The author, who worked for the BMJ for 25 years, sets out his analysis of the current and future trends in journal publishing. The author takes the position that medical journals have many problems and need reform. He argues they are over influenced by the pharmaceutical industry, too fond of the mass media, and yet neglectful of patients. The research they contain is hard to interpret and prone to bias, and peer review, the process at the heart of journals and all of science, is deeply flawed. Editors themselves misbehave. The authors of the studies in journals have often had little to do with the work they are reporting and many have conflicts of interest that are not declared. He discusses current topics including the move towards open access publishing.