No professionals care more about quality than clinical chemists. We monitor the precision of every assay, the relevance of every test, and the accuracy of every laboratory. But we let institutional, grant, and editorial review boards operate behind the scenes and without oversight (1). No one has even the slightest estimate of the magnitude of intra- and inter-board variation, or the risk of false positive (rejection of good work) or false negative (approval of bad work) errors.

I suggest creating a Commission on Board Review Accuracy (COBRA) and inviting all clinical institutions, foundations, and journals to submit to its oversight, which would include single-blind proficiency testing. At irregular intervals, all participating boards would receive inconspicuous proposals or manuscripts of known quality. Review results would be treated in the same manner as results from current proficiency testing for laboratories. In this well-established manner, inter-board variation could be monitored and risks of error quantified and controlled. By extending our traditional concern for quality to review boards, we will manifest the cultural change that has been recognized as sorely needed (2-3).

I suggest that COBRA be governed democratically by a triumvirate representing the NACB, the ABCC, and the AACC. Each triumvir would monitor one of the three species of review boards, and each participating institution, foundation, and journal would appoint one delegate for the purpose of creating the respective proficiency tests and advising the respective triumvir. Each participating organization would contribute a small fee to fund the operation.


  1. Stark L. Behind Closed Doors, IRBs and the Making of Ethical Research, University of Chicago Press, Chicago, 2012.
  2. Keiger D., De Pasquale S. Trials & tribulation, Johns Hopkins Magazine, vol. 54, No. 1, February 2002.
  3. London A., Kimmelman J., Carlisle B. Rethinking research ethics: The case of postmarketing trials, Science 336, 544-45, 2012.