Peer review (referee system) is a tool used in the critical assessment of manuscripts submitted by authors in scientific journals and is the fundamental mechanism of quality control, feasibility, and credibility of scientific research. A growing number of journals use it for selection and improvement of manuscripts before their publication. Its implementation raises doubts regarding the evaluation process which is still far from being an objective, reliable, and reproducible method.

Surprising as it may seem, there is no clear consensus on the nature of the process, especially on its objectives. There are some evidence biases of various kinds; some well documented (bias towards positive bias, institutional or geographical origin of the authors).

The subjectivity of the process is one of the major disadvantages, which in my humble opinion they do detract this process. Other disadvantages are conflicts of interest, paradigms struggle, and the “alleged expertise” of reviewers.

It is a myth that the prestige of an expert based on their daily professional practice and many years of experience guarantees validity and quality at reviewing manuscripts; this believing is such an alarming matter.

In reality, having a solid experience of practice in health sciences is not in any way guarantee for proper methodological rigor and ethical performance as a reviewer.

Medicine is a magical blend of science and art materialized in practice; and inevitably exercised under the influence of socio-cultural, scientific and conceptual information, technical skills, human relations, and ethical values.

What would happen if a study proposed for publication goes beyond the paradigms of their reviewers?

What would happen if a proposed study solves problems, and expert referees have not noticed it for generations?

Facing this uncertain and bleak outlook, there are diverse rising voices towards the increasing transparency of the process, so that both author and reader can be placed in the lowest position of "vulnerability" as possible, to the imperfection of methods and decisions by the editorial process.

Without doubt, the system of peer review or peer review of manuscripts has advantages for all participants in the editorial and publication process; and lately it still rules the impression that this is the "least-worst and more sustainable" method of selection and improvement of scientific evidence.

However, this can and should be improved quickly for the sake of scientific work.

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