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A research paper presents the results of investigations on a selected topic. Based onresearchers own thoughts and the facts and ideas they have gathered from a variety of sources,a research paper is a creation that is usually unique. In Bangladesh about 100 science andresearch journals are published annually in English language of which 45 are biomedicaljournals. Most of these do not reach their target readers and are not indexed or abstracted.Amongst many other deterrents, poor peer review is one of the most important hindrance toquality publication of science journals regularly. For quality publication, journals need carefuland consistent editing. A well prepared systematic and organized manuscript is a prerequisitefor this purpose. Critical but sensible peer review can enhance and enrich the whole process.The final outcome will be a journal with sound science that can play its proper role in thedevelopment of the country.doi: 10.3329/taj.v15i2.3920TAJ December 2002; Vol.15(2): 98-102

Peer review means different things to different people. To most American physicians it means PSRO, to the British House of Lords it means Peers examining other Peers for moral turpitude, and to the scientific community, it means Study Sections and Councils that determine a grantee's financial and possibly research future. I shall prudently leave discussion of the first two to my peers. But as an ancient peer reviewer (ad 1949) I feel impelled, by my desire to have all physicians understand the threat to biomedical research, to challenge Secretary Weinberger's quoted statement (UPI) that, "There is too much emphasis on investigator-initiated research and not enough on directed research." Further, the Bureau of Management and Budget let it be known by way of a position paper released by Senator Kennedy, that the peer review groups of the National Institutes of Health (NIH) are self-serving, too numerous and costly, allow government administrators

To serve the interests of members and to function in the public interest, the California Medical Association must set policies and take positions on current issues affecting the health care of Californians. These policies then guide the activities of the Association in fulfilling its leadership role and its responsibility to the public.Delegates, elected by the membership of CMA's component medical societies, meet annually to deliberate and determine the policies and courses of action for the Association. Between meetings of these Delegates, the CMA Councilors, elected by their district membership, implement the directives of the Delegates and set interim policies. By this democratic process, the membership governs the CMA. Association members must be informed if they are to participate effectively in the affairs of their medical organizations. To disseminate better understanding of CMA's activities, position papers on current issues have been developed. They are based on House of Delegates resolutions and Council actions. Entitled "Where We Stand on Medical and Health Issues," these papers represent the current policy positions of CMA. Each paper is annotated to give the reference source of the policy actions. As with any organization, CMA policies are subject to timely revision. When policies are amended or new policies are adopted, new papers will be developed.

The conventional reviewing system of American biomedical journals determines where and when an author may publish, and hence may affect his career. Yet the system's effectiveness in validating reports, or the cost of such validation, has been little studied. Problems are inadequate review, unrealistic editorial expectation of what reviewers can do, and bias. Expert reviewers frequently disagree. Thus concurrence between two reviewers of each of some 500 papers submitted to the New England Journal of Medicine was only moderately better than a chance result. Costs of the reviewing system include time and effort involved, the possible violation of confidentiality, and occasional suppression of the novel advance. Despite deficiencies, the reviewing system is important to maintain standards. It could be improved if studies of its operation were carried out, if reviewers were better indoctrinated, if the work load of reviewers were lessened, if reviews were signed, and if the reviewing process were more rewarding to reviewers.

A review of abstracts and papers reporting clinical trials of new anticancer agents reveals that only a small percentage have been controlled. Arguments against employing randomized controls in such trials are understandable but hardly valid at the present stage in cancer research. Randomization of drugs tested or dosage regimens at the earliest stages of clinical use is needed to evaluate relative therapeutic efficacy and toxicity. Potent ethical arguments also require that when a new drug is tried, patients should be given a 50–50 chance of receiving the conceivably better standard therapy. An important and subtle consideration, that of how long to continue a controlled trial, requires continued development of the study-design process and new uses of peer review.

The implementation of quality control programs of health care service requires a technology no less complex than that of the quality control program itself. Previous efforts to implement programs where health care practitioners are truly accountable have foundered on: 1. The lack of enthusiasm of major third party payers, 2. The functional inadequacies of Medicare utilization review committees, and 3. The conflict of interests of medical societies. For the Professional Standards Review Organizations (PSRO) to be effective rather than ceremonial, evaluation that is arm's length between evaluator and practitioner is indispensable. The PSRO is the last chance for organized medicine to demonstrate that it can and will control those practitioners who habitually do violence to its ethical and professional norms. The paper lists other options should the presently structured PSRO program fail.

For any dentist interested in review by peers for maintaining the quality of services, reading of this paper is urged.