“The Philosophical Basis of Peer Review and the Suppression of Innovation”, 1990-03-09 (; backlinks; similar):
[Formal academic] Peer review can be performed successfully only if those involved have a clear idea as to its fundamental purpose. Most authors of articles on the subject assume that the purpose of peer review is quality control. This is an inadequate answer.
The fundamental purpose of peer review in the biomedical sciences must be consistent with that of medicine itself, to cure sometimes, to relieve often, to comfort always. Peer review must therefore aim to facilitate the introduction into medicine of improved ways of curing, relieving, and comforting patients. The fulfillment of this aim requires both quality control and the encouragement of innovation. If an appropriate balance between the two is lost, then peer review will fail to fulfill its purpose.
…But I think we must take seriously the possibility that we have traded innovation for quality control, not only in medical publishing but throughout medical science. Here is a specific example. My particular historical interest is in the development of psychiatric therapy. There are 5 major types of drugs in use in psychiatry: the neuroleptics, the benzodiazepines, the tricyclic antidepressants and related compounds, the monoamine oxidase inhibitors, and lithium.
All 5 classes were discovered prior to 1960. Some new molecular variants have been introduced, but all the original compounds are still extensively used and no major new therapeutic principles have been developed and shown to be effective clinically. This is in spite of the incomparably greater expenditure on research in neurobiology and psychiatry since 1960. [Scott Alexander notes that older psychiatry drugs are also more highly rated by patients.]
Lithium is in some respects the most successful of these 5 classes of compounds. It is the only one that when properly used appears to bring about a true normalization of behavior. Yet modern peer review practices would certainly have blocked its introduction. Cade worked under primitive conditions in a psychiatric hospital in Australia in the period immediately following the Second World War. His animal experiments were crude and would not now be regarded as remotely adequate to justify a trial in humans.
Yet more comprehensive and detailed animal studies would have been impossible because of a lack of resources. The article describing his completely uncontrolled clinical observations5 would almost certainly now have been rejected. If that had happened, it is very doubtful whether Cade would have been in a position to do the additional work that would justify publication and lithium would have been lost to medicine. Cade’s originality would probably not have overcome the current emphasis on accuracy and reliability.
[Horrobin provides an additional 18 examples of work initially suppressed by the publication & grant-making process, ranging from the Krebs cycle to infectious cancer to cave paintings; some are questionable (like Horrobin’s own work).]
…This is by no means a complete list of all the examples of which I am aware of situations in which peer review has delayed, emasculated, or totally prevented the publication and investigation of potentially important findings. The list is extensive enough to demonstrate that, while antagonism to innovation during the peer review process may not be the norm, it is far from being exceptional. The examples I have given, together with the numerous cases of scientific fraud that have been documented in a book [Betrayers of the Truth, 1983] and described ad nauseam in the pages of Nature and Science, demonstrate that what some might call ‘psychopathology’ is not rare in the scientific community. Most decent scientists are reluctant to admit this and therefore reluctant to take it into consideration when assessing peer review.
There can be little doubt that this wish to believe that all is for the best in the best possible world has led to serious injustice. If the shepherds do not believe that wolves exist, then some of the sheep are going to have a bad time.