What is “Credible Science”?

What is “Credible Science”?

At the heart of every peer-reviewed journal is a publication philosophy. Most popular medical journals focus on “important” medical science. However, from my vantage point as a career scholar, “importance” is an ethereal “eye of the beholder” standard which inevitably feeds reviewer bias; one day a topic is hot but soon thereafter journals have lost interest, simply mirroring trends in the broader culture. Meanwhile author provenance also tends to weigh heavy on reviewer decisions about importance; even double-blinded review is not truly blind in the deeply specialized world of medicine in which we live. In contrast, from an author’s vantage, journal acceptance or rejection decisions tend to be rather capricious; submit to a journal (i.e. not Cureus), wait for the rejection before reformatting and resubmitting to a second journal, and repeat as many times as necessary to be published. Although this practice is a huge waste of everyone’s time, it has forever been the modus operandi for a journal industry obsessed with identifying and publishing “important” medical science.

Given the colossal time inefficiency of the current journal paradigm, as well as the real-world expense associated with such subjective decision making, Cureus’ philosophy has been to embrace a very different threshold for publication, which we term “credible medical science”.

What do we mean by the term “credible” science? “Credible science” is published science that simply reflects a “good faith” effort to ask and answer a relevant medical question. It involves care in collecting and analyzing data, then writing and formatting a proper manuscript, and finally responding appropriately to reviewer questions. At the end of this elaborate process, Cureus’ credible science may or may not ultimately be proven correct via future confirmatory studies. Even though this is and always has been the identical reality for every other published peer-reviewed journal, Cureus’ willingness to live without the charade of article importance miffs some (self-anointed) high priests within academic publishing. Furthermore, a lazy news media has grown comfortable with the axiomatic fig leaf that peer-reviewed science is, drum roll, absolute truth. The absence within Cureus of an absolute truth façade that our “credible science” standard accepts is disorienting to those who prefer a black-and-white world while blissfully ignoring the countless examples of once important scientific articles, published in the “best” journals, that are eventually debunked.

My point is that no peer review process is ever foolproof and like everything in life, when it comes to interpreting published science in ALL journals, the old adage “buyer beware” applies. What is presented on the written digital or analog page must, like other forms of human communication, always be interpreted by an engaged reader. Cureus’ “credible science” standard is, at its core, a grown-up acknowledgement of reality. Now I understand that Cureus’ disinterest in article “importance” is particularly irksome to some industry insiders who have made long careers defining and evangelizing on behalf of (and benefitting from) “important” (supposedly) medical science. Cureus’ commonsense standard for “credible science” and our journal’s refusal to censor unpopular (unimportant?) ideas does occasionally rankle critics. However, I am struck by the fact that some of the most vociferous critics of our “credible science” philosophy have themselves almost zero experience publishing real science in real medical journals. I liken most of these experts to the proverbial guy on the couch drinking beer and watching Sunday football on TV. How often is the guy futilely telling the coach on the field how to do his job, himself a former professional star with deep domain knowledge of football? Almost never! Nearly always, the critic is just another dude with an opinion. Nevertheless, if you really know how to call better plays for a professional football team, I urge you to get with it and become a highly-paid coach.

Meanwhile, if you think you know how to create better science, and publish better articles, please be my guest and allow our journal to make the process as effortless as possible. Important or not, all that Cureus demands is that your science be ”credible”.

Wear a Damn Mask, PLEASE!

Wear a Damn Mask, PLEASE!

When Covid first appeared in the US, several Asian physician friends had simple advice for me, “Wear a mask.” Having dealt with various coronaviruses for over a decade, this was the fundamental lesson taken from dealing with and controlling these respiratory viruses. Now, I may only be a dumb neurosurgeon, (said with humility, irony and in jest), but I know a thing or two about masks, having spent 30 years of life wearing them, sometimes for 12 or more hours at a time. There is nothing pleasurable about wearing a mask, but I have experienced first-hand how masks can protect patients and physicians from illness. More broadly I have seen how masks can protect healthcare workers from the worst of infectious diseases, even giving them supernatural-like protection when they must enter the belly of the beast while caring for highly contagious and fatal illnesses like Ebola. Meanwhile, each and every day, healthcare workers all over the world, including my own family members are able to avoid infection while caring for hospitalized Covid patients who are often spewing the virus everywhere. It’s incontrovertible – masks truly work!; they prevent Covid infections.

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The Covid-19 Pandemic: Not a Surprise!

Right now it is impossible to ignore the financial markets panicking, the breathless coverage by news media, the fearful buying at Costcos everywhere, and so many friends and family now worried about the emerging Covid-19 pandemic. Predictions of what might come next raise the specter of an historic pandemic that could literally kill millions or dare I say tens of millions before it runs its course. We are clearly living in an “interesting” time.

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Is it Time to Pull Back the Curtain from Peer Review?

Double-blind and single-blind processes continue to dominate academic peer review. Too often this results in a ‘black box’ – a system without sufficient transparency for authors, readers and reviewers alike. Hopefully one day fully transparent (and even public) peer review will come to be seen as acceptable throughout the world of academic publishing. For now we must take small steps to break down this barrier, just as Cureus works to break down barriers to publication.

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Does the Current Anti-science Crisis Emanate from our Imperious Scientific Journals?

In many domains of modern public discourse and opinion, there appears to have arisen willful ignorance of science, and perhaps even worse in many situations, outright hostility to scientific knowledge. This is most visible in government inaction towards a number of looming crises, most notably manmade global warming, but it’s also widely felt in the public health arena with vaccinations, drug addiction and over-utilization of antibiotics. Scientists and physicians remain frustrated and puzzled that obvious scientific arguments can be so baldly dismissed in the public arena, and in the face of such great collective peril. At the core of this modern tragic dilemma seems to lie a fundamental mistrust of science.

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A Handless Surgeon? It’s Not as Crazy as it Sounds.

During my halcyon college days, long before I knew I would “grow up” to be a surgeon, I was a huge fan of Star Trek. Although the ideas behind warp speed travel and teleportation were mind blowing, I was even more captivated by “Bones” McCoy’s Tricorder. This and other similarly nifty little medical devices could in the hands of the right doctor affect surgical-like cures for most any disease non-invasively and without pain.

Who wouldn’t want to embrace such a future for medicine?

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Medical Journals are Not Just for Docs in Ivory Towers

Why do we publish? As the editor-in-chief of a medical journal, I struggle a lot with this question. After more than 200 years, peer-reviewed journals have clearly established themselves as medicine’s best arbitrator of truth. They are, or at least ideally should be, at the center of everything we practice in our clinics. Yet somehow we physicians, even those of us in academia, are blind to many of the important roles that journals serve in medicine today.

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Hospital Rankings: Can Docs Make the Process Less Stupid?

It’s that time of the year. As Halloween decorations give way to Thanksgiving and now Christmas ornamentation, I, like many other American academic physicians, am sent an array of end-of-the-year email reminders from hospital and medical school leadership about sundry matters ranging from holiday parties to Press Ganey Scores. However none of these notifications stands out quite like being urged to update my membership with Doximity and thereby ensure my good standing with the social media network.

And what lofty academic or clinical function is being served? None other than the academic medical community’s best effort to get out the faculty vote for Doximity’s upcoming and all-important hospital and departmental yearly reputation scoring – a number which ultimately feeds into the even more important, annual hospital rankings among the US News and World Report.

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Fake Science: More Common Than You Think

Yet again the edifices of peer review were shaken by recent retractions in The New England Journal of Medicine and Cochrane Reviews. The article (and another “expression of concern publication”) retracted in the NEJM was authored by a Brigham and Women’s Hospital researcher (an institution of which I am a graduate), Dr. Piero Anversa, who has been implicated in the fraudulent publication of as many as 31 cardiac stem cell articles. Meanwhile, under seeming political pressures from a group of patient activists that decried an analysis entitled: “Exercise as treatment for patients with chronic fatigue syndrome,” deeming it a personal affront to their suffering, the editors of the prestigious Cochrane Reviews decided to withdraw it. The scientist who did the actual review for the journal lodged a bitter complaint about this “editorial” decision; it is hard to miss the irony here of Cochrane Reviews being a supposed impartial arbitrator of medical scientific quality that drives clinical decision-making. Fraudulent scientific results, politics trumping science, what is a reader to believe?

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Towards a Cureus Data Repository

*Co-authored by John R. Adler & Achim Schweikard

Most scientific articles come with some form of data. For Cureus, our data includes medical images, graphics, drawings and tables. Access to such data enables a reader to verify the content and credibility of an article while also better understanding it. Many types of data, provided they are findable via search, can have value to readers independent of the article with which it was originally connected; medical imagery and genetic sequencing information being cases in point. For example, with modern methods of machine learning requiring large data sets for training, journals are a logical repository for such information. Therefore a peer-reviewed article that provides access to data will oftentimes prove much more valuable than that same article without data. Especially for internet-based media with access to large amounts of digital storage space, data sharing between authors and readers would and should become a standard. As an example, instead of showing data for a single representative case in an article, which is typical for traditional journals, we could make data for all cases in this article available to readers. Readers could then download such enhanced data sets directly in electronic format.

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