Manuscript Peer Review -- A Guide for Health Care Professionals

Lynne M. Sylvia, Pharm.D., Massachusetts College of Pharmacy and Health Sciences, Boston, Massachusetts; and Jo L. Herbel, Pharm.D., Mayo Clinic Drug Information Services, Hospital Pharmacy Services, Rochester, Minnesota

Pharmacotherapy. 2001;21(4) 

In This Article

What Is Peer Review?

When a manuscript is submitted to a journal for consideration, the journal editor is ultimately responsible for its fate. If the manuscript is outside the journal's interest, the editor may reject it immediately or ask the author to resubmit it with revisions. If the editor considers the manuscript to be appropriate for the journal, the article will undergo internal review by members of the editorial advisory board and/or external peer review.

External peer review is considered by most as a crucial part of manuscript assessment; however, no consensus exists as to its definition. In one definition, peer review is "a negotiation between the author and journal about the scope of knowledge claims that will ultimately appear in print."[4] In MEDLINE, the medical subject heading defines the term as "evaluation by experts of the quality and pertinence of research or research proposals of other experts in the same field." Based on these definitions, a peer reviewer may be considered a consultant to the editor, content expert, third party, or arbiter for quality research. Other interpretations of these definitions are less positive, with peer review being described as subjective, prejudicial, crude, offensive, and secretive.[5]

To clarify the definition, we consulted Webster's dictionary. The word "review" is defined as "a critical evaluation" and "to re-examine judiciously." The word "peer" is defined as "one that is of equal standing with another," "to look narrowly and curiously," and "rival." These last two definitions offer some insight into the more negative views of peer review. Although a good amount of intellectual curiosity is required of peer reviewers, the process itself should be performed with an open mind, without secret, slander, or insult. Often, in the area of research, one's equal is also one's rival; however, judicious examination of a rival's research requires discretion, sound judgment, and courtesy. Thus, in its most literal sense, peer review should be considered a critical, judicious evaluation performed by one's equals.

The history of peer review is based on fragmentary evidence.[6,7,8] Although it can be traced back to the mid-1700s, it did not become an integral part of biomedical journal editing until the mid-1900s, around the end of World War II.[6] A number of different reasons are suggested for its incorporation into the publication process at that time. As the number of manuscript submissions increased in keeping with advances in laboratory science and technology, many journal editors may have recognized the need for assistance in selecting those to be published. In the mid-1900s most editors were generalists in the field of medicine or surgery. Greater specialization that occurred at this time also may have contributed to the decision to seek expert evaluation.

When the decision was made to implement peer review, each editor did so independently and unsystematically. Some solicited volunteers and offered them a nominal fee for their service, whereas others enlisted more selectively and had no fee structure. Thus independent, nonuniform methods, coupled with lack of sharing of information about these procedures among editors, led to claims of secrecy, parochialism, and bias. To some, peer review was considered nothing more than the "informed prejudices of old men."[9]

It was not until 1989 that the process was put under close scrutiny at the first International Congress on Peer Review in Biomedical Publication.[10,11,12] Sponsored by the American Medical Association (AMA), this congress was intended as a forum for researchers, and information presented focused primarily on technical aspects of peer review, described as manuscript management.[5] Of 23 articles published from the congress, only one addressed the quality of the reviews themselves.[13] At two subsequent congresses in 1993 and 1997, the focus was manuscript assessment, described as the cognitive part of peer review. In addition to studies of mechanisms of peer review, a call was made for research into the cognitive process. For example, what research had been performed from which to assess the validity of peer review? Had the performance of a reviewer been measured in terms of achievement of a positive outcome? Did use of standard evaluation tools improve manuscript quality? A discussion of the proceedings of each congress is beyond the scope of this article. Access to the proceedings and information on the fourth congress scheduled for September 2001 can be found at the World Association of Medical Editors' Web site ( It remains to be determined if peer review is an effective intervention that improves manuscript quality; however, most agree that it provides indispensable guidance and education to those who publish biomedical journals.

Although disagreement exists as to what peer review is and how it should be conducted, almost everyone agrees as to what it is not. It is not a totally objective scientific process; evaluating a manuscript's quality and its fit with a journal has subjective elements. Peer reviewers are not ultimate decision makers. Their appraisals do not determine a manuscript's fate; rather, they help editors make those decisions. The term "referee" has been used interchangeably with peer reviewer for years; however, a peer reviewer does not make the final call. Instead, the process itself is intended to contribute to the balance of power between author and editor.[14]

What are the limitations of peer review? It was said that "all peer review can reasonably do is detect major defects of originality and scientific credibility, together with commenting on important omissions, the rigor of the arguments and defects in writing style."[9] It can contribute to the final version of a manuscript by making it more sound and readable; however, it cannot ensure perfection or determine if study data were presented honestly and without fraud.[9] A reviewer is not present at the time and place in which a study is conducted and thus cannot determine whether data were fabricated or embellished. Peer review can increase the time of manuscript review and delay publication, it can be expensive, and it is subject to biases. It cannot easily detect conflict of interest on the part of one or more of a manuscript's authors and it does not ensure detection of duplicate publications. Despite these limitations, it has a central position in publication of a journal. It may fundamentally exist to help detect and describe flaws, and it offers clinicians and scientists the opportunity to recognize, encourage, and support innovative research.


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