You Call it High Academic Standards, I Call it Racism

I’m not a big fan of identity politics, where, in my opinion, allegations of racism are too often used as a political cudgel to bludgeon an opponent. But sometimes it really is important to call out blatant racism, especially when there is a greater societal good at stake, such as in this case protecting the integrity of peer-reviewed science. I had this very “opportunity” thrown at me just last week.

To introduce our journal, and its unique crowd sourced quality score (SIQ) to new physician authors, Cureus utilizes email to reach specific communities of authors who have published articles in other Open Access journals, inviting them to promote the scoring of their articles via social media and email. While away on business in Beijing last week, I was surprised to see one email and two voicemails on my phone from a (unknown to me) senior and accomplished author in other journals. His messages quickly revealed a surprising anger over having his article promoted by Cureus. I replied with a brief email explaining how the Creative Commons copyright system supported such fair usage by Cureus, but this merely precipitated yet another profanity-laced email volley. Not wanting to inflame matters further, and even more so wanting to understand the true source of his angst, I decided to call the author. To say the call was unpleasant would be an understatement. I am a neurosurgeon and have fairly tough skin but it is never fun to have all kinds of profanity thrown at you, especially when you’re sure it is unjustified.

I let him vent a little, as my primary goal was figuring out why he was so upset. No matter how patiently I asked this guy to explain the source of his anger, he repeatedly deflected. Finally, after having asked multiple times, this rather accomplished researcher frustratingly blurted out that he did not want his article promoted “alongside the University of Pakistan.” In that instant, everything became clear. There is no institution named The University of Pakistan. Cureus, however, recently published several articles from South Asian-based institutions, namely India and Pakistan. What I suddenly realized is that this person was merely pissed (and seemingly offended) that his “aristocratic” article (allow me some artistic license here) might appear alongside “unworthy” South Asian articles. To put it more bluntly, this otherwise truly accomplished author was just a racist old fool.

In an effort to defuse the situation I complied with his request to remove his article. Upon further reflection I now feel a deep sense of gratitude to this old racist for providing me the opportunity to expose how racism—implicit and overt (like this case), sadly lurks in the background of all peer-reviewed journals. Truthfully I am amazed that so many in this day and age are still clueless about what is happening in medical science. As I sit writing this in a world-renowned Chinese hospital, I am surrounded by the very type of medical excellence that my racist critic deems unworthy of his association. A close American friend of mine (and Cureus editorial board member) is one of the premier pediatric cardiac surgeons in the world, having invented several important heart operations. He has visited several South Asian hospitals that have refined his original operation, enabling them to operate on vastly more patients than him, and do so at less than 10% the price of a U.S. hospital. In light of this, it strikes me as complete foolishness to restrict such important medical knowledge. Scholarly racism is utterly self-defeating for authors, readers and the world at large.

Although I could find no formal studies documenting the extent of racism within scholarly journals, there is a modest body of research and other evidence pointing towards the existence of sexism, as well as prejudice against non-academic physicians, in the world of academic publishing [1-3]. Perhaps it is time to formally study the extent of racial bias in peer-reviewed journals. Any takers?

Recently, the CEO of an authoritative digital health website shared an interesting statistic with me: 40% of the articles published in the New England Journal of Medicine, arguably the most important medical journal, originate within a 200 mile radius of the journal’s headquarters. No one would disagree that Boston, New York and New Haven are centers of academic excellence, but the medical community that dominates the NEJM represents but a tiny fraction of world physicians, thus excluding an immense amount of clinical experience and knowledge. Although such willful blindness or elitism is not as blatant as the prejudice exhibited by my new acquaintance, does a hugely influential and even entitled societal institution like the NEJM not have a responsibility to open itself up to more of the world of medicine?

While I will continue to respect the world’s leading medical journals for the important work they publish, I remain proud that Cureus serves the vast numbers of physicians truly in the trenches of medicine who have been disenfranchised through what might be best termed “scholarly elitism.” Lastly, I want to thank this narrow-minded dolt for reminding me yet again why Cureus’ mission is so important to the world of medicine.

References:

1). Pololi LH, Civian JT, Brennan RT, Dottolo AL, Krupat E. “Experiencing the Culture of Academic Medicine: Gender Matters, A National Study.” J Gen Intern Med. 2012 Aug 31; [Epub ahead of print] PMID: 22936291. [PMC free article] [PubMed]

2) http://www.sciencemag.org/news/2015/05/plos-one-ousts-reviewer-editor-after-sexist-peer-review-storm

3) From abstract to impact in cardiovascular research: Factors predicting publication and citation. Eur Heart J. 2012 Winnik S, Raptis DA, Walker JH, Hasun M, Speer T, Clavien PA, et al. From abstract to impact in cardiovascular research: Factors predicting publication and citation. Eur Heart J. 5 June 2012 [Epub ahead of print] PMID: 22669850. [PMC free article] [PubMed]

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Publish or Perish

For physicians, what is the purpose of publishing journal articles? When totally new ideas are involved, the peer review process is clearly important for communicating and validating scientific understandings and breakthroughs. For physicians, however, publishing often provides a very important additional function. Specifically, the process of publishing a peer-reviewed article involving patient outcomes enables a physician to examine, reflect upon and learn from a specific clinical experience. The rigid discipline involved in honestly subjecting one’s own patient outcomes to peer review provides a unique environment for improving one’s clinical practice.

At the same time, the integrity manifested by going through this process communicates to colleagues one’s clinical interest and skills in a specific subject area, and in doing so, invites new patient referrals. This notion being true, it must then be acknowledged that publishing is often a form of marketing one’s clinical skills to the broader world.

To some scientific purists, the idea of peer-reviewed publishing being an extension of marketing is crass and unseemly. Nevertheless, most physician specialists who require large referral bases know the value of publishing outcome studies in support of their practices. Moreover, I would argue that rather than being crass and unseemly, honestly communicating one’s patient outcomes is more successful and manifests more integrity than any other means of marketing a clinical practice. Is this process not a lot better than anecdote or vague notions of reputation fostered through friendship, or for that matter a highway billboard?

One of the beauties of marketing one’s skills through the publication process is that once published, patients themselves, who clearly have the most at stake in finding good medical care, can ideally access critical information. For this later point to be true, however, an article in question must be available to interested patients, which is rarely the case with traditional journal articles that are locked up behind very expensive subscriptions and paywalls. No matter, the movement towards open access journals is finally breaking down such barriers. As a result, it’s reasonable to expect many more physicians to take advantage of—and focus their marketing efforts on—publishing within the peer-reviewed literature. To my way of thinking, this is real progress!

Luxury vs. Quality: Why Journal Prestige Doesn’t Guarantee Good Science

In an op-ed in last week’s The Guardian, this year’s Nobel Laureate in Medicine, Randy Schekman, declared that he would no longer be publishing his papers in the big prestigious “luxury” journals that have dominated scientific discourse for generations such as Science, Nature and Cell. Dr. Schekman declares that the processes required for publishing in these journals have distorted the “incentives” for creating quality science and thereby undermine humanity’s deep and abiding interest in scientific progress. In his op-ed, Schekman recounts numerous instances of big name journals publishing articles on popular “sexy” subjects at the expense of quality, efficiency, and at times, truth.

Sadly the marketing of science, even within what should be the most objective of scientific forums, i.e. peer-reviewed publication, appears to not be that different than Louis Vuitton handbags and Rolex watches. If the LV brand label is attached, the handbag is widely assumed to be high quality! Alternatively among many consumers (readers) of scientific journals, if Nature publishes an article, it is assumed to be good science. But truthfully, how many handbags are merely cheap knock-offs of what is currently fashionable? While this analogy may make many scientists recoil in horror, there is clearly an element of truth which makes it so painful.

The rewards for publishing in the big name journals can make careers for many a determined academic; in the process of academic promotion, the importance of the journal in which an article is published, as typically measured by journal impact factor, has become the primary yardstick for assessing quality and importance. But is it? Yes, the average article in a prestigious journal is very good, but not all published papers within such journals are necessarily good or important.

The converse argument is important to emphasize; through the lens of hindsight, many great peer-reviewed articles were published in less than famous journals. Despite this reality, nearly all promotion committees continue to fawn over journal brand names. Shockingly, one is left to conclude that even scholarly groups are incapable of or unwilling to, read the articles of young academics and gauge for themselves the quality of a scientist’s work.

The above reality has corrupted the truth and beauty that is supposedly at the core of scientific publication. Most troublingly, in (seemingly) rare cases unscrupulous academics will of course stop at nothing to publish in luxury journals, even if it means scientific fraud. Can the madness spawned around prestige journals, some of which are nearly two centuries old, be reversed? Fortunately yes. The move towards publishing in online open access journals is gradually shaking up the antiquated and counterproductive world of publishing. When reading open access journals, the reader is compelled to judge for themselves the quality of the science being presented. From many vantage points, but especially because of its unique crowd sourcing tool (SIQ), a measure of paper quality, almost no journal is better positioned than Cureus to fix the very broken world of scientific publishing.

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Cureus Medical Journal Featured in San Francisco Chronicle

Cureus Medical Journal Featured in San Francisco Chronicle
John R. Adler M.D.

The San Francisco Chronicle interviewed John Adler, MD, Professor of Neurosurgery, Stanford University and Editor-in-Chief at Cur&#275us. They were interested in our revolutionary concept of using crowdsourcing to evaluate and publish medical papers.

John Adler points out that “Nowadays, you wouldn’t go to a restaurant without Yelping it first. You wouldn’t go see a movie without seeing what Rotten Tomatoes had to say about it.”

Still for some reason the world of medical journals is stuck in a 200 year old paradigm. He has spent the last three years changing the status quo.

The Cur&#275us model was created to expedite the process of medical publishing. An editorial board of experts will review submitted papers within days rather then months. But most of all, Cur&#275us is moving medical journals into the open from behind pay walls.

“The average Joe has little to no access to the medical literature today,” Adler said. “It’s not right. It should be a human right.”

Although the idea of crowdsourcing seems revolutionary, Dr. Adler’s vision has been stirring for some time.

He writes in A New Age Of Peer Reviewed Scientific Journals that he founded Cur&#275us “to address the challenges I have observed first-hand as an editor of numerous journals and an academic physician who has published and reviewed for years. We can do much better by authors, reviewers and certainly patients. This is the mission of Cur&#275us.”

Read the entire article at SF Gate.

Update: Fast Company picked this story up as well.

Should the process of publishing a paper trump the power of scientific ideas within?

Should the process of publishing a paper trump the power of scientific ideas within?
Henry Jacob Bigelow

Last week the New England Journal of Medicine announced that a survey of readers selected the 1842 publication of a paper by Henry Jacob Bigelow, reporting the first use of anesthesia, as the single most important paper in the 200 year old history of the journal.

Given the future implications of what was being reported in this paper, especially as we now look back over the medical landscape 150 years later, I cannot disagree with the selection. However, what I do find more than a little bit ironic is that such a paper, if submitted today, would stand almost no chance of being published in the NEJM, or virtually any so-called high impact journal.

As the Bigelow paper wended through the review process, this in-hindsight completely transformational paper, would be rightly criticized (and surely killed) as being little more than anecdote.

There is certainly no randomized blinded trial with rigorous statistical measures that ensures the quality of findings live up to the highest “scientific standards”. Moreover, lacking an IRB stamp of approval would certainly invalidate the paper for publication right out of the gate.

So I ask, have the standards of the NEJM and nearly all modern journals become so obtuse and elevated that the findings they now report are irrelevant to truly novel clinical innovation?

Also last week, I was advised by one of the journals for which I have long served as an editor, that future observational studies, if they are to even be considered for publication, must now assiduously adhere to STROBE guidelines.

Such STROBE guidelines represent the consensus of a 2004 big funded workshop, i.e. self appointed committee, composed of editors and sundry luminary academics who, presumably with the best of intentions, felt compelled to improve the reporting of observational studies.

But what started as well meaning “guidelines” have (perhaps not surprisingly) now morphed into a compulsory directive enforced by the editor in chief.  Will the quality of the journal articles now being published under the STROBE guidelines truly benefit from this new set of regulations?  Surely the editor in chief and politically-connected self-appointed STROBE experts would argue yes, but notably these sacrosanct “guidelines” have themselves never been subjected to any empirical test.

What I am quite confident about is that the journal in question has put up yet another barrier to authors reporting potentially interesting, and even ground breaking, clinical studies. As a result is it possible that that today’s equivalent to the good Dr. Bigelow’s reporting of anesthesia will go undiscovered because of the sheer hassle of publishing in the peer reviewed literature?

Is it possible that STROBE processes might drive some of today’s clinical innovators to just throw up his or her hands and say no thank you to reporting their findings? This leads to the bigger question, should the process of publishing a paper trump the power of scientific ideas within?

Readers of Cur&#275us are well aware of our Journal’s bias in this regard!

A New Age Of Peer Reviewed Scientific Journals

A New Age Of Peer Reviewed Scientific Journals
We can do much better by authors, reviewers and certainly patients. – John Adler MD

John Adler, MD, Professor of Neurosurgery, Stanford University; Editor-in-Chief, Cur&#275us, has published a new editorial on the variety of issues associated with the centuries-old industry of peer reviewed scientific publication.

In today’s internet age, can the status quo peer review system provide value to our society – or is there a better way for “establishing scientific validity” and dissemination of knowledge?

Dr. Adler highlights some of the serious hurdles with current traditional peer review (i.e. fraud, and reviewer bias) and proposes to re-imagine peer review to  become more suitable to our internet age. In a digital platform, the space limits within paper journals are gone. Without having to ration the space, there is no need to “kill” papers and artificially limit the number of papers published in a given month.

And to assess the quality of these papers Adler proposes crowd sourcing. To tap into the collective intelligence via Cur&#275us’ Scholarly Impact Quotient (SIQ). The SIQ is an “evolving, yet enduring reflection of a paper’s true scientific impact.”

Dr. Adler founded Cur&#275us “to address the challenges I have observed first-hand as an editor of numerous journals and an academic physician who has published and reviewed for years. We can do much better by authors, reviewers and certainly patients. This is the mission of Cur&#275us.”

Source: A new age of peer reviewed scientific journals – John R. Adler Jr

 

A new age of peer reviewed scientific journals – John R. Adler Jr

 

Mid Poster Competition Message from Editor-in-Chief

Mid Poster Competition Message from Editor-in-Chief

John Adler, MD, Professor of Neurosurgery, Stanford University and Editor-in-Chief at Cureus gives us a poster competition update in this latest video.

Posters continue to come in and promotion is underway. If you want to finish in the top 10 and have a chance at winning your category, get your peers and professors to vote for you.

Several programs are doing a great job of getting their team behind their posters…ensuring they will be in the top 10 in their respective category. Nice work!

Nice work from Stanford and University of Washington coming out of nowhere to get onto the leader-board in strong fashion….and late breaking news…congratulations to Alabama and University of Central Florida coming on very strong in the last few days.

There is lots of time left for new schools to get on the board and for those of you already entered to start promoting. Have you used the “social voting” tools?

 

httpvh://youtu.be/gtMyxEgtmhc