997.

A prominent feature of this attention, and a major focus of the Congress, was the issue of anonymity. Stated briefly, the question is whether peer review is less biased when the authors' identity is withheld from reviewers (masking) and when the reviewers' identity is not revealed to authors (blinding). Most medical journals, including Annals, have on the one hand traditionally behaved as though anonymity did not matter, because we have not masked the names and institutional affiliations of authors when sending manuscripts to peer reviewers. These same journals, including Annals, have on the other hand behaved as though anonymity mattered a great deal, because we have blinded authors to the reviewers' identity. (Annals does accept signed reviews, but few reviewers choose to sign them.) As editors we have, at the very least, been inconsistent, largely because we have accepted the efficacy of the traditional peer review process on blind faith rather than on the basis of evidence-a clear case of the blind leading the blinded.

That said, the a priori case for masking and blinding is strong. Maintaining anonymity occupies an honorable position in the canon of science; blinding is, after all, a central tenet of the methodology of clinical trials, …