Perish to Publish: Repeated Episodes of Peer Rejection During the Publication Process

David B. Sykes, MD, PhD
Assistant professor of medicine at Harvard Medical School in Boston, Massachusetts
Michael T. Sykes, PhD
Bioinformatics scientist in San Diego, California
Darren N. Nichols, MD
Associate professor of family medicine at the University of Alberta in Edmonton, Canada

In adults – sensitive adults, in particular – who consider themselves academics, repeated episodes of peer rejection can have serious emotional repercussions. We (David B. Sykes, MD, PhD, and Darren N. Nichols, MD) experienced multiple repeated episodes of peer rejection, or MREPR, in our attempt to publish a 1,200-word essay in the medical education literature.1 This journey from first submission to final acceptance provided new insights into the process of publication and the emotional consequences of recurrent rejection.

Author and biochemist Isaac Asimov wrote that “Rejection slips, however tactfully phrased, are lacerations of the soul, if not quite inventions of the devil.” The phrase “inventions of the devil” sounds rather dramatic, though certain editors come across as lacking key components of a functional soul.

The FIGURE outlines our 11 submissions to nine journals over a period of 915 days. Ten of these submissions resulted in rejection, with a variety of proffered explanations. Many journals were kind, saying that they felt quite badly that they could not accept our work (“gentle rejection”). Others suggested that our work was perhaps best placed elsewhere (“deflective rejection” or “It’s not you, it’s me”). Still other journals coldly cited the ratio of submissions to accepted papers as a rationale (“statistical rejection”).

Throughout the process, our manuscript underwent major reworkings. During this period, many colleagues read and made changes to the paper; whole paragraphs were both created and omitted. On day 365, our seventh submission went back to our original target journal (“Journal #1”). The column editor rejected our resubmission within 24 hours with the following comment: “This manuscript is nearly identical to one you submitted one year ago, which was rejected.”

This comment surprised (DNN) and saddened (DBS) us. It also prompted us to seek the help of an available expert (Michael T. Sykes, PhD) to analyze the similarities among the various manuscript drafts. As one can see clearly in the TABLE, the resubmitted manuscript showed only a 55-percent similarity to the original. We were asked to resist forwarding this graph to the journal editor, as it was felt to represent rather passive-aggressive behavior on our part.

Remarkably, just when we thought that we were running out of journals to which the essay could be submitted, the manuscript slipped past the editors and went out for its first peer review on day 748. We were delighted!

We never expected the peer reviewers to want so many additional changes to a manuscript that already bore little resemblance to the original. Comments such as “title does not work” and “very confusing” left us shaken, but we remained motivated for another rewrite.

Still, our reviewers were not satisfied. We managed more changes under the guidance of “try to add dialogue” and “you can do more,” bringing our paper similarity score down to an all-time low of 24 percent, at which time the manuscript was finally accepted for publication.

Joy at last!

Like a phoenix reborn, we flew high on our lofty success in the peer-review process. Laudatory emails full of hyperbole flew back and forth. Feeling invincible, our tall lattés were upgraded to ventisized and gingerbread-flavored – with little caloric or fiscal regard. As though suffering from an editorial Stockholm syndrome, the pains of the submission process melted away and we applauded the reviewers for their cogent insights and deep wisdom.

The careful reader may note that our publication success was inversely proportional to the similarity of the original work (now termed the “Sykes-Nichols phenomenon”). What had become of that first draft? With dogged perseverance, we had ruthlessly purged and abandoned whole sections of our precious text. Had the MREPR truly translated into publication success? Or had we merely reinforced a timeless academic reality: In this publish-or-perish world, papers sometimes need to perish in order to be published.


  1. Sykes DB, Nichols DN. There is no denying it, our medical language needs an update. J Grad Med Educ. 2015;7:137-8.