Intended for healthcare professionals


Minimal refereeing will lead to global equity of information

BMJ 2001; 323 doi: (Published 14 July 2001) Cite this as: BMJ 2001;323:111
  1. Peter A Singer (peter.singer{at}, Sun Life chairman in bioethics
  1. University of Toronto Joint Centre for Bioethics, Toronto, ON, Canada M5G 1L4

    EDITOR—The comment attributed to William Shulenberger in Smith's editorial on electronic publishing in science1—that “minimal refereeing services” such as BioMed Central “may not get far because some scientific communities, particularly medicine, are nervous of minimal refereeing”—is pivotal. Minimal refereeing is only half the story. The other half concerns improving measures of the quality of published articles.

    At the moment, our primary measure of quality is the brand name of the journal in which an article is published. This can lead to problems of validity, but also permits some top brand name journals to persist with restrictive policies on prior publication and copyright that block open access to primary research (the BMJ is the chief counterexample among the top journals because of its innovative approach to open access, open peer review, prior publication, copyright, and membership of PubMed Central; the Canadian Medical Association Journal is also a counterexample because of its policy on open access and membership of PubMed Central).

    This “information blockade” deserves close ethical scrutiny, not least because it impedes access to health information for healthcare workers in developing countries. The inequities in global health represent the greatest ethical challenge in the world today. Underlying these inequities are inequities in health information.

    The combination of minimal refereeing with maximal quality measurement is a way to break the information blockade. It decouples quality measurement of an article from the brand name of the journal in which it is published. This sets the stage for freeing the literature by changing the incentive structures of medicine and science to reward staff not on the basis of the brand name of the journal in which they publish but rather on the basis of the quality of the work itself.

    Because minimal refereeing services such as BioMed Central potentially cover so many scholarly articles, it is with them that innovations in quality measurement will occur. A conceptual framework to guide this quality research, and a better developed version of the incentives argument, is at

    Minimal refereeing, coupled with innovation in quality measures and advocacy around incentive structures, represents one path to a future of global health information equity.


    • Competing interests PAS is a member of the BMJ ethics committee, a subject adviser for BioMed Central medical ethics, and associate editor of the Canadian Medical Association Journal.


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