In an era defined by information overload, limited time, and competing professional demands, the role of the peer reviewer often comes at the expense of personal or free time. Yet, despite these challenges, performing this role remains an essential contribution to maintaining trustworthy science. I realize as I write this, I'm also proclaiming “Do as I say, not as I do,” as I have fallen victim to continually declining requests to act as a peer reviewer because of an ever-increasing workload from my employer, or important commitments I have made to my family and friends. However, today, where misinformation about science and medicine spreads rapidly across social media platforms, where political agendas often distort evidence-based discourse, and where questionable ‘science’ circulates without scrutiny, the peer review process, more than ever, serves as a critical safeguard for ensuring the credibility and rigor of science. Thus, if one identifies as a proponent of the scientific method and values a logical, data driven, and evidence-based foundation for scientific and medical dialogue, then active participation as a peer reviewer is less of an option and more of an ethical and professional responsibility. We cannot passively stand by and watch the ongoing deterioration of public trust in the professions we devoted our lives to. Rather, we must collectively reaffirm our commitment to credible research and the mechanisms by which knowledge remains verifiable, reproducible, and transparent. At its core, peer review is a process that brings scientific and medical manuscripts to evaluation by independent experts within the same field of study. This process helps to ensure that the research being published meets the standards of validity, originality, and methodological soundness, while also safeguarding ethical integrity.1 By filtering out research that doesn't meet these standards, the peer review process serves as a quality assurance mechanism that helps not only protect the academic record on the subject, but ultimately the public welfare. Moreover, the peer review process plays an important role in advancing knowledge and fostering innovation. It can facilitate intellectual exchange by encouraging researchers to refine their methods, clarify findings or interpretations, question assumptions, and even explore potential new directions not previously considered.2 In this way, peer review is more than just a gatekeeping function, it acts as a source of collaboration, accountability, and innovation that sustains the continuous evolution of science. The integrity of this process depends fundamentally on the ethical conduct and professional responsibility of reviewers. Reviewers must approach their task with impartiality, confidentiality, and respect for the intellectual property of others. Declaring conflicts of interest, whether financial, personal, or professional, is not merely a formality, but a necessary measure against bias and misconduct.3 Equally important is the recognition that reviewers serve both the scientific community and the public. Their evaluations can influence not only academic careers (based on approval or rejection of the work), but also policies, guidelines, and practices, medical or otherwise, that can ultimately affect lives. Reviewers have an ethical obligation to provide thoughtful, constructive feedback that enhances the quality of the manuscript and promotes the professional development of authors. Critiques should be evidence-based, balanced, and free from prejudice related to the author's identity, institutional affiliation, or country of origin.4 Furthermore, reviewers should resist the pressures of the “publish or perish” culture that can distort judgment, lead to irreproducible research, or foster unethical behaviors, such as rejecting or delaying competitor research or taking unpublished ideas for their own use.5 Upholding these principles helps to ensure that peer review remains a fair and transparent process that prioritizes knowledge advancement over personal gain. Despite its strengths, the peer review system faces several challenges that can undermine its effectiveness. Currently, one of the key issues is the imbalance between the growing number of submitted manuscripts and the limited pool of qualified reviewers. As the volume of scientific and medical publications increase exponentially, the burden on the limited pool of qualified reviewers intensifies. This in turn leads to burn-out, significant delays in the review process, and, in some cases, sub-satisfactory evaluations. Other concerns include the uneven quality of reviews, often a consequence of insufficient training for reviewers, particularly those early in their career, whom many times assume the role of reviewer without proper guidance or formal training. This can leave them unaware of the ethical expectations or knowledge regarding how to properly perform critical and balanced reviews. Another concern is the absence of tangible incentives for reviewers, who usually undertake this intensive work voluntarily, with little recognition or reward. Finally, the anonymity of the traditional peer review model, while designed to protect reviewers from retaliation, can have ethical drawbacks.6 Sometimes, reviewer anonymity can foster unconstructive criticism or bias, as reviewers may feel shielded from accountability. Conversely, with an open peer review system, in which the reviewer is identified, and all comments are fully disclosed, while promoting transparency and accountability, can also introduce pressures that discourage candid critique. Therefore, the challenge lies in finding a balanced model, one that maintains both integrity and openness while respecting the needs of reviewers and authors alike. To preserve the integrity of the peer review process, it is imperative that more researchers contribute to this important process and view participation as a professional responsibility rather than an optional service. Authors who benefit from peer review should, in turn, contribute as reviewers.7 Institutions should support this participation by formally recognizing peer review as a valuable component of academic and professional service during performance evaluations, promotions, and tenure reviews. Journals and professional societies should consider investing in reviewer education, if not already done so. Structured training programs, whether created as online modules, live workshops at congresses, or mentorship initiatives, can equip the next generation of reviewers with the skills necessary for critical appraisal and ethical judgment. This training should also emphasize cultural competence and awareness of unconscious bias, ensuring that reviews are balanced and inclusive across diverse research communities. Scientific integrity relies on the strength of the peer review system. It is a shared responsibility that demands active participation, ethical vigilance, and institutional commitment. Reviewers must engage with diligence and fairness; journals should provide training, recognition, and proper oversight; and academic and professional institutions should value peer review as an integral part of their employees’ careers. The American College of Clinical Pharmacology (ACCP) therefore calls upon its members and the broader scientific and medical community to take up this responsibility by actively participating in the peer review process. By doing so, we collectively uphold the integrity of scientific discourse, strengthen the reliability of the evidence base for clinical and scientific data, that ultimately supports scientific rigor, medical guidelines, policy decisions, and protects the foundation upon which public trust in medicine and science depends.
Kenneth T. Moore (Sun,) studied this question.