Peer- and editorial review of research submitted to biomedical journals (‘manuscript review’) is frequently argued to be essential for ensuring scientific quality and the dissemination of important ideas, but there is also broad agreement that manuscript review is often unsuccessful in achieving its goals. Problems with manuscript review are frequently attributed to the social and subjective dimensions of the process (e.g. bias and conflict of interest). While there have been numerous efforts to improve the process, these have had limited success. This may be because these efforts do not account sufficiently for all of the social and subjective dimensions of the process. We set out, therefore, to characterise the most salient social and subjective dimensions of the manuscript review process, from the perspective of practising reviewers and editors. Open-ended interviews were carried out with 35 journal editors, and peer reviewers in the UK, USA and Australia. It emerged from these interviews that reviewers and editors were conscious of a number of social and subjective influences on the review process including: a wide variety of motivations for participation, complex relations of power, epistemic authority and moral responsibility, and unavoidable prejudice and intuition. Importantly, these social and subjective influences were often viewed positively and were seen as expressions of, rather than threats to, editors’ and reviewers’ epistemic authority and expertise. From this we conclude that the social and subjective dimensions of biomedical manuscript review should be made more explicit, accommodated and even encouraged, not only because these dimensions of human relationships and judgements are unavoidable, but because their explicit presence is likely to enrich, rather than threaten the manuscript review process. We suggest a ‘dialectical’ model which can simultaneously accommodate, and embrace, all dimensions of the manuscript review process.