Addressing Reviewers’ Comments
and Revising Manuscripts After Peer
Review
Moyses Szklo
Editor-in-Chief
American Journal of Epidemiology
Peer Review Process in the American Journal of Epidemiology
Changes his mind
and agrees: paper
is rejected
Disagrees
Paper reviewed by EIC
Editor believes it should
go to external reviewers
EIC believes it should
be rejected out of hand
(low priority)
Agrees
Disagrees
2nd editor
Agrees: paper
is rejected
Disagrees
Outside reviews
Primary Prevention
• In a case-based case-control study, odds ratios instead of
beta coefficients
• In a cross-sectional study or when calculating cumulative
incidence ratio without adjustment for time-to-event,
prevalence ratio regression
• Presentation of p values, 95% confidence limits and standard
errors simultaneously is often redundant
• Be careful when comparing association strengths
• Stratified data instead of interaction terms (the latter are
useful for statistical testing and for predictive equations)
Primary Prevention
• In a case-based case-control study, odds ratios instead of
beta coefficients
• In a cross-sectional study or when calculating cumulative
incidence ratio without adjustment for time-to-event,
prevalence ratio regression
• Presentation of p values, 95% confidence limits and standard
errors simultaneously is often redundant
• Be careful when comparing association strengths
• Stratified data instead of interaction terms (the latter are
useful for statistical testing and for predictive equations)
Primary Prevention
• In a case-based case-control study, odds ratios instead of
beta coefficients
• In a cross-sectional study or when calculating cumulative
incidence ratio without adjustment for time-to-event,
prevalence/incidence ratio regression
• Presentation of p values, 95% confidence limits and standard
errors simultaneously is often redundant
• Be careful when comparing association strengths
• Stratified data instead of interaction terms (the latter are
useful for statistical testing and for predictive equations)
(Spiegelman D, Hertzmark E, Am J Epidemiol 2005;162:199-200)
Primary Prevention
• In a case-based case-control study, odds ratios instead of
beta coefficients
• In a cross-sectional study or when calculating cumulative
incidence ratio without adjustment for time-to-event,
prevalence/incidence ratio regression
• Presentation of p values, 95% confidence limits and standard
errors simultaneously is often redundant
• Be careful when comparing association strengths
• Stratified data instead of interaction terms (the latter are
useful for statistical testing and for predictive equations)
Primary Prevention
• In a case-based case-control study, odds ratios instead of
beta coefficients
• In a cross-sectional study or when calculating cumulative
incidence ratio without adjustment for time-to-event,
prevalence/incidence ratio regression
• Presentation of p values, 95% confidence limits and standard
errors simultaneously is often redundant
• Be careful when comparing association strengths
• Stratified data instead of interaction terms (the latter are
useful for statistical testing and for predictive equations)
Primary Prevention
• In a case-based case-control study, odds ratios instead of
beta coefficients
• In a cross-sectional study or when calculating cumulative
incidence ratio without adjustment for time-to-event,
prevalence/incidence ratio regression
• Presentation of p values, 95% confidence limits and standard
errors simultaneously is often redundant
• Be careful when comparing association strengths
• Stratified data instead of interaction terms (the latter are
useful for statistical testing and for predictive equations)
Association of Center for Epidemiologic Studies Depression Scale
(CES-D) scores (ln(CES-D + 1) with bereavement and baseline
CES-D scores at 1 and 12-month interviews, adjusted for health
and social network variables§, widowed and married women aged
65-74 yrs, Washington Co., MD, 1979-83
o
Widowed
1-month

SE
t test
0.76 0.10
7.9¶
1.93 0.15 13.3¶
12 months

SE
t test
0.74 0.09 8.3 ¶
0.31 0.10 3.2 §
CES-D (baseline)
CES-D ** widowed
0.44
-0.32
0.40
Factor
0.05
0.09
9.0 ¶
-3.8 §
0.05
8.6 ¶
Self-reported health status, level of physical activity, family size and friendship
size; ¶ p<0.0001; §p<0.001
§
Center for Epidemiologic Studies Depression Scale (CES-D) Mean
Baseline and Follow-up Scores According to Whether Bereavement
Occurred, Women Ages 65-75 Years, Washington County, MD,
1979-1983
Title: informative
16
CES-D Score
14
12
10
married
widowed
8
6
4
2
0
baseline
1 month
12 months
Time post-bereavement
*Adjusted for self-reported health status, level of phys. activity, family size
and friendship size; Test for interaction between status and difference [1
month – baseline]: p<0.001.
Primary Prevention
• Read carefully the Instructions to Authors (focus on maximum
number of pages, other rules of presentation  e.g., AjE requires aa
to plot ratio-based measures on a log scale)
• Do not submit the same or similar publications to different journals
• Avoid abbreviations
• Description of results in text should follow the same order as in table
• Avoid the word, “effect”, when reporting observational results
• Make sure text, tables and figures match. When a result is presented
only in the text, add parenthetically something like “not shown in
table/figure”
Primary Prevention
• Read carefully the Instructions to Authors (focus on limit on number
of pages, other rules of presentation  e.g., AjE requires aa to plot
ratio-based measures on a log scale)
• Avoid abbreviations
• Description of results in text should follow the same order as in table
• Avoid the word, “effect”, when reporting observational results
• Make sure text, tables and figures match. When a result is presented
only in the text, add parenthetically something like “not shown in
table/figure”
Primary Prevention
• Read carefully the Instructions to Authors (focus on limit on number
of pages, other rules of presentation  e.g., AjE requires aa to plot
ratio-based measures on a log scale)
• Avoid abbreviations
• Description of results in text should follow the same order as in table
• Avoid the word, “effect”, when reporting observational results
• Make sure text, tables and figures match. When a result is presented
only in the text, add parenthetically something like “not shown in
table/figure”
Table and text: same order
Factor
(1) Age
(2) Smoking
Total
(3) cholesterol
Relative Risk
Unit
1.6
5 years
Current vs.
3.2
never
200+ Vs.
2.5
<200 mg/dL
“Relative risks for total cholesterol, age and current smoking
are shown in the table. Current smoking was associated with
an approximately 3-fold increase in risk. The relative risk for
total cholesterol levels of 200 mg/dL or higher was 2.5,
whereas that related to a 5-year age increase…”
Primary Prevention
• Read carefully the Instructions to Authors (focus on limit on number
of pages, other rules of presentation  e.g., AjE requires aa to plot
ratio-based measures on a log scale)
• Avoid abbreviations
• Description of results in text should follow the same order as in table
• Avoid the word, “effect”, when reporting observational results
• Make sure text, tables and figures match. When a result is presented
only in the text, add parenthetically something like “not shown in
table/figure”
(Wang N et al, Am J Epidemiol 2009 [Epub ahead of print])
Primary Prevention
• Read carefully the Instructions to Authors (focus on limit on number
of pages, other rules of presentation  e.g., AjE requires aa to plot
ratio-based measures on a log scale)
• Avoid abbreviations
• Description of results in text should follow the same order as in table
• Avoid the word, “effect”, when reporting observational results
• Make sure text, tables and figures match. When a result is presented
only in the text, add parenthetically something like “not shown in
table/figure”
Primary Prevention
• Focus on trends, not just on testing or precision
• Do not repeat results in the text that are clearly shown in tables
• Discuss the study’s limitations
• Paper should be as short as possible
Primary Prevention
• Focus on trends, not just on testing or precision
• Discuss the study’s limitations
• Paper should be as short as possible
Primary Prevention
• Focus on trends, not just on testing or precision
• Discuss the study’s limitations
• Paper should be as short as possible
Avoiding wordiness (Friedman, AJE 1990;132:591)
Other investigations exploring the association between
multiparity and scleroderma have obtained information on
multiparity using surrogate measures. The amount of
money spent on diapers, without consideration of inflation,
has been used as a proxy by several groups of
investigators, and all have reported that no significant
differences were observed once the data were stratified by
age at last full term pregnancy. Similar results were found in
the analysis and reported here. (73 words)
Shortened: Other investigators have used surrogate
multiparity measures, such as amount spent on diapers,
without inflation adjustment; as with our study, no
significant differences were identified in data stratified by
age at last full term pregnancy. (35 words)
Alleged letter from Mark Twain to a friend
Dear …
I am sorry that I have written you such a long
letter. I did not have any time to write
you a short one…
Secondary Prevention:
Responding to Reviewers’ Comments
• In your cover letter, answer each critique/comment made by
reviewers.
• Highlight in the revised paper the changes made as a result of the
reviewers’ comments.
• Be courteous. A good idea is to start your response with, “I thank the
reviewer for this thoughtful suggestion…” (that is, if you think it is
thoughtful…)
• Try to consider carefully each suggestion or comment.
• If you disagree somewhat with the request for a change, but it is
easy to implement it and it does not affect the science…do it!
• If you disagree entirely with a criticism and believe it is scientifically
sound, explain why.
Secondary Prevention:
Responding to Reviewers’ Comments
• In your cover letter, answer each critique/comment made by
reviewers.
• Highlight in the revised paper the changes made as a result of the
reviewers’ comments.
• Be courteous. A good idea is to start your response with, “I thank the
reviewer for this thoughtful suggestion…” (that is, if you think it is
thoughtful…)
• Try to consider carefully each suggestion or comment.
• If you disagree somewhat with the request for a change, but it is
easy to implement it and it does not affect the science…do it!
• If you disagree entirely with a criticism and believe it is scientifically
sound, explain why.
Secondary Prevention:
Responding to Reviewers’ Comments
• In your cover letter, answer each critique/comment made by
reviewers.
• Highlight in the revised paper the changes made as a result of the
reviewers’ comments.
• Be courteous. A good idea is to start your response with, “I thank the
reviewer for this thoughtful suggestion…” (that is, if you think it is
thoughtful…)
• Try to consider carefully each suggestion or comment.
• If you disagree somewhat with the request for a change, but it is
easy to implement it and it does not affect the science…do it!
• If you disagree entirely with a criticism and believe it is scientifically
sound, explain why.
Secondary Prevention:
Responding to Reviewers’ Comments
• In your cover letter, answer each critique/comment made by
reviewers.
• Highlight in the revised paper the changes made as a result of the
reviewers’ comments.
• Be courteous. A good idea is to start your response with, “I thank the
reviewer for this thoughtful suggestion…” (that is, if you think it is
thoughtful…)
• Try to consider carefully each suggestion or comment.
• If you disagree somewhat with the request for a change, but it is
easy to implement it and it does not affect the science…do it!
• If you disagree entirely with a criticism and believe it is scientifically
sound, explain why.
Secondary Prevention:
Responding to Reviewers’ Comments
• In your cover letter, answer each critique/comment made by
reviewers.
• Highlight in the revised paper the changes made as a result of the
reviewers’ comments.
• Be courteous. A good idea is to start your response with, “I thank the
reviewer for this thoughtful suggestion…” (that is, if you think it is
thoughtful…)
• Try to consider carefully each suggestion or comment.
• If you disagree with a request for a change, but it is easy to
implement it and it does not affect the science…do it!
• If you disagree entirely with a criticism and believe it is scientifically
sound, explain why.
Secondary Prevention:
Responding to Reviewers’ Comments
• In your cover letter, answer each critique/comment made by
reviewers.
• Highlight in the revised paper the changes made as a result of the
reviewers’ comments.
• Be courteous. A good idea is to start your response with, “I thank the
reviewer for this thoughtful suggestion…” (that is, if you think it is
thoughtful…)
• Try to consider carefully each suggestion or comment.
• If you disagree with a request for a change, but it is easy to
implement it and it does not affect the science…do it!
• If you disagree entirely with a criticism and believe it is scientifically
sound, explain why.
Tertiary Prevention
Should authors request reconsideration if you paper has been rejected,
and you believe that the reasons for rejection were not reasonable?
I am sorry to inform you that after careful review, we are unable to accept your
paper for publication. As you know, we can accept only a fraction of the meritorious
manuscripts submitted to the American Journal of Epidemiology. I appreciate the
considerable effort that you and your colleagues have put into this manuscript and
am sorry to bring you this unfavorable news.
The comments of the reviewers are enclosed for your consideration. I hope the
information provided by the reviewers will be helpful if you decide to revise the
manuscript for submission to another journal. Please keep in mind that our
decisions regarding acceptance of manuscripts are based not only on the
reviewers' comments to the authors, but also on the reviewers' comments to
the editor, in-house evaluations by editors, and an assessment of the priority
rating of the manuscript in relation to our many other submissions.
On behalf of the Journal, I thank you for submitting your manuscript and hope that
the outcome of this specific review will not discourage you from sending future
papers to us.
Sincerely
Decisions made for submissions to the AjE between
1/1/08 and 6/30/08
Accepted
Total
No.*
No. not
pending
No.
%
Original contributions, meta-analysis
and rapid communications
510
382
29
8
Practice of Epi
138
108
5
4
Commentaries, Editorials and Special
Articles
23
21
11
52
Reviews
9
4
1
25
Letters to the Editor
29
25
19
76
Book Reviews
5
5
5
100
714
545
70
13
Total
E-mail message from an European author upon
receiving a rejection letter:
Dr. Szklo,
What could I expect from an american (sic) editor? I
will no longer buy american (sic) products.
Reputed rejection slip from a Chinese
economics journal
We have read your manuscript with boundless delight.
If we were to publish your paper, it would be impossible
for us to publish any work of a lower standard.
And, as it is unthinkable that, in the next one
thousand years, we shall see its equal,
we are, to our regret, compelled to return your divine
composition, and to beg you a thousand times to overlook our
short sight and timidity.
Adjusted* Risk (Hazard) Ratios of Coronary Heart Disease by
Selected Factors, with 95% Confidence Intervals, Men 40-64 Yrs.
Old at Baseline, 5-year Follow-up, 1975-79
Factor
Age
Cholesterol
Smoking
Units
10 years
40 mg/dL
Heavy smokers (20+
cig/day) vs non-smokers
Family History Yes vs no
Hazard Ratio
4.5
1.7
3.1
1.8
*Each variable is simultaneously adjusted for all other variables
seen in the table using Cox Proportional Hazards model
Relative Risk of Pancreatic cancer in Relation to Drinks per Day by Gender
in the NIH-AARP Diet and Health Study, USA, 1995/1996-2003