Dear Editorial Team, Thank you for giving authors the opportunity to provide feedback\. I would like to offer some comments based not only on my experience with this particular manuscript, but also on my broader experience as an academic author\. I have been involved in clinical research and scientific publishing for approximately 20 years and, to date, have authored 287 publications indexed in PubMed\. I have also published 87 manuscripts through the F6Publishing/BPG platform\. I therefore have considerable experience both with scientific publishing in general and with your editorial system specifically\. Over the past few years, and particularly more recently, I have found the BPG manuscript submission, processing, and revision pathway increasingly complex and time\-consuming\. I believe it has now reached a level at which the administrative burden risks becoming a significant deterrent to experienced authors and clinical researchers\. In a conventional editorial workflow, the process is relatively straightforward: manuscript submission, technical and editorial checks, peer review, editorial decision, author revision and rebuttal, possible reassessment by reviewers, and a final editorial decision\. Scientific rigor does not necessarily require procedural complexity\. In contrast, the current BPG workflow appears to contain as many as 26 separate processing stages before publication, including multiple editorial\-office decisions, revision checks, repeated processing steps, and additional assessments\. From an author’s perspective, many of these stages appear redundant and substantially increase the time required to manage a manuscript without an obvious corresponding improvement in scientific quality\. This became particularly evident with our recently published paper\. We underwent four rounds of rebuttal and produced more than 30 pages of responses and explanations\. In practical terms, my co\-authors and I spent more time managing the revision and rebuttal process than we spent writing the manuscript itself\. I am also concerned about the increasingly prominent role of automated AI\-based manuscript assessments\. Authors are screened for AI\-generated content, yet during the revision process they may also receive extensive AI\-generated Manuscript Quality Assessment Reports in addition to reviewers’ comments and editorial comments\. In our experience, these reports can extend to approximately 20 pages\. There is an additional issue that deserves clarification\. If an unpublished manuscript is submitted by the publisher to external or proprietary AI systems, authors should be clearly informed about which system is being used, whether manuscript content is retained, whether it can be incorporated into training or other datasets, and whether such processing could subsequently affect similarity or AI\-detection assessments, including iThenticate results\. For unpublished scientific work, transparency regarding confidentiality and data handling is essential\. The paradox is difficult to overlook: authors are being scrutinized closely for their use of AI while increasingly extensive AI\-generated assessments are being incorporated into the publisher’s own editorial workflow\. AI can undoubtedly assist editorial processes, but it should reduce the workload for authors and editors rather than create an additional layer of mandatory responses on top of conventional peer review\. This experience has led my research group to reconsider future invitations from BPG journals\. This is unfortunate because I have had a long publishing relationship with the group, as demonstrated by my 87 previous publications through F6Publishing\. I would therefore strongly encourage the President and senior management of BPG to critically reassess the entire manuscript pathway, particularly the number of processing stages and the role of AI\-generated assessments\. The objective should be to streamline the system while preserving rigorous peer review, editorial oversight, research integrity, and publication quality\. Clinical researchers are frequently practicing physicians\. Time spent navigating unnecessary administrative complexity is time taken away from patients, research, teaching, and the production of new scientific work\. A rigorous editorial system should therefore also be efficient and proportionate\. My PhD mentor taught me a principle that has remained with me throughout my academic career: write as though you had to pay for every word you use\. I believe the same principle could usefully be applied to editorial workflows—every additional requirement, report, and processing step should have a clear purpose and add demonstrable value\. Reducing unnecessary complexity would not lower scientific standards\. On the contrary, I believe it would result in a more focused, professional, author\-friendly, and scientifically rigorous publication process\. I offer these comments constructively, as a long\-standing author who has published extensively with BPG and who would genuinely like to see the system improve\. Kind regards, Marco Zeppieri, MD, PhD