Minimizing the three stages of publication bias.

Publication bias can be considered to have three stages: (1) Prepublication bias occurs in the performance of research, caused by ignorance, sloth, greed, or the double standard applied to clinical trials but not to clinical practice. (2) Publication bias refers to basing acceptance or rejection of a manuscript on whether it supports the treatment tested. Potentially biased reviewers are of equal concern. (3) Postpublication bias occurs in publishing interpretations, reviews, and meta-analyses of published clinical trials. Bias can be minimized by (1) insisting on high-quality research and thorough literature reviews, (2) eliminating the double standard concerning peer review and informed consent applied to clinical research and practice, (3) publishing legitimate trials regardless of their results, (4) requiring peer reviewers to acknowledge conflicts of interest, (5) replacing ordinary review articles with meta-analyses, and (6) requiring the authors of reviews to acknowledge possible conflicts of interest.