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Pall T. Onundarson: Is Anonymous Peer Review Always Objective

Pall T. Onundarson/LinkedIn

May 29, 2026, 12:20

Pall T. Onundarson: Is Anonymous Peer Review Always Objective

Pall T. Onundarson, Professor Emeritus at Landspitali University Hospital, shared a post on LinkedIn:

“The anonymous peer-review process can be flawed.

The Fiix test, a new method designed to improve VKA monitoring and outcomes, generally received very favorable anonymous reviews in high-impact journals based on results.

There were, however, exceptions.

After publication of the Fiix RCT in Lancet Hematology in 2015, the pre-post interrupted time series study in Blood in 2021, and additional papers in JTH, JTT, and IJLH, I submitted a Fiix review article to one of the leading thrombosis and hemostasis journals.

In May 2021, I received a letter from the editor-in-chief, whom I respect: ‘…Over the past two weeks, a number of very well qualified clinician scientists have reviewed your submission informally – prior to any in depth evaluation.

Unfortunately, none of these scientists expressed an interest in reviewing your manuscript and several indicated significant concerns that the manuscript would not fare well during the peer review process.

In light of these experiences we will not be pursuing the assessment of your submission further at this time.’

I had never encountered this type of rejection before: potential reviewers, presumably editorial board members, effectively warning – or threatening – that if reviewed by peers, ‘the manuscript would not fare well.‘

Since then, I have wondered whether conflicts of interest biased these anonymous reviewers, given that major pharmaceutical companies subsidize the journal and the association behind it, including its conventions.

Many of these companies have profited massively consequent to poor PT-INR–monitored warfarin outcomes in their own clinical trials.

Although initially annoyed, I realized the editor had little choice but to reject the manuscript.

In retrospect, I believe he did me a favor by revealing what might be occuring behind the scenes.

I immediately submitted the paper to the Thrombosis Journal, where the review – similar to most reviews of this work – was highly favorable: ‘…if the Fiix modification is confirmed which I believe will be the case, it will be a significant improvement over the current methods for monitoring oral anticoagulant therapy.’

The paper was published later in 2021, and independent studies are now underway.”

Pall T. Onundarson: Is Anonymous Peer Review Always Objective