1. Salcido, Richard "Sal MD"

Article Content

THE EDITORIAL TEAM of Advances in Skin & Wound Care has made a substantive change in policy and procedure regarding the journal's acceptance of letters to the editor. The purpose of this editorial is to notify authors, peer reviewers, and readers of that change.


Like most professional journals, Advances in Skin & Wound Care frequently receives letters to the editor. Although space constraints make it difficult for us to publish them, we do read these letters and forward them to our authors with a recommendation that they read and respond appropriately.


However, this approach has a basic flaw: It does not allow the letters we receive to fulfill their potential-to make a scientific contribution to the journal and to serve as the final step in the peer review process (postpublication peer review 1). It also prevents readers from benefiting from the wisdom and experience of their peers and from interacting with the journal's authors. According to a recent article by Horton, 1 the International Committee of Medical Journal Editors, 1,2 recommends that all biomedical journals have a Letters to the Editor section. (As an aside, physician trainees taking part in the journal club for our residency training program at the University of Pennsylvania are encouraged to view letters to the editor for a particular article as a companion document for the purpose of their review. 3-6 Our goal is to teach them to critically evaluate the literature.)


Letters to the editor also create a secondary method of checks and balances for authors and editors. Those of us who write and critically review articles are rarely satisfied with the final product. The discussion section of most scientific articles allows the author to conduct a self-appraisal of his or her manuscript and to list the shortcomings of the research. Most well-done letters to the editor facilitate even more discussion in relation to specific points in the manuscript (the methods or the materials, the statistical power, and the generalizability of the paper).


Solving a Dilemma

Taking all this into consideration, our dilemma was how to carve out space in the journal for letters without sacrificing new content that our readers wanted us to publish. Superimposed on this dilemma was a larger issue: the evolving needs of consumers of health-based information. They are interested in managing more information in a compressed time frame, often using on-line literature searches to help them.


That gave us an inkling of how we could solve our problem: We needed to explore a less-traditional avenue for publishing our letters to the editor.


The journal's leadership team met with the editorial board in September, and the board agreed that we should incorporate our letters to the editor into a readily available venue: our Web site, This action has resulted in the creation of an on-line only Letters to the Editor department, 7 which we launched with the November/December 2002 issue of the journal.


With this new department, we can publish more letters, augment constructive dialogue, and contribute to the wound care literature. Moreover, the journal's on-line only content will be indexed in Medline and, therefore, will be subject to some level of peer review. Appropriate credit will also be given to the author or authors of the letter.


A New Protocol

Letters to the editor are meant to be a scholarly exchange, and most letters received by Advances in Skin & Wound Care fall into that category, which is one of a constructive exchange of clinical and scientific opinions. A few, however, are argumentative and add nothing to the literature.


To establish a uniform policy for increased accountability by authors, reviewers, editorial board members, the editor-in-chief, and the editorial staff, we will institute the following protocol:


* The editor-in-chief will review every letter to the editor to determine its suitability for publication. The editor-in-chief reserves the right to reject any letter.


* If the letter addresses a specific article published in the journal, the letter will be sent to the corresponding author of the article for a response. The response will be shared with the letter writer, even if the letter is not selected for publication on the Web site.


* An additional peer reviewer will be selected to evaluate the letter's scientific and clinical accuracy.


* Letters to the editor that are case reports will be evaluated by 3 peer reviewers and the editor-in-chief, the same as any original investigation or clinical review article published in the journal.


* Letters that are not based on scientific evidence and contain no references will not be accepted for publication. In other words, letters that simply vent the writer's opinions, contain inappropriate comments, and lack scientific merit will not be accepted.


* An ombudsman will be appointed as a final level of review to help resolve disputes between authors and letter writers in a fair manner.


* Letters submitted for consideration must be signed.



Write to Us

We encourage you to continue sending us letters that critically evaluate the manuscripts we publish in Advances in Skin & Wound Care. Letters should be mailed to: Letters to the Editor, Advances in Skin & Wound Care, 1111 Bethlehem Pike, PO Box 908, Springhouse, PA 19477-0908. Or, send them electronically to Susan Doan-Johnson, editorial director of the journal, at


Please check our Web site to find out what your peers are saying about manuscripts published in Advances in Skin & Wound Care.


Something New

Speaking of changes, you will notice that, with this issue, Advances in Skin & Wound Care has a new design and new color scheme, inside and outside. Our goal is to achieve a more professional appearance in keeping with the nature of the journal's content and the design standards of the other medical journals published by Lippincott Williams & Wilkins. We will also introduce some new sections this year. Watch for them in coming issues.




1. Horton R. Postpublication criticism and the shaping of clinical knowledge. JAMA 2002; 287:2843-7. [Context Link]


2. International Committee of Medical Journal Editors. Uniform requirements for manuscripts submitted to biomedical journals. Available at: Accessed December 24, 2002. [Context Link]


3. Bhopal RS, Tonks A. The role of letters in reviewing research. Br Med J 1994; 308:1582-3. [Context Link]


4. Winker MA, Fontanarosa PB. Letters: a forum for scientific discourse. JAMA 1999; 281:1543. [Context Link]


5. Goodman NW. How to write a critical letter and respond to one. Hosp Med 2001; 62:426-7. [Context Link]


6. Edwards R, White M, Gray J, Fischbacher C. Use of a journal club and letter-writing exercise to teach critical appraisal to medical undergraduates. Med Educ 2001; 35:691-4. [Context Link]


7. Smith R. Electronic publishing in science. Br M J 2001; 322:627-9. [Context Link]