The current scientific culture is strongly driven by publication prestige and impact, epitomized in the “publish or perish” maxim. In the field of general medicine, six journals have historically been the most prestigious and influential. These ‘Big Six’ (B6) the New England Journal of Medicine (NEJM), the Lancet, the Journal of the American Medical Association (JAMA), the British Medical Journal (BMJ), the Annals of Internal Medicine (Annals IM) and JAMA Internal Medicine, formerly Archives of Internal Medicine (Archives IM).