The editor exercises unique authority in the marketplace of scientific communication. Indeed, the degree of independence granted to the editor's office may be unequaled by any other educational or scientific position in the medical world. Critical decisions concerning publication or rejection are based ultimately on the judgment of the chief editor, and since submitted manuscripts are privileged communications, few additional individuals are party to these deliberations. At first glance, such practices would appear to resemble 19th century academic authoritarianism. An understanding of why the editor's privileges must be preserved can be attained only if we consider both actual and potential pressures to which he may be exposed.
A large number of journals of original investigation are published by specialty medical societies, and officers or staff presumably could exert overt or subtle pressure through elected or appointed positions. Fortunately, the editor's position is carefully isolated from such interference. Editorial decisions are