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The college or university matters too. I'd bet research from MIT gets published more easily than the same research from University of North Dakota even if the quality is the same.

Clearly the best way to do peer-review is to remove the authors names from the paper.

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I have reviewed for Journals from Science to NEJM to JAMA to some no one has heard of. It often takes several hours to do a competent review. When I compare mine to some of the others, it is clear that some others are not spending nearly as much time and attention on the review.

And after all that, the editor still gets to approve articles for his/her friends/important people if that is what they wish. The approval of the badly flawed NEJM masking study (which would never have gotten past my review -- criticisms of that are fundamental and mine would have been scathing) is a great demonstration of this or the inadequacy/conformance of the "peer non-review" that seems to be increasingly ubiquitous.

The process can work, but it is not working very well now. Really, all reviews need to be open and transparent in some way -- that would quickly solve some of this. (But opens other issues such as idea-theft that would have to be considered.)

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Brilliant contribution. I have reviewed manuscripts for over 30 years for journals. I am always looking for ways to improve manuscripts. In my own experience, I have recommended rejections in only about 10% of the papers that I have received. There are probably only 5% in which I have no recommendations. The shocking biases noted in this posting should lead editors to review their peer review process very critically. Many thanks, John.

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And - noticing that a lot of journals have pharma ads now - adding the financial component makes me wonder about rigorous scientific inquiry in this day and age. I have to say, I’m grateful - as a person with spina bifida and many related issues (including late onset crohns - I musta been a bad person in a former life! 🤣), that the majority of my surgeries and medical procedures are behind me. It’s tough to “trust the science” anymore, especially after the clear Politicization of Medicine over the past several years.

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Jim, we MUST trust science while understanding our own limits and faults as well as those of our peers. Our journals should help introduce new ideas but always be open to challenge. The NEJM masking article of last week should have had multiple reviewers including some who had clear background of COVID treatment skepticism. Likely, many were friends and colleagues of the Harvard School of Public Health. Our community should let the NEJM editors know that the inclusion of the gratuitous and unsupported invocation of systemic racism at the end of the article was a serious breech of ethical norms.

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I agree entirely. I definitely want to feel some trust in those who performed the science. That’s been my challenge.

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It's hardly a secret, or surprising to be reminded, that articles first-authored by the Big Cigars in any niche area of research usually get sweet, sure, and swift treatment at the manuscript submission point relative to work first-authored by "unknown" worker bees peddling away on their varied tenure-seeking journeys in the world of "Healthcare Science". There is an unsettling whiff of corruption telegraphed by this phenomenon, yet what is really happening is very hard to pin down (which neatly nourishes the ongoing grift). Related perhaps, and also nearly laughable, is the increasingly prevalent appearance of scientific papers with giant-sized numbers of co-authors. I saw one the other day in a major journal. There were 98 names listed under its title. That's almost eleven baseball teams. Please. Enough of this bullshit already.

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