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Peer review
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For Wikipedia's Peer Review area, see Wikipedia:Peer review.

For other uses, see Peer review (disambiguation).

A reviewer at the National Institutes of Health evaluates a grant proposal.

A reviewer at the National Institutes of Health evaluates a grant proposal.

Peer review (also known as refereeing) is the process of subjecting an author's scholarly work, research or ideas to the scrutiny of others who are experts
in the same field. Peer review requires a community of experts in a
given (and often narrowly defined) field, who are qualified and able to
perform impartial review. Impartial review, especially of work in less
narrowly defined or inter-disciplinary fields may be difficult to
accomplish, and the significance (good or bad) of an idea may never be
widely appreciated among its contemporaries. Although generally
considered essential to academic quality, peer review has been criticized as ineffective, slow, and misunderstood.

Pragmatically, peer review refers to the work done during the screening of submitted manuscripts and funding applications. This normative process encourages authors
to meet the accepted standards of their discipline and prevents the
dissemination of unwarranted claims, unacceptable interpretations and
personal views. Publications that have not undergone peer review are
likely to be regarded with suspicion by scholars and professionals.



[edit] Reasons for peer review

It is difficult for an individual author or research team to spot
every mistake or flaw in a complicated piece of work. This is not
because deficiencies represent "needles in a haystack" that are
difficult to locate, but because with a new and perhaps eclectic
subject, an opportunity for improvement may be more obvious to someone
with special expertise or experience. Therefore, showing work to others
increases the probability that weaknesses will be identified, and, with
advice and encouragement, fixed. For both grant-funding and publication
in a scholarly journal, it is also normally a requirement that the
subject is both novel and substantial.[citation needed]

Reviewers are typically anonymous and independent, to help foster unvarnished criticism, and to discourage cronyism
in funding and publication decisions. However, US government guidelines
governing peer review for federal regulatory agencies require that
reviewer's identity be disclosed under some circumstances. Anonymity
may be unilateral or reciprocal (single- or double-blinded reviewing).
There is a perception that scientific evaluation may be more biased in
the former case.

Since reviewers are normally selected from experts in the fields
discussed in the article, the process of peer review is considered
critical to establishing a reliable body of research and knowledge.
Scholars reading the published articles can only be expert in a limited
area; they rely, to some degree, on the peer-review process to provide
reliable and credible research that they can build upon for subsequent
or related research. As a result, significant scandal ensues when an
author is found to have falsified the research included in an article,
as many other scholars, and the field of study itself, may have relied
upon the original research (see Peer review and fraud below).

[edit] How it works

In the case of proposed publications, an editor sends advance copies of an author's work or ideas to researchers or scholars who are experts
in the field (known as "referees" or "reviewers"), nowadays normally by
e-mail or through a web-based manuscript processing system. Usually,
there are two or three referees for a given article.

These referees each return an evaluation of the work to the editor,
including noting weaknesses or problems along with suggestions for
improvement. Typically, most of the referees' comments are eventually
seen by the author; scientific journals
observe this convention universally. The editor, usually familiar with
the field of the manuscript (although typically not in as much depth as
the referees, who are specialists), then evaluates the referees'
comments, her or his own opinion of the manuscript, and the context of
the scope of the journal or level of the book and readership, before
passing a decision back to the author(s), usually with the referees'

Referees' evaluations usually include an explicit recommendation of
what to do with the manuscript or proposal, often chosen from options
provided by the journal or funding agency. Most recommendations are
along the lines of the following:

  • to unconditionally accept the manuscript or proposal,
  • to accept it in the event that its authors improve it in certain ways,
  • to reject it, but encourage revision and invite resubmission,
  • to reject it outright.

During this process, the role of the referees is advisory, and the
editor is typically under no formal obligation to accept the opinions
of the referees. Furthermore, in scientific publication, the referees
do not act as a group, do not communicate with each other, and
typically are not aware of each other's identities or evaluations.
There is usually no requirement that the referees achieve consensus. Thus the group dynamics are substantially different from that of a jury.

In situations where the referees disagree substantially about the
quality of a work, there are a number of strategies for reaching a
decision. When an editor receives very positive and very negative
reviews for the same manuscript, the editor often will solicit one or
more additional reviews as a tie-breaker. As another strategy in the
case of ties, editors may invite authors to reply to a referee's criticisms
and permit a compelling rebuttal to break the tie. If an editor does
not feel confident to weigh the persuasiveness of a rebuttal, the
editor may solicit a response from the referee who made the original
criticism. In rare instances, an editor will convey communications back
and forth between authors and a referee, in effect allowing them to
debate a point. Even in these cases, however, editors do not allow
referees to confer with each other, and the goal of the process is
explicitly not to reach consensus or to convince anyone to change their
opinions. Some medical journals, however (usually following the open access
model), have begun posting on the Internet the pre-publication history
of each individual article, from the original submission to reviewers'
reports, authors' comments, and revised manuscripts.

Traditionally, reviewers would remain anonymous to the authors, but
this standard is slowly changing. In some academic fields, most
journals now offer the reviewer the option of remaining anonymous or
not, or a referee may opt to sign a review, thereby relinquishing
anonymity. Published papers sometimes contain, in the acknowledgements
section, thanks to anonymous or named referees who helped improve the

Some university presses undertake peer review of books. After
positive review by two or three independent referees, a university
press sends the manuscript to the press's editorial board, a committee
of faculty members, for final approval.[1] Such a review process is a requirement for full membership of the Association of American University Presses.[2]

In some disciplines there exist refereed venues (such as conferences
and workshops). To be admitted to speak, scholars and scientists must
submit papers (generally short, often 15 pages or less) in advance.
These papers are reviewed by a "program committee" (the equivalent of
an editorial board), which generally requests inputs from referees. The
hard deadlines set by the conferences tend to limit the options to
either accept or reject the paper.

[edit] Recruiting referees

At a journal or book publisher, the task of picking reviewers typically falls to an editor.[3] When a manuscript arrives, an editor solicits reviews from scholars or other experts who may or may not have already expressed a willingness to referee for that journal or book division. Granting agencies typically recruit a panel or committee of reviewers in advance of the arrival of applications.

Typically referees are not selected from among the authors' close colleagues, students, or friends. Referees are supposed to inform the editor of any conflict of interests
that might arise. Journals or individual editors often invite a
manuscript's authors to name people whom they consider qualified to
referee their work. Indeed, for a number of journals this is a
requirement of submission. Authors are sometimes also invited to name
natural candidates who should be disqualified, in which case
they may be asked to provide justification (typically expressed in
terms of conflict of interest). In some disciplines, scholars listed in
an "acknowledgements" section are not allowed to serve as referees
(hence the occasional practice of using this section to disqualify
potentially negative reviewers).

Editors solicit author input in selecting referees because academic
writing typically is very specialized. Editors often oversee many
specialities, and may not be experts in any of them, since editors may
be full time professionals with no time for scholarship.
But after an editor selects referees from the pool of candidates, the
editor typically is obliged not to disclose the referees' identities to
the authors, and in scientific journals, to each other. Policies on
such matters differ among academic disciplines.

Recruiting referees
is a political art, because referees, and often editors, are usually
not paid, and reviewing takes time away from the referee's main
activities, such as his or her own research. To the would-be
recruiter's advantage, most potential referees are authors themselves, or at least readers, who know that the publication system requires that experts
donate their time. Referees also have the opportunity to prevent work
that does not meet the standards of the field from being published,
which is a position of some responsibility. Editors are at a special
advantage in recruiting a scholar
when they have overseen the publication of his or her work, or if the
scholar is one who hopes to submit manuscripts to that editor's
publication in the future. Granting agencies, similarly, tend to seek
referees among their present or former grantees. Serving as a referee
can even be a condition of a grant, or professional association

Another difficulty that peer-review organizers face is that, with
respect to some manuscripts or proposals, there may be few scholars who
truly qualify as experts. Such a circumstance often frustrates the
goals of reviewer anonymity and the avoidance of conflicts of interest.
It also increases the chances that an organizer will not be able to
recruit true experts – people who have themselves done work similar to
that under review, and who can read between the lines. Low-prestige or
local journals and granting agencies that award little money are
especially handicapped with regard to recruiting experts.

Finally, anonymity adds to the difficulty in finding reviewers in another way. In scientific circles, credentials and reputation
are important, and while being a referee for a prestigious journal is
considered an honor, the anonymity restrictions make it impossible to
publicly state that one was a referee for a particular article.
However, credentials and reputation are principally established by
publications, not by refereeing; and in some fields refereeing may not
be anonymous.

The process of peer review does not end after a paper completes the
peer review process. After being put to press, and after 'the ink is
dry', the process of peer review continues in journal clubs.
Here groups of colleagues review literature and discuss the value and
implications it presents. Journal clubs will often send letters to the
editor of a journal, or correspond with the editor via an on-line
journal club. In this way, all 'peers' may offer review and critique of
published literature.

[edit] Different styles of review

Peer review can be rigorous, in terms of the skill brought to bear, without being highly stringent.
An agency may be flush with money to give away, for example, or a
journal may have few impressive manuscripts to choose from, so there
may be little incentive for selection. Conversely, when either funds or
publication space is limited, peer review may be used to select an
extremely small number of proposals or manuscripts.

Often the decision of what counts as "good enough" falls entirely to
the editor or organizer of the review. In other cases, referees will
each be asked to make the call, with only general guidance from the
coordinator on what stringency to apply.

Very general journals such as Science and Nature
have extremely stringent standards for publication, and will reject
papers that report good quality scientific work if editors feel the
work is not a breakthrough in the field. Such journals generally have a
two-tier reviewing system. In the first stage, members of the editorial
board verify that the paper's findings — if correct — would be
ground-breaking enough to warrant publication in Science or Nature.
Most papers are rejected at this stage. Papers that do pass this
'pre-reviewing' are sent out for in-depth review to outside referees.
Even after all reviewers recommend publication and all reviewer
criticisms/suggestions for changes have been met, papers may still be
returned to the authors for shortening to meet the journal's length
limits. With the advent of electronic journal editions, overflow
material may be stored in the journal's online Electronic Supporting
Information archive.

A similar emphasis on novelty exists in general area journals such as the Journal of the American Chemical Society (JACS).
However, these journals generally send out all papers (except blatantly
inappropriate ones) for peer reviewing to multiple reviewers. The
reviewers are specifically queried not just on the scientific quality
and correctness, but also on whether the findings are of interest to
the general area readership (chemists of all disciplines, in the case
of JACS) or only to a specialist subgroup. In the latter case,
the recommendation is usually for publication in a more specialized
journal. The editor may offer to authors the option of having the
manuscript and reviews forwarded to such a journal with the same
publishers (e.g., in the example given, Journal of Organic Chemistry, Journal of Physical Chemistry, Inorganic Chemistry,...)
if the reviewer reports warrant such a decision (i.e., they boil down
to "Great work, but too specialized for JACS: publish in ..."), the
editor of such a journal may accept the forwarded manuscript without
further reviewing.

Some general area journals, such as Physical Review Letters, have strict length limitations. Others, such as JACS, have Letters and Full Papers sections: the Letters sections have strict length limits (two journal pages in the case of JACS) and special novelty requirements. In contrast, online-only journals may have no space limitations.[4] More specialized scientific journals such as the aforementioned chemistry journals, Astrophysical Journal, and the Physical Review
series use peer review primarily to filter out obvious mistakes and
incompetence, as well as plagiarism, overly derivative work, and
straightforward applications of known methods. Different publication
rates reflect these different criteria: Nature publishes about 5 percent of received papers, while Astrophysical Journal publishes about 70 percent. The different publication rates are also reflected in the size of the journals. PLoS ONE was launched by the Public Library of Science
in 2006 with the aim to "concentrate on technical rather than
subjective concerns", and to publish articles from across science,
regardless of the field.[5]. Another open access journal, Biology Direct, has the policy of making the reviewers' reports public by publishing the reports together with the manuscripts.

Screening by peers may be more or less laissez-faire depending on the discipline. Physicists,
for example, tend to think that decisions about the worthiness of an
article are best left to the marketplace. Yet even within such a
culture peer review serves to ensure high standards in what is
published. Outright errors are detected and authors receive both edits
and suggestions.

To preserve the integrity of the peer-review process, submitting
authors may not be informed of who reviews their papers; sometimes,
they might not even know the identity of the associate editor who is
responsible for the paper. In many cases, alternatively called "masked"
or "double-masked" review (or "blind" or "double-blind" review), the
identity of the authors is concealed from the reviewers, lest the
knowledge of authorship bias their review; in such cases, however, the
associate editor responsible for the paper does know who the author is.
Sometimes the scenario where the reviewers do know who the authors are
is called "single-masked" to distinguish it from the "double-masked"
process. In double-masked review, the authors are required to remove
any reference that may point to them as the authors of the paper.

While the anonymity of reviewers is almost universally preserved,
double-masked review (where authors are also anonymous to reviewers) is
still relatively rarely employed.

Critics of the double-masked process point out that, despite the
extra editorial effort to ensure anonymity, the process often fails to
do so, since certain approaches, methods, writing styles, notations,
etc., may point to a certain group of people in a research stream, and
even to a particular person.[6][7]
Proponents of double-masked review argue that it performs at least as
well as the traditional one and that it generates a better perception
of fairness and equality in global scientific funding and publishing.[8]

Proponents of the double-masked process argue that if the reviewers
of a paper are unknown to each other, the associate editor responsible
for the paper can easily verify the objectivity of the reviews.
Single-masked review is thus strongly dependent upon the goodwill of
the participants.

A conflict of interest
arises when a reviewer and author have a disproportionate amount of
respect (or disrespect) for each other. As an alternative to
single-masked and double-masked review, authors and reviewers are
encouraged to declare their conflicts of interest when the names of
authors and sometimes reviewers are known to the other. When conflicts
are reported, the conflicting reviewer is prohibited from reviewing and
discussing the manuscript. The incentive for reviewers to declare their
conflicts of interest is a matter of professional ethics and individual
integrity. While their reviews are not public, these reviews are a
matter of record and the reviewer's credibility depends upon how they
represent themselves among their peers. Some software engineering
journals, such as the IEEE Transactions on Software Engineering, use non-blind reviews with reporting to editors of conflicts of interest by both authors and reviewers.

A more rigorous standard of accountability is known as an audit.
Because reviewers are not paid, they cannot be expected to put as much
time and effort into a review as an audit requires. Most journals (and
grant agencies like NSF) have a policy that authors must archive
their data and methods in the event another researcher wishes to
replicate or audit the research after publication. Unfortunately, the
archiving policies are sometimes ignored by researchers.

[edit] Criticisms of peer review

One of the most common complaints about the peer review process is
that it is slow, and that it typically takes several months or even
several years in some fields for a submitted paper to appear in print.
In practice, much of the communication about new results in some fields
such as astronomy no longer takes place through peer reviewed papers, but rather through preprints submitted onto electronic servers such as
However, such preprints are often also submitted to refereed journals,
and in many cases have, at the time of electronic submission, already
passed through the peer review process and been accepted for

While passing the peer-review process is often considered in the scientific community to be a certification of validity, it is not without its problems. Drummond Rennie, deputy editor of Journal of the American Medical Association
is an organizer of the International Congress on Peer Review and
Biomedical Publication, which has been held every four years since 1986.[9]
He remarks, "There seems to be no study too fragmented, no hypothesis
too trivial, no literature too biased or too egotistical, no design too
warped, no methodology too bungled, no presentation of results too
inaccurate, too obscure, and too contradictory, no analysis too
self-serving, no argument too circular, no conclusions too trifling or
too unjustified, and no grammar and syntax too offensive for a paper to
end up in print."[10]

Richard Horton,
editor of the British medical journal The Lancet, has said that "The
mistake, of course, is to have thought that peer review was any more
than a crude means of discovering the acceptability — not the validity
— of a new finding. Editors and scientists alike insist on the pivotal
importance of peer review. We portray peer review to the public as a
quasi-sacred process that helps to make science our most objective
truth teller. But we know that the system of peer review is biased,
unjust, unaccountable, incomplete, easily fixed, often insulting,
usually ignorant, occasionally foolish, and frequently wrong." [11]

[edit] Allegations of bias and suppression

The interposition of editors and reviewers between authors and
readers always raises the possibility that the intermediators may serve
as gatekeepers. Some sociologists of science argue that peer review makes the ability to publish susceptible to control by elites and to personal jealousy.[12] The peer review process may suppress dissent against "mainstream" theories.[13][14][15] Reviewers tend to be especially critical of conclusions that contradict their own views,
and lenient towards those that accord with them. At the same time,
elite scientists are more likely than less established ones to be
sought out as referees, particularly by high-prestige journals or publishers.
As a result, it has been argued, ideas that harmonize with the elite's
are more likely to see print and to appear in premier journals than are
iconoclastic or revolutionary ones, which accords with Thomas Kuhn's well-known observations regarding scientific revolutions.[16]

Others have pointed out that there is a very large number of scientific journals in which one can publish, making total control of information
difficult. In addition, the decision-making process of peer review, in
which each referee gives their opinion separately and without
consultation with the other referees, is intended to mitigate some of
these problems. Some have suggested that:

"... peer review does not thwart new ideas. Journal editors and the
'scientific establishment' are not hostile to new discoveries. Science
thrives on discovery and scientific journals compete to publish new

Nonetheless, while it is generally possible to publish results
somewhere, in order for scientists in many fields to attract and
maintain funding it is necessary to publish in prestigious journals.
Such journals are generally identified by their impact factor. The small number of high-impact journals is susceptible to control by an elite group of anonymous reviewers.[citation needed]
Results published in low-impact journals are usually ignored by most
scientists in any field. This has led to calls for the removal of
reviewer anonymity (especially at high-impact journals) and for the
introduction of author anonymity (so that reviewers cannot tell whether
the author is a member of any elite).[citation needed]

[edit] Peer review failures

For more details on this topic, see Peer review failure.

Peer review failures occur when a peer-reviewed article contains
obvious fundamental errors that undermines at least one of its main
conclusions. Peer review is not considered a failure in cases of
deliberate fraud by authors. Letters-to-the-editor that correct major
errors in articles are a common indication of peer review failures.
Many journals have no procedure to deal with peer review failures
beyond publishing letters.[18]
Some do not even publish letters. The author of a disputed article is
allowed a published reply to a critical letter. Neither the letter nor
the reply is usually peer-reviewed, and typically the author rebuts the
criticisms. Thus, the readers are left to decide for themselves if
there was a peer review failure.

Peer review, in scientific journals, assumes that the article
reviewed has been honestly written, and the process is not designed to
detect fraud. The reviewers usually do not have full access to the data
from which the paper has been written and some elements have to be
taken on trust. It is not usually practical for the reviewer to
reproduce the author's work, unless the paper deals with purely
theoretical problems which the reviewer can follow in a step-by-step

The number and proportion of articles which are detected as fraudulent at review stage is unknown. Some instances of outright scientific fraud and scientific misconduct
have gone through review and were detected only after other groups
tried and failed to replicate the published results. An example is the
case of Jan Hendrik Schön, in which a total of fifteen papers were accepted for publication in the top ranked journals Nature and Science
following the usual peer review process. All fifteen were found to be
fraudulent and were subsequently withdrawn. The fraud was eventually
detected, not by peer review, but after publication when other groups
tried and failed to reproduce the results of the paper.

The International Committee for Medical Journal Editors' Uniform Requirements for Manuscripts Submitted to Biomedical Journals[19] states that "if a fraudulent paper has been published, the journal must print a retraction",[20] and gives guidelines on investigating alleged fraud. Members of the UK-based Committee on Publication Ethics[21](COPE) have a duty to investigate allegations of misconduct.[22]

A study published in the peer reviewed
Lancet Journal associating long-term use of non-steroidal
anti-inflammatory drugs (NSAIDs) with a lower risk of oral cancer, was
shown to be "completely fabricated"[23] , after which the journal published a retraction, and acknowledged that the study "contains fabricated data." [24]

Although it is often argued that fraud cannot be detected during peer review, the Journal of Cell Biology uses an image screening process that it claims could have identified the apparently manipulated figures published in Science by Woo-Suk Hwang.[25]

[edit] Peer review and plagiarism

A few cases of plagiarism by historians have been widely publicized.[26] A poll of 3,247 scientists funded by the U.S. National Institutes of Health found 0.3% admitted faking data, 1.4% admitted plagiarism, and 4.7% admitted to autoplagiarism.[27]
Autoplagiarism involves an author republishing the same material or
data without citing their earlier work. An author often uses
autoplagiarism to pad their list of publications. Sometimes reviewers
detect cases of likely plagiarism and bring them to the attention of
the editor. Reviewers generally lack access to raw data, but do see the
full text of the manuscript. Thus, they are in a better position to
detect plagiarism or autoplagiarism of prose than fraudulent data.

Although it is more common than plagiarism, journals and employers
often do not punish authors for autoplagiarism. Autoplagiarism is
against the rules of most peer-reviewed journals, which usually require
that only unpublished material be submitted.

[edit] Abuse of inside information by reviewers

A related form of professional misconduct that is sometimes reported
is a reviewer using the not-yet-published information from a manuscript
or grant application for personal or professional gain. The frequency
with which this happens is of course unknown, but the United States Office of Research Integrity
has sanctioned reviewers who have been caught exploiting knowledge they
gained as reviewers. A possible defense (for authors) against this form
of misconduct on the part of reviewers is to pre-publish their work in
the form of a preprint or technical report on a public system such as arXiv. The preprint can later be used to establish priority.

[edit] Dynamic and open peer review


It has been suggested that this section be split into a new article entitled Open peer review. (Discuss)


It has been suggested that traditional anonymous peer review lacks
accountability, can lead to abuse by reviewers, and may be biased and
inconsistent,[28] alongside other flaws.[29][30] In response to these criticisms, other systems of peer review with various degrees of "openness" have been suggested.

In 1996, the Journal of Interactive Media in Education[31] launched using open peer review.[32]
Reviewers' names are made public and they are therefore accountable for
their review, but they also have their contribution acknowledged.
Authors have the right of reply, and other researchers have the chance
to comment prior to publication. In 1999, the open access journal Journal of Medical Internet Research[33]
was launched, which from its inception decided to publish the names of
the reviewers at the bottom of each published article. Also in 1999,
the British Medical Journal[34] moved to an open peer review system, revealing reviewers' identities to the authors (but not the readers),[35] and in 2000, the medical journals in the open access BMC series[36] published by BioMed Central, launched using open peer review. As with the BMJ,
the reviewers' names are included on the peer review reports. In
addition, if the article is published the reports are made available
online as part of the 'pre-publication history'.

Several of the other journals published by the BMJ group[37] allow optional open peer review,[38][39][40] as do PLoS Medicine, published by the Public Library of Science[41][42].

The evidence of the effect of open peer review upon the quality of
reviews, the tone and the time spent on reviewing is mixed, although it
does seem that under open peer review, more of those who are invited to
review decline to do so.[43][44]

In June 2006, the high impact journal Nature
launched an experiment in parallel open peer review — some articles
that had been submitted to the regular anonymous process were also
available online for open, identified public comment.[45]
The results were less than encouraging — only 5% of authors agreed to
participate in the experiment, and only 54% of those articles received
The editors have suggested that researchers may have been too busy to
take part and were reluctant to make their names public. The knowledge
that articles were simultaneously being subjected to anonymous peer
review may also have affected the uptake.

In 2006, a group of UK academics launched the online journal Philica, which tries to redress many of the problems of traditional peer review. Unlike in a normal journal, all articles submitted to Philica
are published immediately and the review process takes place
afterwards. Reviews are still anonymous, but instead of reviewers being
chosen by an editor, any researcher who wishes to review an article can
do so. Reviews are displayed at the end of each article, and so are
used to give the reader criticism or guidance about the work, rather
than to decide whether it is published or not. This means that
reviewers cannot suppress ideas if they disagree with them. Readers use
reviews to guide what they read, and particularly popular or unpopular
work is easy to identify.

Another approach that is similar in spirit to Philica is that of a dynamical peer review site, Naboj.[48] Unlike Philica, Naboj is not a full-fledged online journal, but rather it provides an opportunity for users to write peer reviews of preprints at The review system is modeled on Amazon
and users have an opportunity to evaluate the reviews as well as the
articles. That way, with a sufficient number of users and reviewers,
there should be a convergence towards a higher quality review process.

In February 2006, the journal Biology Direct[49] was launched by Eugene Koonin, Laura Landweber, and David Lipman,
providing another alternative to the traditional model of peer review.
If authors can find three members of the Editorial Board who will each
return a report or will themselves solicit an external review, then the
article will be published. As with Philica, reviewers cannot suppress publication, but in contrast to Philica,
no reviews are anonymous and no article is published without being
reviewed. Authors have the opportunity to withdraw their article, to
revise it in response to the reviews, or to publish it without
revision. If the authors proceed with publication of their article
despite critical comments, readers can clearly see any negative
comments along with the names of the reviewers.[50]

An extension of peer review beyond the date of publication is Open Peer Commentary, whereby expert commentaries are solicited on published articles, and the authors are encouraged to respond. The BMJ's Rapid Responses[51] allow ongoing debate and criticism following publication.[52]
By 2005, the editors found it necessary to more rigorously enforce the
criteria for acceptance of Rapid Responses, to weed out the "bores".[53]

[edit] Peer review of policy

The technique of peer review is also used to improve government policy. In particular, the European Union uses it as a tool in the 'Open Method of Co-ordination' of policies in the fields of employment and social inclusion.

A programme of peer reviews in active labour market policy[54] started in 1999, and was followed in 2004 by one in social inclusion.[55]
Each programme sponsors about eight peer review meetings in each year,
in which a 'host country' lays a given policy or initiative open to
examination by half a dozen other countries and relevant European-level
NGOs. These usually meet over two days and include visits to local
sites where the policy can be seen in operation. The meeting is
preceded by the compilation of an expert report on which participating
'peer countries' submit comments. The results are published on the web.

[edit] U.S. government peer review policies

Main article: U.S. Government peer review policies

[edit] History of peer review

The first recorded peer review process was at The Royal Society in 1665 by the founding editor of Philosophical Transactions of the Royal Society, Henry Oldenburg.[56][57]

According to the common definition of a peer review, the first peer review was the Medical Essays and Observations published by the Royal Society of Edinburgh in 1731. The present-day peer review system evolved from this 18th century process.[58]

A practice similar to a peer review process is found in the Ethics of the Physician written by Ishaq bin Ali al-Rahwi (854–931) of al-Raha, Syria.
His work, as well as later Arabic medical manuals, state that a
visiting physician must always make duplicate notes of a patient's
condition on every visit. When the patient was cured or had died, the
notes of the physician were examined by a local medical council of
other physicians, who would review
the practising physician's notes to decide whether his/her performance
have met the required standards of medical care. If their reviews were
negative, the practicing physician could face a lawsuit from a maltreated patient.[59]

Peer review has been a touchstone of modern scientific method only since the middle of the 20th century, the only exception being medicine. Before then, its application was lax in other scientific fields. For example, Albert Einstein's revolutionary "Annus Mirabilis" papers in the 1905 issue of Annalen der Physik were not peer-reviewed by anyone other than the journal's editor in chief, Max Planck (the father of quantum theory), and its co-editor, Wilhelm Wien.
Although clearly peers (both won Nobel prizes in physics), a formal
panel of reviewers was not sought, as is done for many scientific
journals today. Established authors and editors were given more
latitude in their journalistic discretion, back then. In a recent
editorial in Nature, it was stated that "in journals in those
days, the burden of proof was generally on the opponents rather than
the proponents of new ideas."[60]

[edit] Peer review of software development

Main article: Software peer review

[edit] See also

[edit] References

The references used in this article may be clearer with a different or consistent style of citation, footnoting, or external linking.

  1. ^ Arnold, Gordon B. (2003). "University presses". Encyclopedia of Education (2nd ed.) v. 7. Ed. James W. Guthrie. New York: Macmillan Reference USA, p. 2601. ISBN 0-02-865601-6. 
  2. ^ AAUP Membership Benefits and Eligibility. Association of American University Presses. Retrieved on 2008-02-02.
  3. ^ Lawrence O'Gorman (January 2008). "The (Frustrating) State of Peer Review". IAPR Newsletter 30 (1): 3–5. 
  4. ^ BioMed Central | for authors | Reasons to publish with us
  5. ^ PLoS ONE: Publishing science, accelerating research
  6. ^ Action Potential: Double-blind peer review?
  7. ^ "Editorial: Working double-blind" (7 February 2008). Nature 451 (451): 605–606. NPG. doi:10.1038/451605b. Retrieved on 2008-03-01. 
  8. ^ "Peer Review—The Newcomers' Perspective" (2004) PLoS Biol. 2005 September; 3(9): e326 doi: 10.1371/journal.pbio.0030326.
  9. ^ JAMA - Fifth International Congress on Peer Review and Biomedical Publication: Call for Research, March 19, 2003, Rennie et al. 289 (11): 1438
  10. ^ Science Writers: The Maharishi Caper
  11. ^ eMJA: Horton, Genetically modified food: consternation, confusion, and crack-up
  12. ^ "British scientists exclude 'maverick' colleagues, says report" (2004) EurekAlert Public release date: 16 August 2004
  13. ^ Brian Martin, "Suppression Stories" (1997) in Fund for Intellectual Dissent ISBN 0-646-30349-X
  14. ^ See also Juan Miguel Campanario, "Rejecting Nobel class articles and resisting Nobel class discoveries", cited in Nature, 16 October 2003, Vol 425, Issue 6959, p.645
  15. ^ Juan Miguel Campanario and Brian Martin, "Challenging dominant physics paradigms" (2004) Journal of Scientific Exploration, vol. 18, no. 3, Fall 2004, pp. 421-438
  16. ^ See also: Sophie Petit-Zeman, "Trial by peers comes up short" (2003) The Guardian, Thursday January 16, 2003
  17. ^ Ayala, F.J. "On the scientific methods, its practice and pitfalls", (1994) History and Philosophy of Life Sciences 16, 205-240.
  18. ^ Afifi, M. Reviewing the “Letter-to-editor” section in the Bulletin of the World Health Organization, 2000-2004. Bulletin of the World Health Organization.
  19. ^
  20. ^
  21. ^ Committee on Publication Ethics (COPE) – Seminar 2008 — COPE
  22. ^ A code of conduct for editors of biomedical journals — COPE
  23. ^ The Scientist: Lancet study faked
  24. ^ Elsevier
  25. ^ The Scientist: How to Guard Against Image Fraud
  26. ^ Historians on the Hot Seat
  27. ^ Weiss, Rick. 2005. Many scientists admit to misconduct: Degrees of deception vary in poll. Washington Post. June 9, 2005. page A03.[1]
  28. ^ Reproducibility
    of peer review in clinical neuroscience: Is agreement between reviewers
    any greater than would be expected by chance alone? - Rothwell and
    Martyn 123 (9): 1964 - Brain
  29. ^ The Peer Review Process
  30. ^ Alison McCook (February 2006). "Is Peer Review Broken?". The Scientist. 
  31. ^ Journal of Interactive Media in Education
  32. ^ About JIME
  33. ^ JMIR Home
  34. ^ BMJ - Helping doctors make better decisions
  35. ^ Opening up BMJ peer review - Smith 318 (7175): 4 - BMJ
  36. ^ BMC series
  37. ^ BMJ Group website — BMJ Group website
  38. ^ Peer review at ARD
  39. ^ Peer review at JME
  40. ^ Peer review at EMJ
  41. ^ Public Library of Science
  42. ^ PLoS Medicine: A Peer-Reviewed, Open-Access Journal
  43. ^ Effect
    of open peer review on quality of reviews and on reviewers'
    recommendations: a randomised trial - van Rooyen et al. 318 (7175): 23
    - BMJ
  44. ^ Elizabeth Walsh, Maeve Rooney, Louis Appleby, Greg Wilkinson (2000). "Open peer review: a randomised controlled trial". The British Journal of Psychiatry 176 (1): 47–51. doi:10.1192/bjp.176.1.47. PMID 10789326. 
  45. ^ Peer Review Trial
  46. ^ Overview: Nature's trial of open peer review
  47. ^ Peer review and fraud: Article: Nature
  48. ^ Naboj Dynamical Peer Review
  49. ^ Biology Direct | Home page
  50. ^ Biology Direct |
  51. ^ Rapid Responses published in the past day
  52. ^ Twenty thousand conversations - Delamothe and Smith 324 (7347): 1171 - BMJ
  53. ^ Revitalising rapid responses - Davies and Delamothe 330 (7503): 1284 - BMJ
  54. ^ Manila Housting: Home Page
  55. ^ Peer Review and Assessment in Social Inclusion — Evaluations par les pairs
  56. ^ On Being a Scientist National Academies Press
  57. ^ The Origin of the Scientific Journal and the Process of Peer Review House of Commons Select Committee Report
  58. ^ Dale J. Benos et al.: "The Ups and Downs of Peer Review", Advances in Physiology Education, Vol. 31 (2007), pp. 145–152 (145): "Scientific peer review has been defined as the evaluation of research findings
    for competence, significance, and originality by qualified experts.
    These peers act as sentinels on the road of scientific discovery and
  59. ^ Ray Spier (2002), "The history of the peer-review process", Trends in Biotechnology 20 (8), p. 357-358 [357].
  60. ^ Coping with peer rejection. Nature 425 (6959), 645 (16 October 2003).doi:10.1038/425645a

[edit] General references and further reading

[edit] External links

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Sham peer review
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Sham peer review or malicious peer review, a concept explained by Roland Chalifoux in Medscape General Medicine, is the practice of using a medical peer review process to remove a doctor who is seen to be disruptive, too great an advocate for change, or competitive with other doctors within the same institution.[1] While technically sham peer review is a concept that applies to every discipline, it has most commonly been applied to the healthcare industry recently.

In healthcare, the lines between peer review of physicians and performance appraisal
by non-peers has been blurred. Administrators, nurses, and even
patients play a role in performance appraisals, while peer review is a
system that is only supposed to involve the physicians themselves.

Scientific peer review has traditionally been held to be achievable
only when research and investigations are able to be examined openly.
Medical peer review, in contrast, is protected from open examination by
rules of confidentiality. In this way it also diverges from true peer



[edit] Sham peer review in medicine

In 2005 and 2006, sham peer review was a subject of some controversy in medical circles in the United States.

In some instances, the staff of a poorly functioning hospital may
attempt to blame an individual physician for system failures. Such
system failures are now believed to be widespread in healthcare.

A 2006 New England Journal of Medicine article notes that
"patient-safety experts stress that complex, error-prone systems are at
the root of most mistakes in health care. Archaic, poorly designed
systems often undermine the best efforts of well-intentioned, highly
motivated clinicians and health care personnel to provide safe care. A
major goal of contemporary patient-safety programs is to encourage a
culture of safety and create a blame-free environment in which errors
are seen as a by-product of bad systems, not as caused by bad or
incompetent people. This orientation toward improving systems rather
than blaming people who make mistakes is critical, since it encourages
caregivers to report adverse events and near misses that might be
preventable in the future."[2][3]

In addition to shifting blame to an individual physician for actual system failures, hospitals also attempt to blame physicians for potential
system failures (that have come under scrutiny). In the latter
situation, "errors" are cited which have no associated adverse
outcomes. Such a practice is a scientifically unvalidated premise for
peer review action and has been questioned.[4]
In both situations, scapegoating is the reason for the sham peer
review. This situation appears to be an outgrowth of the legally
contentious atmosphere of healthcare in the 21st century.

Physicians who point out true (or potential) system failures in
healthcare institutions, either from within the institution or to
external evaluators, have been labeled as whistleblowers.

Lawrence R. Huntoon, chairman of the Association of American Physicians and Surgeons
Committee to Combat Sham Peer Review, states that sham peer review is a
tactic that is being increasingly employed as a retaliation against
physicians whom the hospital regards to be whistleblowers. He
distinguishes sham peer review, or "peer review done in bad faith for some purpose other than the furtherance of quality care", from good-faith peer review, or "peer review done in furtherance of the goal of improving the quality of care."[5]

[edit] Sociological analogies

Westhues, Professor of Sociology at the University of Waterloo, describes sham peer review as a special case of workplace mobbing.
Physicians identified the organizational pathology in healthcare and
noted the similarity to workplace mobbing in other fields. Westhues
notes six major parallels between sham peer review of "disruptive
physicians" (in the medical profession) and the academic mobbing of
"difficult professors" in universities.[6]

[edit] Legal basis for sham peer review

Both Chalifoux and Huntoon attribute the ease by which sham peer review can be applied to an unintended side-effect of the Healthcare Quality Improvement Act (HCQIA) of 1986, which grants nearly absolute immunity from liability to doctors who participate in peer reviews.

This immunity extends to fact finding and investigative activities
as well as to any associated peer review hearing whether or not it
leads to a disciplinary (or other) action.[7] [8]

In California, a "peer review body" is defined in Business and Professions Code 805[9]
to include not only the medical or professional staff of a healthcare
institution, but also a health care service plan, a disability insurer,
a local non-profit medical or professional society, and any ad hoc
committee organized for the purpose of peer review by any entity with at least 25 licentiates.

In Oregon (ORS 41.675), the definition of a peer review body is even
broader, and includes "tissue committees, governing bodies or
committees including medical staff committees of a [licensed] health
care facility ... or any other medical group in connection with bona
fide medical research, quality assurance, utilization review,
credentialing, education, training, supervision or discipline of
physicians or other health care providers."[10]

California has imposed fines of $100,000 to any peer review body
that does not report an action to the medical board (an "805 report").
Complete civil and criminal immunity is afforded any person making an
805 report (BPC 805(j)).

The California legislature
recognized the possibility for abuse of an absolute immunity, however,
and left an opportunity for legal review of peer review committee
decisions through the court system. It framed its statutes so as to
allow "aggrieved physicians the opportunity to prove that the peer
review to which they were subject was in fact carried out for improper
purposes, i.e., for purposes unrelated to assuring quality care or
patient safety".[11] These statutes allow that a peer review can be found in court (by an administrative mandate, CA CCP 1085)[12]
to have been improper due to bad faith or malice, in which case the
peer reviewers' immunities from civil liability "fall by the wayside".[11]
Nevertheless, such cases filed by aggrieved physician prior to the
conclusion of the judicial peer review hearing have been labeled as SLAPP
suits. California has a law against SLAPP suits that has been held to
apply to the medical peer review setting. Therefore, physicians are not
allowed to file suits against peer review participants unless they
first exhaust the peer review process completely (including the
judicial peer review hearing and any appeals process within the

Although California BP&C 809(a)(7) specified an intent that peer
review progress expediently, this is frequently circumvented in sham
peer review, by legal maneuvering. The fairness of a peer review
judicial review hearing that has been unduly delayed has been called
into question,[15] and many medical staff laws specify guidelines for the timeliness of peer review, in compliance with JCAHO
standards. Nevertheless, HCQIA procedural standards for peer review are
less stringent than that of JCAHO, and the immunity granted by HCQIA
has prevented attempts at redress for ignoring timeliness of peer
review proceedings at the federal level in an anti-trust case (Austin
v. McNamara)[1]

No decision has yet been made whether HCQIA affords immunity when
the written intent (regarding timeliness of peer review) of California
statutes is violated.

[edit] The Kibler case

In the July 2006 California Supreme Court decision in Kibler v.
Northern Inyo County Local Hospital District, Inc., that because peer
review proceedings were reviewable by administrative mandate under
B&PC 809.8,[9] they were therefore meant to constitute an "official proceeding authorized by law."[16]

They further noted that under B&PC 809(a)(5) " '[p]eer review,
fairly conducted, will aid the appropriate state licensing boards in
their responsibility to regulate and discipline errant healing arts
practitioners.' Because a hospital's disciplinary action may lead to
restrictions on the disciplined physician's license to practice or to
the loss of that license, its peer review procedure plays a significant
role in protecting the public against incompetent, impaired, or
negligent physicians. (See Arnett, supra, 14 Cal.4th at pp. 7, 11, 56
Cal.Rptr.2d 706, 923 P.2d 1.)"

This interpretation implies that the peer review process, as an
extension of the function of a medical board, may be subject to all the
restrictions to which a medical board is subject. Because medical
boards are usually subject to a large number of legislative regulations
to which peer review proceedings have not historically been subject,
this may be a new, additional, and appropriate significant legal burden
on the peer review process.

States have recently refined the criteria concerning medical board
reviews, regarding expert witnesses, publishing proceedings and
outcomes, and other procedures. It would be beneficial for peer review
to be bound by the same criteria by which a medical board is bound, if
this Kibler interpretation is upheld.

[edit] Jury model of Medical Peer Review

The medical peer review system is a quasi-judicial one. It is modeled in some ways on the grand jury
/ petit jury system. After a complainant asks for an investigation, a
review body is assembled for fact-finding. This fact-finding body,
called an ad hoc committee, is appointed by the medical Chief
of Staff and is composed of other physician staff members chosen at the
Chief of Staff's discretion. This ad hoc committee then conducts an
investigation in the manner it feels is appropriate. This may include a
review of the literature or an outside expert. In Sham Peer Review
there is often neither.

In sham peer review, the committee is unduly influenced by the complainant,
and members may even have financial or other ties to the complainant.
The degree of willingness to rely on testimony during investigation
instead of evaluating facts (such as chart records, labs, and other
"hard data") is one hallmark of sham peer review.

While JCAHO guidelines recommend use of the literature and relevant
clinical practice guidelines (JCAHO Hospital Accreditation Standards
2003 MS 8 to MS 8.4), there is no such requirement for the hospital
under HCQIA. The definition of "peer" also is so open to broad
interpretation that essentially anyone with an advanced degree can
qualify. For example, a family practitioner can review a trauma case.
In one hospital a family practitioner who had attended an Advanced
Trauma Life Support course (but was not a surgeon) was relied upon for
a peer evaluation. A nurse, who may have no knowledge of the issue
before the committee, may also be relied upon to testify.[1]

The ad hoc committee then reports its findings, in whatever detail
it sees fit, to both the Chief of Staff and to a special meeting of the
Medical Executive Committee (fulfilling the basic functions of a grand
jury). At this point the Medical Executive committee invites the
accused physician to provide input. This chance to provide input is
required by law in many states, but there is no standard of what type
of input may be allowed. Similar to a grand jury, the accused physician
is not allowed counsel to represent him or her at this stage.
Furthermore, the Medical Executive Committee is under no obligation at
this point to allow the physician to present a defense, as this right
is afforded at a formal hearing. In Sham Peer Review, the physician is
usually allowed to present very little, if any, evidence at the Medical
Executive Committee (MEC) meeting.

[edit] Verdict and imposition of sentence prior to a hearing

Although the function of the MEC is similar to a grand jury in some
ways, most grand juries only determine whether there is enough evidence
for indictment and do not have the power to issue an injunction or to mete out a sentence.

In the quasi-legal system of medical peer review, however, the MEC
has the ability to not only review any evidence available and decide
whether a hearing is warranted, but also to summarily impose sanctions against the accused physician, such as a suspension or limitation of privileges. These sanctions constitute an injunction that prevents or limits the accused physician's practice of medicine at that institution.

In a Sham Peer Review these sanctions are usually the maximum
possible, i.e. suspension with recommendation for revocation of
hospital privileges. These sanctions are immediately published
nationally through the National Practitioner Data Bank and through
reports to state medical boards. The effects of the sanctions are
therefore not only local but also statewide and national.

The physician is not allowed counsel to contest such an injunction
at the MEC meeting. In this regard it is an extreme deviation from
generally held principles of justice in the United States.

The stated justification for this is the theory that a physician
potentially poses a greater risk of danger to society than other types
of societal dangers. He or she must immediately be removed from
circulation until conclusively proven not to be a danger. A commonly
stated belief is that there is an equal percentage of criminals in the
medical profession as in other professions. There is very little
evidence to substantiate this claim.

relieves the peer review from any potential sanctions for this type of
abuse as well, and there is no defined standard of diligence required
prior to any imposition of injunctive sanctions.

Severity of sanctions in sham peer review is in contravention of
California law (BP&C 809(a)(7)) that states "It is the intent of
the Legislature that peer review of professional health care services
be done efficiently, on an ongoing basis, and with an emphasis on early
detection of potential quality problems and resolutions through
informal educational interventions."[9]

[edit] The Fair Hearing process

Once the physician has been indicted (and sanctioned) he or she then has the right to request a hearing. At the hearing, counsel
is allowed. A second independent panel of physicians is chosen as the
petit jury, and a hearing officer is chosen. The accused physician has
the option to demonstrate conflicts of interest and attempt to
disqualify jurors based on reasonable suspicions of bias or conflicts
of interest in a voir dire process.

At the hearing, the plaintiff
is formally the medical staff, of which the medical executive committee
is comprised. In this regard the grand jury and the plaintiff are the
same body. This is also unusual in American justice.

[edit] Potential conflicts of interest between Hospital and Medical Staff

Most medical staff bodies utilize the hospital attorney and accept
hospital funds to try peer review cases. Although the hospital and
medical staff are technically independent entities, this independence
is lost by this arrangement. In Sham Peer Review, the hospital, through
its shared attorney, unduly influences the outcome of the proceeding.
This effectively negates the independence of the medical staff.

Several law firms have made a business around the country promoting
"Strategies and Tactics for Medical Staff Peer Review Disputes." The
largest is Horty, Springer and Mattern, which hold regional conferences
around the country to teach hospitals how to take advantage of the
absolute immunity protections afforded to the peer review process.
Hospital administrators or physicians in positions of power (often
board members) often attend seminars to learn legal techniques to
influence peer review outcomes. Colloquially these have become known as
Horty Springer techniques.[17] These large multi-state law firms, such as Davis, Wright, and Tremaine[18] and Foley and Lardner,[19]
specialize in racketeering and labor disputes and have both attacked
and defended racketeering cases and therefore accumulated extensive
experience in these fields.

The California Medical Association and others have strongly
advocated against this practice and warns medical staffs about its
dangers. California has enacted legislation formally requiring the
separation of the hospital and medical staff.[20]

[edit] Other Sham Peer Review techniques in healthcare

One of the most common techniques, the one used most frequently, is a system of sham "performance appraisal,"
in which a file is created for each member of the hospital staff. Minor
complaints accrue in this file for each physician or nurse on staff.
Many hospitals now encourage a system of complaints against physicians
(and nurses and other hospital personnel). The number of complaints,
rather than the content, are then used as justification for a sham peer

It is usually not very difficult to collect vague and minor
complaints about a large number of physicians and nurses in the
hospital using such a system. The system is often given the euphemism
"suggestion box for quality improvement." In hospitals where there is a
contentious nursing environment, such as an ongoing union dispute,
complaints are very easy to garner.

This practice has been a major source of contention between nurses' unions and hospitals.

Physicians often may not be part of the system as contributors or
reviewers, despite being the target of complaints. A physician (or
nurse) that reaches a threshold number of complaints (which can vary
from hospital to hospital), is labeled a "disruptive physician" (or
"disruptive nurse").

Originally the term "disruptive physician" was used to characterize
an individual who promoted an atmosphere of physical or other fear in
employees of a degree that they would not be able to execute their job.
However, it is now most commonly applied in the context of vague
slights and normal frictions that are normal in a large organization.
These are encouraged to be reported and are then catalogued. (It is
rare to have a truly disruptive physician paralyze the medical staff.)

"Dissatisfaction with a colleague's performance" surveys are
pseudo-quality data are used to justify personnel changes or cutbacks
(in nursing) or to justify a disruptive physician accusation in sham
peer review. As touted in tactics seminars, the more vague the
accusation, the harder it is to disprove.

In recent years, this type of sham performance appraisal, often used
to replace outcomes reviews, has become popular with both
administrators and insurance companies alike. It is used in sham
"pay-for-performance" schemes directed at reducing reimbursements to
physicians or other personnel based on vague pseudo-indicators.
Hospital-based employees, such as hospitalists, anesthesiology groups,
radiologists, emergency departments, and pathologists, are especially
prone to this type of maneuver during salary negotiations or other
contract negotiations.

[edit] The role of independent appraisal systems in sham peer review

In some instances, sham peer review can be independent from physician-run departmental peer review.

A sham peer review may entail multiple complaints to an informal "systems analysis"
committee, run by administration, that is not bound by the regulations
of the Patient Safety Quality Improvement Act of 2005 (see below).
These complaints may be reviewed by administrators, nurses, or
physicians that are part of, or sympathetic to, the administration, and
may not be run through a clinical departmental peer review.

These complaints may then be referred directly to an ad hoc
committee, bypassing departmental peer review. If they are
simultaneously or later also evaluated in departmental peer review,
their conclusions may be contradictory to those determined by
physician-based departmental review.

Complaints from "performance appraisal" review committees (almost
always run by the administration) may also be forwarded to an ad hoc
peer review committee run by a medical staff member sympathetic to the
administration, bypassing normal channels of departmental peer review
as well.

When such charges stemming from this type of review are brought
against a physician bypassing or in contradiction to clinical
departmental peer review, this is almost always a sham peer review.

[edit] Non-binding nature of Fair Hearing

Lastly, while the medical staff is the plaintiff in a peer review
hearing and the Medical Executive Committee serves as grand jury, the
hospital board has final decision whether to accept the results of the
hearing or not. There have been instances in which a fair hearing has
concluded that no merit exists to accusations against a physician, only
to have a board impose penalties anyway. In the most extreme
circumstance, the same physician can be complainant, member of the
medical executive committee, and also a member of the board. This not
entirely uncommon situation is very susceptible to sham peer review and
an unbiased outcome is highly unlikely. Currently there are no checks
and balances against such abuse.

In the case of Mileikowsky v Tenet (which ran Tarzana Hospital in
2000), Mileikowsky was subject to multiple hearings for the same
charges and his rights of an expedited hearing were allegedly denied
while a suspension was in place. On May 15, 2001, the California
Medical Association filed an amicus curiae
brief to emphasize legal protections meant to prevent physicians being
arbitrarily excluded from access to healthcare facilities based on
mechanisms such as summary suspension without a speedy hearing. This
case is still being heard in the California Court of Appeals.[21]

[edit] Whistleblowing and sham peer review

The contention that many physicians are targets of sham peer review due to whistleblowing activities has received significant attention recently. The Sarbanes-Oxley Act
of 2002 was passed at the federal level in response to whistleblowing
in the accounting scandals of major companies such as Enron, Tyco, and

In 1999, an anesthesiologist in (Yuba City, CA) named Khajavi fought
with a surgeon when he believed an elderly patient should not undergo
cataract surgery. The anesthesiologist was subsequently terminated from
his anesthesia group over the altercation. He sued for wrongful
termination per California B&PC 2056, and the suit was allowed by
the California Court of Appeals, which held in 2000 that a physician
could bring a suit for wongful termination on the basis of advocating
for medically appropriate health care (it did not rule on the merits of
the altercation.)[22]

[edit] Attempts to prevent sham peer review

The Healthcare Quality Improvement Act
of 1986 was initially introduced by a Congressman from Oregon. Nearly
20 years later, the Oregon Medical Association has passed a resolution
to "explore ways and means to prevent misuse of the "Disruptive Doctor
Doctrine," a reference to the label hospitals attach to doctors viewed
as troublemakers, sometimes unfairly.[23]

The Illinois State Medical Society has placed Sham Peer Review and
Sham Privileges Suspension on its legislative agenda for 2007.[21]

In 2006, the Michigan Supreme Court ruled that the Michigan immunity
statutes does not protect the peer review committee if it acts with
malice, specifically meaning that the committee acted with a reckless
disregard of the truth.[24]

Protection from immunity under the federal HCQIA is not absolute. If
a peer review panel is not taken after a reasonable effort to obtain
the facts or if its actions are unreasonably restrictive, then it is
not afforded immunity (Brown v. Presbyterian Healthcare Services, from
the 10th Circuit Court of Appeals.)[25]

The HCQIA avoided establishing good faith standards for peer review, as noted in Austin v. McNamara.[25]

Medical professional organizations have reviewed concepts of medical
error in detail, given the alarmist but inconsistent claims of
widespread error in the healthcare industry by attorneys and consumer
groups. They describe a wide spectrum of medical error, from
insignificant to catastrophic, and note that errors are not all equal
for purposes of peer review.[4]

In New York in 1986, peer review actions were required to be
adjudicated in court to provide an independent forum. At the time, the
AMA objected, because they feared peer review would become inefficient
if tied up in the legal system.

Many other state boards, however, have a system of administrative
review to provide an independent forum to review their peer review

Oversight of the peer review process by the Medical Board of
California (through an independent committee) was established by the
California legislature to prevent peer review abuse.(BP&C 805.2)[9]

[edit] The development of the Patient Safety Organization (PSO)

The Patient Safety and Quality Improvement Act of 2005 (Public Law
109-41) allows for the creation of Patient Safety Organizations.
Because of widespread belief that the peer review system had become
corrupted and was not useful for systems failure analysis, these
parallel quality of care committees were authorized to gather
information to be analyzed by hospital administrators, nurses, and
physicians as a tool for systems failure analysis.

They are able to be used by any healthcare entity except insurance companies, but must be registered with the AHRQ wing of the US Department of Health and Human Services.

In these PSOs, root cause analysis and "near misses" are evaluated in an attempt to avert major errors.

As discussed above, the definition of an "error"
or "near miss" is predicated on adverse events, however, and should not
be based on speculation or non-evidence-based, non-standardized
personal opinions of participants of the PSO.[4]
In an attempt to prevent the common situation of introducing personal
bias in systems analysis committees, a Network of Patient Safety
Databases was authorized to which PSO data is to be communicated, so
that individual institutions can compare their statistics to national
averages and thereby avoid personal biases.

In addition, the AHRQ is attempting to assemble clinical guidelines
from peer-reviewed medical journals to be used nationally in an effort
to formalize national treatment standards.

Participants in the use of these PSOs are immune from prosecution in civil, criminal, and administrative hearings.[26]

A potential for sham peer review still exists, however, when a
single physician serves on a systems analysis committee (even if it is
a PSO) and is also the major player in a sham peer review process. The
individual may be the chairman of a department, or the chief of staff
(and therefore gatekeeper of peer review), may also serve on the peer
review committee, and may even be a member of the hospital board.

However, the Patient Safety and Quality Improvement Act
allows for a $10,000 fine to be applied to any individual provider who
allows PSO data to be "admitted in a professional disciplinary
proceeding of a professional disciplinary body established or
specifically authorized under State law."[26] Immunity from civil liability also disappears in the event of such an infraction.

In California and in many states, both the peer review hearing and
the investigation have been held to be part of a professional
disciplinary proceeding, so that the penalty applies in the event of
usage of PSO data in either.

[edit] Related Links

[edit] References

  1. ^ a b c Roland Chalifoux, Jr (2005). "So What Is a Sham Peer Review?". Medscape General Medicine 7 (4): 47. 
  2. ^ Donald Goldmann, MD (2006-07-13). "System Failure versus Personal Accountability — The Case for Clean Hands". New England Journal of Medicine 355(2):121-123.
  3. ^ SE Feldman, MD (Nov 1997). "Medical accidents in hospital care: applications of failure analysis to hospital quality appraisal". Jt Comm J Qual Improv. 23(11):567-80.
  4. ^ a b c Timothy P. Hofer (Nov 2000). "What Is an Error?". Effective Clinical Practice (American College of Physicians).
  5. ^ Lawrence R. Huntoon (2006-05-09). "Sham Peer Review: A National Epidemic". Association of American Physicians and Surgeons, Inc..
  6. ^ Kenneth Westhues (2006). SHAM PEER REVIEW IN MEDICINE. University of Waterloo.
  7. ^ Matthews v Lancaster General Hospital 87 F.3d 624 (3rd Cir. 1996)
  8. ^ Fobbs v. Holy Cross Health System Corp. 789 F. Supp. 1054 (E.D. Cal. 1992)
  9. ^ a b c d "California Business and Professions Code Section 800-809.9" . Official California Legislative Information. 
  10. ^ "JCAHO Periodic Performance Review" . Legal Bulletin of Oregon Association of Hospital and Health Systems. 
  11. ^ a b Greg Abrams (February 2006). "Attacking Bad Faith Peer Review: Is It a SLAPP?". San Mateo County Medical Association Bulletin 55 (1). 
  12. ^ "California Code of Civil Procedure Section 1084-1097" . Official California Legislative Information. 
  13. ^ Kibler v. Northern Inyo County Local Hospital District, Inc. (2006) 39 Cal.4th 192, 46 Cal.Rptr.2d 41.
  14. ^ Brown, Lowell C. (August 1, 2006). "California's Highest Court Extends Anti-SLAPP Protections to Medical Peer Review Proceedings". Foley & Lardner Law Watch. 
  15. ^
    see Mileikowsky v. Tenet (Tarzana Hospital) (in Health Policy in the
    Courts -- California Medical Association's participation in Amicus
    Curiae Briefs - January 2007) referenced below.
  16. ^ Kibler v. Northern Inyo County Local Hospital District, Inc. (2006) 39 Cal.4th 192, 46 Cal.Rptr.2d 41.
  17. ^ Charles Bond (2004-3-23). "The War Is On: Why Your Medical Staff Needs to Incorporate and Obtain Its Own Independent Counsel". Medscape General Medicine 6 (1): 57. 
  18. ^ Federal Trade Commission (September 2000). "In the Matter of Alaska Healthcare Network, Inc., a corporation. Agreement Containing Consent Order.". Federal Trade commission File # 991-0103. 
  19. ^ Antitrust. Foley & Lardner, LLP. Retrieved on 2007.
  20. ^ Bruce Adornato, MD (March 2005). "Column by the President of the Medical Staff: Purple fingers, Purple toes". Stanford Hospital and Clinics Medical Staff Updates. 
  21. ^ a b Health Policy in the Courts -- California Medical Association's participation in Amicus Curiae Briefs - January 2007. California Medical Association (2007-01).
  22. ^ California Appeals Court (October 10, 2000). "Khajavi v. Feather River Anesthesia Medical Group, Inc.". 
  23. ^ Twedt, Steve (December 28, 2003). "Oregon MDs study law on peer review. Question its use to stop "whistleblowers"" (subscription required). Pittsbrugh Post Gazette. 
  24. ^ Michigan High Court Lets Physician Sue over Bad Peer Review. American Medical News (American Medical Association) (2006-09-18).
  25. ^ a b Michael J. Baxter (2001). "A
    Potent Weapon: Federal Peer Review Immunity under HCQIA Federal
    legislation provides credentialing organizations a golden opportunity
    to gain immunity for their decisions
    ". Baxter, Baker, Sidle, Conn & Jones, P.A.., Baltimore, MD. Retrieved on 2007-06-10.
  26. ^ a b William E. Fassett, PhD (2006). "Patient Safety Organizations". Ann Pharmacother. 40(5):917-924 Cincinnati, OH. Retrieved on 2007-06-10.

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michele ciavarella

Subscribe to Comments for "Wikipedia on peer review --- an excellent article, an example of wikipedia quality, and interesting anyway!"

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