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

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?” →

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 3^rd. That was far from the end of it, however, as another round of editing requests arrived on May 11^th.

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.

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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.

Publishing all credible science: Where do we draw the line?

Stemming from the belief that market-driven open access publishers are inherently predisposed to publish any article for which an author is willing to pay, there is a common prejudice that the scientific quality of such articles must be inferior to those published within non-open access journals. Whether true or not for other journals, this rationale certainly does not apply to a free publication model like Cureus.

For us, ensuring scientific quality is about preserving the brand of Cureus; by undermining credibility, bad science will, over the long term, inevitably diminish every conceivable measure of journalistic success. Destroying our reputation is the last thing Cureus leadership wants to see happen. However, working against this same concern is our journal’s philosophical commitment to publish all “credible” medical science; inevitably these two contradicting objectives require a delicate balancing act.

Despite (or as a sad result of) Cureus’ idealism, our journal sometimes receives questionable submissions: carelessly prepared manuscripts, sloppily presented results, poorly argued and unfounded conclusions, etc. Authors occasionally suffer from the misperception, perhaps due to our status as an open access journal, that we will publish whatever they submit and therefore they need invest only minimal effort.

Not so fast! I must caution against such thinking. Cureus is happy to publish articles that might be rejected elsewhere due to “political” or contrarian philosophical reasons, but like most quality journals, we will not abide substandard manuscripts. Cureus takes peer review and editorial oversight very seriously. Ensuring that authors do not abuse the easy-to-use Cureus submission system is quickly becoming a full-time job for editors who, frankly, have many better things to do.

Please do not confuse the ease of Cureus submission process with a willingness to overlook second-rate science. Does your article have a clear message and can it help interested colleagues in their daily clinical and/or scientific work? Put yourself in a reader’s shoes; if you were a reader, would you feel that the author in question has shown proper respect for your time? If you cannot answer yes, please do not submit your article to Cureus.

Anyone who intends to submit a shoddy article (and yes, you know who you are), be prepared to be blocked during editorial review. And should anyone choose to abuse Cureus’ generous spirit more than once, they should expect to be banned from our platform for an eternity. Meanwhile, the vast majority of conscientious authors, who both respect their potential readers and do their utmost to produce a quality manuscript, will be amply rewarded with a hassle-free submission process, and, once published, a large, appreciative audience of readers.

Ultimately we at Cureus like to think that a beautiful article of science is in itself, the best reward possible. Thank you for your understanding, cooperation and support.

Intellectual Fascism

I have been Co-Editor-in-Chief of Cureus for about three years and in this time I’ve learned a lot about how peer-reviewed journals function. It’s often said that in water polo the real game happens beneath the surface of the water. Similarly with journals, sometimes the serious action goes on behind the scenes. From its inception, Cureus was designed to minimize the role of politics in scientific publishing by way of its post-publication SIQ scoring process. Despite these ambitions, politics have occasionally crept into our efforts to publish great medical science. So it was with one recent article, and boy did the Cureus editorial staff learn a lot through this experience!

The article in question was written by several very accomplished clinical neuroscientists and involved a complex intersection of multiple scientific fields. Despite being evaluated by three reviewers, a clear error was noted in the published article by a reader; the error was of a political nature and not scientific in the least, but still an unambiguous error. An erratum was being prepared when a big hullabaloo broke loose in social media. Two individuals, whose specialty overlapped the erroneous article, attacked the article for its political misstatement, and by extension, Cureus’ journalistic integrity for missing this error during our pre-publication review process.

I immediately invited these critics to set the record straight via our liberal comment and scoring processes, but in a series of personal (and necessarily confidential) emails, the critics refused, insisting on remaining anonymous. Over the next several days they recruited a chorus of similarly-minded colleagues who insisted that the article in question represented serious scientific misconduct and demanded it be retracted… period! In light of these demands, Cureus, by virtue of its status as a peer-reviewed journal, was obligated to investigate under ICJME (International Committee of Medical Journal Editors) guidelines.

I personally oversaw the investigation, which started by recruiting seven truly world-class domain experts, who after reading both the original and the proposed corrected manuscripts, were to advise me; I deliberately included a couple of researchers suggested by the critics of the article. In parallel, I stumbled upon the existence of a listserv community of likeminded researchers including the two critics, whose major modus operandi is to fiercely act en-mass, hyena-like, oftentimes via social media, when certain partisan political issues arise, such as the article Cureus had unwittingly published.

If ever I witnessed intellectual fascism, this was it; the only thing missing was a goose-stepping mustached man. However, this was also to be a moment of truth for our young journal. Pending the advice of the seven domain experts, would Cureus stand up for open scientific discourse? Or would we join the ranks of cowering researchers?

After almost one month of analysis by the aforementioned unimpeachable panel of experts, some of whom are at the very pinnacle of their respective fields, it was determined that the Cureus article had erred badly (yet seemingly inadvertently) in misstating a political reality. However, the science itself was credible. As a result, an erratum addressing the erroneous facts was published and the original article retracted.

Ultimately this experience reminds me, and by virtue of this blog should remind all readers, that standing up for open and honest scientific discussion, devoid as much as possible from political considerations, is a constant struggle even in our supposedly democratic world. In fact I invite the very critics of the article in question to now publish their own scientific concepts with Cureus, which perhaps might even refute the published paper. The function of journals is not to anoint “scientific truths,” but to provide a forum for scientific truths to be discovered, and refuted.

We at Cureus are especially fortunate to have such a liberal post-publication comment and scoring system. This process, which is available to everyone, is intended to provide a voice for even the most contrarian scientific ideas. The power of the Cureus community-at-large remains a great potential strength. Please don’t be afraid. Step up and use it!

Enhanced Navigation and Article Displays Have Arrived!

We’re excited to debut an enhanced navigation system designed to make reading, reviewing and publishing articles a smooth and efficient experience. The next time you navigate to the Cureus homepage you’ll be greeted by an entirely new navigation bar along with a “ticker” highlighting recent Cureus activity, including new articles, comments, SIQ scores and more. We’ve also brought back the “Submit an article” button. This button strips away everything but the essentials to get you on the road to publication ASAP.

The Cureus library is now organized into two sections: peer-reviewed and non-peer-reviewed content (articles and posters, respectively). Clicking on “Articles” in the journal dropdown menu will take you to the same article overview page as before. (But don’t worry, it’s going to be redesigned too!) Clicking on a specific article, however, reveals our brand new article page:

Article tabs provide easy access to author and article information, as well as figures and tables. Meanwhile, the article’s SIQ score, disclosures, acknowledgements and audience discussion are all highlighted along the left side of the page. Speaking of SIQ, we’ve also revamped our Scholarly Impact Quotient system to make rating articles more straightforward:

Here at Cureus, we’re a medical journal first, and with everything we do we aim to craft a better publishing experience for our growing community. That said, we’re also very cognizant of our position at the forefront of the online, open access journal movement and we’re confident that our enhanced look and feel will make the Cureus experience even better. Remember, we’ll be overhauling the rest of Cureus in the near future so stay tuned for more updates!

Building Your Professional Reputation With Posters

It used to be that building a professional reputation as a physician was just a matter of working hard, publishing and speaking to demonstrate your thought leadership while also developing strong word of mouth from well treated patients.

No longer! A physician’s reputation is increasingly built and displayed online. The web is now the largest source of information for physicians AND patients. When your colleagues want to know more about you…they turn to the web.

Writing is one of the most powerful ways a physician develops his or her reputation and publishing medical posters is often the first experience most physicians have with publishing.

Cureus is hosting our first international poster competition for many reasons among which are the opportunity for authors to showcase their works to the world rather than a few people at a conference. Additionally, it’s a way to begin building one’s “Digital CV” while possibly making connections with other authors with similar interests.

With that context, I want to offer some very simple advice to every medical student and physician author…spend a little time building out your profile. People connect with people first then they connect with content. The Fall 2012 Poster Competition site traffic has shown very clearly that those authors who create a full profile along with a picture are far more likely to generate poster views and votes.

Realize this is not specific to Cureus — as you move forward in your career, don’t short-change your work and expertise by not taking advantage of the tools at your disposal. This may include personal or practice web sites, LinkedIn accounts and more.

As for generating maximum readership of your posters on Cureus…take a few extra minutes now to add a picture, list awards you may have earned, your address etc. Our data shows that these steps work!

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