This article is concerned with strategies to bolster ethical review against insinuations that it might not be well done. My discussion traces doubts about the competences of ethics review committees in low and middle income settings to ask how a real ethical review is known, and for whom it must be evidenced. Drawing on ethnographic fieldwork amongst committees participating in the Forum of Ethics Review Committees of Asia and the Western Pacific, an organization started in 2000 to support grass-roots regional networking and capacity building, I describe three mechanisms by which a ‘real’ review can be identified, and pre-emptively distinguished from a ‘pseudo’ review. I argue that each strategy is premised on articulating a different facet of ethical interiority. By contextualizing ethical review within histories of debates about global health research ethics, and a growth in regional responses to build local capacity, I explore how geographies of competence motivate responses to anxieties about whether and how ethical review can be made real.