The International Committee of Medical Journal Editors (ICMJE) is an influential group of general medical journal editors, some from the five leading publishing houses, representing more than 50% of the market, and representatives of select related organisations. Working together to improve the quality of medical science and its reporting, they have rightly acknowledged the threat posed by predatory journals. However, we argue that ICMJE has overlooked deeper structural issues, particularly the publishing industry’s own economic interests, thus hindering efforts to address this problem. It overlooked numerous initiatives aimed at systemic change, eg, the 2012 Declaration on Research Assessment, Transparency and Openness Promotion, and the Coalition for Advancing Research Assessment. Notably, models such as Diamond Open Access, which have the potential to address the issue of predatory journals, while also posing challenges to traditional publishers’ interests, are not mentioned. By not addressing these concerns, there is a risk that the ICMJE's crusade against predatory journals could look like cartelisation.