Hear From the Co-Founder: Dr. Alexander Muacevic

alexander-muacevic_01Cureus: Tell us about your background – how did you decide to pursue a career in medicine? How did you settle on brain surgery?

Alex: I started my medical career at the University of Mainz and did my doctoral on surgical strategies for multiple intracranial aneurysms. I was always fascinated by the option to work at the very central part of human beings – the brain. I got the chance to participate in one of the best neurosurgery programs in our country at the University of Munich Hospitals and finished the residency program there in 2003.

Cureus: You’ve also worked as the Director of the European Cyberknife Center in Munich for the past 9 years. How did you get involved with Cyberknife radiosurgery? What’s a typical day like for you at the Cyberknife Center?

During my residency program I got more acquainted with the possibilities of brain radiosurgery and it was obvious to me that this kind of non-invasive and equally effective therapy for certain tumors has a big future perspective. I did an additional two years of training in radiation oncology and teamed up with my partner Berndt Wowra who already was an experienced brain radiosurgeon. During that time we learned about the new radiosurgery innovation called Cyberknife and decided to found a new center together with the University of Munich Hospitals to offer this kind of treatment option for the first time in Germany. My ambition was and is to establish radiosurgery as a full body treatment method for the whole body, not only the brain.

Cureus: And as if that wasn’t enough, you’re also a professor at the University of Munich! What can you tell us about your professorial experiences over the years?

Alex: During my residency I worked on several research projects to do a thesis for an additional medical degree which is similar to the Ph.D. in the U.S.. Since I continued to publish scientific contributions after my thesis, the University of Munich appointed me a full professor in 2013. I was fortunate to receive this title as this is something you can not apply for yourself.

Cureus: How did you get involved with Cureus? What attracted you to the concept of an open-access, free-to-publish medical journal?

Alex: I’ve known John Adler for many years and we were both very involved in a medical society called The Radiosurgery Society. Initially our idea was to establish a medical journal for this society but when we started to work on it we came to the conclusion that there is urgent demand for a new way for medical publications to take on the web capabilities of the 21st century. We started with a small group and called our platform Peeremed.com. It was obvious that we needed to step up and find a more professional group to pursue our dreams of a real powerful web 2.0 journal plattform for the upcoming publishing generation. We had contacted several groups in Germany, but as all of the big web innovations nowadays come out of Silicon Valley we worked on establishing the new company – Cureus.com – in the San Francisco Bay Area.

Cureus: Not only are you a co-founder of Cureus, but you’re also the Co-Editor-in-Chief – what does that entail? Describe your daily editorial duties.

Alex: My job is to manage the articles from submission to final publication. I need to make sure they fulfill the criteria of a scientific contribution in terms of data quality, and also bureaucratic aspects like disclosures and conflict of interest. Furthermore I manage the review process with our team to achieve fast and high-quality reviews for our authors.

Cureus: Peer-reviewed medical science has grown increasingly political of late, with accusations of reviewer and editorial bias. What are your thoughts on this? Why is Cureus different?

Alex: Cureus offers the most unbiased possibility for publishing scientific data, as the decisions of how and what to publish remain up to the author. The author himself is responsible for his data, he keeps his copyright and is evaluated by the scientific community-at-large similar to ratings at YouTube or Amazon. This is a huge difference from the conventional publication process where two or three so-called insiders decide what is published or rejected - a very biased and inadequate way to evaluate the academic work of your fellow researchers.

Cureus: Thanks so much for taking the time!

Alex: Thank you.

Publication Bias: Who is to Blame?

Publication bias occurs when a study’s results influence its probability of publication. This has been acknowledged already in 1959 (1). An article this past week in Newsweek rightfully laments the impact of such publication bias on the public health.

The Newsweek article implicates big bad pharma as the primary culprit in this process. But is it? Logic and human nature would surely suggest that marketing departments inside big corporations, where money is the primary incentive, are unlikely to go out of their way to publicize the negative effects of their pharmaceuticals or medical device. Therefore, I get this argument and I don’t disagree. Meanwhile there are clear cases where a pharmaceutical company threw its considerable weight around to squash negative studies. A case in point being the much-ballyhooed instance that happened in the mid 1990s – Knoll Pharmaceuticals threatened legal action against UCSF when an investigator sought to publish a negative study. But where is the evidence that such behavior by pharma is common? The PLoS article cited by Newsweek only demonstrates that many clinical trials (roughly half) go unpublished. Since big bad pharma is as beholden to academia as academia is to big pharma, I find it more than a little disingenuous to ascribe all of the publication bias to a pharma conspiracy.

Having been personally involved in scientific publishing over almost three decades, and having seen two clinical studies go unpublished, I believe that the primary culprit behind publication bias lies with academia itself. Why? For starters, medical academia controls most scientific journals as well as the incentives for most of the scholarly publishing of clinical trials, hence the interdependence with pharma. Moreover, it is a reality that academic promotion is a primary motivation for publishing journal articles. In this regard, a young academic scores few points in the chase for tenure by publishing negative studies, which just aren’t sexy in the eyes of promotion committees. Meanwhile, negative studies don’t score many points in the impact factor game played by so many big name “luxury” journals whose cachet is highly coveted by academic promotion committees. Given academia’s near stranglehold on both authors and journals, there are no incented physicians left to publish negative studies, hence the publication bias we all decry.

Meanwhile when it comes to publishing any scientific article, medical journals themselves have created ever-burgeoning barriers involving cost, process and time. The reality is that in a world where the rewards are so small, or in truth non-existent, it is just too painful for many physicians to publish any number of societally high-value observations such as negative studies. For example, look at the academic and journalistic bias (including PLoS) against case reports, arguably the only instance of publishing pure truth devoid of underpowered studies, misleading statistics and heterogeneous patient populations. So ultimately I argue that the same powers-to-be that bemoan the lack of more publishing are the very source of the problem, and active steps to mitigate publication bias across the academic literature are needed. Cureus, with its streamlined process for scientific publication, is quite happy to help remedy the challenge of publication bias!

  1. Sterling TD. Publication decision and their possible effects on interference drawn from tests of significance – or vice versa. J Am Stat Assoc 1959;54:30-34.

ZEISS/Cureus Competition Spotlight: 3rd Place Article

ZEISS recently partnered with Cureus to host a publishing competition focused on microscope-integrated intraoperative fluorescence. The competition attracted articles submitted from all over the world, with the final field of published articles standing at 10. While prizes have already been awarded, we wanted to take some time to recognize a few of the highest-scoring articles.

Today we’ll take a look at the 3rd place article, “Indocyanine Green Videoangiography and Intraoperative Catheter Digital Subtraction Angiography in the Treatment of Intracranial Aneurysms: A Consecutive Series of 235 Cases,” written by Archie Defillo, Mushtaq Qureshi and Eric Nussbaum. Receiving an SIQ score of 6.9, this deserving article could’ve easily finished in either of the top two spots.

Cureus Editor-in-Chief Dr. John Adler was impressed with the scope of the article, focusing on the fact that “this article represents one of the largest published clinical series reporting experience with intraoperative fluorescence microscopy.”

Co-Editor-in-Chief Dr. Alexander Muacevic was also pleased with the article: “Large patient series of Indocyanine Green Videoangiography and Intraoperative Catheter Digital Subtraction Angiography in the treatment of intracranial aneurysms with distinct results and suggestions for the daily clinical praxis. Interesting to read for all neurovascular surgeons.”

Perhaps the size of this study is a sign that we’ll soon see larger and larger undertakings in the research and reporting of intraoperative fluorescence. That’s it for our coverage of the ZEISS/Cureus Intraoperative Fluorescence Publishing Competition. You can find the complete list of published articles here. Contact us at info@cureus.com to learn more about hosting your own competition!

Ebola Wars

What’s it like right now to be on the front lines of treating Ebola victims in West Africa, or in the past few weeks, even here in the US? Given that this battle might be waged in my community tomorrow, it would be nice to know that we healthcare providers are getting smarter in humanity’s tectonic battle. The traditional peer-reviewed journals do a credible job of publishing the major studies for a disease like Ebola, even on an accelerated basis; in fact when it comes to hot subjects like Ebola, such journals cannot publish fast enough. It may well be, however, that this disease is not defeated by a big scientific breakthroughs or insights, but rather myriad little things. In fact that is the kind of stuff I want to learn about; which detailed little steps in terms of containment, infection control, tracing of contacts etc. seem to be working against this disease and which are not?

Clearly something wasn’t working correctly when two nurses caring for the first Ebola patient in the U.S. contracted the disease! Over the past week I have certainly received my daily dose of The New York Times and NBC TV reporting about what went wrong, however, I would like to read about the subject after it has been vetted by medical professionals via the peer review process. What, if anything, did the infectious disease unit, ICU or any other staff at Dallas Presbyterian learn in the past 2 weeks? It seems impossible to believe that absolutely nothing has been learned. Even if expert analysis of the problem is incomplete, they probably have some working hypotheses. Is training an issue? Are the wrong gowns being used? What about facial splash shields? There are dozens and dozens of small things being practiced by the medical teams caring for Ebola patients, some of which worked and some which might not have, yet for most of us, the best source of info is, frustratingly enough, the news media.

Clearly my “ask” will find its share of critics. It is rightfully argued that incomplete knowledge is misleading and potentially dangerous if misinterpreted. If the physicians on the front lines of the Ebola fight arrive at incorrect conclusions as a result of a rushed analysis and this information is passed on to the medical community via journals, patients could die. But such a paternalistic critique assumes that the physicians and nurses reading the early lessons of this war are incapable of understanding that such observations are preliminary. How can it not be better to learn from experienced healthcare providers via medical journals than it is to rely on mass media or alternatively, know nothing?

The current approach to disseminating knowledge about the Ebola fight seems to be through panels of “experts” like the CDC or Doctors without Borders or other Federal and State government organizations. This method of establishing protocols is, in an emergency, clearly necessary and needs to be done. Anyone who has ever participated on such committees, however, will tell you that political considerations invariably color recommendations, especially when quality information is scant. For this reason I believe that rapid communication via the peer-reviewed publication process can supplement expert guidelines and keep the “expert” community from straying into all too common political minefields. Moreover, even experts can wrongly interpret some procedure as being inconsequential when in fact it is the key to success. When it comes to publishing seemingly trivial information about a scary and fast moving disease like Ebola, I say simply, “bring it on.”

What if the secret to controlling Ebola is a specific technique for cleaning bedpans? And what if some low ranking nurse has stumbled upon the answer about how to do it right? What if, unsurprisingly, the big government experts are oblivious to this nurse’s unique insight? It might well take 100 years before such unglamorous information was to make it into Lancet or NEJM; there are just so many barriers to vetting and communicating this type of idea in the conventional medical journal world. It is into this void that Cureus would like to boldly step. In the Cureus world of publishing no medical idea submitted in scientific good faith is too humble to be vetted and rapidly and widely communicated through the peer review process. So I say, if clean bedpans could be the answer to eradicating Ebola, let’s hear your story. And once it is published, I trust the wider court of medical expertise will be there to either vet or discredit your idea through Cureus’ SIQ process. A great idea, no matter how humble the origins, is a terrible thing to waste during an epidemic like Ebola.

Although I am far away from the front lines of Ebola, I have been in the trenches of publishing in peer-reviewed medical journals for almost 30 years and I am doubtful that all important information is being documented at the rate at which it’s learned. Nevertheless, since I am not an infectious disease expert nor on the front lines of the current epidemic, I’d love to hear what experienced (with Ebola) physicians think about the hypothesis I have put forward here.

Cureus Advisor Dr. George Lundberg Wins 2014 ASCP Ward Burdick Award for Distinguished Service to Pathology

Cureus is thrilled to share the news that Dr. George Lundberg, special advisor to Cureus, was recently bestowed the 2014 ASCP Ward Burick Award for Distinguished Service to Pathology. Awarded annually by the Board of Directors of the American Society for Clinical Pathology (ASCP), the ASCP Ward Burick Award was presented to Dr. Lundberg during the ASCP Annual Meeting in Tampa, Florida on October 9.

Citing Dr. Lundberg’s illustrious career and extensive history as both educator and editor, the ASCP stated, “Dr. Lundberg has advocated for pathologists to play the critical role as the ‘interpreter’ who guides clinicians to select the appropriate diagnostic test and encourages medical laboratories to focus on the quality outcomes of diagnostic testing, rather than the volume of testing they perform.”

Dr. George LundbergWhen asked for his reactions to winning the ASCP Ward Burick Award, Dr. George Lundberg stated, “I have always, or at least since about 1969, believed that a laboratory test is a loop that begins when an individual decides to obtain a laboratory test, proceeds through a series of some 9 steps such as ordering, specimen collection, transportation, analysis, reporting and interpretation and ends with an action. Like a chain being only as strong as its weakest link, the test is only valid if all steps are completed correctly. In 2014, in AJCP, I proposed that we should add a 10th step…outcome….as a routine in what has come to be known as the ‘Brain to Brain Loop in Laboratory Testing.’”

Join us in congratulating Dr. Lundberg on his achievement – we are thrilled that he is part of the Cureus team!

SBMT and Cureus Team Up To Accelerate the Publication of Leading Edge Neuroscience

One challenge of the twenty-first century is to catalyze the development of medical advances from basic science. To help accelerate diagnostic and therapeutic discoveries, one of the leading multispecialty and multidisciplinary associations, Society for Brain Mapping and Therapeutics, has teamed with Cureus, an innovative online open-access medical journal, to bring together clinicians, scientists, engineers and policy makers from multiple disciplines who share this aspiration of improving patient care. The two cutting edge organizations believe their partnership is essential to bring about advances in neurosurgery, radiology, neurology, stem cell research, nanotechnology and psychiatry.

“Cureus is a free, open access, peer-reviewed journal that rapidly publishes a broad range of medical science including all types of articles, posters and meeting abstracts,” said John Adler, Professor of Neurosurgery at Stanford University and Cureus Founder.

Cureus’ browser based tools enable well written articles to be routinely peer reviewed and published in less than one week. The journal is the first and only journal employing “crowd sourcing” to ascertain the scientific quality of published peer-reviewed articles. While accepting a broad range of medical science, Cureus focuses on advanced technology and innovative medical procedures. Additionally, case reports are enthusiastically welcomed and routinely published.

“Cureus seeks to find the broadest possible audience for every paper, including curious patients, and uniquely offers a “Patient Reported Outcome” section that runs in parallel with articles reporting clinical outcomes,” stated John Adler.

Cureus also uniquely supports the solicitation of charitable gifts to an author’s not-for-profit research fund; this could be a great tool for SBMT, which is a non-profit organization that encourages scientists in areas of brain mapping, engineering, stem cells, nanotechnology, imaging, and medical devices to improve the diagnosis, treatment and rehabilitation of patients with neurological disorders.

“We believe this collaboration will provide an additional tool for our colleagues and members who are thinking out of the box and taking a multidisciplinary approach to solving complex neurological disorders,” said Dr. Ramin Rak, SBMT board member and neurosurgeon at Winthrop University.

Cureus and SBMT will be exhibiting their vision at the Congress of Neurological Surgeons in Boston, MA next week from October 20-22 at booth 660 in the exhibit hall of the Boston Convention Center.

To learn more about SBMT, visit http://www.worldbrainmapping.org

ZEISS/Cureus Competition Spotlight: 1st & 2nd Place Articles

ZEISS recently partnered with Cureus to host a publishing competition focused on microscope-integrated intraoperative fluorescence. The competition attracted articles submitted from all over the world, with the final field of published articles standing at 10. While prizes have already been awarded, we wanted to take some time to recognize a few of the highest-scoring articles.

The articles featured today finished the competition in 1st and 2nd place, respectively.

With a final SIQ score of 7.5, the winner of the Grand Prize for Scientific Acclaim, A Bioengineered Peptide that Localizes to and Illuminates Medulloblastoma: A New Tool with Potential for Fluorescence-Guided Surgical Resection was submitted by Shelley Ackerman, Christy Wilson, Suzana Kahn, James Kintzing, Darren Jindal, Samuel Cheshier, Gerald Grant & Jennifer Cochran.

Cureus Co-Editor-in-Chief Dr. Alexander Muacevic had this to say about the winning article, “It’s all about finding ways to better illuminate brain tumors for complete tumor resection – something I feel this article certainly accomplished.”

The 2nd place article, recieving an SIQ score of 7.0, was Fluorescence-Guided Tumor Visualization Using the Tumor Paint BLZ-100, and was submitted by David Kittle, Adam Mamelak, Julia Parrish-Novak, Stacey Hansen, Rameshwar Patil, Pallavi Gangalum, Julia Ljubimova, Keith Black and Pramod Butte.

Dr. Muacevic, again with his thoughts: “This is an interesting new innovation and I congratulate the authors for their work. They developed an imaging system for in-vivo imaging of the tumor ligand BLZ-100 for use in surgical resections of gliomas. Next step is to prove the clinical application. Ultimately the question remains if a clinical benefit in terms of prolonged survival can be demonstrated using this new innovation.”

Meanwhile, Cureus Founder and Co-Editor-in-Chief, Dr. John Adler chipped in with his reaction: “Both of these gorgeous articles are examples of cutting edge science which will enable futuristic intraoperative fluorescence techniques to do ever better tumor resections.”

We’re thrilled that these excellent articles were submitted and published as part of the competition and we’re looking forward to publishing many more as our competitions continue! Stay tuned for a look at the 3rd place article!