Medical journals currently find themselves in the throes of 2 powerful trends: (1) a growing concern for the irreproducibility of scientific reports, and (2) a rising imperative to accelerate dissemination of new knowledge in the digital era. Without question, the individual merit of tackling each issue is readily apparent. Irreproducibility of scientific reports is surprisingly common and contributes to an overall loss of confidence in research by the public and other stakeholders. And who could argue with efforts to leverage new online technologies to distribute information as rapidly and widely as possible? However, it also is evident that, at times, these 2 challenges of research reliability and timeliness may be at cross purposes. To tackle the former, editors have traditionally insisted on careful, detailed, and time-consuming vetting of a manuscript’s data, methods, and conclusions before publication. This largely occurs through the use of external peer review, and the American Heart Association portfolio of journals has prided itself on its ability to adhere to this high standard for its manuscripts. Efforts to address timeliness involve authors finding new ways to share raw data and preliminary conclusions, often before peer review, in the hopes of accelerating dissemination. Although natural tensions between these 2 challenges have always existed for journals and their authors, from a practical standpoint there really was no conflict. Until recently, it remained virtually impossible for authors to distribute their work without journals. The emergence of preprint servers in the digital era changes this equation while also raising new questions. For those unfamiliar with them, preprints are online postings of scientific reports in a public venue before their official publication in a journal.1 The types of manuscripts represented by preprints include research articles, editorials, perspectives, and reviews. They are typically formatted as if ready for submission to a journal …