Intended for healthcare professionals

Editor's Choice Editor’s Choice

Reduce, reuse, recycle

BMJ 2008; 336 doi: (Published 24 April 2008) Cite this as: BMJ 2008;336:0
  1. Trish Groves, deputy editor, BMJ
  1. tgroves{at}

The BMJ’s carbon footprint is shrinking. From this week most copies will be printed on 100% recycled paper, each year diverting around 1670 tonnes of paper waste from landfill and avoiding the production of around 2204 tonnes of carbon dioxide. Admittedly, this carbon reduction is fairly modest, equating to a bit more than the total annual carbon emissions of 100 average Americans or 200 Britons—but it’s a good start. The paper comes from the Leipa mill in Germany, which collects most of its recyclable waste locally and is working on a collaborative project to burn its own waste to create power and steam, with excess power going into the national grid.

For the moment one of the four editions of the journal—the one that goes out to UK general practitioners—will continue to use virgin paper. This is necessary for business resilience and because the size of that edition’s BMJ Careers section needs bulkier paper for binding purposes, but the paper comes from a sustainable Finnish forestry with a relatively low carbon footprint.

What are we doing to reduce the environmental impact of the BMJ’s glossy cover and plastic wrapper? As much as we can, while still ensuring that journals will arrive intact. Finding 100% recycled paper that will not tear easily would save an additional 103 tonnes of carbon dioxide a year. Failing that, we may be able to use partially recycled paper for the wrapper. We already use recyclable polythene and continually strive to reduce the amount needed: we hope to switch to a biodegradable polythene in the next 12-18 months, subject to testing. Meanwhile, the BMJ Group is considering using recycled materials for all its publications.

We have no plans as yet to stop producing a print journal. This would make the biggest contribution to cutting our carbon footprint, but we hear from readers who get the print journal that they don’t want to give it up. We are exploring what else it will take to make the BMJ Group carbon neutral, and we will keep you posted on this.

The switch to recycled paper comes, largely by serendipity, in the week that the print BMJ is much fatter than usual. That’s because it includes the supplement launching the BMJ Group’s Making a Difference campaign. Fiona Godlee (doi: 10.1136/bmj.39541.660289.94) and Domnhall MacAuley ( explain this initiative to focus our resources on the quality improvement projects that could make the greatest difference to healthcare. Thousands of you have already voted online for the most pressing of these challenges; see the result now at

And don’t miss the new series on grading evidence in clinical management guidelines, systematic reviews, and health technology assessments using the GRADE system (doi: 10.1136/bmj.39489.470347.AD). It rates the quality of evidence as high, moderate, low, or very low and grades recommendations as strong or weak. Practical and clinically focused, GRADE recognises that high quality evidence doesn’t necessarily lead to strong recommendations, and that strong recommendations can arise from low quality evidence. No wonder that it is now used by numerous bodies, including the World Health Organization and the Cochrane Collaboration.