Fallibility & Accountability in the Peer Review Process in Healthcare

Instructor: Patricia Jankowski

Patricia has a BSChE. She's an experienced registered nurse who has worked in various acute care areas as well as in legal nurse consulting.

The peer review process is a well-established method of quality assurance in the publication of scientific and healthcare-related research. However, this process is not infallible. This lesson will examine its drawbacks and how it can be improved.

What Is The Peer Review Process?

Journals and magazines that publish articles about scientific and medical experiments want to publish material that is of good quality and that stands up to scientific scrutiny. This is what's behind the peer review process, which is a way of ensuring the scientific validity of published material.

In peer review, the written report of a scientific experiment is submitted to the editor of a journal, who determines whether or not it's appropriate for the publication. If it is, it then goes to reviewers, who are peers in the same field and have knowledge of the type of experiment. The reviewers are also called referees.

In a single-blind review, the referees know the identity of the report's author, but the author does not know that of the referees. In a double-blind review, neither the author nor the referees know the other's identity.

When the review of the article or report is completed, the referee submits it to the journal and recommends that they either accept or reject it. It's then up to the journal to decide what to do.

If it's rejected, the author can revise it or try another journal. If it's accepted, it's prepared for publication. However, peer review isn't used only for journal publication. It's also used for grant funding. The grant proposals that pass the peer review process are the ones that get grant money to do their work.

Peer Review Problems

We live in an imperfect world, and even the best and most well-intentioned methods can sometimes go wrong.

Confirmatory Bias

It takes a great deal of courage to be a good researcher, because one has to be willing to let go of one's preconceptions about the research outcomes in order to be objective. However, even researchers are human, and this doesn't always happen.

We sometimes have the tendency to give more attention to the data that confirms what we think is going to be the answer to a given question that's being researched. This is called confirmatory bias, and it ends up not telling us the truth about what's really going on.

The File Drawer Effect

The file drawer effect is a form of bias in which studies are published mainly because they have results with a large statistical significance, while other studies on the same topic, with less impressive results, remain unpublished, or in the ''file drawer''.

For example, suppose we want to know whether eating more blueberries helps prevent people from getting heart attacks. To find out, we do a lot of experiments in which people eat the berries, then are monitored over time for heart attacks.

If our studies show that they ate the berries, but still had heart attacks, we end up putting them in a file somewhere, and we're not happy. But if the studies show that they ate the berries and all remained heart-attack free, we're excited, so we publish our results because we think we've solved the problem of heart attacks!

Because of this file drawer effect, much valuable information can end up unused, and we get an incomplete story about blueberries.

The Matthew Effect

In the Bible, Matthew 25:29, it says, ''For to every one who has will more be given, and he will have abundance; but for him who has not, even what he has will be taken away.'' This is sometimes stated more simply as ''the rich get richer, and the poor get poorer'', and this often seems to be true, even in peer review.

In the Matthew effect, the most famous researchers are simply taken more seriously than those who have not yet made a reputation for themselves. Even if those less established researchers have produced work of equal quality, it may not be published.

The Doctor Fox Effect

You may have heard of Michael Fox, a character actor active on shows like Perry Mason. But not everyone knows that he played the part of a doctor giving a lecture at a real medical school, and the students loved him, even though he wasn't a real doctor!

If a lecturer can give a captivating performance, people will listen and say that they learned from them, and give them a good evaluation afterwards. This is called the Dr. Fox effect.

Gender And Race Bias

Being female can be a hurdle to getting past the peer review process. A 2013 study showed that even though more than half of science graduates are female, fewer than 30% of the authors of scientific articles are women.

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