Where did 'Peer Review' originate? What is its legal status? Is it required? If we already have M&M Conference and other conferences to improve care, what is 'peer review'? If 'Better medicine' is the purported purpose of peer review, by which standards should it be conducted, and by whom, to protect patients and competing physicians?
The randomized controlled double-blind trial is a standard of judgment, not because it assures accuracy, but because it defines the limits of error.
In a society with constant competition, personal bias is inevitable when co-workers judge each other (See Scott Segall's first article on the Home Page.).
Good-faith usually accompanies medical 'outcomes', including unfortunate outcomes such as death. The purpose of peer review should be to educate in good-faith how to reduce error and advance knowledge.
Bad-faith peer-review is a witch-hunt for profit, such as a vindictive M&M conference. To the degree that doctors fear discussion, learning is limited.
Remember, there was a time in our medical history when knowledge was suppressed, for example when the secrets of obstetric forceps were 'closely-held' for private profit.