The Exploitation of Peer-Review Extends Beyond Scholarly Journals
The recent perspective article by Haug describes the exploitation of the peer-review process to increase publications.1 The author insightfully identifies the incentives to publish which might be considered as a “confluence of interest,” or as a part of the paradigm of “reward for scholarly work.”2 A hybrid system of journal-selected and author-selected reviewers would mitigate the risks from fraudulent peer-reviewers while still permitting journals to benefit from the recommendation of experts. The incentive of “reward for work” is fundamental to the practice of medicine and science and occurs at all levels of research. For example, a scientist fabricated clinical trial results to generate a study worthy of publication.3
Parenthetically, the abuse of peer-review occurs outside scholarly journals by hospital review committees and state medical boards (SMBs).4 The 1993 case of the neurosurgeon Mishler v. Arizona Board of Medical Examiners (ABME) is an example where the ABME exploited a hospital’s malicious peer-review processes to destroy the career of an outspoken physician. On page 297, the Arizona Supreme Court justices wrote:
In short, we conclude that the Board's actions and the proceedings against Dr. Mishler constituted a disturbing abuse of its power. Therefore, we reverse the disciplinary order of the Board in its entirety and dismiss all proceedings against Dr. Mishler with prejudice.5
In 1985, the late Arnold Relman wrote that doctors could launch powerful counter litigation against would-be accusers.6 However, the 1986 Healthcare Quality Improvement Act may have given rise to an increasing number of cases of sham peer review by hospitals and SMBs. There will always be perverse incentives for those who succeed in publishing, clinical practice, or regulation. It would be a mistake to look at the gaming of the scholarly journals as merely an isolated problem without considering the tightly aligned universities, institutes, and agencies that can be involved or demonstrate similar misconduct.
The report by Haug of the retraction of numerous articles highlights the value, albiet imperfect, of the peer-review process, as well as the value of post-publication scrutiny.1 Fabrication of data, fake reviewers, or false claims filed in court by a SMB are all fraudulent activities that can be detrimental to the care delivered to patients. Therefore, policy makers, journal editors, clinicians, and scientists must remain vigilant to prevent unscrupulous persons from exploiting the processes of peer review.
1. Haug CJ. Peer-Review Fraud — Hacking the Scientific Publication Process. N Engl J Med. Published Online: October 21, 2015. DOI: 10.1056/NEJMp1512330
2. Cappola AR, FitzGerald GA. Confluence, Not Conflict of Interest: Name Change Necessary. JAMA 2015:1-2.
3. Ahimastos AA, Askew C, Leicht A, et al. Notice of retraction: Ahimastos aa, et al. effect of ramipril on walking times and quality of life among patients with peripheral artery disease and intermittent claudication: a randomized controlled trial. jama. 2013;309(5):453-460. JAMA 2015;314:1520-1.
4. Chalifoux R, Jr. So what is a sham peer review? MedGenMed 2005;7:47; discussion 8.
5. Mishler v. State Bd. of Med. Examiners, 849 P. 2d 291 - Nev: Supreme Court 1993. http://law.justia.com/cases/nevada/supreme-court/1993/22397-1.html Accessed October 21, 2015.
6. Relman AS. Professional regulation and the state medical boards. N Engl J Med. 1985;312:784-5.