Referees are very important in scientific communications. Therefore, after successfully publishing a review paper, it is necessary to draw attention to the disparateness of the assessments of 2 referees who had handled it for another Journal that ultimately rejected it. Consequently, it is hypothesized that at least three choice voices should be the minimum team for equitable decision.

Keywords: script, refereeing, number, equitability

The role of the refereeing process in the advancement of Science was thoroughly examined recently.¹ In fact, it included an important aspect, namely, rejection of the submitted manuscript. Recently, I successfully published a review entitled “Spontaneous regression of breast carcinoma: review of English publications from 1753 to 1897.² Therefore, it is deemed appropriate to draw attention to two referees whose reports were diametrically opposite when that very manuscript was submitted elsewhere. Unfortunately, it was rejected. Accordingly, I am persuaded that there is need to draw attention to their respective comments. Clearly, one of them wrote with rectitude and the other with recklessness!

“The manuscript is an interesting approach at the historical documentation of tumor regression. The author has collected an impressive set of references and quotations from prominent physicians of the 18th and 19th century, as well as case reports of apparent tumor regression. Unfortunately, the manuscript lacks the structure that would allow a reader to understand the phenomenon of regression and comes across more as a collage of anecdotes. I believe the author could give the paper a more fluid structure without sacrificing the impressive collection of data that he has acquired. I would also strongly encourage that, while not the central purpose of the article, the author reviews briefly the scientific theories behind the phenomenon of regression, as an introductory section. Further review of Ross et al's paper I think is also warranted. The author should comment on the possibility that the described tumors were not in fact of neoplastic nature. I would also recommend illustrating the manuscript, as historical illustrations always generate a lot of interest. In summary, I believe this is a very interesting topic, which could be presented in a significantly better way but adding structure to the manuscript.”

“This paper is reviewing two historical cases of regression on advanced breast cancer. The first case (abridged case report of Gould - reference 2) is from 1890s and was presumptively verified by histology. The second case (William Walshe’s report - reference 3) is from 1846. This patient was diagnosed before the area of histological pathology. The second patient review is very limited and slides over into referring some historical views on cancer. I think a discussion of the medical history of cancer in the period 1753 to 1897 cannot be done in 1-2 pages like here. It is not informative. I am not able to judge if his references are representative for the medical history. Such cases are interesting, but the diagnoses are questionable, especially the second case, which has no histo-pathological evidence. Both cases have been published before and this paper does not add anything new. Regression of late stage cancer has been observed for many cancers but is very rare. Old cases without histo-pathological evidence and blood tests are not interesting (except for medical historians) I think. This paper has no scientific structure. It is not a systematic review. I did not learn anything from reading this paper.”

I am persuaded that these two decidedly disparate examples of refereeing are instructive. Their very marked differences speak for the need for weightier carefulness in the selection of referees. Indeed, as Lundberg and Carney³ put it, “There is an art to choosing the right reviewers and in deciding how much credence to give to their opinions.” Hence, let the progress be made along the line of very careful selections. Indeed, in all probability, having at least 3 reviewers will make for a bountiful balance!.⁴

None.

Author declares there are no conflicts of interest.

1. El-Munshid HA. Evaluation of peer review in biomedical publication. Ann Saudi Med. 2001;21(5‒6):275‒282.
2. Onuigbo WIB. Spontaneous regression of breast carcinoma: review of English publications from 1753 to 1897. Oncol Rev. 2012;6(2):171‒174.
3. Lundberg GD, Carney MJ. Peer review at JAMA-1985. J Am Med Assoc. 1986;255(23):3286‒3292.     
4. Onuigbo WIB. One referee constitutes a poor method of assisting the editor to assess epidemiologic research: Should three not be the standard? J Med Diag Methodol. 2016;5:206.