Graft-versus-host disease.

measuring quality in medical articles) described a study of publications on schistosomiasis.'7 The articles were ranked in importance by a team of experts, and Warren found that, though the BMJ (which has always used peer review) and the Lancet (which for this period did not) had published roughly an equal and large number of articles on the subject, the two journals were ranked near the bottom of the league table for quality (quite the reverse for their overall rating as measured by citation indexes and impact factors). Thus merely having a peer-review system is not enough: editors must ensure that it works. Was a previous editor of the Lancet, Sir Theodore Fox,18 really joking when he said in his Heath Clark lectures "When I divide the week's contributions into two piles-one that we are going to publish and the other that we are going to return-I wonder whether it would make any real difference to the journal or its readers if I exchanged one pile for the other"? Editors and referees should start a rigorous audit of their practices so that Sir Theodore's question can be answered. STEPHEN LOCK Editor, BMJ

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