Peer Review

washington -- Mitt Romney twice emphasized his unique business background when he and eight other Republican presidential candidates faced off in a debate last week in Iowa. "I've spent the last, as I've told you, 25 years in the private sector," former Massachusetts Gov. Romney declared at one point. "I understand why jobs come and why jobs go. I've done business in 20 countries."

Fresh questions about the ridership and revenue projections that underpin the state's $43-billion bullet train project have been raised in a new internal report by the agency charged with building the system. Among the key conclusions of a California High Speed Rail Authority panel of experts is that forecasts of up to 117 million annual riders by 2030 — which have helped support predictions that the system would generate billions in profits — need to be recalibrated to be more conservative and better reflect important factors that could affect ridership.

They can change the course of medicine, influence the careers of researchers, and determine the for tunes of pharmaceutical manufacturers and their stockholders. They are the powerful biomedical journals, such as the New England Journal of Medicine and Nature, whose names are often preceded by the word prestigious in the news media. But how scientific is the process by which biomedical journal editors decide what research articles to publish? Journal editors conceded at a three-day meeting earlier this month that their editorial procedures are imperfect, frequently fallible, and have received little serious scrutiny.

An auditing firm that has come under scrutiny for failing to uncover corruption in the city of Bell has hired an independent accounting company to review its practices as some government agencies review their ties with the firm. CalPERS, the state employee retirement fund, has decided not to give Mayer Hoffman McCann any more work until state Controller John Chiang completes a review of Bell's auditing. Officials in several Southern California cities said they too are waiting to see Chiang's report before deciding what to do. Mayer Hoffman conducts outside audits for numerous California government agencies as well as some federal agencies.

In a fight that could have wide-ranging implications, Los Angeles County supervisors are pushing to see confidential medical records used by county doctors to evaluate their peers to determine whether they have met accepted standards of care, saying they need the information to ensure patient safety and justify settling malpractice claims against the county. Access to such information emerged as an issue earlier this year after concerns were raised about peer review at Olive View-UCLA Medical Center . An anonymous letter to state regulators alleged that among other problems at the county hospital's neonatal intensive care unit, doctors and staff were not meeting to discuss medical mistakes and that peer review was "missing.

With dual doctorates in chemistry and materials science and 23 years as a college instructor, Abdul Ismail looked like a dream candidate for a job teaching high school science. But despite his glowing resume, Ismail quickly ran into trouble. He had difficulty relating to 14-year-olds. His lectures were dry recitations delivered facing the chalkboard. When the students acted up, he kicked them out. In most schools, such a teacher would give up or muddle along in isolation.

A lawsuit following a tonsillectomy that left a boy permanently brain damaged has threatened to undermine a system California doctors use to police the quality of medical care they provide in hospitals, according to the state medical association. The anesthesiologist in the 1979 tonsillectomy was suspended from practicing at Santa Ana-Tustin Community Hospital, now known as Western Medical Center, after a peer committee reviewed her performance during the operation.

The membership of the Los Angeles teachers union has overwhelmingly ratified a plan to have senior teachers consult with colleagues who receive poor evaluations to help them improve or encourage them to leave the profession. In three days of balloting, 77% of the teachers agreed to add the new peer assistance and review program to their contract.

The first skirmish in the war between neurosurgeon Mark Anderson and orthopedic surgeon Brian Ewald erupted one day in surgery at St. Joseph Hospital, where their unconscious patient lay on the operating table with a broken neck. Anderson says that as he tried to mend the damaged vertebrae with prosthetic wire, Ewald refused to continue and threatened to get Anderson kicked off the staff at St. Joseph, one of Orange County's premier medical facilities.

It was a victimless crime, and it didn't make many headlines. Only someone who spends hours a day with her nose pressed against a computer screen would have noticed when, earlier this summer, a researcher formerly at the Lawrence Berkeley National Laboratory was found by federal watchdogs to have fabricated information on the health effects of electromagnetic fields.

Steve Franklin, a middle school teacher in L.A. Unified, had some issues with the Times series on teacher evaluations, so he fired off a letter to the editor. It read, in part: "When somebody can prove that high test scores produce good citizens, critical thinkers and productive members of society, then and only then can we say the teachers who taught those kids were 'good.' " Yeah, yeah, yeah, I thought. Test scores aren't always the best measure of students or teachers, but without them, how do we judge the performance of either?

In a fight that could have wide-ranging implications, Los Angeles County supervisors are pushing to see confidential medical records used by county doctors to evaluate their peers to determine whether they have met accepted standards of care, saying they need the information to ensure patient safety and justify settling malpractice claims against the county. Access to such information emerged as an issue earlier this year after concerns were raised about peer review at Olive View-UCLA Medical Center . An anonymous letter to state regulators alleged that among other problems at the county hospital's neonatal intensive care unit, doctors and staff were not meeting to discuss medical mistakes and that peer review was "missing.

Los Angeles County supervisors on Tuesday ordered improvements intended to shore up patient safety at the county's hospitals and clinics after reviewing a study commissioned to look at malpractice payouts. The risk management study, conducted by the Abaris Group, a Walnut Creek-based independent consulting firm, found that payouts for malpractice cases settled between 2005 and 2007 increased from more than $8 million to more than $12 million. At the same time, a review of records found that the number of incidents that either resulted in or were expected to result in malpractice lawsuits dropped from 354 in 2002 to 107 last year.

• Providers collaborate to emphasize preventive care for all and the reduction of complications in cases of major chronic illnesses like diabetes and heart disease. • A non-profit hospice emphasizes comfort for the dying over futile chemotherapy and surgery, extending life an average of 10 days and saving $5,150 for every person who dies there. • The one dominant home health agency is non-profit, not owned by doctors ordering treatment that brings them profits.

Undercooked chicken. Poor customer service. A bug in the guacamole. For years, users on the popular review website Yelp have had the final -- and only -- word when reviewing their most-loved or most-hated local restaurants, clothing shops and beauty salons. Now business owners are getting their chance. And talking back is sweet. This month, Yelp will open up its site to public responses from businesses, a first for the 5-year-old San Francisco company.

Re "Tainted medicine," Opinion, April 6 The reason that efforts by the medical profession to reform its conflicts of interest have been, as Dr. Jerome P. Kassirer describes them, "superficial" is that physicians are allowed to police themselves, unlike in some other professions. Peer review is a sacred cow in the medical community, but it is in need of some major doctoring. Consider the police and the airlines, for example, before outside agencies began to police them. And consider their safety records since they have had parts of their functions placed under the direction of independent agencies.

One of the great sacred cows of science, the "peer review" system that determines who gets published in professional journals and who gets funding for their work, is now facing a serious attack. The system, in which proposals for publication and funding must first be approved by others in the same field, has always been unpopular with some who feel their work is not getting the support it deserves.

Even in science, a flawed system that is the "best process we've got" can turn out to be the only game in town. Readers responding to my Oct. 25 column cite many problems with the peer review system that determines who gets published in professional journals and who gets funding for their work, but none recommended abolishing it.

Re "Tobacco funding of research reviewed," March 28 It appears to me that UCLA is simply trying to sweep this controversy under the rug. The tobacco industry deliberately deceived the world for decades for its own profit and took with it our grandparents, parents, brothers, sisters and friends, who died slow, painful deaths. We need scientific facts to counter what this industry has done to our society, not facts clouded by who is writing the checks. UCLA should get rid of epidemiologist James Enstrom; he can go to work directly for Philip Morris -- I hear they pay very well.

Re "A below-average audit," editorial, Dec. 14 Thirty of the nation's best school superintendents and senior managers from 17 major city school systems across the nation traveled to Los Angeles this year, volunteered their time to give their best advice to the city's school system -- and the thanks they get from The Times was to question their motives and belittle their efforts. The study -- not an audit but a peer review -- praised the Los Angeles Unified School District for the progress it had made on student achievement and facilities, took it to task on a number of organizational and operational issues and proposed a roadmap for taking the district to the next level -- something the school board asked us for about 14 months ago. That the 300-page report did not cover every issue or spell out every detail suggests that The Times ought to go back to school on how these systems work before criticizing the district and the people trying to help it. MICHAEL CASSERLY Executive Director Council of the Great City Schools Washington, D.C.