Paper rejections: a coin tossing in science or a conservative narrow-minded view of science toward the authors

I have received (September 17, 2010) a decision about a paper that I submitted to a biomedical engineering journal on November 08, 2010. Guess What? The decision was rejection after the editor received ONE advice email. This is the second rejection that I received this week (I promise to make another critic comment on the other rejection soon). It is not that I didn't have received rejections before, but this one make me think that some referees are not capable of making constructive commentaries on the paper that they are assigned to as they should be. In special, it is interesting to see how referees are biased towards their own fields (I explain below). I wonder why they don't just decline the invitation to review a paper if they don't have time to do it or is not their subject of interest. That, of course, would be a much more simple solution, because now I need to submit the paper to another journal. It implies that I will need to bother the other authors to ask if they agree on sending the paper to journal X and spending more time formatting the file to follow the journal X guidelines.

In the following lines, I show in blue, the comments that made the editor-in-chief reject my paper followed by my comments in red, then I come back again to the discussion in black. Few remainders are in green.

This paper deals with electrocardiographic analysis of heart rate and is suggested to be applicable to diagnose heart failure in patients, and to discriminate heart failure form sinus rhythm.

This is the general idea of the paper according to the referee view. Until here is OK. It is wonderful when someone can understand what are you trying to explain. This paragraph is very common among scientific authors and reflect politeness. Unfortunately, the referee didn't have time to check the phrase after writing it to correct small mistakes, as we can see at the end of the paragraph.

In some cultures, as the Japanese, mistakes like that are considered a very rude behavior. It shows that someone didn't have time for a double check before submission. In particular, I agree with the Japaneses, because it sounds that you are careless to the person to whom you are writing to.

The background is very confusing. Most heart failure patients are in normal sinus rhythm. Normal sinus rhythm is a prerequisite for its autonomic modulation. The diagnosis of heart failure is not made by electrocardiographic analysis, as the authors appear to suggest. Echocardiography is usually employed to quantify ejection fraction, but subjective criteria (dyspnoea, fatigue on exertion) as well as other objective criteria (rales etc) are important as well.

Now, I am asking myself which king of background in heart rate variability the referee has. It appears to me that the referee is struggling to differentiate between disease (congestive heart failure) and healthy (normal sinus rhythm). The term normal sinus rhythm means that the heart rhythm is normally produced on the sinoatrial node and its electrical impulse travels without any abnormally in the heart. Note that it is easy to the referee to judge the quality of the paper according his/her field instead of checking if the applied methodology is a well-used approach on other field. The referee point of view would be much more easy to understand if the referee had used a simple example to clarify what she/he is thinking about. Or, am I wrong?

Somewhat I feel that the referee is biased to judge this work according to the first two lines of the second paragraph, where the referee states: "Most heart failure patients are in normal sinus rhythm. Normal sinus rhythm is a prerequisite for its autonomic modulation." Although the first phrase is correctly stated, I am almost sure that the second phase is not. Therefore it is hard to accept that someone with large experience on (computers in) cardiology (or engineering) could write something like that without prejudice. Let me explain:

It is well-known that the heart (not including the transplant cases) is (almost) continually subject to autonomic regulation. From the moment the heart cannot maintain a proper cardiac output, we can assume that there is a problem, influencing thus the electrical activity of the heart, resulting in an abnormal cardiac state (e.g., congestive heart failure). Consequently, the cardiac state will also influence the cardiac modulation. But, it seems to me that the referee doesn't want to accept that congestive heart failure and normal sinus rhythm are different cardiac states. I also believe that the second part of the phrase should be better stated the other way around; that is, autonomic modulation is a prerequisite for normal sinus rhythm, but not [a prerequisite] to congestive heart failure. I am not sure if I understand why the referee used the possessive adjective ITS on the second part the phrase. Could someone help me to solve this mystery?

Lesson learned. Nothing is obvious. I should have made clear what I want to mean with normal sinus rhythm when I have the chance. Rejecting a paper because of minor comments is ridiculous and sounds like a bad joke.

All right, if the appeal of the referee could have being that the number of samples used to classify congestive heart failure from normal sinus rhythm it is not enough, then it would be a good start point for a discussion. However, it would only make sense if the propose technique was intended to be applied to other fields than the ones involving congestive heart failure and normal sinus rhythm. One experienced referee on the subject knows that a common problem here is to have enough samples from a refutable database. By "refutable database" I mean that anyone could use the same signals to test the results.

There are also minor comments (if there are any) that I would like to highlight:

• In the first part of the email the referee says "This paper deals with electrocardiographic analysis of heart rate". In the second paragraph the referee states the contrary "...the diagnosis of heart failure is not made by electrocardiographic analysis...". Which one is he correct?
  
• An interesting point that call my attention is that the referee start to explain about a topic that is not cited in the paper at all. If I have a chance, I would like to directly ask the referee to point out in which part of the text he/she found the word echocardiography. I wish I could post the paper or a link to it, so anyone could verify what I am emphasizing here.

So far, in only two paragraphs, there are so many disconnect points that I would say that the paper was refereed by a PhD student at most, but I am almost sure that I am wrong.

In time: It is not that PhD students are inept to do perform a good review, it is just that they lack of experience in most of the time to make concise comments on their own. There are a plenty number of exceptions, of course.

Relevance of the methods therefore seems absent.

The last paragraph sounds to me that until the minor reviews are observed (or corrected), the rest of the paper is not worthy of further consideration. Thus, I don't believe that the referee tried to understand the methods described on the paper. In fact, the phase is too short to mean anything else.

A point that deserves attention is the use of the word seems on the phase above. It should not be used to disclose opinions on scientific writing. The reason is simple, it is too vague to express any meaningful idea. In other words, I need to guess what the referee is trying to say. And, in science, there is not space to such a thing like guess.

I am glad that the review process only took eight days to send me a note about my paper, but I am little confused (to not say shocked) with the comments of the referee. I hope that the next referee assigned to review my paper will be less biased towards minor review and more interested on pointing out serious flows to increase the impact of the paper.

Sometimes, there are referees to whom papers are assigned that are likely to have a conservative narrow-minded view of science. Note that to avoid a dubious interpretation, the term conservative narrow-minded view refers to referees that are strongly connected to traditional attitudes and values, and that are cautious about any kind of changes. Perhaps, if someone has a different term to describe those referees, please let me know. I believe that there are so many other points in which referees could kindly help authors to improve the quality of their papers that is shameful when referees tend to forget the meaning of the term peer-review because of few mistakes.

Despite the fact that the referee strongly influenced the decision of the editor-in-chief in rejecting my paper because of minor reviews (according to my opinion), the referee's opinion should be respected above all. Maybe, I could include she/he in the category of masters of the universe (topic to another post).

PS: Someone after reading the post can suggest that I should have appealed of the decision, but I will say that is not worthy to try. I will explain in another post why it is better not try to appeal of the editorial board committee decision. Don't worry, the paper is going to be publish, just don't ask when.