Objective: To describe the process of scientific peer review as it is used in the manuscript submission process, assess threats and challenges to the peer review process, and to offer suggestions for enhancing its effectiveness. Discussion: Peer review is often seen as one of the hallmarks of scientific publication. The primary goal ofpeer review is to improve the science within papers that are ultimately published, by helping an editor better understand the strengths and weaknesses of a given paper. This process, while fairly well studied within the medical field, has received almost no attention at all within chiropractic. This paper provides guidance toreviewers and potential reviewers which can help them to understand both the scientific and the human aspects of peer review. This is designed to elevate this function to one trusted by the profession rather than seen as simply another hurdle to overcome. Several future directions are offered, including unblinding the review process for transparency, conducting rigorous studies looking at peer review, and developing formal training programs for potential reviewers.Conclusion: Peer review is likely to remain in force as a means to provide guidance to authors and editors about the rigor of submitted papers. However, the nature of peer review may be changing and editors and authors need to stay aware of the implications of these changes. Recommendations to open the process, study it anddevelop training programs are designed to ensure that the process remains as impartial as possible. (JCCA 2008; 52(4):211–223)