This week the peer-review system has been in the newspapers, after a survey of scientists suggested it had some problems. This is barely news. Peer review – where articles submitted to an academic journal are reviewed by other scientists from the same field for an opinion on their quality – has always been recognised as problematic. It is time-consuming, it can be open to corruption, and it cannot always prevent fraud, plagiarism or duplicate publication, although in a more obvious case it might. The main problem with peer review is: it’s hard to find anything better.
Here is one example of a failing alternative. This month, after a concerted campaign by academics aggregating around websites such as Aidstruth.org, academic publishers Elsevier have withdrawn two papers from a journal called Medical Hypotheses. This academic journal is a rarity: it does not have peer review; instead, submissions are approved for publication by its one editor.
Articles from Medical Hypotheses have appeared in this column quite a lot. It carried one almost surreally crass paper1 in which two Italian doctors argued that ‘mongoloid’ really was an appropriate term for people with Down’s syndrome after all, because they share many characteristics with Oriental populations (including: sitting cross-legged, eating small amounts of lots of different types of food with MSG in it, and an enjoyment of handicrafts). You might also remember two pieces discussing the benefits and side effects of masturbation as a treatment for nasal congestion.2
The papers withdrawn this month step into a new domain of foolishness. Both were from the community whose members characterise themselves as ‘Aids dissidents’, and one was co-authored by its figureheads, Peter Duesberg and David Rasnick.
To say that a peer reviewer might have spotted the flaws in their paper – which had already been rejected by the Journal of Aids – is an understatement. My favourite part is the whole page they devote to arguing that there cannot be lots of people dying of Aids in South Africa, because the population of that country has grown over the past few years.
We might expect anyone to spot such poor reasoning – and only two days passed between this paper’s submission and its acceptance – but they also misrepresent landmark papers from the literature on Aids research. Rasnick and Duesberg discuss antiretroviral medications, which have side effects, but which have stopped Aids being a death sentence, and attack the notion that their benefits outweigh the toxicity: ‘Contrary to these claims,’ they say, ‘hundreds of American and British researchers jointly published a collaborative analysis in the Lancet in 2006, concluding that treatment of Aids patients with anti-viral drugs has “not translated into a decrease in mortality”.’
This is a simple, flat, unambiguous misrepresentation of the Lancet paper to which they refer. Antiretroviral medications have repeatedly been shown to save lives in systematic reviews of large numbers of well-conducted randomised controlled trials. The Lancet paper they reference simply surveys the first decade of patients who received highly active antiretroviral therapy (HAART) – modern combinations of multiple antiretroviral medications – to see if things had improved, and they had not. Patients receiving HAART in 2003 did no better than patients receiving HAART in 1995. This doesn’t mean that HAART is no better than placebo. It means outcomes for people on HAART didn’t improve over an eight-year period of their use. This would be obvious to anyone familiar with the papers, but also to anyone who thought to spend the time checking the evidence for an obviously improbable assertion.
What does all this tell us about peer review? The editor of Medical Hypotheses, Bruce Charlton, has repeatedly argued – very reasonably – that the academic world benefits from having journals with different editorial models, that peer review can censor provocative ideas, and that scientists should be free to pontificate in their internal professional literature. But there are blogs where Aids dissidents, or anyone, can pontificate wildly and to their colleagues: from journals we expect a little more.
Twenty academics and others have now written to Medline, requesting that Medical Hypotheses should be removed from its index. Aids denialism in South Africa has been responsible for the unnecessary deaths of an estimated 330,000 people. You can do peer review well, or badly. You can follow the single-editor model well, or foolishly. This article was plainly foolish.