Peer Review

On how “reality” is made.

Update: 19.01.2023 - I’ve had several wonderful, and important comments to this post, so I’ve updated the stack. Starting with this from CK:

A mathematician once advised:

If you understand something and can prove it, then publish it in a mathematics journal.

If you understand something, but can't prove it, then publish it in a physics journal.

And if you don't understand something and can't prove it, then publish it in an engineering journal.

To this I would add:

And if you don't understand something and can't prove it and don't care anyway because you're just trying to make a fast buck, then publish it in a medical journal.

My son reminded me of the above Sagan clip recently, it is from a 1996 interview with Charlie Rose.

Sagan understood the threat that “The Science™” posed to society, and the charlatans waiting to take advantage of the public’s naivety, trust, and ignorance.


In fact, that ignorance can be manufactured, as Toby Rogers highlighted recently:

The premise of agnotology is both simple and profound. Most people think of ignorance as the absence of knowledge. Proctor and others in the field argue the opposite — that ignorance is socially constructed in the same way that knowledge is. Powerful interests instruct society to pay attention to some things and not others through a variety of inducements (you get paid to study certain topics and not others) and punishments (you will be blacklisted if you ask too many questions about forbidden topics). Over time these values become invisible and just a part of culture.

Let me repeat:

“Ignorance is socially constructed in the same way that knowledge is.”

Ignorance can be manufactured.

Which begs the question: How?

Well, there are a variety of tactics and strategies that would sit comfortably under the label of “propaganda” or more generously under the label of “marketing”.

But whichever label you want to use, the building block, in fact the key ingredient in the propaganda/marketing dish, especially in a “scientific” culture, is the Peer Reviewed Study.

Peer Review is the truth-making, sense-making, holy grail of “knowledge” in a culture that has no ability to understand it’s high priests (The Scientists™) anymore.

If it’s peer reviewed, it must be true.

Our realities are perceived. Those realities are constructed on scaffolding. The bars, and joints and screws of that scaffolding are all made at the Peer Review factory.

Whoever runs that factory, runs “reality”.

Desmet’s book on The Psychology of Totalitarianism spends a lot of time on the problems of a culture built on Science. He comments on Peer Review this way:

The lack of quality in scientific research raises a few pressing questions, including about the blind peer review system, which is used in all scientific journals and is considered the ultimate seal of approval for scientific legitimacy. Peer review requires that a study be read and critically evaluated by two or three independent experts in the field before publication. These experts are supposed to be “blind” (they don’t know who conducted the study), but in reality, they usually do know the authors because they know the other researchers working in their field. Hence, they can usually guess who conducted the research.

For this reason, a fair assessment by an expert requires not only that he is willing and able to free up sufficient time and energy—far from given in the current academic climate. Moreover, it requires that he is capable of identifying his personal prejudices with regard to the research and its authors, and put them aside.

In other words: Peer review stands or falls on the ethical and moral quality of the expert—that is, his subjective, human characteristics.

Here is a very insightful comment left below by the Dr Mike Yeadon, that is worthy of inclusion here:

During my PhD research, I made an interesting observation which challenged the dominant narrative in the field. Encouraged by my supervisor, I wrote it up & submitted it to a good journal. During peer review, it was rejected, citing questions with the novel methodology. In fact the methodology was superior to that used by peers. I had designed it to permit estimates of in vivo pA2, using pharmacokinetic principles, which theoretically should approximate pA2 values for pure antagonists obtained in vitro.

My supervisor found out through back channels that a jealous reviewer didn’t want their body of work to be thrown into question. I managed to publish it in a lesser journal.

As a post-doc, I had extensively characterised the impact of ozone on “twitchy” (“hyperresponsive”) airways, evaluating the effect (or lack of it) of various experimental treatments (this might have helped prioritise programs for clinical trials in asthma). A leading London researcher, who’d taken on the peer review, left my manuscript to age on his desk for six months, while his lab repeated my experiments & published ahead of me. I did get published but was required to make changes to acknowledge that my work was not entirely novel. I had to cite their papers! (they were “in press”).

It’s not just peer review that isn’t always objective, though mostly it was.

In my first professional job after obtaining my PhD, doing some “skunkworks” with another researcher in analytical a chemistry, we devised a method to measure concentrations of nitric oxide (NO) in exhaled breath. I did most of the sampling from multiple species & my collaborator measured [NO] using mass spectrometry. We were the first in the world to show that exhaled breath contained NO & measuring it in trials became quite common.

The research director liked the results so much that he added his name to the manuscript and booted me off it! I got a “technical mention”!

It was one of the most-cited papers of that year. I minded at the time but looking back it simply reinforced how badly I didn’t want to become an academic.

Which brings us to one of my readers, now a mentor of mine, who is an elite researcher and peer reviewer, who shall remain anonymous for reasons obvious to all of us by now.

In a recent conversation I asked if they would be kind enough to write me an article about peer review, from an insider’s perspective. How does it work, who gets paid what and why? Where are the weaknesses in the process and how can it be influenced, manipulated and weaponised.

And so, they did; here is the piece. I am responsible for the final English edit, so any issues of grammar or expression are on me solely.

With much gratitude to The Researcher, you know who you are.

Publish or perish: What is a “peer-reviewed” paper?

Referee = peer= reviewer

1)      Who can write a “scientific paper”?

Any staff with an affiliation (university, industry, hospital) can submit an article. You don’t need a degree to submit an article.

2)      What is the process to be published?

The authors write the article, format it according to the standards of the chosen journal and submit it online. The publishers assign a number to the submitted article and offer it to several "peers" who agree or not to evaluate the manuscript. When the referees (usually 2 or 3) have finished, they complete an online evaluation page, with a list of standard yes/no questions on the quality or originality of the work (rated from 1 to 5) and can also send their remarks/questions, intended for the authors. The referees must indicate whether they accept the manuscript as it is, accept it with minor modifications, accept it with major modifications, refuse the article. The publisher takes note of these reports and sends them to the authors. If the article is not rejected, the authors must then respond to the remarks and make the requested changes, provided that they are relevant. Responses and edited manuscripts are resubmitted online, and reviewers have access to this and can make a second set of comments (not always the case, sometimes the editor makes the decision at that time, without re-consulting referees). A rejected article may be submitted to another journal. An accepted article will then follow the publication process (last proofreading by the authors, online publication and assignment of a unique number, payment if open access).

3)      Are the authors directly paid for?

No. Publishing is part of a researcher's job, who is not specifically paid for an article. The number and level of publications by a researcher or a team is an important element of evaluation, and therefore impacts their ability to obtain future funding.

4)      Is it necessary to pay to be published?

When articles are available in "open access" for readers, it means that the authors have paid. The sum is usually around 2,000 – 2,500 dollars, depending on the journal, and up to 12,000 dollars! With some journals, “open access” is the only publishing option.

5)      What does “peer reviewed” mean?

It means that the article has been reviewed and critiqued by 2 or 3 “experts” in the field. Note that a researcher may be asked to review an article on a subject on which he is not at all an expert. When an editor sends an email to a researcher as an “invitation to review a manuscript”, the researcher (the “peer”) is perfectly free to accept or not. Including if they in fact are not an expert in the field. Most of the time I refuse because I know nothing about the topic or methodology.

No one evaluates the content of a referee's comments.

6)      Does every scientific paper need to be peer reviewed?

This is the classic process of scientific publication, which “ensures” a certain level of relevance and quality. Possibilities of “pre-print” articles are possible, but this remains a little marginal and really less well considered.

7)      Who are the reviewers?

The “peers” are scientists solicited by publishers for their expertise in the field. But it is also the case that “peers” are not necessarily experts in that field, but because of their existing relationship with the publisher (they may have submitted research in the past), they are asked to review a submission.

8)      How many “peers” are there?

There are 2 or 3 for an article.

9)      How do they work and how long do they have to review the paper?

They evaluate the work done in depth or not, it relies on the professional conscience of each reviewer.

10)  Are they paid? If not paid, why do “peers” accept the reviewing work?

They are not paid to do this. Depending on the publishing groups, they can get a percentage discount on publishing future articles. The evaluation of articles is something essential to the functioning of research today and most researchers willingly lend themselves to it, despite the time it can take if things are done rigorously.

As a researcher, you may need to read a paper on the same topic you are reviewing, for instance to understand the data or the methodology. If you are reviewing quite the same data, it may be a way to waste time on the article for which you are referee or simply to refuse it without honest justification. But, if the paper is from friends, you can agree to be the referee and then accept the paper even if it is not deserved.

Reviewers typically have 3 weeks for a first evaluation. For the 2nd round, some publishers ask to respect a deadline of a few days, with very frequent reminders.

11)  Is this process anonymous?

The process is not necessarily anonymous, the journals sometimes display the name of the reviewers for a given article, but this is a choice of the reviewer, who can therefore refuse.

12)  Can “peers” kill a paper?

A referee can completely destroy an article, without true arguments.

If a referee doesn’t want a paper to be published, they just need to check the "refusal" box on the website of the journal. The reason can be as poor as “it is not in the scope of the journal”, or no reason is given at all.

13)  Who are the Editors?

The editors of scientific journals are researchers in the field concerned. They are paid for this function and decide what is published or not in their journal.

14)  Who owns scientific journals?

See this excellent article by Xavier Bazin, a French scientific journalist, author of 2 books with very, very strong work.


And yet, in fact, these newspapers are intimately linked to Big Pharma's interests.

First, because they agree to insert advertisements for the pharmaceutical industry in their columns.

But above all because these medical journals practice without restraint the very lucrative system of "reprinting".

Here's how it works: as soon as one of these newspapers publishes a positive study on a drug, the manufacturer buys thousands of copies of the relevant edition.[11] !

However, the massive recirculation of a single issue can generate up to 2 million euros in turnover for the magazine!

This is not nothing, when you know that the annual turnover of The Lancet is $ 40 million.[12] (and NEJM of 100 million).

In total, it is estimated that these "reprints" represent up to a third of the revenues of these newspapers.[13] !

This is all the more significant since these revenues have a margin rate of at least 80% (because it costs nothing to re-print)[14].

In short, these reprints ordered by Big Pharma make a lot of money for medical journals!

You may tell me that it is not a big problem because these journals are selfless.

But this is not the case at all! The vast majority of these medical journals are privately owned, and are therefore "for-profit"... That is, their legal goal is to earn as much money as possible.

And the directors of these journals are very well paid, thank you very much! for example, the editor-in-chief of NEJM earns the modest sum of 703,324 dollars per year, or about 60,000 euros per month.

These magazines are real businesses, so necessarily sensitive to advertising revenues and "reprints" granted by Big Pharma!

And that's not all.

Because it is also necessary to know who really directs these journals!

In any company, the real decision-maker is not the director, but the shareholder. It is the shareholders who appoint (and dismiss) the directors of the companies, and therefore decide on the strategy to be pursued.

But who are the shareholders of these medical journals?

The Lancet, for example, is owned by Elsevier, itself a subsidiary of the multinational RELX Group.

And who owns RELX Group?

Answer: financiers!

You can look at the official list of shareholders: they are essentially large asset management groups, such as BlackRock.[15].

However, these "investment funds" are known to seek and demand maximum profitability.

And as if this were not reason enough to be suspicious, you should know that the main shareholders of Elsevier are also the main shareholders... of Big Pharma!

For example, BlackRock, to name but one, is the number 1 shareholder of RELX Group, and one of the top 10 shareholders of... Pfizer.

It's even worse than that, because the number 1 shareholder of Pfizer is Vanguard Group... who is himself the main shareholder of BlackRock!

In short, these are the same players (and probably the same people) who own the leading medical journals AND the major pharmaceutical multinationals.

[11] https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC3386142/


[13] https://qz.com/2121448/medical-journals-have-incentives-to-publish-positive-drug-studies/

[14] https://blogs.bmj.com/bmj/2018/01/24/richard-smith-the-hypocrisy-of-medical-journals-over-transparency/

[15] https://fr.wikipedia.org/wiki/RELX_Group

15)  Who controls the “conflict of interest” section?

Nobody. You can write what you want.

16)  If you don’t agree with a published paper, what can you do?

You can write and submit a letter to the editor or a comment, a kind of “right of reply”. The editor can refuse to publish this.

17)  Are all published studies good?


18)  What “retractation” means?

After publication, an editor can take the decision to withdraw a study. This remains referenced, with the mention “retracted” and an associated notice of withdrawal, explaining this decision. A study can be retracted if it is very bad or fraudulent. It can also be very good and still be retracted. The authors have no way to counter this decision. However, they can resubmit the article in another journal. The mention “retracted” is very damaging for the study and for the team.

19)  Are all retracted papers bad?


20)  Is peer review used as a tool (weaponised) to maintain orthodoxy?

It's a possibility. The mention “peer-reviewed” is an argument of authority, which does not guarantee 100% the relevance and the value of a study.


- Dr. AS Relman, professor of medicine at Harvard:

“The medical profession is being bought off by the drug and vaccine industry, not only at the level of medical practice but also at the level of teaching and research. Academic institutions in this country (USA) have indulged in becoming paid agents of the pharmaceutical industry. I find that hideous.”

- Dr M Angell, physician, former editor of the New England Journal of Medicine:

"It is simply no longer possible to believe the essential clinical research that is published, or to rely on the judgment of reference doctors or to authoritative medical guidelines. I take no pleasure in making this observation, which I came to slowly and reluctantly over two decades as editor of the New England Journal of Medicine.”

- Dr R Horton, editor of The Lancet:

“A scandalous number of published studies are unreliable at best, when they are not completely misleading, in addition to fraudulent. Much of the scientific literature, perhaps half, may simply be untrue. Afflicted by studies with small sample sizes, tiny effects, invalid exploratory analyses, and flagrant conflicts of interest, together with an obsession for pursuing fashionable trends of dubious importance, science has taken a turn towards darkness.”

And lastly, I’ll end with this insight, in the comments, from antitermite.

Now that we understand that it is unpaid work to be a “peer”, that obviously will attract a particular type:

An institution I previously worked for had regular peer review sessions.

It was open invite, but in practice consisted of only a handful, maybe 3 regulars.

I didn't join in because it was time consuming (I was busy enough!), the subject material didn't always interest me, and most importantly, I didn't gel with the other "peers".

The sort of person who did attend the peer review sessions, were the exact same people who made it their business to be in every meeting (whether or not it directly involved them), and who never seemed to be doing any real work.

Busybodies & powertrippers.

Their productiveness so low that when they had a day off, no one noticed or cared (in fact, the place often ran more smoothly!)

I considered the peer review sessions, and all the circlejerk meetings, as ways for them to get paid to sit on their asses all day, but it was also a means of gaining influence.

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