LAUSR

Studies with statistically significant results—positive findings— are more readily published. This phenomenon is known as “positive outcome bias” [7]. The word positive has the additional connotation of “agreeable” and “pleasant.” Positive outcome bias likely extends to those meanings, too. Studies with agreeable and pleasant conclusions—namely, those that endorse the status quo, confirm prevailing expert opinion or prop up popular beliefs—seem to be the most common type I encounter in my reading. Writers want to be liked. Thus, papers debunking popular operations are rare and newsworthy [6, 11]. Beyond that, “whole research areas are offlimits,” according to the journalist, Katie Herzog, [5] owing to what I think is a rational desire to avoid the scorn that disagreeable or unpleasant findings might bring [8]. To remedy the preference for agreeable and pleasant papers, I propose that authors should be allowed to publish without signing their names to their work. Full anonymity is probably a bad idea, as anyone familiar with internet trolls can attest. Full anonymity can foster research fraud and undermine the credibility of results as well. Nonetheless, giving authors the possibility towrite with a certain degree of concealment—say, the option to reveal their identity to the editor, but publish under a pseudonym—may encourage them to write with a degree of necessary but absent openness. There is a noble history of pseudonymous publication. For example, the essays written by Alexander Hamilton, James Madison, and John Jay in 1787 to promote the ratification of the US Constitution, now known as The Federalist Papers, were published under the pseudonym, “Publius.” This small bit of privacy no doubt gave the authors the freedom to express their opinions more candidly. Likewise, in academic settings, when candor is critical, commentators are offered confidentiality. Applicants to residency programs, for example, are encouraged to waive their rights to see their letters of recommendation, to give the letter-writers necessary room for bluntness, if that’s what’s needed. Another related benefit of hiding the author’s name is that this step will allow readers to focus on the arguments being made and not the authors who are making them [9]. In that regard, Okike et al. [12] found that reviewers who were able to seewriters’ identities weremore likely to recommend a paper associated with prestigious authors and institutions, as compared to reviewers receiving completely deidentified manuscripts. Moreover, meta-analyses and systematic reviews—ourmost powerfulmethods for reaching valid conclusions—also employ anonymity implicitly: They consider only the content of a manuscript and not the author byline. Granted, most authors will want their names attached to their work. Scientific journals do not pay royalties; publication credit is the only coin of the realm. Still, for some research studies, the potential shame and blame of the conclusions are so great that authors might prefer to forgo the publication credit and bury their results. In those cases, an option for anonymous or A note from the Editor-in-Chief: We are pleased to present to readers of Clinical Orthopaedics and Related Research the next Not the Last Word. The goal of this section is to explore timely and controversial issues that affect how orthopaedic surgery is taught, learned, and practiced.Wewelcome reader feedback on all of our columns and articles; please send your comments to [email protected]. The author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request. The opinions expressed are those of the writer, and do not reflect the opinion or policy of CORR or The Association of Bone and Joint Surgeons. J. Bernstein ✉, University of Pennsylvania, 424 Stemmler Hall, Philadelphia, PA 19104, USA, Email: [email protected] Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA