Prestige bias- -an old, untreated enemy of the peer-review process


Hippokratia 2020, 24(2): 94

Bazoukis G
Second Department of Cardiology, “Evangelismos” General Hospital, Athens, Greece

Keywords: Publication, prestige bias, peer review, blinding

Corresponding author: George Bazoukis, MD, MSc, PhD, Second Department of Cardiology, General Hospital of Athens “Evangelismos”, 47 Ipsilantou str., Athens, 10676, Greece, fax: +30213456873, e-mail:

Dear Editor,

During an informal dinner, a guest referred to a distant relative’s death caused by a severe lower respiratory tract infection treated at an unprestigious small private hospital in a rural area. To my surprise, it was argued that the patient’s outcome would be better if treated at a reputable private hospital in the capital – without any support of such an argument with evidence. A strange correlation was created between unprestigious hospitals and authors without prestigious affiliations with the “unfair” treatment of subjects and the “unfair” rejection of studies during the peer-review process. Without losing time, an online search revealed that the potential influence of the affiliated authors’ institutional prestige on reviewers and editors is a real enemy of the unbiased peer-review process that has been well-known since 19821. Editors of high-impact journals have recognized the susceptibility of the review process to bias2,3. Back in 1990, a randomized study showed that reviews’ quality was graded slightly higher for blinded versus unblinded manuscripts4.

Furthermore, a recent study compared the review bias in single-blind (blinded for authors, while not blinded for reviewers) versus double-blind (the identities of both authors and reviewers are hidden from each other) peer-review process5. Interestingly, the authors found that the acceptance rates for papers from famous authors, top universities, and top companies were significantly higher in single-blind reviews5. Additionally, another study confirmed these results showing that the single-blind peer-review process favors reputed authors compared to the double-blind process6. Interestingly, in a randomized study, reviewers were arbitrarily grouped to receive either a single-blind or a double-blind version of a fabricated manuscript in a single journal7. The authors achieved a 28 % higher acceptance rate and higher overall reviewer scores when their prestigious names and institutions were visible7. These data provide strong evidence that the existing unblinded peer-review process that most medical journals use is prone to bias.

Even though the problem is well-known, medical journals have not implemented a double-blind, triple-blind (in addition to blinding the reviewers’ identity, the authors’ identity is also hidden from the editors) or quadruple-blind (the blinding is augmented by hiding the identity of the handling editor) peer-review process. At the same time, such a measure can eliminate peer review bias8. Also, “honorary authorship” is a common cause of misconduct in research practices9. The implementation of blinding in the review process could eliminate the “honorary authorship” of prestigious authors that mainly occurs to increase the likelihood of achieving a publication in high impact journals.

Why do the prestige and affiliation bias still exist as enemies of medical journals’ peer-review process when there are many less biased methods?  Why is no action taken while the review bias directly affects outcome that depends on the peer-review process? As currently, the peer review process does not universally address such concerns, the prestige bias remains “an old, untreated enemy of the peer-review process…”

Conflicts of interest

The author declares no conflicts of interest.


1. Ceci SJ, Peters DP. Peer review–a study of reliability. Change. 1982; 14: 44-48.
2. Smith R. Opening up BMJ peer review. BMJ. 1999; 318: 4-5.
3. Bauchner H, Fontanarosa P. Bias Among Peer Reviewers. JAMA. 2017; 318: 755-756.
4. McNutt RA, Evans AT, Fletcher RH, Fletcher SW. The effects of blinding on the quality of peer review. A randomized trial. JAMA. 1990; 263: 1371-1376.
5. Tomkins A, Zhang M, Heavlin WD. Reviewer bias in single- versus double-blind peer review. Proc Natl Acad Sci U S A. 2017; 114: 12708-12713.
6. Seeber M, Bacchelli A. Does single blind peer review hinder newcomers? Scientometrics. 2017; 113: 567-585.
7. Okike K, Hug KT, Kocher MS, Leopold SS. Single-blind vs Double-blind Peer Review in the Setting of Author Prestige. JA-MA. 2016; 316: 1315-1316.
8. Haffar S, Bazerbachi F, Murad MH. Peer Review Bias: A Critical Review. Mayo Clin Proc. 2019; 94: 670-676.
9. Artino AR Jr, Driessen EW, Maggio LA. Ethical Shades of Gray: International Frequency of Scientific Misconduct and Ques-tionable Research Practices in Health Professions Education. Acad Med. 2019; 94: 76-84.