Measles, the Anti-Vaccine Crowd and the Peer-Reviewed Article Partially to Blame

A big measles outbreak in the US is generating considerable news of late. Much of the blame, rightfully so in my opinion, is centered on parents who have refused to vaccinate their children out of ill-founded paranoia. Most of their anti-vaccine “thinking,” if you can call it that, is grounded in muddled anti-science. However, one of the intellectual pillars of the anti-measles movement is rooted in peer-reviewed science. And not just any science, but none other than the acclaimed high impact journal Lancet. To my way of thinking this is a big part of the problem.

Andrew Wakefield’s much ballyhooed and eventually discredited 1998 Lancet article, concluded that childhood vaccines were a possible cause for autism. Parents of autistic children seized upon this possibility, especially A-list celebrity Jenny McCarthy, invoking the Wakefield article as proof of their fears. Unable to weigh the scientific merits for themselves, the fanatical anti-vaccine public at large ascribed considerable veracity and power to the Wakefield article in large part because of its publication in Lancet; although undoubtedly this article also reinforced a narrative they wanted to believe. Like most of its peers within the “luxury” journal domain, Lancet revels in every opportunity to burnish its reputation for publishing “important,” high quality science and in doing so, laughing all the way to the bank. It is impossible to believe that had the Wakefield article been published in the Burmese Journal of Gastroenterology it would have gotten nearly the same zealous respect it did in Lancet.

Don’t get me wrong. I don’t fault Lancet for publishing a bad paper; such risk is intrinsic to publishing a peer-reviewed journal. However I do take issue with the reputation Lancet seeks to foster around impact factor and by intimating that their peer review process results in a meaningfully more valid scientific publication; the Wakefield article being a perfect case in point of why this thinking is flawed. Any scientist with integrity knows that the proper perspective for approaching all scientific publications involves a substantial dose of skepticism until the findings within have been replicated, oftentimes more than once.

Despite its subsequent retraction, Wakefield anti-vaccine believers refuse to relent, claiming even today that allegations of scientific misconduct are a conspiracy at the highest levels of science. If the Wakefield article had instead been refuted by a democratic barrage of post-publication critique and scoring, ala SIQ, it would be much harder for the anti-vaccine fanatics to keep believing in discredited science. That said, as long as luxury journals are perceived as having a uniquely rigorous peer review system, and therefore uniquely truthful, the public health will be disserved as we are currently witnessing in this measles outbreak. We at Cureus continue to believe that there is a better process via more rigorous post-publication review, as implemented in our SIQ. Give it a chance – you’ll be surprised.

Is your Academic Department Getting the Most Out of its Marketing?

Thousands spent on traditional mailer campaigns. Countless hours spent printing, packing and sending department-produced newsletters or magazines. How many are dumped in the recycling without being opened? Every academic department with a serious interest in promotion needs to ask itself – is that investment of time and money really worth it?

In a word – no. We live in an increasingly digital age, and although some industries continue to do things the old-fashioned way, paying to produce a mail a hard copy newsletter or magazine just isn’t efficient anymore. We’ve created Cureus Channels as a way to fill this void while taking full advantage of all the latest and greatest digital technology.

Your department’s custom, branded Channel homepage serves as the one-stop shop for all of your latest published research and clinical experiences, as well as departmental news, media, event info and more! What’s more, we’ll also send out a branded quarterly email digest highlighting some of your latest articles and their authors. We work with you to fashion each quarterly digest to your liking – you pick the articles and authors to feature and supply a short introductory message and we take care of the rest!Screen Shot 2015-01-29 at 11.58.29 AM

Promote up-and-coming faculty, gain referrals and raise your department’s profile throughout the medical research community with a Cureus Channel. Contact me today at graham.parker@cureus.com to learn more.

Publishing with Cureus for the first time? Check out our new how-to videos!

New to Cureus? Has it been awhile since you last published with us? Good news! Our revamped Author Guide now features a series of short, snackable how-to videos designed to walk you through each step of the article submission process.

Just click the blue video icon next to select headers located throughout the Author Guide to view a short video walking you through that specific step of the submission process. We recommend taking a few minutes to watch the videos for each of the eight article submission steps before beginning the process. Taking ten minutes now will save you time later!

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An Introduction to Cureus’ First Student Ambassador

The processes of peer-reviewed medical science have been around a very long time with the New England Journal of Medicine even passing its 200th anniversary last year. It, like many other old journals, has become venerated for the important science reported over the centuries, and in conjunction, there has evolved the aura of scholarly respect and status. In fact the prestige of a journal, perpetuated by medical school tenure processes, and as quantified by Impact Factor, is roughly proportional to the age of the journal. Roughly speaking, old journals are prestigious, while new journals tend not to be; academic medicine tends to be a very tradition-leaning and status-conscientious community! Despite its relative youth, Cureus’ leadership team also includes a number of senior academics, some of whom have five decades of medical publishing under their belts. Our advisor and former editor at JAMA, George Lundberg, is a perfect example; experience always has a lot to teach us all.

Despite medicine’s veneration of history, it cannot be denied that the future belongs to the young, and just possibly, they might choose to evolve peer-reviewed journalism in new directions. In the past decade, youthful exploits have truly transformed human culture and commerce, with Facebook, Google, Uber and AirBnB being only a few cases in point. In many ways the pace of social change seems to be accelerating on the backs of the young. To date, youthful exuberance has not been part of science, however, Cureus is hoping to change that. As we aspire to be a new concept in peer-reviewed medicine, we would like to introduce Cureus’ first medical student ambassador, Paul Windisch, from the University of Munich. Paul’s role at Cureus will be to help introduce our tools for publishing peer-reviewed science to a new generation of physicians and simultaneously provide our team with a deeper insight to the needs and aspirations of younger doctors.

When stepping into this new role, Paul was quick to encounter a little bit of skepticism among fellow students. Their concern was whether or not publishing an article in a newer journal like Cureus, and thereby not publishing in a more conventional journal, might negatively impact the career of an aspiring young academic; many professors have stressed the importance of publishing in the most highly-regarded journals. My counterargument is that by all means it’s good to publish in prestigious journals, but do not let that dissuade one from publishing in Cureus as well. To publish in Lancet or Nature or NEJM is a very time-consuming process with much of the effort being expended throughout the rationing process of responding to multiple rejections, each one eating up precious time that might have gone into publishing yet additional papers. The most successful scholarly careers in medicine tend to combine important papers in highly-regarded journals AND much more numerous peer reviewed articles in lesser-known journals. Quality (or at least the perception of such) is important, but so is the QUANTITY of one’s scholarly work as one seeks to become known and rise through the academic ranks. As the maxim “publish or perish” clearly implies, it is important to publish frequently as one seeks to build an academic reputation. Need I remind you, Cureus makes that process easier than ever. Just maybe when Cureus has enough of its own storied history in the future, the aura of our articles will bring the cachet of academic tradition as well!

The Academy Awards of Medical Science

Last week a friend of mine told me about watching a notable old movie at a film festival entitled “Sergeant York.” Besides being a story about WWI and starring Gary Cooper, I can’t say I know much about this film other than one interesting fact; it was also nominated for the Best Picture Academy Award in 1941. Of note, it did not win, losing out to “How Green is My Valley.” Now before you start to worry about me running off on a tangent here, I’ll get to my point. Two other movies were also nominated, but lost out, for the 1941 Best Picture Academy Award: “The Maltese Falcon” and “Citizen Kane.” Now through the lens of hindsight is there almost anyone alive today who would truly believe that the Academy Award voting process got the decision right back in ‘41?

To my way of thinking such a question is directly relevant to the world of peer-reviewed medical publishing. How often have important ideas in medicine struggled to get published within contemporary leading journals, only to have such ideas be recognized as true genius after the passage of time? Two weeks ago, my friend and mentor Tom Fogarty was honored by his induction into the National Inventors Hall of Fame by none other than President Barak Obama. Tom was recognized especially for his invention of the Fogarty Balloon Catheter, which through another lens of history has proven to be one of the most important medical devices ever created. Clearly once upon a time the reviewers of the scientific article written by a young Tom Fogarty to report his new discovery must have recognized the genius of his invention, right? Not at all! Tom’s 1965 article reporting how and why his new catheter might work was rejected three times before ultimately being accepted. Even today, Tom has no idea why so many (supposedly) open-minded and wise reviewers rebuffed this important article.

I don’t for a second believe that Cureus reviewers are innately smarter, or politically less biased, than the reviewers who rejected the original Fogarty balloon catheter paper. The Cureus review and publication process, however, does not put reviewers in a position to choose what is important or unimportant medical science. As long as the article in question represents a good faith effort (following peer review) to apply reasonable scientific standards, and is neither fraudulent nor clinically dangerous, Cureus will publish your article for free with no questions asked!

Cureus believes that good ideas available to the broad court of scientific critique will invariably be discovered over time and serve to advance medical science – “the cream will generally rise to the top.” Meanwhile wrong-headed scientific ideas can and will be discredited. Very importantly, we at Cureus also believe that SIQ, our unique post-publication peer-review process, can, through the democratic power of the many, serve to discern real and enduring scientific quality over time, not unlike like the once overlooked masterpiece “Citizen Kane”. It is our fervent hope that at some point in the future, after the passage of enough time, when we look back at Cureus’ growing library of medical articles, we will see that our SIQ system can accurately foretell the inductees into the National Inventor Hall of Fame or, for that matter, the winners of medical science Academy Awards.

Please don’t forget that all Cureus readers are invited to cast their SIQ ballots after each and every article they read!

Does the Journal Make the Author or Does the Author Make the Journal?

Last week I attended a grand rounds lecture at a major medical school given by an internationally-renowned, chaired professor at the peak of his academic career. Through our personal relationship, I know he also happens to be a man of great integrity. Nevertheless, this professor presented data during his lecture that he tried to publish in three different specialty journals but was ultimately rejected. Why? We will never know. In fact, I equate the traditional peer review process to the game of water polo; during a water polo meet the real action occurs beneath the water’s surface. Undeterred, the professor in question commented in the middle of his talk that he would now publish his article in Cureus. At that instant, I, as proud Editor-in-Chief of Cureus, felt a little like the guy who realizes he is not the first, or even second, choice of the teen who asks a girl to the prom. However, I quickly consoled myself; if ultimately I get to go to the prom with a beautiful girl, then where is the downside to that?

In reflecting on the experience of the above professor, I fully acknowledge the right of any journal to choose what gets published through its peer review processes. Nevertheless, this reminds me of how inefficient the “game” is – there is so much human effort required to reformat, resubmit and re-review a article. Once published, will this article be better for having survived this process? I for one am deeply skeptical. Meanwhile, if an acclaimed and politically connected academic has such problems getting his articles published, one can only imagine the difficulties that a less accomplished and, god forbid, non-academic (or even developing country) physician has in getting their ideas into the ocean of pubic discourse at many journals.

We at Cureus like to continuously, and quite provocatively, question why the medical community-at-large subjects itself to such abuse. My answer: being innately insecure, we academics engage in such self-flagellation merely for the perceived status derived from seeing one’s ideas published in luxury journals (a term I am stealing from 2013 Nobel laureate Randy Schekman) as well as the sloth embodied by most university promotion committees, who by virtue of their intellectual laziness, have chosen to make tenure decisions through journal impact factor. In response to this, I urge more physician authors to let their ideas speak for themselves by publishing in Cureus, a journal in which the process of getting published has never been easier. After all, does the journal make the scientific article, or do scientific articles make the journal?

Comments from an Invited Reviewer: How Cureus is Different

Here at Cureus we take author and reviewer satisfaction very seriously. We strive to respond to all questions, comments and complaints as soon we can, often within just a few hours. If you’re familiar with the Cureus mission, you know that constructing a publication process devoid of politics (and supporting the increased transparency that comes with it) are our primary goals.
With that in mind, we’d like to share a recent exchange between an anonymous Cureus peer-reviewer unhappy with the amount of time he received to review an article.

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Reviewer: Less than a week for an academic neurosurgeon to provide a review? Hmmmm.

Cureus: I was forwarded your recent email lament about the review period ending on a paper to which you were recently invited to comment. I wanted to reach out to you by email to firstly, thank you for responding, and secondly to explain a little bit more how the Cureus review process is designed to work, which as you perhaps noted is quite different than traditional journals.

As an academic neurosurgeon myself, I am all too aware that sometimes it can be impossible to find the time to review a manuscript just because one is just too darn busy. That is a given!! What happens in traditional journals routinely is that such busy academics plan to review a paper but for a range of reasons never get around to it. Therefore, the editor in chief and staff of most journals spend most of their time (and journal money) chasing down reviewers and as a result the process of review can last for months in many cases. We at Cureus have tried to do something quite different in our review process. We invite a number of reviewers to review but we fully expect most to be too busy and decline. If anyone is busy, it is quite ok to decline, our Cureus editorial team totally understands. However, the expectation is that a few of the invited reviewers will have both the time and the interest to perform a timely review……in fact, we are eventually hoping to achieve a review cycle of just a few days.

While this review cycle is better than nearly all other medical journals, it should be noted that NEJM does offer a turn around time in a week for some selected topics so this objective is not totally beyond current trends at the most selective journals. By resetting expectations for reviews, Cureus hopes to avoid the many month review cycles that are commonplace with JNS or Neurosurgery for example. The beauty of a faster review cycle is that the reviewed article remains fresh in everyone’s mind so that a lot of time is not wasted reacquainting oneself (both author and reviewers) with the article and any reviewer comments that emanate with each review cycle. Moreover, Cureus’ in-browser reviewing tool makes it easier than ever for a reviewer to comment on a paper and communicate their critique directly to the author. In the process hopefully everyone wins. The ultimate objective is to accelerate the process of publishing/documenting medical science, which I believe to be a net positive.

Clearly your first interaction with Cureus was less than ideal. I am hoping that after my explanation here you might give Cureus another try? In particular I would love you to perhaps even consider publishing your own article in our totally FREE open access journal, an experience first hand how a faster/easier review process can even make publishing peer reviewed papers FUN!!  I note that you are a DBS guy and by virtue of such you clearly must be comfortable with new ideas and technology. As Cureus seeks to innovate in the medical journal space, we especially welcome early adopters like yourself.

I am happy to answer any further questions should you have any or address any other concerns your might have.

Reviewer: Many thanks for your email and clarification. I do agree that the review process is often too lengthy, especially with the journals you mention. Sadly, even with the best will in the world, the pressures of clinical work and other academic deadlines do not make it feasible for me to provide a thorough review on a paper within a week of receiving the request.

That said, now that I understand the philosophy behind the Cureus review process and I do like the idea. It is a clean and workable solution, but I fear it may work against the clinical scientist, especially in the surgical field where time is more limited.

I do find publishing fun … especially the debate with constructive reviewers. I will think of Cureus if I have any suitable material in the coming months.

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A fair argument? What do you think?