Paper first published 1997 @ VetScape

For once everyone is agreed, the information super highway is going to transform our lives at an unprecedented rate. Not that everyone is enraptured by this prospect with groups as diverse as parents and politicians bemoaning the loss of cherished standards. The supposition is that immature or inexperienced people are going to be called upon to make judgments on material that previously the system would have screened.

Some of the perceived deficiencies arise from the mechanics of the system. The Medline terms and conditions provide an example, "Due to the number of sources from which information on the service is obtained, and the inherent hazards of electronic distribution, there may be delays, omissions or inaccuracies in such information and the service. The service could include technical or other inaccuracies or typographical errors."¹

A more fundamental question is that of the integrity of the message as determined by peer review. The Australian Dental Association comes straight to the point. "Information on the Internet does not undergo peer review and must always be approached with caution."² This statement, to the average reader of professional journals, requires little explanation. Based on a long history, and now a wide circulation, there is tacit assumption that peer reviewed journals produce the best available scientific literature.

Editors and anonymous peer reviewers demonstrate faith in the system. In the book "How to Write and Publish a Scientific Paper" Robert A Day spends little time defending the system. "The answer to this question is a resounding, yes! all editors, and most authors, will affirm that there is hardly a paper published that has not been improved, often substantially, by the revisions suggested by referees." Day backs up his assertions, "editors encounter very few instances of unfairness and blatant bias expressed by referees; perhaps for 0.1% or less of the manuscripts handled, an editor is obliged to discount the referees comments."³

Authors are the other major group participating in and reinforcing the peer review process. Successful authors seldom have reason to complain and the majority of unsuccessful authors simply try harder. A small minority of failed authors harbour dissenting views but these views suffer the same fate as their manuscripts. Members of the public have remained outside of the process having no knowledge or opinions to disturb their resultant apathy.

Affirming that the peer review system is not widely challenged is not the same as saying it provides widespread benefit to our science dependent society. Bernard Barber in his paper "Resistance by Scientists to Scientific Discovery" provides psychological, cultural and social explanations for why vital information is frequently suppressed or rejected. He presents a clear image of a constant phenomenon in science, a pattern in which all scientists may sometimes and perhaps often participate, now on the side of the resistors, now on that of the resisted. He remarks that, "cultural blinders are one of the constant sources of resistance to innovations of all kinds. And scientists, for all the methods they have invented to strip away their distorting idols, or cultural blinders, and for all the training they receive in evading the negative effects of such blinders, are still as other men, though surely in considerably lesser measure because of these methods and their special training. Scientists suffer, along with the rest of us, from the ironies that evil sometimes comes from good, that one noble vision may exclude another, and that good scientific ideas occasionally obstruct the introduction of better ones."⁴

If this is a fair description of scientists then it is true of editors and peer review committees in similar measure. David Horrobin takes up the subject in his paper, "The philosophical basis of peer review and suppression of innovation." His thesis is that peer review is not merely a matter of quality control. Whilst he recognises the necessity for this rather mechanistic aspect he believes that the fundamental purpose in the biomedical sciences must be consistent with that of medicine itself, "to cure sometimes, to relieve often, to comfort always." He observes that in this regard the system often stifles innovation and provides a number of examples starting with the seminal paper on the identification of B lymphocytes. This paper in immunology was rejected by leading general and specialist journals before it was finally published in 'Poultry Science' (a credible but obscure journal not known for the publication of landmark science). Horrobin goes on to say that peer review is so restrictive in the grant giving process that, "Scientists therefore have to tell lies in their grant applications".⁵

Whilst peer review often serves to suppress good new information the corollary is that it tends to perpetuate old outmoded dogma. In the 1995 Annual review of Microbiology Costerton et al state, "As disciples of Koch and Pasteur, we have been taught to extrapolate from single-species laboratory cultures to predict bacterial behaviour in actual environments. With modern tools we can now make direct observations of structure and of chemical function in living biofilms growing in specific ecosystems. This perception of functional biofilm communities, reinforced by novel methods for direct observation,will usher in a new golden age of understanding in virtually all fields of microbiology."⁶ This sounds like a reconsideration of the 'germ theory' which has stood virtually unchallenged since its introduction. Paradoxically, Louis Pasteur the author of the theory on his death bed in 1985 is reported to have said "the terrain is more important than the germ".⁷ Despite this recantation the biomedical industry and attendant publications have continued to function as if the 'germ theory' held an unassailable position.

In Australia, since 1991, natural diets and periodontal disease in domestic carnivores has been a divisive issue. The Veterinary establishment at first tolerated the 'rebel' claims but then progressively either suppressed or sought to trivialise the issues. In a move designed to take some of the heat out of the debate the 1993 Australian Veterinary Association (AVA) AGM commissioned a study. In March 1994 in the final report the AVA stated, "those investigating small animal health problems should also take diet and diet consistency into account when researching systemic diseases - possible confounding effects of diet and poor oral health must be considered in such studies."⁸ To my knowledge this injunction has not been followed in any Australian peer reviewed publication since that time.

My personal experience of the peer review system has been limited and paradoxical. Having received savage rejections from 'modest' journals, I resubmitted my two manuscripts (in one case unchanged) to what are considered to be more prestigious publications. Much to my amazement the papers were published almost as submitted. Some readers were not so much amazed as incensed and sent letters of protest alleging serious lapse in editorial standards. The Journal in question toyed with the idea of publishing the correspondence but finally settled for censorship. We can only speculate as to their reasons but thanks to the new forms of publishing we can at least speculate in public.

And this I suspect is the central issue. The environment has changed and there is now competition where previously there was monopoly control. Under the new conditions all participants whether they be authors, reviewers, editors or readers will need to readjust in the absence of tried and tested standards. Or perhaps I should rephrase that to say in the absence of tried and tested artificial standards. For fundamental basic principles have always been available if somewhat obscured. In charting a course in the new environment reference to basic principles, nature and normal control groups could enjoy a revival. This 'reality check' could be the vital ingredient for secure navigation in cyber space. Sometimes we may gravitate back to the old insularity and may need extra help. It's only a suggestion but how about the creation of a navigation tool? When losing touch with reality simply "Point and click on 'reality check'".

References: 1.Healthgate - Free Medline terms and conditions. December 1996. http://www.healthgate.com/HealthGate/MEDLINE/terms-and-conditions.html

2. Australian Dental Association, News Bulletin November 1996 239. p38.

3. Day, R.A.(1995) How to write and publish a scientific paper. The review process (How to deal with editors). Cambridge University Press. Cambridge. pp102-103

4. Barber, B. (19961) Resistance by Scientists to Scientific Discovery. Science 134 596-602

5. Horrobin, D.F. (1990) The Philosophical Basis of Peer Review and the Suppression of Innovation. The Journal of the American Medical Association. 263 1438-1441

6. Costerton J. W. et al. (1995) Microbial biofilms. Annual Review of Microbiology 49. 711-45.

7. Root-Bernstein, R.(1993) Rethinking AIDS. The tragic cost of premature consensus. The Role of HIV in AIDS. Free Press. New York. p106.

8. Australian Veterinary News (1994) Diet and disease link. February. Pages 1 and 6.