Does exchanging comments of Indian and non-Indian reviewers improve the quality of manuscript reviews?

Background. The quality of peer reviewing in developing countries is though t to be pear. To examine whether this was so, we compared the performance o f Indian and non-Indian reviewers who were sent original and review article s submitted to The National Medical Journal of India. We also tested whethe r informing reviewers that their comments would be exchanged improved the q uality of their reviews. Methods. In a prospective, randomized, blinded study, we sent 100 manuscrip ts to pairs of peer reviewers (Indian and non-Indian) of which 78 pairs of completed replies were available for analysis. Thirty-eight pairs of review s were exchanged and 40 were not. The quality of the reviews was assessed b y two editors who were unaware of the reviewers' nationality and whether th ey had been told that their reviews would be exchanged. The quality of the reviews was scored out of 100 (based on a predesigned evaluation proforma). We also measured the time taken to return a manuscript. Results Overall, non-Indian reviewers scored higher than Indians (mean scor es non-Indians firn, 56.7 v.48.6, p < 0.001), especially those in the non-e xchanged group (58.4 v.47.3, p<0.001) but not the exchanged group (54.8 v. 50.0, p < 0.06). Being informed that reviews would be exchanged did not aff ect the quality of reviews by non-Indians (54.8 exchanged v. 58.4 non-excha nged) or of reviews by Indians (50.0 exchanged v. 47.3 non-exchanged). The editors' assessment of the reviewers matched well (r = 0.59, p < 0.001). No n-Indians took the same amount of time as Indians to return their reviews, although the postage time was at least eight days longer. Conclusions. We found that non-Indian peer reviewers were better than India ns and informing them that their views would be exchanged did not seem to a ffect the quality of their reviews. We suggest that Indian editors should a lso use non-Indian reviewers and start training programmes to improve the q uality of peer reviews in India.