Medical journals should provide readers with a mechanism for submitting comments, questions, or criticisms about published articles, usually but not necessarily always through a correspondence section or online forum. The authors of articles discussed in correspondence or an online forum have a responsibility to respond to substantial criticisms of their work using those same mechanisms and should be asked by editors to respond. Authors of correspondence should be asked to declare any competing or conflicting interests.

Correspondence may be edited for length, grammatical correctness, and journal style. Alternatively, editors may choose to make available to readers unedited correspondence, for example, via an online commenting system. Such commenting is not indexed in Medline unless it is subsequently published on a numbered electronic or print page. However the journal handles correspondence, it should make known its practice. In all instances, editors must make an effort to screen discourteous, inaccurate, or libellous comments.

Responsible debate, critique and disagreement are important features of science, and journal editors should encourage such discourse ideally within their own journals about the material they have published. Editors, however, have the prerogative to reject correspondence that is irrelevant, uninteresting, or lacking cogency, but they also have a responsibility to allow a range of opinions to be expressed and to promote debate.

In the interests of fairness and to keep correspondence within manageable proportions, journals may want to set time limits for responding to published material and for debate on a given topic.

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