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

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In Response:

We thank Dr Katritsis for his letter on our article on preprints recently published in Circulation and Circulation: Cardiovascular Quality and Outcomes.1,2 We agree with many of his points. Like him, we recognize that we now live in a revolutionary era and the new digital world calls for adaptation beyond old models that have been in place for centuries. Where we tend to disagree, however, is with the potential implications of preprints in this environment. Dr Katritsis is concerned that preprints will add to confusion by not allowing for proper vetting of science before its official dissemination. He seems particularly worried about the use of citations of preprints while also mentioning that papers evolve over time and improve through peer review.

These are both fair points. Regarding the question of allowing authors to cite preprints, we are hopeful that readers are sophisticated enough to understand the difference between a preprint citation and a peer reviewed publication. As we mentioned in our article, we see preprints in this regard as analogous to abstracts presented at scientific meetings or unpublished communications — which are occasionally referenced in articles — and we believe readers will also. And, while we wholeheartedly concur (as editors ourselves) that the peer review and editorial process bring enormous value to a paper, we do not see that preprints will diminish this process. It is unlikely in our mind that preprints (at least in the near-term) will lead authors to subvert or bypass journals. Will preprints unleash unlimited, unexamined, and random information in the internet? The concerns raised by Dr Katritsis are real, and we hope at Circulation and Circulation: Cardiovascular Quality and Outcomes to be careful in our experiment with this new approach. But we would point out that many of the examples he has expressed actually occurred despite peer review (eg, vaccines).

This serves as a cautious reminder that peer review cannot serve alone as a fortification against inaccurate or fake science. Indeed, it could be that preprints — which are openly available to be examined and reviewed without pay firewalls or restrictions — could aid in the dissemination of science by allowing for a more critical view of reports that are simply taken at face value currently because of their peer-reviewed status.

Brahmajee K. Nallamothu, MD, MPH
Joseph A. Hill, MD

Michigan Integrated Center for Health Analytics and Medical Prediction (MiCHAMP), Department of Internal Medicine,
University of Michigan, and the Center for Clinical Management and Research, Ann Arbor VA Medical Center,
MI (B.K.N.). Departments of Internal Medicine and Molecular Biology, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX (J.A.H.)

Originally published in Circulation 2018;137:1643–4. 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. Nallamothu BK, Hill JA. Preprints and cardiovascular science: prescient or premature? Circ Cardiovasc Qual Outcomes. 2017;10:e000033.