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  <front>
    <journal-meta>
      <journal-id journal-id-type="nlm-ta">Arq Bras Cardiol</journal-id>
      <journal-id journal-id-type="publisher-id">abc</journal-id>
      <journal-title-group>
        <journal-title>Arquivos Brasileiros de Cardiologia</journal-title>
        <abbrev-journal-title abbrev-type="publisher">Arq. Bras. Cardiol.</abbrev-journal-title>
      </journal-title-group>
      <issn pub-type="ppub">0066-782X</issn>
      <issn pub-type="epub">1678-4170</issn>
      <publisher>
        <publisher-name>Sociedade Brasileira de Cardiologia - SBC</publisher-name>
      </publisher>
    </journal-meta>
    <article-meta>
      <article-id specific-use="scielo-v3" pub-id-type="publisher-id">NC7BMwfDMTRCQsLf6BLwzXg</article-id>
      <article-id specific-use="scielo-v2" pub-id-type="publisher-id">S0066-782X2025000800601</article-id>
      <article-id pub-id-type="other">00601</article-id>
      <article-id pub-id-type="doi">10.36660/abc.20250315</article-id>
      <article-categories>
        <subj-group subj-group-type="heading">
          <subject>Ponto de Vista</subject>
        </subj-group>
      </article-categories>
      <title-group>
        <article-title>Assist&#234;ncia de Intelig&#234;ncia Artificial na An&#225;lise de Artigos M&#233;dicos por Pares: Vantagens, Desvantagens e Considera&#231;&#245;es &#201;ticas</article-title>
      </title-group>
      <contrib-group>
        <contrib contrib-type="author">
          <contrib-id contrib-id-type="orcid">0000-0001-8977-6929</contrib-id>
          <name>
            <surname>Zimerman</surname>
            <given-names>Andr&#233;</given-names>
          </name>
          <role>Revis&#227;o cr&#237;tica do manuscrito quanto ao conte&#250;do</role>
          <xref ref-type="aff" rid="aff1">
            <sup>1</sup>
          </xref>
        </contrib>
        <contrib contrib-type="author">
          <contrib-id contrib-id-type="orcid">0000-0001-8769-1411</contrib-id>
          <name>
            <surname>d&#8217;Avila</surname>
            <given-names>Andre</given-names>
          </name>
          <role>Concep&#231;&#227;o e desenho da pesquisa</role>
          <role>Revis&#227;o cr&#237;tica do manuscrito quanto ao conte&#250;do</role>
          <xref ref-type="aff" rid="aff2">
            <sup>2</sup>
          </xref>
        </contrib>
      </contrib-group>
      <aff id="aff1">
        <label>1</label>
        <institution content-type="orgname">MOVE Academic Research Organization</institution>
        <institution content-type="orgdiv1">Hospital Moinhos de Vento</institution>
        <addr-line>
          <named-content content-type="city">Porto Alegre</named-content>
          <named-content content-type="state">RS</named-content>
        </addr-line>
        <country country="BR">Brasil</country>
        <institution content-type="original">MOVE Academic Research Organization, Hospital Moinhos de Vento, Porto Alegre, RS- Brasil</institution>
      </aff>
      <aff id="aff2">
        <label>2</label>
        <institution content-type="orgname">Hospital SOS Cardio</institution>
        <addr-line>
          <named-content content-type="city">Florian&#243;polis</named-content>
          <named-content content-type="state">SC</named-content>
        </addr-line>
        <country country="BR">Brasil</country>
        <institution content-type="original">Hospital SOS Cardio, Florian&#243;polis, SC &#8211; Brasil</institution>
      </aff>
      <author-notes>
        <corresp id="c01"><label>Correspond&#234;ncia:</label> Andr&#233; d&#8217;Avila &#8226; Hospital SOS Cardio - Rodovia, SC-401, 121. CEP 88030-000, Itacorubi, Florian&#243;polis, SC - Brasil Email: <email>andredavila@mac.com</email> </corresp>
        <fn fn-type="conflict">
          <label>Potencial conflito de interesse:</label>
          <p>N&#227;o h&#225; conflito com o presente artigo</p>
        </fn>
        <fn fn-type="edited-by">
          <label>Editor respons&#225;vel pela revis&#227;o:</label>
          <p>Gl&#225;ucia Maria Moraes de Oliveira</p>
        </fn>
      </author-notes>
      <pub-date date-type="pub" publication-format="electronic">
        <day>01</day>
        <month>09</month>
        <year>2025</year>
      </pub-date>
      <pub-date date-type="collection" publication-format="electronic">
        <month>07</month>
        <year>2025</year>
      </pub-date>
      <volume>122</volume>
      <issue>8</issue>
      <elocation-id>e20250315</elocation-id>
      <history>
        <date date-type="received">
          <day>02</day>
          <month>05</month>
          <year>2025</year>
        </date>
        <date date-type="rev-recd">
          <day>30</day>
          <month>05</month>
          <year>2025</year>
        </date>
        <date date-type="accepted">
          <day>30</day>
          <month>05</month>
          <year>2025</year>
        </date>
      </history>
      <permissions>
        <license license-type="open-access" xlink:href="https://creativecommons.org/licenses/by/4.0/" xml:lang="en">
          <license-p>Este &#233; um artigo de acesso aberto distribu&#237;do sob os termos da licen&#231;a de atribui&#231;&#227;o pelo Creative Commons</license-p>
        </license>
      </permissions>
      <kwd-group xml:lang="pt">
        <title>Palavras-chave</title>
        <kwd>Revis&#227;o por Pares</kwd>
        <kwd>Intelig&#234;ncia Artificial</kwd>
        <kwd>&#201;tica</kwd>
        <kwd>Publica&#231;&#245;es</kwd>
      </kwd-group>
      <counts>
        <fig-count count="0"/>
        <table-count count="2"/>
        <equation-count count="0"/>
        <ref-count count="9"/>
      </counts>
    </article-meta>
  </front>
  <body>
    <p>Recentemente, os autores deste artigo &#8220;Ponto de Vista&#8220; foram convidados a revisar por pares um manuscrito para um prestigiado peri&#243;dico cardiovascular internacional. Ap&#243;s dedicar alguns dias &#224; an&#225;lise, eles decidiram, por curiosidade, inserir o manuscrito em um modelo de linguagem de intelig&#234;ncia artificial (IA) comercialmente dispon&#237;vel com o seguinte prompt: &#8220;Analise e Critique o Arquivo Anexo&#8221;. Ambos os revisores ficaram surpresos com a resposta gerada em segundos pelo algoritmo de IA &#8212; sua profundidade e precis&#227;o superaram suas expectativas, com alguns insights se mostrando complementares aos seus. Como resultado, eles incorporaram esses elementos &#224; revis&#227;o oficial submetida ao peri&#243;dico.</p>
    <p>Essa experi&#234;ncia, no entanto, levantou outra quest&#227;o: eles deveriam reconhecer a assist&#234;ncia fornecida pelo algoritmo de IA? Sem saber a resposta, eles consultaram outros m&#233;dicos que revisam regularmente manuscritos para peri&#243;dicos de alto impacto, e suas opini&#245;es variaram bastante. Alguns argumentaram que a IA &#233; apenas uma ferramenta para aumentar a efici&#234;ncia, n&#227;o exigindo reconhecimento &#8212; os revisores s&#227;o respons&#225;veis pelo conte&#250;do final e devem usar quaisquer estrat&#233;gias que lhes permitam alcan&#231;ar o melhor resultado. Outros insistiram que n&#227;o divulgar a assist&#234;ncia da IA seria anti&#233;tico.</p>
    <p>Para resolver o dilema, os autores recorreram novamente &#224; pr&#243;pria IA para obter insights sobre seu papel no processo de revis&#227;o por pares de manuscritos m&#233;dicos. A resposta, apresentada aqui, exigiu ajustes editoriais m&#237;nimos por parte dos autores. <italic>Sempre que necess&#225;rio, as contribui&#231;&#245;es dos autores s&#227;o relatadas ao longo do manuscrito em it&#225;lico</italic>.</p>
    <sec>
      <title>IA fala sobre o papel da IA como revisora de artigos m&#233;dicos:</title>
      <p>O processo de revis&#227;o por pares &#233; um pilar fundamental da integridade cient&#237;fica, particularmente na &#225;rea da medicina, onde uma avalia&#231;&#227;o rigorosa garante que a pesquisa publicada seja confi&#225;vel, reproduz&#237;vel e segura para aplica&#231;&#227;o cl&#237;nica. No entanto, o crescente volume de artigos m&#233;dicos submetidos para publica&#231;&#227;o, aliado &#224; complexidade da pesquisa moderna, tem sobrecarregado o sistema tradicional de revis&#227;o por pares.</p>
      <p>O uso de IA na revis&#227;o por pares de artigos m&#233;dicos representa uma oportunidade transformadora para enfrentar os crescentes desafios da publica&#231;&#227;o acad&#234;mica em uma &#225;rea onde precis&#227;o, pontualidade e confiabilidade s&#227;o primordiais. No entanto, al&#233;m de seus potenciais benef&#237;cios, a IA apresenta desvantagens significativas e desafios not&#225;veis. Este ensaio examina os benef&#237;cios e as defici&#234;ncias da IA na an&#225;lise por pares de artigos m&#233;dicos, bem como as implica&#231;&#245;es &#233;ticas de sua integra&#231;&#227;o.</p>
      <sec>
        <title>Vantagens da IA na revis&#227;o por pares</title>
        <list list-type="order">
          <list-item>
            <p><bold>Efici&#234;ncia e velocidade aprimoradas</bold> O volume de pesquisas m&#233;dicas submetidas para publica&#231;&#227;o aumentou acentuadamente, muitas vezes sobrecarregando revisores humanos e atrasando a dissemina&#231;&#227;o de descobertas cruciais. A IA pode processar grandes quantidades de texto rapidamente, realizando tarefas como verifica&#231;&#227;o de refer&#234;ncias, an&#225;lise de dados estat&#237;sticos e triagem de pl&#225;gio quase instantaneamente, enquanto revisores humanos podem levar dias para realizar uma verifica&#231;&#227;o compar&#225;vel. Essa efici&#234;ncia permite que os peri&#243;dicos gerenciem taxas de submiss&#227;o mais altas e reduz o tempo entre a submiss&#227;o e a publica&#231;&#227;o.</p>
          </list-item>
          <list-item>
            <p><bold>Objetividade e consist&#234;ncia aprimoradas</bold>Os revisores humanos, apesar de sua expertise, s&#227;o propensos a vieses decorrentes de cren&#231;as pessoais, familiaridade com autores ou prest&#237;gio institucional. A IA, quando treinada com base em crit&#233;rios claros e padronizados, pode avaliar manuscritos sem tais influ&#234;ncias, proporcionando uma an&#225;lise consistente e imparcial. Um sistema de IA poderia avaliar a adequa&#231;&#227;o do tamanho de uma amostra ou a validade de m&#233;todos estat&#237;sticos com base apenas em par&#226;metros predefinidos. Essa objetividade pode criar um ambiente mais equitativo, garantindo que todas as submiss&#245;es sejam julgadas por seus m&#233;ritos e n&#227;o por fatores externos, o que &#233; particularmente ben&#233;fico para pesquisadores em in&#237;cio de carreira ou aqueles de institui&#231;&#245;es menos proeminentes.</p>
          </list-item>
          <list-item>
            <p><bold>Escalabilidade e suporte para revisores</bold>A escassez de revisores por pares qualificados &#233; um problema persistente na publica&#231;&#227;o m&#233;dica, especialmente em especialidades de nicho, onde a expertise se concentra em um pequeno grupo de indiv&#237;duos. A IA pode escalar o processo de revis&#227;o auxiliando revisores menos experientes ou realizando avalia&#231;&#245;es preliminares, liberando especialistas seniores para tarefas mais complexas. Ferramentas de IA podem avaliar as submiss&#245;es quanto &#224; conformidade b&#225;sica &#8212; garantindo declara&#231;&#245;es de aprova&#231;&#227;o &#233;tica, conjuntos de dados completos ou formata&#231;&#227;o adequada &#8212; permitindo que revisores humanos se concentrem no rigor cient&#237;fico e na inova&#231;&#227;o. Essa escalabilidade tamb&#233;m se estende a peri&#243;dicos menores ou &#224;queles em ambientes com recursos limitados, permitindo que mantenham altos padr&#245;es sem depender exclusivamente de volunt&#225;rios humanos sobrecarregados.</p>
          </list-item>
          <list-item>
            <p><bold>Detec&#231;&#227;o de erros e controle de qualidade</bold> A IA se destaca na identifica&#231;&#227;o de erros t&#233;cnicos que podem escapar aos revisores humanos, especialmente em manuscritos extensos ou com grande volume de dados. Ela pode sinalizar inconsist&#234;ncias em figuras e tabelas, detectar dados fabricados ou manipulados (por exemplo, por meio da an&#225;lise de imagens de gr&#225;ficos ou fotografias) e verificar a precis&#227;o dos estudos citados. Em ensaios cl&#237;nicos, por exemplo, a IA pode comparar os resultados relatados com os dados brutos enviados, detectando discrep&#226;ncias que, de outra forma, poderiam passar despercebidas. Ao aprimorar o controle de qualidade, a IA ajuda a manter a integridade da literatura m&#233;dica, reduzindo o risco de pesquisas err&#244;neas ou fraudulentas influenciarem o atendimento ao paciente.</p>
          </list-item>
          <list-item>
            <p><bold>Aprendizagem cont&#237;nua e adaptabilidade</bold> Os sistemas modernos de IA, especialmente aqueles que utilizam aprendizado de m&#225;quina, podem melhorar ao longo do tempo, &#224; medida que s&#227;o expostos a mais dados e recebem feedback. Essa adaptabilidade significa que as ferramentas de IA podem se manter atualizadas com os padr&#245;es em evolu&#231;&#227;o na pesquisa m&#233;dica &#8212; como novas t&#233;cnicas estat&#237;sticas ou diretrizes de relat&#243;rios &#8212; sem exigir um extenso retreinamento de revisores humanos.</p>
          </list-item>
        </list>
      </sec>
      <sec>
        <title>Desvantagens da IA na revis&#227;o por pares</title>
        <list list-type="order">
          <list-item>
            <p><bold>Compreens&#227;o contextual limitada</bold> Embora a IA seja h&#225;bil no processamento de dados estruturados, ela enfrenta dificuldades com os aspectos diferenciados e dependentes do contexto da pesquisa m&#233;dica. A revis&#227;o por pares frequentemente exige a interpreta&#231;&#227;o de linguagem amb&#237;gua, a avalia&#231;&#227;o da viabilidade das implica&#231;&#245;es de um estudo ou o reconhecimento da import&#226;ncia de uma abordagem n&#227;o convencional &#8212; tarefas que exigem intui&#231;&#227;o e experi&#234;ncia humanas. Por exemplo, uma IA pode julgar mal as implica&#231;&#245;es &#233;ticas de um estudo (por exemplo, a aceitabilidade de um bra&#231;o placebo em um ensaio cl&#237;nico) ou deixar de avaliar uma ideia inovadora que carece de precedentes em seus dados de treinamento. Essa limita&#231;&#227;o corre o risco de ignorar trabalhos inovadores ou interpretar mal cen&#225;rios cl&#237;nicos complexos, comprometendo a profundidade do processo de revis&#227;o.</p>
          </list-item>
          <list-item>
            <p><bold>Risco de excesso de confian&#231;a e desqualifica&#231;&#227;o</bold> A conveni&#234;ncia da IA pode levar revisores e editores a dependerem fortemente de seus resultados, tratando-os como definitivos em vez de complementares. Se revisores humanos recorrerem &#224; IA para tarefas como valida&#231;&#227;o estat&#237;stica ou verifica&#231;&#245;es de metodologia, eles podem negligenciar o exame minucioso dessas &#225;reas, potencialmente ignorando erros que a IA n&#227;o consegue detectar. Com o tempo, essa depend&#234;ncia excessiva pode corroer as habilidades de pensamento cr&#237;tico entre os revisores, um fen&#244;meno conhecido como &#8220;desqualifica&#231;&#227;o&#8221;. Desqualifica&#231;&#227;o refere-se ao processo pelo qual a expertise especializada &#233; reduzida por meio da automa&#231;&#227;o, avan&#231;os tecnol&#243;gicos ou mudan&#231;as nos processos de trabalho. Envolve a decomposi&#231;&#227;o de tarefas complexas que antes exigiam conhecimento especializado ou treinamento em a&#231;&#245;es mais simples e repetitivas que podem ser executadas por trabalhadores ou m&#225;quinas menos qualificados. Isso pode levar a uma for&#231;a de trabalho que exige menos treinamento ou experi&#234;ncia, ou a um decl&#237;nio na habilidade artesanal. O termo &#233; frequentemente associado a mudan&#231;as industriais e econ&#244;micas, como o surgimento de linhas de montagem ou ferramentas baseadas em IA, onde as habilidades humanas s&#227;o substitu&#237;das ou desvalorizadas. Na medicina, onde falhas sutis podem ter consequ&#234;ncias profundas, essa perda de vigil&#226;ncia representa um risco significativo para a qualidade da pesquisa.</p>
          </list-item>
          <list-item>
            <p><bold>Vi&#233;s nos dados de treinamento</bold> Os sistemas de IA s&#227;o t&#227;o bons quanto os dados com os quais s&#227;o treinados, e vieses nesses dados podem perpetuar ou amplificar falhas existentes no processo de revis&#227;o. Se uma IA for treinada predominantemente em estudos de institui&#231;&#245;es ocidentais ou &#225;reas m&#233;dicas espec&#237;ficas, ela pode subestimar pesquisas de regi&#245;es ou especialidades sub-representadas, julgando erroneamente suas metodologias ou descartando sua relev&#226;ncia. Teoricamente, uma ferramenta de IA treinada em dados de pa&#237;ses de alta renda pode sinalizar um estudo de um ambiente de poucos recursos como inadequado devido a tamanhos de amostra menores, ignorando, assim, restri&#231;&#245;es contextuais. Esse vi&#233;s pode refor&#231;ar as desigualdades na publica&#231;&#227;o e distorcer a base de conhecimento m&#233;dico.</p>
          </list-item>
          <list-item>
            <p><bold>Erros t&#233;cnicos e falsos positivos/negativos</bold> A IA n&#227;o &#233; infal&#237;vel e pode produzir erros que interrompam o processo de revis&#227;o. Falsos positivos &#8212; como acusar indevidamente um autor de pl&#225;gio devido a uma formula&#231;&#227;o comum &#8212; ou falsos negativos &#8212; como ignorar uma manipula&#231;&#227;o de dados habilmente disfar&#231;ada &#8212; podem levar a resultados injustos. Por exemplo, uma IA excessivamente zelosa pode atrasar um artigo leg&#237;timo, sinalizando problemas menores, frustrando autores e obstruindo os fluxos de trabalho editoriais, enquanto uma IA com baixo desempenho pode aprovar um estudo falho, colocando em risco aplica&#231;&#245;es cl&#237;nicas posteriores. Essas limita&#231;&#245;es t&#233;cnicas destacam a necessidade de supervis&#227;o humana, mas tamb&#233;m corroem a confian&#231;a na IA como ferramenta independente.</p>
          </list-item>
          <list-item>
            <p><bold>Barreiras de custo e acessibilidade</bold> O desenvolvimento, a manuten&#231;&#227;o e a implanta&#231;&#227;o de sistemas sofisticados de IA exigem recursos financeiros e t&#233;cnicos significativos, que podem n&#227;o estar dispon&#237;veis para todos os peri&#243;dicos. Custos elevados podem limitar a ado&#231;&#227;o da IA a editoras bem financiadas, deixando peri&#243;dicos menores ou de acesso aberto em desvantagem. Essa disparidade pode ampliar a lacuna entre publica&#231;&#245;es de &#8220;elite&#8221; e &#8220;menores&#8221;, afetando sua capacidade de atrair submiss&#245;es de qualidade ou manter padr&#245;es rigorosos. Al&#233;m disso, a necessidade de atualiza&#231;&#245;es cont&#237;nuas para manter a IA alinhada aos avan&#231;os da ci&#234;ncia m&#233;dica aumenta os custos, tornando-a potencialmente uma op&#231;&#227;o insustent&#225;vel para algumas organiza&#231;&#245;es.</p>
          </list-item>
        </list>
        <p>Um resumo das principais vantagens e desvantagens da IA na revis&#227;o por pares &#233; apresentado na <xref ref-type="table" rid="t1">Tabela 1</xref>.</p>
        <p>
          <table-wrap id="t1">
            <label>Tabela 1</label>
            <caption>
              <title>&#8211; Vantagens e desvantagens da intelig&#234;ncia artificial na revis&#227;o por pares e na publica&#231;&#227;o acad&#234;mica</title>
            </caption>
            <table frame="hsides" rules="groups">
              <colgroup>
                <col/>
                <col/>
              </colgroup>
              <thead>
                <tr>
                  <th align="left">Vantagens</th>
                  <th align="left">Desvantagens</th>
                </tr>
              </thead>
              <tbody>
                <tr>
                  <td>Efici&#234;ncia e velocidade aprimoradas<bold>:</bold> A IA processa grandes volumes de texto rapidamente, verificando refer&#234;ncias, analisando dados e rastreando pl&#225;gio, reduzindo o tempo de revis&#227;o e atrasos na publica&#231;&#227;o.</td>
                  <td>Compreens&#227;o contextual limitada<bold>:</bold> A IA tem dificuldades com aspectos diferenciados da pesquisa, como interpretar linguagem amb&#237;gua ou reconhecer abordagens n&#227;o convencionais, o que pode resultar na potencial perda de trabalhos inovadores.</td>
                </tr>
                <tr>
                  <td>Objetividade e consist&#234;ncia aprimoradas<bold>:</bold> A AI avalia manuscritos sem preconceitos pessoais, usando crit&#233;rios padronizados para garantir um julgamento equitativo com base no m&#233;rito.</td>
                  <td>Risco de excesso de confian&#231;a e desqualifica&#231;&#227;o<bold>:</bold> A depend&#234;ncia excessiva da IA pode reduzir o pensamento cr&#237;tico entre os revisores, levando &#224; perda de conhecimento especializado e vigil&#226;ncia.</td>
                </tr>
                <tr>
                  <td>Escalabilidade e suporte para revisores<bold>:</bold> A IA auxilia revisores menos experientes e lida com tarefas preliminares, permitindo que especialistas se concentrem em avalia&#231;&#245;es complexas e possibilitando que peri&#243;dicos menores mantenham altos padr&#245;es.</td>
                  <td>Vi&#233;s nos dados de treinamento<bold>:</bold> IA treinada em conjuntos de dados tendenciosos pode subestimar pesquisas de regi&#245;es ou especialidades sub-representadas, refor&#231;ando as desigualdades na publica&#231;&#227;o.</td>
                </tr>
                <tr>
                  <td>Detec&#231;&#227;o de erros e controle de qualidade<bold>:</bold> A IA identifica erros t&#233;cnicos, inconsist&#234;ncias e dados manipulados, melhorando a integridade da literatura m&#233;dica.</td>
                  <td>Erros t&#233;cnicos e falsos positivos/negativos<bold>:</bold> A IA pode produzir erros como falsas acusa&#231;&#245;es de pl&#225;gio ou deixar passar manipula&#231;&#245;es sutis, interrompendo o processo de revis&#227;o.</td>
                </tr>
                <tr>
                  <td>Aprendizagem cont&#237;nua e adaptabilidade<bold>:</bold> A IA melhora com o tempo, mantendo-se atualizada com os padr&#245;es de pesquisa em evolu&#231;&#227;o, sem necessidade de retreinamento humano extensivo.</td>
                  <td>Barreiras de custo e acessibilidade<bold>:</bold> Os altos custos de desenvolvimento e manuten&#231;&#227;o de IA podem limitar a ado&#231;&#227;o a peri&#243;dicos bem financiados, aumentando assim as disparidades na qualidade das publica&#231;&#245;es.</td>
                </tr>
              </tbody>
            </table>
            <table-wrap-foot>
              <fn id="TFN1">
                <p>IA: intelig&#234;ncia artificial.</p>
              </fn>
            </table-wrap-foot>
          </table-wrap>
        </p>
      </sec>
      <sec>
        <title>Aspectos &#233;ticos da IA como ferramenta para revis&#227;o por pares de artigos m&#233;dicos</title>
        <p>A integra&#231;&#227;o da IA no processo de revis&#227;o por pares de artigos m&#233;dicos introduz uma s&#233;rie de considera&#231;&#245;es &#233;ticas que v&#227;o al&#233;m de suas vantagens e limita&#231;&#245;es t&#233;cnicas. Essas preocupa&#231;&#245;es envolvem justi&#231;a, transpar&#234;ncia, responsabiliza&#231;&#227;o, equidade e a preserva&#231;&#227;o da supervis&#227;o humana em um campo em que os riscos &#8212; sa&#250;de e bem-estar humanos &#8212; s&#227;o excepcionalmente altos.</p>
        <p>Embora a IA ofere&#231;a benef&#237;cios ineg&#225;veis, sua integra&#231;&#227;o deve ser pautada por princ&#237;pios que priorizem a confian&#231;a, a justi&#231;a e o contexto humano da medicina. Os peri&#243;dicos devem adotar a IA de forma transparente, como um complemento e n&#227;o como um substituto para a expertise humana, e garantir que seu uso n&#227;o aprofunde desigualdades ou obscure&#231;a responsabilidades. Ao abordar esses desafios &#233;ticos de frente, a comunidade m&#233;dica pode aproveitar o potencial da IA salvaguardando os valores que sustentam a investiga&#231;&#227;o cient&#237;fica e o atendimento ao paciente. Em &#250;ltima an&#225;lise, a quest&#227;o n&#227;o &#233; se a IA pode auxiliar na revis&#227;o por pares, mas como ela pode faz&#234;-lo de forma a manter os mais altos padr&#245;es &#233;ticos.</p>
      </sec>
      <sec>
        <title>Justi&#231;a para com os autores e a comunidade cient&#237;fica</title>
        <p>Uma das principais quest&#245;es &#233;ticas &#233; se &#233; justo submeter o trabalho de um autor &#224; avalia&#231;&#227;o por uma m&#225;quina em vez de um especialista humano. A revis&#227;o por pares tem sido, h&#225; muito tempo, um processo conduzido por humanos, fundamentado na expertise, empatia e racioc&#237;nio cr&#237;tico de cientistas que entendem os desafios da pesquisa. Um sistema de IA, por mais sofisticado que seja, carece da experi&#234;ncia vivida e da intui&#231;&#227;o que os revisores humanos trazem para a mesa. Por exemplo, um pesquisador que prop&#245;e uma nova hip&#243;tese que desafia a sabedoria convencional pode ser injustamente penalizado por uma IA treinada em padr&#245;es existentes, o que poderia sinalizar o trabalho como um caso at&#237;pico ou anomalia em vez de reconhecer seu potencial brilhantismo. Isso levanta a quest&#227;o de se os autores merecem um processo de revis&#227;o que valorize plenamente o contexto humano de seu trabalho, especialmente na medicina, onde a inova&#231;&#227;o pode salvar vidas.</p>
        <p>Al&#233;m disso, a justi&#231;a se estende &#224; consist&#234;ncia. Se alguns peri&#243;dicos adotarem revis&#227;o assistida por IA enquanto outros dependem exclusivamente de revisores humanos, podem surgir disparidades no escrut&#237;nio. Um artigo rejeitado por um processo baseado em IA pode ter sido aceito sob revis&#227;o humana, ou vice-versa, potencialmente afetando a trajet&#243;ria profissional do autor, as oportunidades de financiamento ou a capacidade de influenciar a pr&#225;tica cl&#237;nica. Essa variabilidade desafia o princ&#237;pio de tratamento equitativo em toda a comunidade cient&#237;fica.</p>
      </sec>
      <sec>
        <title>Transpar&#234;ncia e confian&#231;a</title>
        <p>A transpar&#234;ncia &#233; um pilar fundamental da pr&#225;tica cient&#237;fica &#233;tica, mas o uso de IA na revis&#227;o por pares complica esse ideal. Os peri&#243;dicos devem divulgar quando as ferramentas de IA s&#227;o utilizadas e, em caso afirmativo, em que medida? Se um sistema de IA sinalizar um erro estat&#237;stico ou potencial pl&#225;gio, os autores t&#234;m o direito de saber como essa determina&#231;&#227;o foi feita &#8212; no entanto, a natureza de &#8220;caixa preta&#8221; de muitos algoritmos de IA dificulta a explica&#231;&#227;o das decis&#245;es em termos humanos. Sem uma divulga&#231;&#227;o clara, autores e leitores podem questionar a legitimidade do processo de revis&#227;o, suspeitando que julgamentos opacos de m&#225;quinas substitu&#237;ram a rigorosa avalia&#231;&#227;o humana.</p>
        <p>Essa falta de transpar&#234;ncia pode minar a confian&#231;a, um ativo essencial na publica&#231;&#227;o m&#233;dica. Os leitores dependem de peri&#243;dicos revisados por pares para fornecer pesquisas confi&#225;veis e verificadas que embasam decis&#245;es cl&#237;nicas. Se perceberem que a IA est&#225; moldando silenciosamente os resultados &#8212; talvez rejeitando estudos v&#225;lidos ou aprovando estudos falhos devido a peculiaridades algor&#237;tmicas &#8212;, a confian&#231;a na literatura pode vacilar. Do ponto de vista &#233;tico, os peri&#243;dicos devem encontrar um equil&#237;brio entre a efici&#234;ncia da IA e a necessidade de manter um processo aberto e confi&#225;vel, possivelmente exigindo relat&#243;rios detalhados sobre o papel e as limita&#231;&#245;es da IA.</p>
      </sec>
      <sec>
        <title>Responsabilidade e responsabiliza&#231;&#227;o</title>
        <p>Uma quest&#227;o &#233;tica particularmente espinhosa &#233; a da responsabiliza&#231;&#227;o. Na revis&#227;o por pares tradicional, revisores e editores humanos s&#227;o respons&#225;veis por seus julgamentos. Se um estudo falho escapa e causa danos &#8212; digamos, ao promover um tratamento ineficaz &#8212; a comunidade cient&#237;fica pode rastrear o erro at&#233; indiv&#237;duos ou processos espec&#237;ficos e corrigi-lo. No entanto, quando a IA est&#225; envolvida, essa cadeia de responsabiliza&#231;&#227;o se torna confusa. Se uma ferramenta de IA n&#227;o detecta uma falha cr&#237;tica em um artigo m&#233;dico, quem &#233; o culpado? Os desenvolvedores que projetaram o algoritmo? O peri&#243;dico que o implementou? O revisor humano que confiou em seus resultados? A IA n&#227;o pode ser responsabilizada moral ou legalmente, deixando uma lacuna que pode minar a justi&#231;a e o aprendizado com os erros.</p>
        <p>Essa quest&#227;o se torna ainda mais urgente na medicina, onde erros podem ter consequ&#234;ncias de vida ou morte. Considere um cen&#225;rio em que uma revis&#227;o assistida por IA aprova um estudo com falhas metodol&#243;gicas sutis, resultando em uma diretriz cl&#237;nica amplamente adotada, mas potencialmente prejudicial. A difus&#227;o de responsabilidades &#8212; entre humanos e m&#225;quinas &#8212; pode atrasar a&#231;&#245;es corretivas e agravar os danos. Do ponto de vista &#233;tico, o uso de IA exige uma estrutura clara de supervis&#227;o, garantindo que os revisores humanos mantenham a autoridade m&#225;xima e que os peri&#243;dicos estabele&#231;am protocolos para auditar as decis&#245;es de IA.</p>
      </sec>
      <sec>
        <title>Equidade e acesso</title>
        <p>O princ&#237;pio &#233;tico da equidade levanta quest&#245;es sobre quem se beneficia da IA na revis&#227;o por pares e quem pode ficar para tr&#225;s. Ferramentas avan&#231;adas de IA frequentemente exigem investimentos financeiros significativos, recursos computacionais e expertise para serem implementadas de forma eficaz. Peri&#243;dicos de prest&#237;gio e bem financiados podem adotar prontamente essas tecnologias, aumentando sua efici&#234;ncia e reputa&#231;&#227;o, enquanto peri&#243;dicos menores ou aqueles em ambientes com poucos recursos podem ter dificuldade para acompanhar o ritmo. Isso pode exacerbar as disparidades existentes na publica&#231;&#227;o acad&#234;mica, onde pesquisadores j&#225; marginalizados &#8212; como aqueles de pa&#237;ses em desenvolvimento ou institui&#231;&#245;es subfinanciadas &#8212; enfrentam barreiras adicionais para ter seus trabalhos revisados e publicados.</p>
        <p>Tais desigualdades podem ter efeitos colaterais sobre o conhecimento m&#233;dico. Se peri&#243;dicos assistidos por IA publicarem desproporcionalmente pesquisas de regi&#245;es ou institui&#231;&#245;es com bons recursos, a comunidade m&#233;dica global poder&#225; perder perspectivas diversas, especialmente de &#225;reas onde as doen&#231;as s&#227;o end&#234;micas, mas a infraestrutura de pesquisa &#233; limitada. Do ponto de vista &#233;tico, a implanta&#231;&#227;o da IA n&#227;o deve exacerbar essas lacunas; em vez disso, esfor&#231;os devem ser feitos para garantir amplo acesso, talvez por meio do uso de ferramentas de IA de c&#243;digo aberto ou de subs&#237;dios para peri&#243;dicos menores.</p>
      </sec>
      <sec>
        <title>Preserva&#231;&#227;o do julgamento humano</title>
        <p>Em sua ess&#234;ncia, o debate &#233;tico gira em torno do papel do julgamento humano na ci&#234;ncia. A medicina n&#227;o &#233; meramente uma &#225;rea t&#233;cnica, mas profundamente humana, envolvendo dilemas &#233;ticos, experi&#234;ncias de pacientes e implica&#231;&#245;es sociais que a IA n&#227;o consegue compreender plenamente. A revis&#227;o por pares visa tanto avaliar o peso moral de um estudo &#8212; seu potencial para curar ou causar danos &#8212; quanto verificar seus dados. Uma IA pode ser excelente em detectar erros estat&#237;sticos, mas falhar ao avaliar se as conclus&#245;es de um estudo ultrapassam suas evid&#234;ncias de forma a induzir m&#233;dicos ou formuladores de pol&#237;ticas a erro.</p>
        <p>O uso da IA corre o risco de diminuir esse elemento humano, transformando a revis&#227;o por pares em uma lista de verifica&#231;&#227;o mec&#226;nica em vez de um processo reflexivo e deliberativo. Do ponto de vista &#233;tico, a comunidade cient&#237;fica deve questionar se a efici&#234;ncia justifica deixar de lado a empatia, a criatividade e a sensibilidade &#233;tica proporcionadas por revisores humanos. Uma abordagem equilibrada &#8212; na qual a IA lida com tarefas rotineiras, mas os humanos mant&#234;m o controle sobre os julgamentos interpretativos e morais &#8212; parece essencial para preservar a integridade da pesquisa m&#233;dica.</p>
      </sec>
      <sec>
        <title>Riscos interligados ao enviar manuscritos para sistemas de IA</title>
        <p>Quando um manuscrito &#233; publicado &#8212; seja por um revisor verificando erros, um editor resumindo o conte&#250;do ou um peri&#243;dico testando pl&#225;gio &#8212; os dados geralmente saem do ambiente controlado dos servidores da editora ou institui&#231;&#227;o. Em vez disso, s&#227;o transmitidos para plataformas externas, normalmente gerenciadas por empresas privadas. Essas plataformas podem n&#227;o estar vinculadas aos mesmos padr&#245;es rigorosos de confidencialidade dos peri&#243;dicos acad&#234;micos, que tradicionalmente tratam manuscritos n&#227;o publicados como sagrados at&#233; a publica&#231;&#227;o formal. O pr&#243;prio ato de publicar transfere o controle do autor e da editora, introduzindo uma terceira parte que pode n&#227;o priorizar ou garantir o mesmo n&#237;vel de privacidade.</p>
        <p>Um perigo espec&#237;fico &#233; que os dados enviados podem ser retidos para fins de treinamento. Muitos sistemas de IA melhoram seu desempenho incorporando entradas do usu&#225;rio em seus conjuntos de dados de treinamento. Se um manuscrito contendo novas descobertas de pesquisa, dados experimentais ou metodologias inovadoras for inserido em um sistema desse tipo, ele poder&#225; ser armazenado indefinidamente nos servidores do provedor. Pior ainda, poder&#225; ser processado e integrado &#224; base de conhecimento da IA potencialmente ressurgindo em resultados futuros.</p>
        <p>O segundo grande risco &#8212; vulnerabilidade a vazamentos ou ataques de hackers &#8212; agrava esse problema. Um hacker que obtivesse acesso aos servidores de um provedor de IA poderia extrair manuscritos n&#227;o publicados, notas de revisores ou identidades de autores, especialmente em processos com dupla oculta&#231;&#227;o, onde o anonimato &#233; crucial. Mesmo sem inten&#231;&#227;o maliciosa, vazamentos acidentais poderiam ocorrer &#8212; por exemplo, por meio de um servidor mal configurado ou de um erro de funcion&#225;rio &#8212;, liberando material confidencial para o dom&#237;nio p&#250;blico. Viola&#231;&#245;es de confidencialidade poderiam minar a confian&#231;a no sistema de revis&#227;o por pares, dissuadir autores de submeter artigos a peri&#243;dicos que utilizam IA ou gerar disputas legais sobre propriedade intelectual. Para &#225;reas como farmac&#234;utica ou tecnologia, onde o sigilo pr&#233;-publica&#231;&#227;o &#233; fundamental, os riscos s&#227;o ainda maiores.</p>
      </sec>
      <sec>
        <title>Alcan&#231;ando um equil&#237;brio</title>
        <p>A an&#225;lise de artigos m&#233;dicos por pares assistida por IA oferece vantagens ineg&#225;veis, incluindo maior efici&#234;ncia, objetividade e escalabilidade. No entanto, suas limita&#231;&#245;es &#8212; como falta de compreens&#227;o contextual, potencial para excesso de confian&#231;a e vieses t&#233;cnicos &#8212; destacam a necessidade de uma implementa&#231;&#227;o cuidadosa. Do ponto de vista &#233;tico, o uso de IA &#233; permiss&#237;vel e at&#233; ben&#233;fico, desde que seja transparente, complementar &#224; expertise humana e projetado para minimizar desigualdades e erros.</p>
        <p>Em vez de substituir revisores humanos, a IA deve servir como uma ferramenta colaborativa, ampliando suas capacidades e preservando o julgamento humano essencial &#224; ci&#234;ncia m&#233;dica. Os peri&#243;dicos devem estabelecer diretrizes claras para o papel da IA garantindo a responsabiliza&#231;&#227;o e mantendo a confian&#231;a da comunidade cient&#237;fica. Com essas salvaguardas em vigor, a IA pode aprimorar o processo de revis&#227;o por pares sem comprometer sua integridade, promovendo, em &#250;ltima an&#225;lise, a qualidade e a confiabilidade da pesquisa m&#233;dica em um mundo cada vez mais complexo.</p>
      </sec>
    </sec>
  </body>
  <back>
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    <fn-group>
      <title>Informa&#231;&#227;o adicional:</title>
      <fn fn-type="other" id="fn1">
        <label>1.</label>
        <p> O manuscrito foi totalmente criado por um sistema de IA. Nenhuma contribui&#231;&#227;o direta dos autores citados foi incorporada ao texto. No entanto, os autores removeram par&#225;grafos considerados redundantes para simplificar o conte&#250;do.</p>
      </fn>
      <fn fn-type="other" id="fn2">
        <label>2.</label>
        <p> Um algoritmo de detec&#231;&#227;o de pl&#225;gio encontrou 0% de similaridade entre o texto do manuscrito e as fontes online.</p>
      </fn>
      <fn fn-type="other" id="fn3">
        <label>3.</label>
        <p> Uma ferramenta adicional de verifica&#231;&#227;o gramatical baseada em IA n&#227;o sugeriu nenhuma corre&#231;&#227;o no texto do manuscrito.</p>
      </fn>
      <fn fn-type="other" id="fn4">
        <label>4.</label>
        <p> Para leitura adicional, os artigos sugeridos est&#227;o listados na se&#231;&#227;o &#8220;Refer&#234;ncias&#8221;.</p>
      </fn>
      <fn fn-type="other">
        <label>Vincula&#231;&#227;o acad&#234;mica:</label>
        <p> N&#227;o h&#225; vincula&#231;&#227;o deste estudo a programas de p&#243;s-gradua&#231;&#227;o.</p>
      </fn>
      <fn fn-type="other">
        <label>Aprova&#231;&#227;o &#233;tica e consentimento informado:</label>
        <p> Este artigo n&#227;o cont&#233;m estudos com humanos ou animais realizados por nenhum dos autores.</p>
      </fn>
      <fn fn-type="other">
        <label>Uso de Intelig&#234;ncia Artificial:</label>
        <p> Durante a prepara&#231;&#227;o deste trabalho, o(s) autor(es) usaram ChatGPT para a reda&#231;&#227;o completa do artigo, conforme descrito no corpo do texto. Ap&#243;s o uso desta ferramenta/servi&#231;o, o(s) autor(es) revisaram e editaram o conte&#250;do conforme necess&#225;rio e assumem total responsabilidade pelo conte&#250;do do artigo publicado.</p>
      </fn>
      <fn fn-type="data-availability" specific-use="data-in-article">
        <label>Disponibilidade de Dados:</label>
        <p> Os conte&#250;dos subjacentes ao texto da pesquisa est&#227;o contidos no manuscrito.</p>
      </fn>
      <fn fn-type="financial-disclosure" id="fnFontesdefinanciamento">
        <label>Fontes de financiamento:</label>
        <p> O presente estudo n&#227;o teve fontes de financiamento externas.</p>
      </fn>
    </fn-group>
  </back>
  <sub-article article-type="translation" id="TRen" xml:lang="en">
    <front-stub>
      <article-id pub-id-type="doi">10.36660/abc.20250315i</article-id>
      <article-categories>
        <subj-group subj-group-type="heading">
          <subject>Viewpoint</subject>
        </subj-group>
      </article-categories>
      <title-group>
        <article-title>Artificial Intelligence Assistance in the Peer Review Analysis of Medical Articles: Advantages, Disadvantages, and Ethical Considerations</article-title>
      </title-group>
      <contrib-group>
        <contrib contrib-type="author">
          <contrib-id contrib-id-type="orcid">0000-0001-8977-6929</contrib-id>
          <name>
            <surname>Zimerman</surname>
            <given-names>Andr&#233;</given-names>
          </name>
          <role>Critical revision of the manuscript for content</role>
          <xref ref-type="aff" rid="aff1001">
            <sup>1</sup>
          </xref>
        </contrib>
        <contrib contrib-type="author">
          <contrib-id contrib-id-type="orcid">0000-0001-8769-1411</contrib-id>
          <name>
            <surname>d&#8217;Avila</surname>
            <given-names>Andre</given-names>
          </name>
          <role>Conception and design of the research</role>
          <role>Critical revision of the manuscript for content</role>
          <xref ref-type="aff" rid="aff2001">
            <sup>2</sup>
          </xref>
        </contrib>
      </contrib-group>
      <aff id="aff1001">
        <label>1</label>
        <country country="BR">Brazil</country>
        <institution content-type="original">MOVE Academic Research Organization, Hospital Moinhos de Vento, Porto Alegre, RS - Brazil</institution>
      </aff>
      <aff id="aff2001">
        <label>2</label>
        <country country="BR">Brazil</country>
        <institution content-type="original">Hospital SOS Cardio, Florian&#243;polis, SC &#8211; Brazil</institution>
      </aff>
      <author-notes>
        <corresp id="c01001"><label>Mailing Address:</label> Andr&#233; d&#8217;Avila &#8226; Hospital SOS Cardio - Rodovia, SC-401, 121. Postal Code 88030-000, Itacorubi, Florian&#243;polis, SC - Brazil Email: andredavila@mac.com </corresp>
        <fn fn-type="conflict">
          <label>Potential conflict of interest:</label>
          <p>No potential conflict of interest relevant to this article was reported.</p>
        </fn>
        <fn fn-type="edited-by">
          <label>Editor responsible for the review:</label>
          <p>Gl&#225;ucia Maria Moraes de Oliveira</p>
        </fn>
      </author-notes>
      <kwd-group xml:lang="en">
        <title>Keywords</title>
        <kwd>Peer Review</kwd>
        <kwd>Artificial Intelligence</kwd>
        <kwd>Ethics</kwd>
        <kwd>Publications</kwd>
      </kwd-group>
    </front-stub>
    <body>
      <p>Recently, the authors of this &#8220;Viewpoint&#8221; article were invited to peer review a manuscript for a prestigious international cardiovascular journal. After dedicating a few days to the analysis, they decided, out of curiosity, to upload the manuscript into a commercially available large language model with artificial intelligence (AI) capabilities, using the following prompt: &#8220;Analyze and Criticize the Attached File.&#8221; Both reviewers were astonished by the response generated within seconds by the AI algorithm &#8212; its depth and precision exceeded their expectations, with some insights proving complementary to their own. As a result, they incorporated these elements into the official review submitted to the journal.</p>
      <p>This experience, however, raised another question: should they acknowledge the assistance provided by the AI algorithm? Uncertain of the answer, they consulted other physicians who regularly review manuscripts for high-impact journals, and their opinions varied widely. Some argued that AI is merely a tool to enhance efficiency, requiring no acknowledgment&#8212;reviewers are accountable for the final content and should use whatever strategies enable them to achieve the best outcome. Others insisted that failing to disclose AI assistance would be unethical.</p>
      <p>To resolve the dilemma, the authors yet again turned to AI itself for insight into its role in the peer review process of medical manuscripts. The response, presented here, required minimal editorial adjustments from the authors. <italic>Whenever deemed necessary, the authors&#8217; inputs are reported throughout the manuscript in italics.</italic></p>
      <sec>
        <title>AI talks about the role of AI as a reviewer of medical papers:</title>
        <p>The peer review process is a cornerstone of scientific integrity, particularly in the field of medicine, where rigorous evaluation ensures that published research is credible, reproducible, and safe for clinical application. However, the growing volume of medical articles submitted for publication, coupled with the complexity of modern research, has strained the traditional peer review system.</p>
        <p>The use of AI in the peer review of medical articles represents a transformative opportunity to address the mounting challenges of academic publishing in a field where accuracy, timeliness, and reliability are paramount. However, alongside its potential benefits, AI introduces significant drawbacks and notable challenges. This essay examines the benefits and shortcomings of AI in the peer review analysis of medical articles, as well as the ethical implications of its integration.</p>
        <sec>
          <title>Advantages of AI in peer review</title>
          <list list-type="order">
            <list-item>
              <p><bold>Enhanced efficiency and speed</bold>The sheer volume of medical research submitted for publication has risen steeply, often overwhelming human reviewers and delaying the dissemination of critical findings. AI can process vast amounts of text rapidly, performing tasks such as checking references, analyzing statistical data, and screening for plagiarism almost instantaneously, while human reviewers might take days to perform a comparable check. This efficiency allows journals to handle higher submission rates and reduces the time from submission to publication.</p>
            </list-item>
            <list-item>
              <p><bold>Improved objectivity and consistency</bold>Human reviewers, despite their expertise, are prone to biases stemming from personal beliefs, familiarity with authors, or institutional prestige. AI, when trained on clear and standardized criteria, can evaluate manuscripts without such influences, providing a consistent and impartial analysis. An AI system could assess the adequacy of a sample size or the validity of statistical methods based solely on predefined benchmarks. This objectivity can create a more equitable environment, ensuring that all submissions are judged on their merits rather than extraneous factors, which is particularly beneficial for early-career researchers or those from less prominent institutions.</p>
            </list-item>
            <list-item>
              <p><bold>Scalability and support for reviewers</bold>The shortage of qualified peer reviewers is a persistent issue in medical publishing, especially in niche specialties where expertise is concentrated among a small pool of individuals. AI can scale the review process by assisting less experienced reviewers or handling preliminary evaluations, freeing up senior experts for more complex tasks. AI tools might screen submissions for basic compliance&#8212;ensuring ethical approval statements, complete datasets, or proper formatting&#8212;allowing human reviewers to focus on scientific rigor and innovation. This scalability also extends to smaller journals or those in resource-limited settings, enabling them to maintain high standards without relying solely on overburdened human volunteers.</p>
            </list-item>
            <list-item>
              <p><bold>Error detection and quality control</bold>AI excels at identifying technical errors that might elude human reviewers, particularly in large or data-heavy manuscripts. It can flag inconsistencies in figures and tables, detect fabricated or manipulated data (e.g., through image analysis of graphs or photographs), and verify the accuracy of cited studies. In clinical trials, for instance, AI could cross-check reported outcomes against raw data submissions, catching discrepancies that might otherwise go unnoticed. By enhancing quality control, AI helps uphold the integrity of the medical literature, reducing the risk of erroneous or fraudulent research influencing patient care.</p>
            </list-item>
            <list-item>
              <p><bold>Continuous learning and adaptability</bold>Modern AI systems, particularly those that leverage machine learning, can improve over time as they are exposed to more data and receive feedback. This adaptability means that AI tools can stay current with evolving standards in medical research&#8212;such as new statistical techniques or reporting guidelines&#8212;without requiring extensive retraining of human reviewers.</p>
            </list-item>
          </list>
        </sec>
        <sec>
          <title>Disadvantages of AI in peer review</title>
          <list list-type="order">
            <list-item>
              <p><bold>Limited contextual understanding</bold>While AI is adept at processing structured data, it struggles with the nuanced, context-dependent aspects of medical research. Peer review often requires interpreting ambiguous language, assessing the feasibility of a study&#8217;s implications, or recognizing the significance of an unconventional approach&#8212;tasks that demand human intuition and experience. For example, an AI might misjudge a study&#8217;s ethical implications (e.g., the acceptability of a placebo arm in a trial) or fail to appreciate a paradigm-shifting idea that lacks precedent in its training data. This limitation risks overlooking groundbreaking work or misinterpreting complex clinical scenarios, undermining the depth of the review process.</p>
            </list-item>
            <list-item>
              <p><bold>Risk of over-reliance and deskilling</bold>The convenience of AI could lead reviewers and editors to depend heavily on its outputs, treating them as definitive rather than supplementary. If human reviewers defer to AI for tasks such as statistical validation or methodology checks, they may neglect to scrutinize these areas themselves, potentially missing errors that the AI fails to detect. Over time, this over-reliance could erode critical thinking skills among reviewers, a phenomenon known as &#8220;deskilling.&#8221; Deskilling refers to the process by which skilled expertise is reduced through automation, technological advancements, or changes in work processes. It involves breaking down complex tasks that once required specialized knowledge or training into simpler, repetitive actions that less-skilled workers or machines can perform. This can lead to a workforce requiring less training or experience, or a decline in craftsmanship. The term is often associated with industrial and economic shifts, such as the rise of assembly lines or AI-driven tools, where human skills are replaced or devalued. In medicine, where subtle flaws can have profound consequences, this loss of vigilance poses a significant risk to the quality of research.</p>
            </list-item>
            <list-item>
              <p><bold>Bias in training data</bold>AI systems are only as good as the data they are trained on, and biases in that data can perpetuate or amplify existing flaws in the review process. If an AI is trained predominantly on studies from Western institutions or specific medical fields, it might undervalue research from underrepresented regions or specialties, misjudging their methodologies or dismissing their relevance. Theoretically, an AI tool trained on high-income country data might flag a study from a low-resource setting as inadequate due to smaller sample sizes, thereby ignoring contextual constraints. This bias could reinforce inequities in publishing and skew the medical knowledge base.</p>
            </list-item>
            <list-item>
              <p><bold>Technical errors and false positives/negatives</bold>AI is not infallible and can produce errors that disrupt the review process. False positives&#8212;such as wrongly accusing an author of plagiarism due to common phrasing&#8212;or false negatives&#8212;such as missing a cleverly disguised data manipulation&#8212;can lead to unjust outcomes. For example, an overzealous AI might delay a legitimate paper by flagging minor issues, frustrating authors, and clogging editorial workflows, while an underperforming AI might approve a flawed study, endangering downstream clinical applications. These technical limitations highlight the need for human oversight, but they also erode confidence in AI as a standalone tool.</p>
            </list-item>
            <list-item>
              <p><bold>Cost and accessibility barriers</bold>Developing, maintaining, and deploying sophisticated AI systems requires significant financial and technical resources, which may not be available to all journals. High costs could limit AI adoption to well-funded publishers, leaving smaller or open-access journals at a disadvantage. This disparity might widen the gap between &#8220;elite&#8221; and &#8220;lesser&#8221; publications, affecting their ability to attract quality submissions or maintain rigorous standards. Additionally, the need for ongoing updates to keep AI aligned with advancing medical science adds to the expense, potentially making it an unsustainable option for some organizations.</p>
            </list-item>
          </list>
          <p>A summary of the main advantages and disadvantages of AI in peer review is presented in <xref ref-type="table" rid="t1001">Table 1</xref>.</p>
          <p>
            <table-wrap id="t1001">
              <label>Table 1</label>
              <caption>
                <title>&#8211; Advantages and Disadvantages of Artificial Intelligence in Peer Review and Academic Publishing</title>
              </caption>
              <table frame="hsides" rules="groups">
                <colgroup>
                  <col/>
                  <col/>
                </colgroup>
                <thead>
                  <tr>
                    <th align="left">Advantages</th>
                    <th align="left">Disadvantages</th>
                  </tr>
                </thead>
                <tbody>
                  <tr>
                    <td>Enhanced efficiency and speed: AI processes large volumes of text quickly, checking references, analyzing data, and screening for plagiarism, reducing review time and publication delays.</td>
                    <td>Limited contextual understanding: AI struggles with nuanced aspects of research, such as interpreting ambiguous language or recognizing unconventional approaches, which can result in the potential missing of groundbreaking work.</td>
                  </tr>
                  <tr>
                    <td>Improved objectivity and consistency: AI evaluates manuscripts without personal biases, using standardized criteria to ensure equitable judgment based on merit.</td>
                    <td>Risk of over-reliance and deskilling: Over-dependence on AI may reduce critical thinking among reviewers, leading to a loss of expertise and vigilance.</td>
                  </tr>
                  <tr>
                    <td>Scalability and support for reviewers: AI assists less experienced reviewers and handles preliminary tasks, allowing experts to focus on complex evaluations and enabling smaller journals to maintain high standards.</td>
                    <td>Bias in training data: AI trained on biased datasets may undervalue research from underrepresented regions or specialties, reinforcing publishing inequities.</td>
                  </tr>
                  <tr>
                    <td>Error detection and quality control: AI identifies technical errors, inconsistencies, and manipulated data, enhancing the integrity of medical literature.</td>
                    <td>Technical errors and false positives/negatives: AI can produce errors like false plagiarism accusations or miss subtle manipulations, disrupting the review process.</td>
                  </tr>
                  <tr>
                    <td>Continuous learning and adaptability: AI improves over time, staying current with evolving research standards without extensive human retraining.</td>
                    <td>Cost and accessibility barriers: The high costs of AI development and maintenance may limit adoption to well-funded journals, thereby widening disparities in publishing quality.</td>
                  </tr>
                </tbody>
              </table>
              <table-wrap-foot>
                <fn id="TFN1001">
                  <p>AI: artificial intelligence.</p>
                </fn>
              </table-wrap-foot>
            </table-wrap>
          </p>
        </sec>
        <sec>
          <title>Ethical aspects of AI as a tool for peer review of medical articles</title>
          <p>The integration of AI into the peer review process of medical articles introduces a range of ethical considerations that extend beyond its technical advantages and limitations. These concerns touch on fairness, transparency, accountability, equity, and the preservation of human oversight in a field where the stakes&#8212;human health and well-being&#8212;are exceptionally high.</p>
          <p>While AI offers undeniable benefits, its integration must be guided by principles that prioritize trust, justice, and the human context of medicine. Journals should adopt AI transparently, as a supplement rather than a substitute for human expertise, and ensure that its use does not deepen inequities or obscure responsibility. By addressing these ethical challenges head-on, the medical community can harness AI&#8217;s potential while safeguarding the values that underpin scientific inquiry and patient care. Ultimately, the question is not whether AI can assist in peer review but how it can do so in a way that upholds the highest ethical standards.</p>
        </sec>
        <sec>
          <title>Fairness to authors and the scientific community</title>
          <p>One of the primary ethical questions is whether it is fair to subject an author&#8217;s work to evaluation by a machine rather than a human expert. Peer review has long been a human-driven process grounded in the expertise, empathy, and critical reasoning of scientists who understand the challenges of research. An AI system, no matter how sophisticated, lacks the lived experience and intuition that human reviewers bring to the table. For instance, a researcher proposing a novel hypothesis that challenges conventional wisdom might be unfairly penalized by an AI trained on existing patterns, which could flag the work as an outlier or anomaly rather than recognizing its potential brilliance. This raises the issue of whether authors deserve a review process that fully appreciates the human context of their work, especially in medicine, where innovation can save lives.</p>
          <p>Moreover, fairness extends to consistency. If some journals adopt AI-assisted review while others rely solely on human reviewers, disparities in scrutiny could emerge. A paper rejected by an AI-driven process might have been accepted under human review, or vice versa, potentially affecting an author&#8217;s career trajectory, funding opportunities, or ability to influence clinical practice. This variability challenges the principle of equitable treatment across the scientific community.</p>
        </sec>
        <sec>
          <title>Transparency and trust</title>
          <p>Transparency is a cornerstone of ethical scientific practice, yet the use of AI in peer review complicates this ideal. Should journals disclose when AI tools are used, and if so, to what extent? If an AI system flags a statistical error or potential plagiarism, authors have a right to know how that determination was made&#8212;yet the &#8220;black box&#8221; nature of many AI algorithms makes it difficult to explain decisions in human terms. Without clear disclosure, authors and readers might question the legitimacy of the review process, suspecting that opaque machine judgments have replaced rigorous human evaluation.</p>
          <p>This lack of transparency could erode trust, a critical currency in medical publishing. Readers rely on peer-reviewed journals to provide credible, vetted research that informs clinical decisions. If they perceive that AI is silently shaping outcomes&#8212;perhaps rejecting valid studies or approving flawed ones due to algorithmic quirks&#8212;confidence in the literature could falter. Ethically, journals must strike a balance between the efficiency of AI and the imperative to maintain an open and trustworthy process, possibly by mandating detailed reporting on AI&#8217;s role and limitations.</p>
        </sec>
        <sec>
          <title>Accountability and responsibility</title>
          <p>A particularly thorny ethical issue is accountability. In traditional peer review, human reviewers and editors bear responsibility for their judgments. If a flawed study slips through and causes harm&#8212;say, by promoting an ineffective treatment&#8212;the scientific community can trace the error back to specific individuals or processes and address it. However, when AI is involved, this chain of accountability becomes blurred. If an AI tool misses a critical flaw in a medical article, who is at fault? The developers who designed the algorithm? The journal that deployed it? The human reviewer who trusted its output? AI cannot be held morally or legally accountable, leaving a gap that could undermine justice and learning from mistakes.</p>
          <p>This issue becomes even more pressing in medicine, where errors can have life-or-death consequences. Consider a scenario in which an AI-assisted review approves a study with subtle methodological flaws, resulting in a widely adopted but potentially harmful clinical guideline. The diffusion of responsibility&#8212;between humans and machines&#8212;could delay corrective action and exacerbate harm. Ethically, the use of AI demands a clear framework for oversight, ensuring that human reviewers retain ultimate authority and that journals establish protocols for auditing AI decisions.</p>
        </sec>
        <sec>
          <title>Equity and access</title>
          <p>The ethical principle of equity raises questions about who benefits from AI in peer review and who might be left behind. Advanced AI tools often require significant financial investment, computational resources, and expertise to implement effectively. Prestigious, well-funded journals may readily adopt these technologies, enhancing their efficiency and reputation, while smaller journals or those in low-resource settings might struggle to keep pace. This could exacerbate existing disparities in academic publishing, where already marginalized researchers&#8212;such as those from developing countries or underfunded institutions&#8212;face additional barriers to having their work reviewed and published.</p>
          <p>Such inequities could have downstream effects on medical knowledge. If AI-assisted journals disproportionately publish research from well-resourced regions or institutions, the global medical community might miss out on diverse perspectives, particularly from areas where diseases are endemic, but research infrastructure is limited. Ethically, the deployment of AI should not exacerbate these gaps; instead, efforts should be made to ensure broad access, perhaps through the use of open-source AI tools or subsidies for smaller journals.</p>
        </sec>
        <sec>
          <title>Preservation of human judgment</title>
          <p>At its core, the ethical debate hinges on the role of human judgment in science. Medicine is not merely a technical field but a deeply human one involving ethical dilemmas, patient experiences, and societal implications that AI cannot fully comprehend. Peer review is as much about assessing the moral weight of a study&#8212;its potential to heal or harm&#8212;as it is about verifying its data. An AI might excel at spotting statistical errors but falter when evaluating whether a study&#8217;s conclusions overstep its evidence in ways that could mislead clinicians or policymakers.</p>
          <p>Using AI risks diminishing this human element, turning peer review into a mechanical checklist rather than a reflective, deliberative process. Ethically, the scientific community must ask whether efficiency justifies sidelining the empathy, creativity, and ethical sensitivity that human reviewers provide. A balanced approach&#8212;where AI handles rote tasks, but humans retain control over interpretive and moral judgments&#8212;seems essential to preserving the integrity of medical research.</p>
        </sec>
        <sec>
          <title>Intertwined risks of uploading manuscripts to AI systems</title>
          <p>When a manuscript is uploaded&#8212;whether by a reviewer checking for errors, an editor summarizing content, or a journal testing for plagiarism&#8212;the data often leaves the controlled environment of the publisher&#8217;s or institution&#8217;s servers. Instead, it is transmitted to external platforms, typically managed by private companies. These platforms may not be bound by the same strict confidentiality standards as academic journals, which traditionally treat unpublished manuscripts as sacrosanct until formal publication. The act of uploading itself shifts control away from the author and publisher, introducing a third party that may not prioritize or guarantee the same level of privacy.</p>
          <p>One specific danger is that the uploaded data might be retained for training purposes. Many AI systems improve their performance by incorporating user inputs into their training datasets. If a manuscript containing novel research findings, experimental data, or innovative methodologies is fed into such a system, it could be stored indefinitely on the provider&#8217;s servers. Worse, it might be processed and integrated into the AI&#8217;s knowledge base, potentially resurfacing in future outputs.</p>
          <p>The second major risk&#8212;vulnerability to leaks or hacking&#8212;compounds this issue. A hacker gaining access to an AI provider&#8217;s servers could extract unpublished manuscripts, reviewer notes, or author identities, especially in double-masked processes where anonymity is critical. Even without malicious intent, accidental leaks could occur&#8212;say, through a misconfigured server or an employee error&#8212;releasing confidential material into the public domain. Confidentiality breaches could erode trust in the peer review system, deter authors from submitting to journals using AI, or spark legal disputes over intellectual property. For fields like pharmaceuticals or technology, where pre-publication secrecy is paramount, the stakes are even higher.</p>
        </sec>
        <sec>
          <title>Striking a balance</title>
          <p>AI-assisted peer review analysis of medical articles offers undeniable advantages, including increased efficiency, objectivity, and scalability. However, its limitations&#8212;such as lack of contextual understanding, potential for over-reliance, and technical biases&#8212;highlight the need for careful implementation. Ethically, the use of AI is permissible and even beneficial, provided it is transparent, supplementary to human expertise, and designed to minimize inequities and errors.</p>
          <p>Rather than replacing human reviewers, AI should serve as a collaborative tool, augmenting their capabilities while preserving the human judgment that is essential to medical science. Journals must establish clear guidelines for AI&#8217;s role, ensuring accountability and maintaining the trust of the scientific community. With these safeguards in place, AI can enhance the peer review process without compromising its integrity, ultimately advancing the quality and reliability of medical research in an increasingly complex world.</p>
        </sec>
      </sec>
    </body>
    <back>
      <fn-group>
        <title>Additional information:</title>
        <fn fn-type="other" id="fn1001">
          <label>1.</label>
          <p> The manuscript was fully authored by an AI system. No direct contributions from the named authors were incorporated into the text. However, the authors removed paragraphs deemed redundant to streamline the content.</p>
        </fn>
        <fn fn-type="other" id="fn2001">
          <label>2.</label>
          <p> A plagiarism detection algorithm found 0% similarity between the manuscript&#8217;s text and online sources.</p>
        </fn>
        <fn fn-type="other" id="fn3001">
          <label>3.</label>
          <p> An additional AI-based grammar-checking tool suggested no corrections to the manuscript&#8217;s text.</p>
        </fn>
        <fn fn-type="other" id="fn4001">
          <label>4.</label>
          <p> For further reading, suggested articles are listed in the &#8220;References&#8221; section.</p>
        </fn>
        <fn fn-type="other">
          <label>Study association:</label>
          <p> This study is not associated with any thesis or dissertation work.</p>
        </fn>
        <fn fn-type="other">
          <label>Ethics approval and consent to participate:</label>
          <p> This article does not contain any studies with human participants or animals performed by any of the authors.</p>
        </fn>
        <fn fn-type="other">
          <label>Use of Artificial Intelligence:</label>
          <p> During the preparation of this work, the author(s) used ChatGPT to write the entire article, as described in the body of the text. After using this tool/service, the author(s) reviewed and edited the content as needed and take full responsibility for the content of the published article.</p>
        </fn>
        <fn fn-type="data-availability" specific-use="data-in-artcile">
          <label>Data Availability:</label>
          <p> The underlying content of the research text is contained within the manuscript.</p>
        </fn>
        <fn fn-type="financial-disclosure">
          <label>Sources of funding:</label>
          <p> There were no external funding sources for this study.</p>
        </fn>
      </fn-group>
    </back>
  </sub-article>
</article>
