Scientific publications in English language are rapidly increasing in volume, with more than 4.2 million journal articles published in 2020 [1]. This number may reflect the tremendous pressure on academics worldwide to publish, and also the rise of publishers that print low or marginal quality research.

The peer review system is considered an integral part of judging scientific articles submitted to medical journals, research funding and academic qualifications. Peer reviewers play a central and critical part in the peer review process. They are invited to review an article by the editors, and they usually volunteer their work as a gift to science and medicine without any payment or reward. Peer reviewers can judge whether a submitted manuscript is novel and worthy of publication. However, many reviewers are not instructed as to how to be a good reviewer, or are not educated on their ethical obligations. Thus, sometimes, this process is not flawless, which makes the position of the editor an extreme occupation. For example, this includes that peer reviewers have unreasonable delays in the response to accepting the invitation to review an article, and delay in submitting his/her report; or they accept or reject a manuscript too easily, with minimal critiques, within a short time interval, or unfairly criticize a competitor’s work, and request too much information.

Many international societies and publishers recommend the ethics of peer review [2, 3]. According to them, the starting main requirement is that the reviewer should carefully accept the offer to review a manuscript only when he/she is an expert in the specific field, properly understand the aims and scope of the journal, where the manuscript has been submitted, and can finish the review within the predefined deadline. Moreover, the reviewers must read the manuscript thoroughly and provide constructive feedback with a respectful tone to improve the quality of the article, regarding study design, methods of data presentation, applied statistical analysis, expressions to improve clarity, relevant references and convincing conclusions. The reviewers’ report should also be objective and free from any personal or professional biases, so that the contents of the manuscript should be considered based on the facts that are being presented, and solely on the paper’s originality, quality and scientific merits. Indeed, the most crucial ethical obligation is the prevention of the publication of erroneous and/or unsubstantiated findings, which could mislead subsequent research. Nonetheless, the reviewer should pay attention to avoid asking for too many revisions that are either outside of author’s reach or not relevant to the findings the authors wish to convey.

On this respect, many of us, as authors of a manuscript, have sometimes received a common request from the reviewers to perform additional experiments or provide more data details of a given clinical study. This occurs not just for manuscripts submitted to top scientific medical journals, but is becoming almost the rule for the hundred open-source journals with low or average impact factor brimming the publishers’ world. In some cases, the request for further work/data is certainly relevant, and useful to provide key support for the results presented and to make conclusions more robust and sound. Frequently, however, in other instances, the reviewers seek from authors something that instead is not strictly linked to the work under revision, but focus on the next step of the research and possibly matter of a follow-up paper. While making trouble to the authors, this kind of reviewer’s feedback may create problem also to the handling editors of the manuscript, who often prefer to refer to other reviewers in search of a majority opinion, instead of looking carefully at the recommendations and requests of additional work/data by the original reviewers, and take their own decision. Moreover, besides loosing further time in the review process, consulting other reviewers may often result in other requests of additional experiments or data. Of course, editors not always have the expertise to evaluate whether a given assay or test, or, for example, a novel surgical technique has been adequately validated, and therefore, they may seek technical guidance to solve the issue and eventually decline the reviewer’s request for additional work.

In conclusion, all actors involved in the peer review process, as well as the manuscript’s authors, have ethical obligations related to the responsibility associated with their specific duty. Nonetheless, each of these tasks require a critical approach. Indeed, quoting an interesting Editorial published in 2011 in Nature [4] “For authors: in the interests of robustness and genuine impact, resist the pressure to publish prematurely. For editors: don’t be supine in the face of referees’ request. For referees: please don’t ignore any impulse to demand more, but be self-critical too”.