Disability Bias in Peer Review?

By Neuroskeptic | February 18, 2018 9:05 am

Writing in the journal Medical Care, researcher Lisa I. Iezzoni says that a peer reviewer on a paper she previously submitted to that journal displayed “explicitly disparaging language and erroneous derogatory assumptions” about disabled people.


Iezzoni’s paper, which was eventually rejected, was about a survey of Massachusetts Medicaid recipients with either serious mental illness or significant physical disability. The survey involved a questionnaire asking about their experiences with Medicaid. According to Iezzoni, one of the two peer reviewers  questioned this methodology on the grounds that these disabled people may not have been ‘competent’ to complete the questionnaire unaided:

The author chose the seriously mental disability patients who may have no competence to self-assess themselves quality of life or the medical service quality… since the respondents have signification physical disability and serious mental disability, how can they complete the questionnaire survey by themselves without a qualify investigators assistant?

Iezzoni charges that these comments are ignorant

Reviewer #2’ s statements reflect an erroneous understanding of the lived experiences of individuals with a psychiatric diagnosis or significant physical disability who reside in the community, as study participants did… Answering a short survey is perhaps among the easier tasks these individuals might perform on a given day

The reviewer’s comments also constitute “stigmatizing language”, “discriminatory attitudes” and “derogatory assumptions” towards the disabled people involved in the study.

There is no rebuttal from the unnamed reviewer or from the journal although Iezzoni says the editors invited her to write the commentary because “We need… to address this issue up front.”


Hmm. I have a mental illness myself. I would not be thrilled to have my competence to complete a questionnaire questioned but to me this looks like a routine case of a peer reviewer who didn’t read the paper properly (or, as Iezzoni says, who struggles with English). The reviewers’ comments make more sense if we assume that he or she thought that the seriously mentally ill patients suffered from serious intellectual disability i.e. cognitive impairment.

It would be legitimate to question how individuals with “severe intellectual disability” were able to complete a questionnaire unaided. Iezzoni’s paper wasn’t about such individuals, but the reviewer may have thought it was: certainly, he or she refers to ‘seriously mental disability patients’.

So if the rather elementary confusion between seriously ‘mentally ill’ and serious ‘mental/intellectual disability’ is what caused the whole episode, then the reviewer was certainly not very ‘competent’ in performing their review, but I don’t think we should accuse them of discriminatory attitudes.

I previously blogged about a case in which a peer reviewer advised two female authors to “find one or two male biologists” to help improve their manuscript. As I said at the time, those comments were outrageous and should never have been accepted by the editors as a valid peer review report. But in this case, my impression is that the reviewer screwed up and submitted a bad review based on misunderstandings.

  • OWilson

    Oh dear!

  • 1×1

    Neuroskeptic, have you read the manuscript in question? Can it be that reviewer’s misunderstanding is due to the ambiguous language somewhere in the paper? I am not claiming anything, but there are two sides of the story, and you are solely base your judgment on only one on of them. This point aside, and irrespectively of who is right/wrong here, both reviewer and especially author exchanged very subjective and emotional arguments. Just consider , for example, such an answer: “regarding the cognitive abilities of the respondents, we controlled it, here the results of their test (Fig.X. and Table Y) Please notice that these respondents reside in the community and have no significant cognitive disability”. Wouldn’t this answer be way more helpful?

    • http://blogs.discovermagazine.com/neuroskeptic/ Neuroskeptic

      The manuscript isn’t available as far as I know, but yes, it is possible that the confusion arises from the manuscript. Although my gut feeling is that the authors were probably more careful about terminology than the reviewer.

      But yes, certainly the authors could have responded to the confused peer review in a more straightforward way than by writing a commentary about it.

  • http://www.mazepath.com/uncleal/EquivPrinFail.pdf Uncle Al

    Productive people are nowhere near sane in a world of Sociai Marxist blockheads and Snowflake whiners. Venezuelate the world with a Zimbabwean mandate. Black Panther for precedent.

    Civilization is defined and created by confident male privilege. Facts do not have “feelings.” If a neurosurgeon has his medical license lifted for suffering Parkinson’s disease, were was our compassion?

  • Pingback: Weekend reads: Automated image duplication detection?; journal editor frustrations; cash for catching errors | shaka()

  • KJA

    In my experience, the vast majority of “invisible” people are very conscientious research participants . A major reason is validation: that someone thinks their experience is important enough to research, that they get a chance to be heard, that perhaps being involved in research gives additional meaning to their experience, and that the research could result in recommendations that can help other people in their situation. This makes them very reliable research participants compared to “important” people such as medicos who have a notoriously low survey response rate.



No brain. No gain.

About Neuroskeptic

Neuroskeptic is a British neuroscientist who takes a skeptical look at his own field, and beyond. His blog offers a look at the latest developments in neuroscience, psychiatry and psychology through a critical lens.


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