Cureus Conversations: Q&A With Cureus Co-Founder Alex Muacevic

Dr. Alex Muacevic Cureus Co-founder and Co-editor-in-chief

Alexander Muacevic is the Medical Director of the European Cyberknife Center in Munich, Germany and holds an academic teaching position at the University of Munich Hospitals. Dr. Muacevic is a board-certified neurosurgeon and radiosurgeon and his main clinical and scientific interest is full body radiosurgery using advanced image-guided robotic technology. In addition to earning a European Neurosurgery Certificate, Dr. Muacevic has published over 100 scientific contributions including peer-reviewed articles, book chapters and congress proceedings. Dr. Muacevic is also a member of several academic societies and president of the International Radiosurgery Society containing over 700 members. Last, but not least, Dr. Muacevic is the Co-Founder and Co-Editor-in-Chief of the Cureus Journal of Medical Science.

Q: What was your first publishing experience like? 

A: I started with smaller retrospective studies around Gamma Knife radiosurgery and I remember it was tough as a junior resident to fulfill all of the scientific standards.  

Q: How did your relationship with Dr. John Adler begin?

A: We knew each other from neurosurgery meetings but got to work more closely together via the Radiosurgery Society and finally when we started our Cyberknife center in Munich in 2005.

Q: Has open science always been something you’ve been passionate about? 

A: No, this developed over time and was based on frustrations in the conventional publishing world with more and more bureaucratic hurdles.

Q: In your opinion, what are the greatest challenges facing Open Access publishing?

A: Getting wide spread acceptance in the academic world.

Q: Is there anything about Cureus that you are particularly proud of?

A: Of course! We started from scratch over 10 years ago with only four people working to publish one article a month and now we have a much larger team and are publishing close to 10,000 articles this year. A great team effort and achievement!

Q: Do you have any advice for first-time authors?

A: Take your time, try to be precise and correct, and learn from more experienced people. Perhaps a simple case report with Cureus is the ideal introduction to the academic world.  

Q: What are you looking for from Cureus peer reviewers?

A: A clear, concise and unbiased analysis of the paper in question.

Q: What is it like having Dr. Adler as a partner?

A: He is the best partner to have, as he is always open to strong arguments. I enjoy the fair battles we have behind the curtain to make Cureus a better journal each and every day.

Q: Why should researchers submit to Cureus?

A: Because it is the best and fastest way to get peer reviewed science out to the world. I might be biased but I don’t know any journal which is more comfortable and also fun to publish with.

Q: Are you currently working on any research? If so, what can you tell us about it?

A: We are working on multiple projects like SRS for Trigeminal Neuralgia, Meningiomas and Renal Cell Cancer.

Cureus Conversations: Q&A With Editor in Chief Dr. John Adler

Cureus Conversations: Q&A With Editor in Chief Dr. John Adler

Dr. John Adler is the Editor in Chief of the Cureus Journal of Medical Science and Dorothy and Thye King Chan Professor in Neurosurgery Emeritus at Stanford University.

In your opinion, what is wrong with the current system of medical publishing? 

So much of publishing is presently geared towards a small elite community of academic physicians who understand the rules of the process and have the most time to engage in the publishing “game”. This means that the ideas from these academics, many of whom are not necessarily accomplished clinicians in the real world, are most widely circulated. Of course much of this process is intended to support the academic tenure process, which needs to create at least the illusion that certain ideas are innovative as opposed to merely being the product of an observant physician. Part of this stems from an excessive reliance on statistics.

Why are some slow to embrace the Open Access philosophy?

For the above reasons, academic physicians who have dominated journals for generations are loath to see publishing democratized. Democratization threatens their exclusivity/power in communicating medical science to the world.

What motivated you to start the Cureus Journal of Medical Science?

Having spent a lifetime in academia I could see that many truly clever, experienced and innovative physicians living in the trenches of medicine had no voice within the broader world of healthcare.

“Ask Me Anything” with Dr. John Adler
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How do you measure success at Cureus?

The number, quality and reach of the articles we publish, as well as how engaged readers are with the content within.

Why should doctors and researchers publish in Cureus?

Cureus’ makes it easier and cheaper to publish a peer reviewed article than was ever possible before.

What makes a strong approval editor? What do the Cureus editors look for when critiquing medical science?

Ultimately Cureus’ most important duty is to our readers. It is somewhat ironic that Cureus’ responsibility to readers transcends that of our physician “customers”, with whom our editorial team primarily interacts. With this understanding in mind, I like it when an approval editor understand this hierarchy of accountability, approaching an article first and foremost from the reader’s perspective. Their job is not to kill/reject articles but to make sure that by reading carefully they suss out any “BS”, so that the reader has less work to do. Having said that every article, every time, by every reader should be approached with some measure of skepticism. There are no absolute truths in science. This is why our mantra is to publish “credible” science allowing the best science to “pass the test of time”.

Are you currently working on any research?

As a matter of fact, I just co-authored the following article published in Cureus: Neuromodulation via Focal Radiation: Radiomodulation Update

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.

Continue reading “Is it Time to Pull Back the Curtain from Peer Review?”

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?

Continue reading “A Handless Surgeon? It’s Not as Crazy as it Sounds.”

Conflicts of Interest and Financial Disclosures: It’s Time to Take a Stand Against Dishonest Authors

The recent announcement that the Chief Medical Officer of Memorial Sloan Kettering Cancer Center failed multiple times to report significant financial conflicts of interest in journal articles and letters authored or co-authored by him has justifiably stirred up quite a hornets nest of controversy.

Truth be told, I too am personally quite angry about his glaring oversight, which at its worst, involved opinions communicated broadly to the medical community via the New England Journal of Medicine. As a physician innovator, entrepreneur and scholar I have sought to play by these disclosure rules, which simply mandate transparency, because I think they are the best tools for fairly communicating possible bias to readers.

Continue reading “Conflicts of Interest and Financial Disclosures: It’s Time to Take a Stand Against Dishonest Authors”

The Long, Arduous Journey to Publication: It Doesn’t Have to be That Way

I recently co-authored an article submitted to Nature Urology, a subdomain of the Nature publishing group. It took roughly eight weeks of review before we received feedback from the editorial office. In December 2016 we were finally presented with several reviewer questions that had to be answered before a final decision could be made. After all outstanding questions and reviewer requests had been answered the article was finally, mercifully “accepted in principle” on February 3rd. That was far from the end of it, however, as another round of editing requests arrived on May 11th.

This time the requests came directly from the Nature editorial office. The majority of the requests concerned tightening up the narrative flow and bringing the article in line with their in-house style. At this time, we discovered that the edits already made by the editorial office were so extreme that the editors had to check with us to make sure the meaning of our words (and indeed the entire article itself) had not been altered by their editing process. All of this for arbitrary language and formatting issues.

On May 15th, with the article still unpublished, we were yet again asked to check affiliations and other minor aspects of the article. The article was finally published yesterday, May 23rd, roughly eight months after submission. (And it could have been worse!)

How does this kind of perfectionism serve the scientific community? Why does the editorial office of the Nature publishing group change the text of professional scientific authors in a way that even they are not sure if the scientific information is still correct? The editorial work of so-called high-end and high-ranking journals has reached a level where their interaction is beyond thoroughness. It is absurd to edit every paragraph, every sentence, and even every word. This does not serve the scientific community. Instead it unnecessarily prolongs the publication process to guarantee the house style of a specific journal. The scientific message does not change with this heavy editing, but an article may look better and therefore may be better sold by the publisher based on the work of scientific authors.

The process (and underlying philosophy) are different with Cureus. In short, we rely on the individual capabilities of our authors, who also retain their copyright. We want to make the publishing process fast and efficient, so while we provide a certain level of support to our authors, we do not intend to alter their scientific message. Instead, we appeal to their own sense of pride and responsibility for adequate language and general accuracy.

In the end it is the scientific community that will evaluate if the article is scientifically sound, informative and correct. If it is not, the article will be met with heavy criticism, both via a low SIQ score and negative comments attached to the article. This system is not only much faster but also unbiased and transparent. We want to keep the focus of scientific publishing on what we feel is most important – the fast, fair and uncomplicated dissemination of interesting findings around the world.

In the Name of Truth and Reconciliation: A Plagiarist’s Mea Culpa

Dr. John Adler, Founder and Editor-in-Chief of Cureus: Speaking as a physician-scholar and an editor-in-chief, damn do I hate plagiarists! The entire idea of plagiarism sucks the life out of something that I believe to be almost sacred. Idealism aside, fraudulent behavior among authors is all too common, and maybe even rampant, within the world of scientific journals. To combat such fraud, Cureus, like most credible journals, has made it a formal policy to aggressively police plagiarism when we encounter it, as stated explicitly in our guidelines for authors’ section:

“Cureus pledges to rigorously enforce all standards, and promptly follow up on any transgressions. In extreme cases, this may call for article retraction and the reporting of individuals to their employer, institution or some appropriate body for further investigation.”

To date, Cureus’ policy appears to have ended the careers (sadly) of some young ambitious physicians; it is the aspiring younger academic who in my experience appears most tempted to cheat, especially given Cureus’ liberal willingness to publish credible science. In response to the cheaters, Cureus’ editorial team has always sought to be ruthlessly punitive, believing it to be the best defense against future plagiarism. Once exposed to the leadership of their medical institution, a plagiarist’s career tends to end in the quiet of the night, which unfortunately does little to communicate the seriousness of such cheating to others.

Therefore, I recently made a decision (for better or worse and somewhat capriciously I might add) to not report a plagiarist to his senior leadership. In the name of “truth and reconciliation” I instead demanded that the attempted-plagiarist explain their underlying motivations so as to serve as a warning to future authors who might be similarly tempted. That is the impetus for the below anonymous blog post. It is my hope and prayer that future potential plagiarists might read this post and come to their senses before very possibly destroying their own medical careers.

My decision for leniency under the current situation was done with great hesitancy. I can rightfully be criticized as undermining our journal’s clear warning to authors. Therefore, I wish for the record to say that as long as I am Editor-in-Chief of Cureus I intend to never ever repeat such leniency towards a fraudulent submission. Any author who might be tempted otherwise, consider yourself to be hereby forewarned.

Anonymous Cureus user: Most residents desire to do research and get published in a journal, for both the academic benefits and to develop one’s resume when applying for future fellowship training. Being such a young ambitious physician, but also having no significant experience in publishing research, I recently made the biggest mistake of my professional life, and this error has haunted me every day since.

A couple of months ago I decided to publish a case report on an interesting patient I had just seen in the clinic. I decided to submit the report to Cureus. As I began to write I realized my research writing skills were seriously wanting. By chance I found a similar case and heavily “borrowed” portions of text; my only focus was on getting my first publication and I turned a blind eye to the consequences of such actions. In fact, I hardly changed any words or sentences and simply submitted this report to Cureus thinking that in this particular case the objective was the same.

Why did I do it? Regretfully I now have only stupid explanations to fall back upon. Nevertheless, it is worth saying that in the country where I was raised, the topic of plagiarism is never discussed or seriously acknowledged. Plagiarism just isn’t such a big deal.

Soon after submitting my manuscript I received an email from Cureus’ editor who told me that I plagiarized and he sent me a link to the original source. I was humiliated, and even more so now very scared. By all rights the editor could and maybe should have reported me to my program director. If that were to happen, I realized that it could very well end my career in medicine. So many years of hard work was potentially destroyed by a single incredibly stupid decision! I pleaded and begged the editor for mercy, and the consequence of that plea is the confessional blog you are now reading.

Once again I ask myself why did I do such a stupid thing? Thinking back now I realize I had been blinded by ambition and was totally dishonest to myself. It disappoints me to know my poor decisions mostly reflect my greedy nature and a willingness to get ahead without hard work; I was largely jealous of my friends and colleagues who were publishing. Blinded by such emotions, I failed to ask myself how dangerous such actions would be for my character, my occupation, my career and my family. In hindsight, had I thought deeply about the potential consequences of my careless act, I would have never done it, and that mistake taught me a very tough lesson.

As a resident, I already knew that laziness can make the difference between the life or death of a patient. However I failed to consider that laziness towards publishing medical research is potentially even more dangerous, as it can put many other lives at risk. My actions can only be described as utterly immoral and unethical; my behavior is completely inexcusable. Although it is the ethical right and privilege of the editor to report me to my departmental chair and residency director, I am sincerely grateful for the career-saving opportunity I have been afforded. I am determined that this painful lesson will lead to my honest behavior in the future, as God is my witness.

Cureus Peer Review Just Got a Heck of a Lot Easier

We’re pleased to announce the launch of our brand new, built-from-the-ground-up peer review tool! Any article submission started today will utilize the new system while in peer review.

Previously, we had used a third-party software tool called Crocodoc for article peer review. Our team has been hard at work creating our own proprietary system that makes reviewing an easier, more intuitive experience.

Similar to Google Docs or Microsoft Word, this new system enables reviewers to highlight text and leave comments. Each reviewer’s comments will be displayed via a unique highlighted color, while also allowing for overlapping comments.

Adding a comment
Adding a comment

Only articles created and submitted after the release will utilize this new system. All articles created before the release will still use our original peer review system. As such, please don’t be alarmed if your review experience changes from article to article!

Viewing a comment
Viewing a comment

Between the peer review and submission systems, we have now overhauled the entire publishing process in the past five months. We’re confident that submitting and reviewing articles with Cureus is easier than it has ever been, but we won’t stop working to make your experience better. Stay tuned for more exciting updates as we continue to tweak and enhance the Cureus Journal of Medical Science. Thanks for your support!

– The Cureus Team

Questions about the new peer review system? Drop us a note at support@cureus.com and we’ll get back to you ASAP.

The Gross Inefficiencies & Politics of Peer Review

A junior colleague described to me a review he was recently asked to perform for one of the leading journals in neurosurgery.  After a careful review he reported that the paper “sucked” and he recommended that it not be published. A few months later a revised paper was sent back to him, despite his rejection, leading him to again recommend that the paper be rejected. The next communication was a letter from the editor-in-chief asking my colleague to write a commentary of the paper in question which was to be published alongside the now twice-rejected article. Eschewing a discussion of whether this paper merited ultimate publication or not, I do question the entire peer-review charade that this vignette exposes. The reality is that too often reviewers have little say in whether a paper gets published or not. Instead journal politics and the discretion of the editor-in-chief is transcendent throughout the peer-review process. My lament is that if the editor-in-chief is intent on publishing a paper from the start, why not say so and at least ensure that the process is efficient; this is of course the Cureus process of peer review!

What the above story calls into question is  just what exactly constitutes peer review? What is its function? The stalwart champions of peer review argue that it alone uniquely enforces scientific quality. The “acceptance” of one’s scientific work by potential critics and academic rivals, represents the highest measure of personal and scientific integrity. It is hard to argue with such a high-minded proposition, but is it grounded in reality?

In my own, and many of my colleague’s considerable experience, the realities of peer review are nothing like the above idealistic notions bandied about by proponents. Gross inefficiency is often embraced in the name of scientific integrity by rivals who are in no rush to see the accomplishments of scholarly competitors lauded. Many reviews are little more than cursory reads by time-harried reviewers resulting in a thumbs up or down. Ironically when all is said and done this may not be the worst outcome!

Too frequently reviews become meaningless intellectual battles, which at their core are little more than exercises in power and ego. These many skirmishes are often expressed in the to-and-fro volleys between reviewers and authors centering around secondary or even tertiary measures of paper quality. Time-wasting reviewer obsessions with incautious conclusions, inadequate words of self-criticism (at times almost Marxist in nature), failure to reference important (reviewer?) publications, by the letter ethical processes, inconsequential statistical measures, etc. often mask the importance, and strip away the beauty, of science. Given human nature and a subjective system that deliberately selects reviewers from the pool of intellectual competitors, is it not too surprising that baser self-interested emotions too often trump fairness, or at least efficiency? There has to be a better way! Because we at Cureus believe there is, we invite you to learn more about our peer review process.

Lessons Learned From Winning a Poster Competition

Lessons Learned From Winning a Poster Competition

Competing For Eyeballs of Those Passing By

    1. You are competing with everyone for the attention of a few (1 minute of their time – MAX)
    2. Catchy titles! Lure in the reader with a title that stands out from the crowd
      • E.g., One title I used was “The Panic Disorder Patient who Cried Wolf.” Clearly, this is not the title for the manuscript I eventually published (which was about information-processing biases and auditory perception in anxious individuals), but, it certainly piqued the curiosity of convention-goers.
    3. BIG PRETTY GRAPHS ROCK!!!
    4. Bullet-pointed text (similar to a talk). A few points of interest or “talking points,” but let the quality of your tables and graphs/images speak to the quality of your data!
      • No one has the time to read tiny text boxes (if the reader has to squint…you lose)!
      • Consider leaving out the abstract (so many words, and these words are redundant with what your poster will convey LOUDLY AND CLEARLY, also the abstract will be published in the Conference Proceedings anyway. On Cur?us, the title of your poster will be directly linked to your published abstract.  In essence, your poster IS the abstract plus some cool graphic design effort!
    5. What to include?
      • Background and Rationale
      • Specific Aims and Hypotheses
      • Methods/Design
      • Results
      • Graphs/Tables
        • Summarize results in bullet pointed text
        • Don’t add a single bullet under a point. What’s the point in the bullet if the bullet IS the point?
      • Conclusions/Discussion
      • Implications/Future Directions

Most of all, have fun with your work, have confidence in it, and BE CREATIVE!

Poster Sample (above): Spinal Chordoma by Stefan Norbert Zausinger