Anonymity for peer reviewers remains the overwhelming norm within biomedical journals. While acknowledging that open review is not without challenges, this article presents 4 key arguments in its favor: (1) ethical superiority, (2) lack of important adverse effects, (3) feasibility in practice, and (4) potential to balance greater accountability for reviewers with credit for the work they do. Barriers to more widespread use of open review include conservatism within the research community and the fact that openness makes editors publicly responsible for their choice of reviewers and their interpretation of reviewers' comments. Forces for change include the growing use of preprint servers combined with open commentary. I look forward to a time when open commentary and review replace the current, flawed system of closed prepublication peer review and its false reassurances about the reliability of what is published.