Despite the inherent advantages of peer review, the record of self-enforcement among physicians has been poor. Failures have been attributed to plausible factors, including protective self-interest, a misdirected sense of professional camaraderie, the paucity of explicity standards, and inadequate resources allocated to professional review boards. Fear of vindictive litigation and peer pressure against whistle-blowers may also contribute to ineffective peer regulation. An illustrative case recently reported by The New York Times involved an internist who received a letter from the Florida Medical Association regarding a complaint filed by three physicians against whom he had given expert testimony in medical malpractice suits. The association found that the internist had given “erronious opinions” and sought to sanction him. The internist subsequently sued the medical association and the complaining physicians, claiming they had libeled them. This scenario, although not typical, reflects the contentious relationship between the medical community and those considered whistle-blowers. Another reason for physicialn reluctance to participate in peer regulation is that the standards of care are difficult to apply ex parte in the context of specific clinical circumstances. Despite their underlying expertise, doctors are reluctant to judge colleagues’ actions harshly in retrospect without complete knowledge of the circumstances that contributed to the original physician’s decisions.