This fall, two of us (H. M., M. T.) attended the JAMA/BMJ Peer Review Congress on Peer Review and Biomedical Publication as Editor-in-Chief and Managing Editor of Chronic Diseases in Canada . Both being new at the job, we were painfully aware of the relative importance of our niche journal when placed side-by-side with the Big Five ( New England Journal of Medicine , JAMA, BMJ, Lancet , Annals of Internal Medicine ).