Three first-person accounts. As editor of JPANDS, the Journal of American Physicians and Surgeons, Huntoon has published a number of essays by doctors subjected to sham peer review and run out of their jobs. To put flesh on the bones of the definition above and get a feel for this specific technique of social elimination, read the following three accounts available online as PDFs:

• A psychiatrist's account of his ouster, by William K. Summers, 2005;
• How a surgeon got eliminated even though he "won," by Verner S. Waite, 2003;
• How a Florida pathologist got the boot, by John R. Minarcik, 2004.

Minarcik has also published on the web a longer account that powerfully conveys the terror of the target and the target's family: Diagnosis for Hire, 2002.

Relation to mobbing. The literature on sham peer review, as the essays linked above illustrate, has developed altogether independently of research on mobbing. It is not as if specialists in mobbing turned their attention to medicine and reported their findings. It is rather that physicians themselves, out of their own and their colleagues' experience, inductively identified an organizational pathology and invented a name for it. What they have called "sham peer review" turns out to be synonymous with "workplace mobbing," but more narrowly focussed in two main ways. First, these studies describe mobbing in a particular class of workers (physicians), in a particular kind of workplace (bureaucratized hospitals), and in a particular legal and social environment (the health-care sector in the United States). Second, "sham peer review" is defined by a particular technique of punishing, discrediting, and humiliating the target: the quasi-judicial procedure of "peer review," whereby in response to one or more complaints, a hospital committee formally deems the target deficient or incompetent in some way, and decides on a penalty (like retraining, suspension, or dismissal).

Points of convergence. For a researcher like me, who has studied mobbing mainly in universities, it is intellectually exciting (even if personally disheartening) to see how many themes and findings of studies of academic mobbing crop up also in studies of sham peer review. Following are half a dozen important points on which these two separate research literatures converge:

1. The singular experience of being ganged up on. The most basic defining attribute of workplace mobbing is the perpetrators' surrender of individuality to the collective. The mob is all for one and one for all — a quality that understandably strikes terror in whoever is targeted. This theme is recurrent in the literature on sham peer review. Waite uses the very term: "a local mob of physicians." Gynecologist Ron A. Vermani laments that the "peer-review process is controlled by the power elite in largely a mob fashion." In a trenchant essay on "medical herdology," Huntoon discusses the sorry fate of those "targeted for extinction" by the herd on account of nonconformity.
   
   
2. Weapons of choice: post-tenure review, peer review. In many cases of academic mobbing, notably those at Virginia State University, the strategy is to put the tenured professor on trial for alleged scholarly inadequacy, and arrange for a judge or tribunal likely to side with the accusers. What is called in law "due process" is usually missing. Even if the case is eventually lost, defense consumes the target's working life for months or years, and gossip about the ongoing investigation smears the target's name. This is essentially the same eliminative strategy involved in sham peer review (see, for example, the Segall/Pearl article on due process).
   
   
3. Enlargement of administrative power. My book, The Envy of Excellence, is subtitled Administrative Mobbing of High-Achieving Professors, because the chief perpetrators in most of the cases analyzed are ful-time administrators or managers, as opposed to practitioners of the crafts of teaching and research. Mobbing thus tightens managerial control and shifts the balance of power away from front-line professionals toward bureaucrats. Similarly, sham peer review tips the balance away from practitioners of the crafts of medicine and surgery toward those Eric N. Grosch calls "arrogant, power-mongering, ethically challenged hospital administrators."
   
   
4. Courts as bystanders. In Eliminating Professors and subsequent books, and in a 2001 article available online, I have described how rarely academic mobbing targets get redress from public courts. In the main, courts uphold the institutional kind of academic freedom: the immunity of colleges and universities from judicial interference in their affairs. The literature on sham peer review (as in Berkeley Rice's articles in Medical Economics) shows that the same point applies to hospitals. Rice wrote in 2002: "Peer review committees are well insulated from legal challenges under state and federal laws that grant immunity to committee members and confidentiality to the review proceedings." In a forthcoming editorial in JPANDS (2006) entitled "Sham Peer Review and the Courts," Huntoon exposes the almost helpless plight of the shammed physician; the thrust of Huntoon's argument applies equally to professors who are mobbed.
   
   
5. How stigma travels and endures. Before the internet and electronic data archives, a professor mobbed in one institution, even with adverse local publicity, could sometimes move to a distant institution and make a fresh start. Today this is much harder. The web is worldwide. Stigma is less easily escaped or wiped away. With a few clicks of a mouse, anybody can find out all about it. Elimination from one faculty thus usually ends a professor's career. The situation is similar but still more terminal for shammed physicians. By US federal legislation, the Health Care Quality Improvement Act of 1986, the name of a physician judged inadequate in one workplace goes into a single registry, the National Practitioner Data Bank, available online. With a negative report there, a physician's goose is likely cooked.
   
   
6. Adjectives for discrediting: difficult and disruptive. Along with other students of academic mobbing, I published commentary in 2001 on the pernicious concept of "difficult professor." We found that this label is used as an instrument of mobbing: a way to ostracize, stigmatize, and in the long run eliminate professors who press for high standards of teaching and research. Huntoon and others have found that the label "disruptive physician" is sometimes imposed for the same purpose on doctors who press for high standards of patient care, as apparently in the case of anesthesiologist Danae Powers.

Additional online resources. To read more about sham peer review and the campaign against it among US doctors, click on the links below.

• "The Cost of Courage: How the tables turn on doctors," a four-day series by Steve Twedt in the Pittsburgh News-Gazette, reporting on physicians targeted for elimination. Subsequent articles:
  "When right can be wrong," October 27, 2003.
  "Centre County Hospital critics soon unwanted," October 28, 2003.
  "Doctor says whistleblowers need more protection," October 29, 2003.
  
  
• "The Hunted Physician," a widely circulated article in Sacramento Medicine (1994) by Sharon Kime and Robert Sullivan. The opening metaphor of lions hunting a gazelle nicely captures how the mobbing process unfolds. Lawrence Huntoon's poem, "Run fast, my little gazelle...," is published at the end of Waite's article. Susan Marais and Margriet Herman organized their 1997 book on workplace bullying around a similar metaphor, Corporate Hyenas at Work (see Brian Martin's review).
  
  
• The Semmelweis Society International, dedicated to "medical peer review with clean hands" and inspired by a similar organization founded earlier in California by Verner Waite, maintains an informative website. A sister website for The Semmelweis Society, includes an archive of horror stories.
  
  
• The Center for Peer Review Justice maintains a website with news and opinion about many cases of injustice due to sham peer review.
  
  
• The Association of American Physicians and Surgeons, an organization of medical professionals, has been active in combatting sham peer review and has produced an educational DVD about it. Many of the links above are to articles published in its journal.