Responding to reviewers
When we finally didn’t get an outright rejection for the EMULSION paper, we then had the task of responding to the comments that the reviewers had given. For the most part it’s a case of swallowing your pride and doing what they ask, which for the most part for IJPP was very reasonable requests (see post on the peer review process). It’s also worth bearing in mind that by the time you get to the point of submitting your prepared article, which may have gone through several stages, both you and your co-authors may be too close to the work and can’t see some of the shortcomings of the writing. Peer reviewers’ comments look at the work with fresh eyes and can see things which may be unclear. They also may have expertise in your discipline and may be able to suggest extra information to include to broaden the work out into a wider context. In our case, some of the comments also gave us permission to spend a bit more time on definitions and concepts around unlicensed medicines which had been cut out of previous versions in an attempt to limit the word count (see post on preparing your article for submission). It also encouraged me to go away and look at other models of unlicensed medicines supply internationally, and actually that was really quite interesting when comparing it to the UK model.
Whatever the comments you receive, it’s important to address all of them. This is best done systematically with individual responses. Even if this is just to say “we agree with the reviewer’s comment” where changes are not required. It’s also important to note that this is a big administrative exercise. Each change needs to be tracked in word, and the changes need to be referenced in the responses with line numbers from the manuscript (sometimes in both a tracked and ‘clean’ copy). My top tip is to leave the line numbers as the very last exercise – otherwise they all go out of sync.
Having said all that, similar to the NHS Ethics Decision response, there are times that you might want to stand your ground. We did this with two similar comments which we actually got from two separate journal reviewers. As part of the guideline analysis, we pulled out the common content features of the guidelines across the sample, and we also pulled out all the risk considerations which were used in the guidelines across all documents. On two occasions, reviewers requested that we transform these elements into ‘recommendations’ for what should be included in an unlicensed medicine guideline. Now, neither me nor Lindsay despite the EMULSION project would be inclined to call ourselves an ‘expert’ on unlicensed medicines and the guideline analysis did not aim to create best practice guidelines on unlicensed medicines use. We simply wanted to answer the question – what is currently in existence to support their use? Of course, we also wanted to find out what we might need to explore in the qualitative element of EMULSION, and have something to provide context for what we found. We feel that the development of best practice guidelines for unlicensed medicines needs to be done by the experts as part of a multidisciplinary discussion which also involves patients. The process of developing a guideline is very different from analysing other guidelines, though granted one can help the other. We would love if our work here helped develop better guidelines in the future, but we feel it isn’t for us to say what they should look like. So in both of these responses, we have made this clear and not transposed these into recommendations.
I hope you found this series of blog articles helpful for planning your own peer reviewed publication.
