Responding to a journal's decision
A journal's decision arrives as a letter that accepts, invites a revision or rejects, and its opening words do not always say which. A revision is answered comment by comment, in a response letter built for the editor and in a tone chosen rather than defaulted to. A rejection is read for what can be fixed before the manuscript goes to another journal, or, occasionally, back to the same one on appeal.
Reading the decision letter
The journal editor's decision comes as a letter that indicates rejection, revision or acceptance. After peer review, an editor sends one of four main types of decision letter: acceptance as is, which is very rare; rejection with a suggestion to submit to a sister or cascading journal from the same publisher; rejection; and conditional rejection with the opportunity to submit a revised manuscript after minor or major revisions. A minor revision usually needs only changes to the text and no further review before acceptance; a major revision often needs further experiments and may go through a second round with the same reviewers.
Very few manuscripts are accepted as they stand, and seldom without requested changes, so authors should expect to revise to address the editor's and reviewers' comments. The author of one guide for clinicians has, through two editions, offered dinner to anyone whose research report is accepted by a major refereed clinical journal on first submission without a single revision, and no one has taken him up; most acceptance letters follow one or more revisions. In his view this is probably a good thing, because revisions based on reviewers' comments usually result in better papers in print, the real goal of peer review being to make the report the best it can be. Most authors believe that the revisions peer review prompted improved their manuscript.
A revision letter, sometimes called a modification letter, can be misleading. It can open with "I regret to inform you that your paper does not meet the Journal's requirements in its present form" and go on, "However, if you make revisions as suggested by the peer reviewers, we will be pleased to reconsider your submission", which the same guide reads as, in effect, a conditional acceptance letter.
A rejection letter will probably avoid the word "reject" and say instead that the paper "does not meet the Journal's needs". It says not only that the paper will not be published in that journal but, by implication, that it cannot be improved to meet the journal's standards, and the editor does not want to see it again. Unless the paper has had the bad luck to compete with a very similar article in press, the rejection rests chiefly on the referees' evaluations, which are usually sent to the author and should be read very carefully.
A publication writer engaged at this stage analyses and interprets the editor's decision after peer review and, where necessary, rewords or simplifies sentences of the letter for clarity while preserving their meaning.
Taking in the reviews
In general, reviewers' comments can really help to improve the manuscript, especially as the reviewers see it with fresh eyes. Comments can be very direct, and it can be hard not to react to negative ones, especially those that seem unfair. Non-native speakers of English can have trouble interpreting nuanced comments from reviewers, where I would suggest… means You should….
Many authors and writers still treat peer review as a major hurdle. After a rejection or extensive review comments, an author may pass through the five stages of grief in the Kübler-Ross model (denial, anger, bargaining, depression and acceptance) before being able to explore options. In some cases a writer can help keep the revision schedule moving by listening to and collating the thoughts of the corresponding author and co-authors as they process the review, and can coach them to treat the reviews as free consultations with two to four subject matter experts.
Revising the manuscript
Where the authors agree with the referees' suggestions, they make the recommended changes, and the resubmission says what was changed, where, and why, in relation to the referees' and editor's comments. How the changes are shown follows the editor's instructions, such as visible track changes or highlighted text, with a clean copy of the revised manuscript included.
In a descriptive analysis of manuscripts submitted to and eventually published by the Annals of Internal Medicine, five leading types of problems prompted changes during peer review and revision: too much information, too little information, inaccurate information, misplaced information, and structural problems; changes most often occurred because information was missing or extraneous.
A revision concentrates on the suggested changes. The reviewers' own language should be used in the response letter, and some of it may belong in the paper. New data or conclusions should not be added, since they can only give the editor and referees something new to criticise; the repairs should be surgical, and the paper resubmitted before the editor has a change of mind. A revision letter that invites the authors to cut the paper to a 500-word brief report, or to resubmit it as a letter to the editor, suggests virtually certain publication in a journal high on their list at the price of giving up full presentation of the data and conclusions; the decision calls for soul-searching, discussion with coauthors and perhaps a trusted senior advisor, and the guide's author recommends that the writing team struggle to a unanimous decision.
After the requested changes are made, the revised manuscript goes back to the authors for final approval before it is returned to the journal with the responses to each comment.
The response letter
The tone of the response letter and the completeness of the reply to each point can influence the editor's decision. The letter thanks the editor and reviewers for their time and efforts, and for the insights the authors believe improved the manuscript, and it stays polite, respectful, objective and professional, with any hint of frustration or sarcasm removed; above all, it is diplomatic. In referring to reviewers' comments, one editor suggests the diplomatic words thorough, prompt, creative and constructive in place of nitpicky, slapdash, farfetched and heavy-handed.
One guide for researchers gives three rules for responding to reviews: do not ruin the article by accepting all the reviewers' comments wholesale, be authoritative, and do not fawn. One editor once edited a set of point-by-point responses in which the author thanked each reviewer for each and every comment, twice.
An effective response letter has two parts: a summary for the editor, and a point-by-point document that shows each reviewer's comment immediately followed by the authors' reply. A table suits straightforward replies, but a sequential format is easier for the editor to review when replies are long, and the format should not make the editor keep flipping between the reply and the revised manuscript. The reply can include the revised text itself, with page and line numbers, giving the editor enough to agree that each comment has been addressed and the paper is ready for acceptance.
The reviews can be considered free consultations with subject matter experts, and the replies take a collaborative tone, congruent with a consultant's suggestions, with the manuscript text revised to address each issue. The authors should be engaged and given enough time to process and accept the reviews and to respond to the comments. All the reviewers' comments go in a numbered list, with a point-by-point response; if comment 2 contains three questions, they are numbered 2a, 2b and 2c and each is answered individually, and comments and replies are set in different font styles or colours, such as black italics against regular type. The reviewers' compliments belong in the letter as well as their requests, because including the positive comments reminds the editor of the manuscript's positive aspects. Replies should answer directly and up front where possible, be supported with very relevant citations as needed, and as a general rule agree with the reviewers at least 75% of the time. The manuscript should be revised as requested whenever possible. Where a reviewer has not understood, the passage should be rewritten to clarify it, considering adding a rationale, method, subgroup, interpretation, diagram or table as needed, and consulting peers. Where the reviews are disparate or the requests many, the revisions can be summarised at the beginning of the letter to the editor.
Each comment is paired with a reply carrying enough support, in data, citations and revised text with page and line numbers, to convince the editor the issue was addressed. Where requested, the manuscript is revised before resubmission to clarify the novelty or significance of the findings or to tone down the conclusions, and the replies and the revised manuscript together show that the authors took the editor's and reviewers' comments seriously.
Replying to misunderstandings and disagreements
Disagreeing with reviewers' comments and tackling contradictory comments from different reviewers are among the tricky issues a decision letter raises. Where the author feels a reviewer has completely misunderstood the paper or overlooked a crucial feature, the author can discuss this with the editor and request another review.
A reviewer's comment may reveal a misunderstanding, a different interpretation, or a point discussed so briefly that the reviewer missed it. Telling the editor that the original manuscript already contained the missed information is a pitfall: the reply should instead involve revised text, perhaps with a table, figure or added citations, so that the reviewer's issue is met and readers can absorb the point too. Phrases that may help start such a reply and introduce the clarifying revision include "The referee is right to point out…", "Thanks for pointing out the ambiguity or a different interpretation. We have clarified…", and "We felt that this point is not completely correct…. We agree that…. However, we disagree about…and have clarified…".
A table of common disagreements suggests responses for each case. For a delayed review or decision, ask for a status update, and consider acknowledging the effort a thorough review takes, offering to review another manuscript for the journal to ease its backlog if the author has published there, or suggesting suitable reviewers. For a reviewer who did not "get it", thank them for pointing out an alternate interpretation and clarify. For requested experiments or analyses, perform them if at all possible; otherwise give a robust rationale, add the limitation to the discussion, suggest them as future work, and understand that not supplying them may mean rejection. For a request to cite many articles by particular authors, citing the one or two most relevant usually improves the introduction or discussion, and declining to cite them all maintains fair balance. For contradicting reviews, include both the positive and the negative comments, consider revising to meet both with replies tailored to each reviewer's perspective, assume the negative reviewer did not understand and consider clarifying, consider the revisions that help readers most, and ask the editor for guidance. Seeming personal attacks come more often when data refute an accepted paradigm; the reply can present results from different, well-established techniques, consider whether the discrepancy comes from different subpopulations, such as patients meeting classification criteria against real-world evidence, and give citations showing the assays used. Glaring attacks in most or all of one reviewer's comments call for a professional, objective tone and a confidential word with the editor, who may provide another reviewer.
The writer's and editor's part
For a conditionally accepted paper, a publication writer determines the editor's exact decision, re-edits the newly added parts, proof-checks the rest of the manuscript for consistency and logical flow, and helps prepare the point-by-point responses. For the responses themselves, the writer edits or rewrites them point by point, upgrades the explanations of the revisions made in both text and cover letter, and edits or rewords the scientific rebuttal by building persuasive, science-based arguments.
Writers or medical communication companies may use software, such as Datavision, Tableau, Excel or PleaseReview, to track each author's suggested revisions and confirm their final approval. They can speed the letter by asking authors to focus on a subset of the comments, such as requests for additional experiments or alternative analyses and questions about significance, implications or conclusions. Where reviewers ask for conclusions to be toned down, the writer can offer several alternative sentences for the authors to revise, and where a manuscript spans several specialties, the writer or project manager can suggest that each expert focus mainly on the comments in their own.
After submission, some authors also involve their own editor, whose role depends on whether the manuscript is accepted, returned for revision and resubmission, or rejected. On revise and resubmit, the editor makes sure the response letter is polite and thanks the reviewers for their suggestions even where slightly off base, helps the authors pick the important battles and yield where it is ethically possible, and makes sure the revision is better rather than worse than the original. On rejection, the manuscript is submitted to another journal, or reworked and then submitted elsewhere.
The response to reviewers is a situation particularly well suited to an editor explaining rather than simply changing. The editor can edit the response for tone, offer another perspective where the author seems to have misunderstood a reviewer's question, and supply evidence from style manuals or author instructions when a reviewer makes an erroneous comment about style or the mechanics of language. In one example, an author answered a query by citing a reference that supported a 50% acquisition result, and the editor suggested that the reviewer was probably not questioning the validity of the result but asking why more mice were not used, so the question might not have been adequately answered; in another, where a response skipped a comment, the editor thought the reviewer wanted to know who had coded the spheroids, a blinded coder or someone who knew the expected results. For tone, rather than saying the reviewer misunderstood, the author can say the sentence was altered to eliminate the possibility of confusion; and rather than pointing a finger, the author can cite the study that supports the point, which stays objective and lets the journal's editor put two and two together.
After a rejection
As one writer puts it, every new author believes his or her manuscript is so good that it will be accepted by the first publication to which it is submitted. In his view it is a rare article that is accepted on first submission. The response to a rejection is to send the piece to the next publication on the list and wait again, perhaps another couple of months, and a first-timer may have to go through that cycle a number of times before an article is ever accepted, so the patience to get published has to be added to the work of preparing a satisfactory article.
On receiving a rejection, take a deep breath and put the manuscript and the reviewers' comments away for a day or two.
An appeal for reconsideration sometimes works, but not often; an editor at the British Medical Journal put the share of successful appeals at some 20%. The appeal must be rational and civil: it politely refutes the reviewers' criticisms point by point, citing evidence, shows how the paper will be especially important to the journal's readers and how that may have been overlooked, and names any recent publications that validate the findings and conclusions. The draft should sit for a day or two to cool off and then be revised to expunge any hint of anger, and the author should be prepared to be rejected again. A manuscript rejected in no uncertain terms is not resubmitted to the editor who rejected it without that editor's invitation; a manuscript that keeps coming back is a zombie.
Once the first journal's judgment is accepted, the rejection is an opportunity to improve the paper. Seek the nuggets of truth in the reviewers' remarks, including in the remarks of a reviewer who seems to have totally misunderstood the paper, since there may be a message in that too. Make the appropriate revisions, update the literature search and references, especially if a few months have passed, and submit to another journal soon, which helps prevent discouragement. Subsequent submissions are sometimes more successful when sent to more specialised journals, especially those with lower rejection rates. The next journal may be one with a lower impact factor or a scope that fits better. Its scope should cover the research and its article type, and the manuscript is revised for it to address as many of the reviewers' issues as possible; the same applies when an editor suggests a sister or cascading journal, with the editorial and reviewers' comments addressed and the manuscript refocused on that journal's scope. Most rejected manuscripts can be revised to address many of the reviewers' points and may be accepted by another journal: about 65% of those rejected by the British Journal of Surgery were published in one of 198 other journals within three years, after an average delay of 13.8 months, a fact that can spur writers and authors to provide the relevant revisions and supporting evidence in the response letter. Save every rejection letter; medical writers all receive many.
After a rejection, a publication writer analyses the original journal's comments, rewrites or edits the newly added parts according to the salient ones, and advises on the choice of a new target journal.
In the experience of an associate director in a university health sciences research office, a rejection letter from a top-tier journal can still tell an author a lot, because its reviewers are usually top-tier too. The task is to interpret the letter and respond in a way that improves the chances of the manuscript eventually being accepted with revisions. A reviewer's comment that the paper could be shortened without loss of important information, for example, can be answered by reducing the introduction and discussion, removing detail from the methods, and referring readers to the laboratory's website. The cover letter for the revised paper should be composed in tactful language.
Sources disagree on whether the next journal should learn of the earlier review. One guide for clinicians advises that the second submission should carry no indication that it is not the first time the paper has left the author's desk, while noting the chance that a reviewer for the second journal is the very person who refereed it for the first, most likely in limited scientific fields. The authors of an article on response letters always recommend disclosing prior peer review, although many authors are reluctant to admit it and some actively deny it. In their view disclosure shows that the authors are transparent and honest, can in some instances make a new review unnecessary, and matters in specialties with small reviewer pools, where nothing is worse for an editor than sending a "new manuscript" to a reviewer who replies that they reviewed it for another journal and the authors made no attempt to address any of the issues, after which the editor doubts the authors' honesty about other aspects of the manuscript. A manuscript rejected outright and revised for a different journal should go with a cover letter that discloses the prior peer review and explains the revisions. Where an editor has suggested a sister or cascading journal, a cover letter with a response detailing the revisions made to address the prior reviews is worth considering. MPIP's authors' submission toolkit suggests that a rejected manuscript submitted elsewhere could be accompanied by a copy of the previous manuscript and the reviewers' comments, to show that the suggestions were incorporated, and as of 2012 some journals already encouraged sharing previous reviews because it improves transparency, avoids duplication and increases the quality of subsequent submissions.