Peer review: a flawed process at the heart of science and journals

Richard Smith was editor of the BMJ and chief executive of the BMJ Publishing Group for 13 years. In his last year at the journal he retreated to a 15th century palazzo in Venice to write a book. The book will be published by RSM Press [www.rsmpress.co.uk], and this is the second in a series of extracts that will be published in the JRSM. Peer review is at the heart of the processes of not just medical journals but of all of science. It is the method by which grants are allocated, papers published, academics promoted, and Nobel prizes won. Yet it is hard to define. It has until recently been unstudied. And its defects are easier to identify than its attributes. Yet it shows no sign of going away. Famously, it is compared with democracy: a system full of problems but the least worst we have. When something is peer reviewed it is in some sense