A Trust That We Work Hard to Maintain

Editor's Note: This article was originally published in the July issue of the journal CHEST (2025;168[1]:1-3). It is republished with the permission of Elsevier Inc.

By Peter J. Mazzone, MD, FCCP
October 3, 2025 | VOLUME 3, ISSUE 3

I recently received a letter from the Department of Justice that asked me to provide information about how our approach to article selection and medical publishing promotes the trust of our readers and protects the public from misinformation. Developing a response to the letter provided me with an opportunity to reflect on the goals and practices that we have established for CHEST.

This exercise helped me to recognize that our readers may not be aware of the rigor with which we steward the content that is published in our journal. In this editorial, I will share some of the structure and processes that we follow to earn your trust and to avoid the publication of misinformation. The questions are used to frame the issues that could threaten these goals. They are not the exact questions that were sent to me by the Department of Justice.

How do you avoid influence and bias related to the financial relationships of the organization, the publisher, journal leaders, and contributors to the journal?

There are many editorial principles outlined by organizations, such as the International Committee of Medical Journal Editors and the Committee on Publication Ethics, that provide guidance about best practices in medical and scientific publishing. One of the key principles is editorial independence. Editorial independence means that our parent organization and publisher can never tell our editorial board what should or should not be published. To further minimize influence, neither I (the editor) nor the editorial board members are involved in, or made aware of, any of the organization’s or publisher’s business relationships.

We further protect our readers from conflicted viewpoints by instituting conflict of interest policies. Editorial board leaders must declare all potential conflicts. Some conflicts prohibit an individual from serving in a leadership role. Others are managed by disclosure, transparency, and recusal from involvement in the handling of specific manuscripts. Individuals are not invited to review a manuscript if a conflict is known (eg, work in the same department as an author); when invited, reviewers are asked to recuse themselves if there are any conflicts that could influence, or appear to influence, their feedback. Authors must declare their potential conflicts. Declaration of a conflict does not exclude their manuscript from being considered for publication. It allows readers to make judgments about the potential influence of the relationships that are declared.

How do you ensure that the viewpoints of the organization do not influence what you publish?

Our criteria for authorship, based on International Committee of Medical Journal Editors standards, include involvement in the design, conduct, interpretation, and writing or reviewing of a submitted research article, as well as the willingness to be responsible for the accuracy of the article’s content. There are no limits to who can be an author beyond meeting these standards. Reviewers and editorial board members are invited based on their content expertise and willingness to provide editorial services. We use a double-anonymized peer review system (author and reviewer identities are hidden from each other) to minimize the potential for professional relationships to bias the reviewers’ comments. Our editorial board includes members from more than 80 institutions in multiple countries. Most of our journal’s editorial board members, reviewers, and authors are not members of the journal’s parent organization, which further limits the influence of the organization’s viewpoints on the selection of articles that we publish.

How do you select the articles you choose to publish? Why do you not publish every article you receive?

Our journal aims to publish research and topic reviews that assist clinicians with the practice of medicine and to stimulate researchers to discover new solutions to clinical problems. Our editorial board makes decisions about whether a manuscript should be published with guidance from invited expert peer reviewers and statistical reviewers. These decisions focus on the novelty and clinical importance of the research question being evaluated, the validity of the research methods used to explore the research question, the accuracy of the interpretation of the study findings, the clinical impact of the results, and the relevance of the research to the scope of the journal and our readers’ interests.

When a submission that we receive lacks novelty or clinical impact, or has substantial limitations in its study design, conduct, data analysis, or in the presentation and interpretation of its findings, we choose not to publish it. Filtering the submissions that we receive allows us to expose our readers to the most impactful and reliable content. Many of our readers do not have the time it would take to read all the research submitted to our journal, the background to identify the limitations of every research study design, and the content expertise to assess the implications of every research finding. I believe that our readers rely on and trust that we publish the highest quality content—a trust that we work hard to maintain.

How do you promote discourse among those with differing viewpoints and manage concerns raised about errors, misinformation, misinterpretation, or unethical conduct in published articles?

Ethical medical publishing requires the humility to accept that every research study has limitations, an openness to different interpretations of published results, and a willingness to explore concerns when they are raised. Our journal promotes dialogue by publishing content in a variety of formats. Editorials from topic experts place the results of published research in context and highlight the implications of a study’s findings. Letters to the editor provide readers with the opportunity to communicate concerns about unidentified limitations of the study design or data interpretation. Authors with opposing views are invited to debate topics in areas of clinical uncertainty in our Point/Counterpoint section. Topical commentaries share authors’ views of new or near future advances in clinical practice. Sharing our content in podcasts and social media posts opens the research to receiving comments from anyone with interest.

Despite our best efforts to publish the highest-quality content, on occasion a reader will note an error or question the conduct and reporting of a research study that we publish. All concerns are reviewed and evaluated through a process guided by ethical standards outlined by organizations such as the Committee on Publication Ethics. These evaluations usually involve direct communication with the authors and always benefit from oversight of the ethical conduct of research provided by the institution in which the research was performed. At the conclusion of this investigation, we may determine that no changes to the published article are needed, may provide a correction by publishing an erratum or corrigendum, may publish a note of editorial concern, or may decide to retract the previously published work.

Is the publishing model that you use the only publishing model?

There are several publishing models for medical journals. They differ in their approach to peer review, reader access to published manuscripts, and author payment requirements. All have their benefits and downsides.

Traditional subscription-based medical journals (such as CHEST) select content to publish with the assistance of expert peer review. When an author’s submission is accepted for publication, the author does not have to pay an article processing charge. Readers, or the institution that they work for, must have a subscription to the journal to view its contents. Many subscription-based medical journals give the author an option to publish their manuscript open access (discussed later) if the author pays a fee. Criticisms of the subscription-based model include the length of time it takes for articles to be reviewed and published and the restriction of access to published articles to those with a subscription.

Open access medical journals (such as CHEST Critical Care and CHEST Pulmonary) also include expert peer review. When an author’s submission is accepted for publication, the author must pay an article processing charge. Any reader can access the published manuscript without a subscription or fee. Criticisms of this model include the length of time it takes for articles to be reviewed and published and the economic filter to publication that results from the article processing charge, which may disproportionately impact those with fewer resources (eg, early career researchers, researchers from lower-income countries).

Preprint server publications do not include any peer review prior to publication. Authors submit their manuscripts, which (after a few ethical checks) are available immediately to all readers (ie, open access). Authors are not required to pay an article processing charge. Many manuscripts published in preprint servers are also submitted to a subscription-based or open access medical journal. Preprint servers allow authors to publish their work quickly and receive feedback from the community of readers. Because the posted manuscripts are not peer reviewed, the veracity of the reported findings is not evaluated, which can result in readers being exposed to misinformation.

The choice of publishing model is based on the purpose of the journal or platform being used. Each has its place, its benefits over other models, and downsides to consider.

Your Trust

Our vision statement includes the phrase “…the most respected source of clinically relevant research…” We track many metrics to help us meet our goals, but we do not have a metric that can measure this most important phrase. It is impossible to achieve this vision without establishing and maintaining the trust of our readers and contributors. I appreciate the opportunity to share the above details in support of this goal.