• regional anesthesia

Recently, Regional Anesthesia & Pain Medicine (RAPM) created a set of guiding principles on which our reviews and decisions are based.1 These principles are based on an assessment of a study’s validity, relevance, effect size and precision. Additionally, the editorial board at RAPM has the responsibility to assure that work published in the journal is held to the applicable bioethical standards and that clinical trial registration is complete and consistent with the submitted manuscript. For each successful manuscript, there are up to four revisions created over many months that require dozens of correspondences and changes before final acceptance. Thus, as any author will validate, there is a lot of work to do prior to acceptance and publication! As RAPM approaches 1000 yearly submissions, we rely on the volunteer peer-review community, with editorial oversight to make our decisions.

Despite the devotion of all who contribute to the rigor of the medical journal peer-review process, no journal is able to completely eliminate every methodological, bioethical or registration error.2 Here at RAPM, we see community engagement as the final check in the peer-review process. After all, you are the busy clinicians, educators and researchers representing our target audience. You have expertize, experience and training that may provide unique insights into interpreting our published studies. We see these attributes each month in our robust Letter to the Editor section that allows for constructive discourse and debate. When you read one of our published manuscripts, you may identify something that merits further attention and commentary. If so, please do not hesitate to contact us at info@rapm.com 24/7. We will take action accordingly.

In RAPM, we invited Hadzic et al 3 to summarize their experience with a ClinicalTrials.gov registration discrepancy that occurred with their industry-funded 2017 article published in RAPM.4 This discrepancy related to a difference in the published primary outcome variable and that which was registered. This discrepancy was missed in the peer-review process and was identified by a concerned reader. RAPM follows the Committee on Publication Ethics (COPE) guidelines,5 which resulted in internal (RAPM) and external (IRB) reviews. Ultimately, and after collaboration with the authors’ institution that granted ethics approval, this discrepancy was determined to be a clerical error with exculpatory evidence. This was an unfortunate set of circumstances given the human and resource stress it placed on all parties involved. However, it serves as an example of how the ‘complete’ peer review process should be considered a community activity. In addition to the registration discrepancy, Hadzic and colleagues accurately summarize other concerns that the RAPM Editorial Board had which emerged during the investigation. These issues were all secondary to the primary outcome discrepancy which represented the sole reason that RAPM requested an investigation. Despite our disagreement with much of their assessment of these secondary issues, we deeply appreciate the authors’ willingness to publicly share their commentary. We encourage all researchers considering publishing work in RAPM to be proactive and contact the editorial board with any questions or concerns prior to submitting your work. Extracaution is warranted, especially in the context of controversial and complex matters such as registration discrepancies, disclosure of industry funding, altered opinions on minimal clinical significance and decisions regarding performing non-planned interim analyzes.

Historically speaking, a large swathe of ‘evidence-based’ recommendations are found to be wrong or even harmful.6 There are many potential reasons for this sobering reality, which likely include undetected confounding factors, lack of validity, misrepresentation of data, publication bias and in some cases even fraud. Thus, it is important for RAPM and the research community to build a repertoire of multiple studies with different methodologies that all point to a similar answer for a specific clinical question. We aspire to have more definitive conclusions in our field that parallel, for example, the unequivocal benefit of aspirin therapy during a myocardial infarction. To realize this goal, we will rely on the full force and talent of the entire RAPM community. We deeply appreciate our readership and their keen insights and skills.