Letter to the Editor by Katritsis Regarding Article, “Preprints and Cardiovascular Science: Prescient or Premature?”

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To the Editor:

I read with great interest indeed the recent editorial by Nallamothu and Hill1 on the issue of preprints. With all due respect to our esteemed colleagues, I beg to differ. Preprints are online postings of scientific reports in a public venue (see or before their official publication in a journal and without prior independent scientific evaluation. The Royal Society, one of the oldest learned societies on the planet, was founded in London in 1660, after >2000 years of periods of “barbarism and religion,” as Edward Gibbon has famously put it, since Plato’s Academia and Aristotle’s Lyceum. Henry Oldenburg was the first secretary of the Royal Society and the founding editor of the Philosophical Transactions of the Royal Society. As a theologian and natural philosopher, he did not feel qualified to judge all submitted papers, and thus he relied on the judgment of experts in relevant fields. This was the introduction of the peer review system that has endured the test of time for centuries during which publication was subjected to the time constraints of printed material. Of course, we now live in a revolutionary era regarding information dissemination, and our digital world calls for adaptation.2 However, this new unlimited freedom is haunted by the ghost of its inherent lack of verification and accountability. We are all familiar with the discussions on the potential role of Facebook in the recent US presidential elections.3 Regardless of whether it is true, the debate emphasizes the impact of the current digital environment of unrestricted dissemination of news, accurate or inaccurate, true or fake, in the public sphere. The same could be argued for important medical issues such as vaccines, among numerous others.

The issue here is not whether manuscripts posted on preprint servers are considered prior publications, bypassing the Ingelfinger rule that prohibits simultaneous submission to >1 journal. The real issue is that the authors state, “We also will allow preprints to be cited in works (like abstracts) during an initial submission, with authors expected to update the reference once a preprint is accepted for publication at a journal.” What happens if the journal subsequently rejects the paper in the context of flawed methodology or bias that precludes reliable conclusions? There is increasing concern that a substantial amount of current published research findings may be false.4 Do we have to add to this uncertainty that undermines our faith in rationalism in medicine by unequivocally accepting such a new concept? As an editor of a cardiology journal, I find it difficult identify any single article, however high its quality and important its content, as publishable without corrections and revision. Peer reviewing is far from perfect, but at least it creates a barrier against subjective and willful publication. Preprinting may be seen as the unleashing of unlimited, unexamined, and random information on the internet. In a democracy, we cannot and should not prevent this from occurring in the general public. Perhaps we should try to constrain it in science.

Demosthenes G Katritsis, Department of Cardiology, Hygeia Hospital, Athens, Greece.

Originally published in Circulation 2018;137:1641–2. Reprinted with permission from Wolters Kluwer Health Inc.


  1. Nallamothu BK, Hill JA. Preprints and cardiovascular science: prescient or premature? Circulation. 2017;136:1177–1179.
  2. Katritsis D. Clinical electrophysiology: a glimpse into the future. Arrhythm Electrophysiol Rev. 2017;6:40.
  3. Halpern S. How he used Facebook to win. June 8, 2017. Accessed June 15, 2017.
  4. Ioannidis JP. Why most published research findings are false. PLoS Med. 2005;2:e124.