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.



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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