Preprints have become something of a hot-button issue in medical publishing. Though many of us have heard the term, especially within the last 3 years, most people aren’t too familiar with what preprints actually are or their implications for future publication of research.
As defined by the JAMA Network in 2020, a preprint is a full and complete version of a research manuscript that’s made publicly available via upload to a preprint repository server before the manuscript receives any peer review or journal evaluation. Notably, most journals don’t consider preprints to violate the rule of prior publication—that is to say that, even if a manuscript has been publicly uploaded as a preprint, it’s still eligible to be published in full by a peer-reviewed medical journal.
The popularity of preprints rose sharply during the beginning of the COVID-19 pandemic, when scientific understanding of the disease was minimal and timely dissemination of research was crucial. Of the >125000 COVID-19–related manuscripts published in medical journals within 10 months of the first recorded case, over 30000 were originally published as preprints. Though the availability of data and research was instrumental in rapidly building our scientific understanding of the disease, this also meant that faulty and problematic research that hadn’t yet been peer-reviewed was being widely circulated.
The overall impression of preprints, both for COVID-19–related research and non-COVID–related academia, has been mixed, to say the least. To better understand this phenomenon, let’s break down the benefits and drawbacks of preprints.
Benefits
- Free accessibility of high-quality research. There’s a misconception that the majority of preprint publications are inherently flawed or faulty, and this simply isn’t the case. Most preprints are based on well-founded and valid research, and the preprint model allows for this research to be rapidly spread in a way that’s free to both the authors and audience. This is especially useful for well-designed research that’s hyper-specific or focused on a small group of patients, which would generally make a paper low-priority for a journal to publish.
- Establishes a body of work for early-career researchers. One of the main hurdles of entering academia is the need for scientists to have an extensive CV of published research to be viable candidates for research grants, but this can be incredibly difficult to achieve. Large funding bodies, such as the National Institutes of Health, have begun recognizing and even encouraging preprint publications to be included as part of grant applications, giving early-career investigators a more reasonable and approachable strategy for building their CV.
- Preprints have quality control processes. Preprint repositories aren’t a completely lawless land where anyone can post whatever they’d like; many well-respected repositories have processes in place to review and vet submitted manuscripts. Though these screening methods aren’t foolproof, they do much of the heavy lifting in blocking faulty manuscripts and those that make overly drastic conclusions. This is especially true for the larger and more established repositories that received an influx of COVID-19 research—for example, bioRxiv now has screening procedures that block preprint publication of most research that makes treatment recommendations for COVID-19.
- Strengthens research before journal submission. Preprints operate using a global peer review model, meaning that readers are intended to critically evaluate the research and comment their thoughts as to the research’s validity. This gives authors an opportunity to edit their paper in response to feedback and criticism before submitting to a journal, strengthening their manuscript and raising their odds of acceptance.
Drawbacks
- Public misinterpretation of research. Increasingly often, members of the public are reading medical publications. Though scientists are explicitly trained on how to evaluate and critically review a study’s methods to gauge how reliable the results are, laypeople don’t have such expertise. When research is published without peer review, people may place unjustified trust in research results, not understand the nuances of the results’ applicability, or may draw entirely faulty conclusions; all of these factors can and have led to reduced public trust in scientific research.
- Public peer review is an inherently faulty model. As mentioned above, preprint repositories encourage global peer review. However, this is a double-edged sword: it also directly means that faulty research must be viewed by large number of people who are willing to take the time to evaluate and review the paper before it can be criticized heavily enough to warrant its withdrawal. This was the exact case for a preprint drawing incorrect similarities between the viruses that cause COVID-19 and HIV: though the paper received hundreds of critical comments and was eventually withdrawn, the paper was still widely read and disseminated before that point. Even now, the research is still easily available online with a relatively small disclaimer that the article has been withdrawn by the authors.
- Potential plagiarism of research conclusions. As the competitive culture of medical research continues to intensify, many authors fear that publishing their results on a preprint server opens them up to competitors reviewing their research and rushing to publish their own manuscripts that ‘steal’ or even plagiarize their conclusions and data. In 2021, the Committee on Publication Ethics (COPE) evaluated a case of potential preprint plagiarism that followed this trajectory; the review board suggested that there was little to nothing that the original author team could do to combat this issue besides raising a formal complaint with the journal publishing the plagiarizing paper.
Takeaways
Now that we have a better understanding of the pros and cons of preprints, let’s turn our attention toward what you need to know about preprints in our contemporary research ecosystem. Considering publishing a preprint? Think about the following:
- Know your copyright licensing. The National Library of Medicine recommends publishing preprints under a Creative Commons-BY (CC-BY) license, which allows for you to reproduce or adapt your preprint for future publication as long as the preprint is credited. This is the least problematic option to avoid problems with duplicate publication.
- Different journals have different duplicate publication policies. Publishers’ responses to preprints have been varied. Before submitting a preprinted manuscript to a journal, be sure to check the Instructions for Authors page for their stance on this issue.
- Review online resources. If you or your author team are considering publishing a preprint, I’d highly recommend reviewing the National Library of Medicine’s brief learning course titled “Preprints: Accelerating Research.”
- Cite at your own risk. If you want to use a preprint as a reference in your own paper, be sure to carefully evaluate its validity first. If the research is sound, though, it’s widely considered acceptable to cite a preprint.
- Journal-integrated preprint servers are gaining traction. Publishers have begun establishing their own preprint servers connected to a particular journal or publishing group. In this model, the process of submitting a manuscript for evaluation by a journal includes a question asking authors whether they would like to upload their manuscript to the affiliated preprint server. This allows for a manuscript to be published as a preprint while it’s simultaneously being evaluated by a journal. The first and most notable of these is Springer Nature’s In Review.
