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.