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Aczel and colleagues estimated that the total time that reviewers worked on peer reviews globally was over 100 million hours in 2020.1 The peer review system in academic publishing is not only time consuming and costly but has many other flaws, including biased reviews, inconsistency, absence of reward, difficulty in finding reviewers, and slowness.2, 3 These flaws hamper scientific progress, career progress, and might even cost lives. Another problem, which is rarely addressed, is that evidence suggests that the number of reviews contributed by high-income countries is higher than the number contributed by low-income countries per published paper, although there are no extensive empirical data available.4 A Publons report noted that researchers in so-called established regions (eg, the USA) provided three times as many reviews per paper submitted than did researchers in so-called emerging regions (eg, China, Turkey, Iran, Poland, and Malaysia).5 The report also showed that women were under-represented.5 One of the reasons for a greater proportion of reviews being provided by researchers from high-income countries than low-income countries could be that researchers from low-income countries are not equally included in the pool, because they have little time for unpaid work. For example, many health researchers in under-funded countries do not have protected or paid time to conduct research. Having reviewers mainly from high-income countries means that the interest of these scientists and populations are perpetuated, and those in low-resource settings are marginalised. We acknowledge that paying for reviews might raise many objections. The payment concept could erode the pure academic ethos of the pursuit for knowledge, would require increase in the total budget for research, and will not address all the problems of the peer review system. To the first objection that financial incentives might corrupt the pure academic ethos of peer review, researchers are sometimes paid to review grant proposals and academic theses-this concept should not be any different. Regarding budget, we think that there is a potential need to reshuffle research funds to accommodate the cost for conducting reviews, which is currently paid by researchers' employers. Finally, we think that payment for reviews should be tested empirically to assess its effects on the other issues in the peer review system.

Aczel and colleagues estimated that the total time that reviewers worked on peer reviews globally was over 100 million hours in 2020.1 The peer review system in academic publishing is not only time consuming and costly but has many other flaws, including biased reviews, inconsistency, absence of reward, difficulty in finding reviewers, and slowness.2, 3 These flaws hamper scientific progress, career progress, and might even cost lives. Another problem, which is rarely addressed, is that evidence suggests that the number of reviews contributed by high-income countries is higher than the number contributed by low-income countries per published paper, although there are no extensive empirical data available.4 A Publons report noted that researchers in so-called established regions (eg, the USA) provided three times as many reviews per paper submitted than did researchers in so-called emerging regions (eg, China, Turkey, Iran, Poland, and Malaysia).5 The report also showed that women were under-represented.5 One of the reasons for a greater proportion of reviews being provided by researchers from high-income countries than low-income countries could be that researchers from low-income countries are not equally included in the pool, because they have little time for unpaid work. For example, many health researchers in under-funded countries do not have protected or paid time to conduct research. Having reviewers mainly from high-income countries means that the interest of these scientists and populations are perpetuated, and those in low-resource settings are marginalised. We acknowledge that paying for reviews might raise many objections. The payment concept could erode the pure academic ethos of the pursuit for knowledge, would require increase in the total budget for research, and will not address all the problems of the peer review system. To the first objection that financial incentives might corrupt the pure academic ethos of peer review, researchers are sometimes paid to review grant proposals and academic theses-this concept should not be any different. Regarding budget, we think that there is a potential need to reshuffle research funds to accommodate the cost for conducting reviews, which is currently paid by researchers' employers. Finally, we think that payment for reviews should be tested empirically to assess its effects on the other issues in the peer review system.

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Award: TOP PICK Instead of testing individual products, Amazon review analyzers focus on the individual reviews left on specific Amazon product pages. The software analyzes the quality of those reviews and then tells you if they are real or fake.