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Or was it? I told my friend that it had not been peer reviewed, but it was too late to pull the story from the front page. My point is that peer review is impossible to define in operational terms an operational definition is one whereby if 50 of us looked at the same process we could all agree most of the time whether or not it was peer review. Peer review is thus like poetry, love, or justice.

But it is something to do with a grant application or a paper being scrutinized by a third party—who is neither the author nor the person making a judgement on whether a grant should be given or a paper published. But who is a peer? Somebody doing exactly the same kind of research in which case he or she is probably a direct competitor? Somebody in the same discipline? Somebody who is an expert on methodology?

And what is review? Or somebody pouring all over the paper, asking for raw data, repeating analyses, checking all the references, and making detailed suggestions for improvement? Such a review is vanishingly rare. What is clear is that the forms of peer review are protean. Probably the systems of every journal and every grant giving body are different in at least some detail; and some systems are very different.

There may even be some journals using the following classic system. The editor looks at the title of the paper and sends it to two friends whom the editor thinks know something about the subject. If both advise publication the editor sends it to the printers.

If both advise against publication the editor rejects the paper. If the reviewers disagree the editor sends it to a third reviewer and does whatever he or she advises. This pastiche—which is not far from systems I have seen used—is little better than tossing a coin, because the level of agreement between reviewers on whether a paper should be published is little better than you'd expect by chance.

He also joked that the Lancet had a system of throwing a pile of papers down the stairs and publishing those that reached the bottom. When I was editor of the BMJ I was challenged by two of the cleverest researchers in Britain to publish an issue of the journal comprised only of papers that had failed peer review and see if anybody noticed.

One answer is that it is a method to select the best grant applications for funding and the best papers to publish in a journal. It is hard to test this aim because there is no agreed definition of what constitutes a good paper or a good research proposal.

Plus what is peer review to be tested against? Or a much simpler process? Stephen Lock when editor of the BMJ conducted a study in which he alone decided which of a consecutive series of papers submitted to the journal he would publish.

He then let the papers go through the usual process. There was little difference between the papers he chose and those selected after the full process of peer review. Maybe a lone editor, thoroughly familiar with what the journal wants and knowledgeable about research methods, would be enough.

But it would be a bold journal that stepped aside from the sacred path of peer review. Another answer to the question of what is peer review for is that it is to improve the quality of papers published or research proposals that are funded. The systematic review found little evidence to support this, but again such studies are hampered by the lack of an agreed definition of a good study or a good research proposal.

Peer review might also be useful for detecting errors or fraud. At the BMJ we did several studies where we inserted major errors into papers that we then sent to many reviewers. Some reviewers did not spot any, and most reviewers spotted only about a quarter.

Peer review sometimes picks up fraud by chance, but generally it is not a reliable method for detecting fraud because it works on trust.

A major question, which I will return to, is whether peer review and journals should cease to work on trust. In addition to being poor at detecting gross defects and almost useless for detecting fraud it is slow, expensive, profligate of academic time, highly subjective, something of a lottery, prone to bias, and easily abused.

Slow and expensive Many journals, even in the age of the internet, take more than a year to review and publish a paper. It is hard to get good data on the cost of peer review, particularly because reviewers are often not paid the same, come to that, is true of many editors. The cost of peer review has become important because of the open access movement, which hopes to make research freely available to everybody.

One open access model is that authors will pay for peer review and the cost of posting their article on a website. So there may be substantial financial gains to be had by academics if the model for publishing science changes. There is an obvious irony in people charging for a process that is not proved to be effective, but that is how much the scientific community values its faith in peer review. Inconsistent People have a great many fantasies about peer review, and one of the most powerful is that it is a highly objective, reliable, and consistent process.

I regularly received letters from authors who were upset that the BMJ rejected their paper and then published what they thought to be a much inferior paper on the same subject.

Always they saw something underhand. They found it hard to accept that peer review is a subjective and, therefore, inconsistent process. But it is probably unreasonable to expect it to be objective and consistent. If I ask people to rank painters like Titian, Tintoretto, Bellini, Carpaccio, and Veronese, I would never expect them to come up with the same order.

A scientific study submitted to a medical journal may not be as complex a work as a Tintoretto altarpiece, but it is complex. Inevitably people will take different views on its strengths, weaknesses, and importance. So, the evidence is that if reviewers are asked to give an opinion on whether or not a paper should be published they agree only slightly more than they would be expected to agree by chance.


I am conscious that this evidence conflicts with the study of Stephen Lock showing that he alone and the whole BMJ peer review process tended to reach the same decision on which papers should be published. The explanation may be that being the editor who had designed the BMJ process and appointed the editors and reviewers it was not surprising that they were fashioned in his image and made similar decisions. Sometimes the inconsistency can be laughable. Here is an example of two reviewers commenting on the same papers.

Jedediah Smith's Journals

This—perhaps inevitable—inconsistency can make peer review something of a lottery. You submit a study to a journal. It enters a system that is effectively a black box, and then a more or less sensible answer comes out at the other end.

The black box is like the roulette wheel, and the prizes and the losses can be big. For an academic, publication in a major journal like Nature or Cell is to win the jackpot. Bias The evidence on whether there is bias in peer review against certain sorts of authors is conflicting, but there is strong evidence of bias against women in the process of awarding grants.

They retyped the papers, made minor changes to the titles, abstracts, and introductions but changed the authors' names and institutions.

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The papers were then resubmitted to the journals that had first published them. In only three cases did the journals realize that they had already published the paper, and eight of the remaining nine were rejected—not because of lack of originality but because of poor quality.

Peters and Ceci concluded that this was evidence of bias against authors from less prestigious institutions. I remember feeling the effect strongly when as a young editor I had to consider a paper submitted to the BMJ by Karl Popper. But we could not. The power of the name was too strong.

So we published, and time has shown we were right to do so. The paper argued that we should pay much more attention to error in medicine, about 20 years before many papers appeared arguing the same. It is also clear that authors often do not even bother to write up such studies. This matters because it biases the information base of medicine.

It is easy to see why journals would be biased against negative studies. Journalistic values come into play.


Who wants to read that a new treatment does not work? That's boring. We became very conscious of this bias at the BMJ; we always tried to concentrate not on the results of a study we were considering but on the question it was asking. If the question is important and the answer valid, then it must not matter whether the answer is positive or negative.

I fear, however, that bias is not so easily abolished and persists.

The Lancet has tried to get round the problem by agreeing to consider the protocols plans for studies yet to be done. Such a system also has the advantage of stopping resources being spent on poor studies.

The main disadvantage is that it increases the sum of peer reviewing—because most protocols will need to be reviewed in order to get funding to perform the study.

Abuse of peer review There are several ways to abuse the process of peer review. You can steal ideas and present them as your own, or produce an unjustly harsh review to block or at least slow down the publication of the ideas of a competitor.

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Why does it have such power? This means that a journal is designed for citing rather than reading and for authors who can cite articles rather than readers who cannot. Maybe a lone editor, thoroughly familiar with what the journal wants and knowledgeable about research methods, would be enough. If both advise publication the editor sends it to the printers. Debate still rages over certain episodes in his life, in particular the alleged "saving" of Smith by Pocahontas - not only whether the event occured at all, but if it did, whether Smith really was in danger or if he was undergoing a kind of "adoption" ritual.

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