path: root/transcripts/startup-science-2012/john-adler-cureus.mdwn

John Adler http://cureus.com/

Thanks Joseph. I am probably the age of your father in most cases. I am going
to talk about the concept in peer review publishing, we believe that the web
can be transformational in the way that medical publishing is traditionally
done.

Medical publishing and peer review can't be emphasized enough. Peer review
defines standard of care, whether a hospital or physician chooses to pursue
things. CMS doesn't pay unless there are references that endorse it. Publishing
is critical for institutions to develop their institutions and their
communities. Publication is at the center of developing therapies and drugs.
$2.5T industry at the center of that healthcare industry is all peer reviewed
back. One end of the spectrum is the 200 year old New England Journal of
Medicine. To what extent do physicians go to develop their reputation? A
critical component is publishing.

What exists today? The old fashion peer reviewed journal. Papers take at least
a month, or even years. It's very political. I have been part of this process
for my professional career. I understand it. I have done this. It's slow. It's
balkanized. You can't find the contents you want. When I publish in the
neurosurgery journal, it's a conscious decision to not publish it in 10 or 15
other journals on anesthesiology or urology journal, in many ways there are
many adjacent areas of interests and these opthamologists will never see what I
publish, the system keeps growing in content and the financial scheme is
retarded. Nobody will see it.

When I work in an operating room, I get paid $1k/hour. But the work here,
nothing. In the end, I have to pay when I have color prints of my articles. I
have to pay when I want copies to give to patients. While there is an online
kind of access, open access movement, it really hasn't harped on the world of
medicine today. The culture is just so unique. Right here is an example in this
past week, the paper was rejected by several of the best journals in the world.
Why? Because, I don't know why. Nobody knows why. Someone wasn't happy. In the
end, this is an important paper that for the first time describes a new method
to treatment.

The existing world is fragmented, access is difficult to have. A week ago, at
Stanford, with this great library network that pays $3-4M a year to give you
access to the journals, looked up a paper in the Journal of Clinical ONtology,
a journal that I gave multiple papers to in the past, but I hit a paywall. I
came from Stanford but didn't mean squat. I paid $15-$20 to get that. Most
papers are locked up behind paywalls despite that I want access or my patients
more and more want access. Their life is on the line. Many patients want to
know the leading research. Some of the patients are interested, they are making
high-value decisions, they get a $100k operation at UCSF, do they get an
outpatient procedure at El Camino? These are $10k decisions. That's a lot of
money.

In the end, it's a very unsocial thing. Every paper has as social network who
cares about it, but it's almost anonymous and you're just a cog working in a
cubicle.

So, the current system is broken. It's too costly, too inaccessible, and it's
filled with discredited systems for defining and finding quality. John and I
found that the literature pointed out how papers had been retracted for fraud,
10 years from now, still are in the scientific literature because they were
published in Nature or Science. It's a BS system. How do you change it?

I think there are really good ideas for changing the world of basic science. We
are moving in a kind of related waters. In parallel, medicine is very unique.
Our solution, most everyone in this room believes that publishing needs to be
faster. We need to remove the political biases, like that paper on addiction I
mentioned that took 2 years to get published. We all believe in Creative
Commons and that atuhors should retain copyright. We all believe that. In
high-value procedure-based medicine should be made. We're in that position.

Physicians love to be scored. We are judged our entire lives. Part of this is
that we part tests all the time. We came p with a proprietary high-value
crowdsourcing tool called SBIQ impact quotient. Who is evaluating a paper? Not
just the number of people, it's not like/dislikes or thumbs up, it's about who
likes it or who doesn't like it. That tells a lot about whether you an expert
or not. The world doesn't need 5000 journals, it needs one comprehensive
ournal. It needs a global one. Enterprise. for which there aren o barriers
between content between specialties. SO much of the content that I want is not
in my usual literature.

We are trying to fosture the notion that journals have served as reptuation
engines for physicians and reeviewers. We can make the system fun. Make it fun.
When you start publishing the papers in medical school or esidency, you enjoy
the process. When you get to my age, you get so fed up with the process that
you want to blow it up. It's about discovery and explanation, it's fun. That's
what physicians went into medicine for.

What are we doing? We're building on My Son's Legacy, that was incubated in my
living room, fueled by coco cola, he owes me. So, I watched this company -
Academia.edu, scripp, researchgate, sermo, doximity. Scribd, mendeley, plosone,
altmetrics, world science. Peer reviewed medicine has incredible work; here
there are a lot of range of scientists, many of these websites you know about -
there are whole new tools that we are developing, as well as these social
connections work well with this. We want to nail nail nail the peer review
concept. THe peer review concept is so critical to traditional medicine.

We're moving forward. In the end it's a blend of the old and the new. We are
about content. There's a social element but it's not the focus. The focus is on
medicine content, medical content, and high-value ... this is a ... in the end,
thisk resovlution will have to be about disinfected insider. I am a disinfected
insider. I want revolution. It's always about the revolution. This is like from
the 60s, so that other old guy in the room gets that.

I welcome you all and your support, let's kick the tires, give us ideas, this
is about democritizing medical publsihing at the world at large.

What do you do abuot drivvel filter? One of the excuses that justifies this
system that exists is that implied quality control. We know it's faulty. But
there's so much noise out there, what are you proposing with your mechanism to
pre-filter drivel from real stuff?

There is a review process. Reviewers cannot kill the paper unless it's
pornographic or fraudulent, or the fact that the reviewer thinks it's medically
dangerous. The editor in chief has the final say. If you want to publish a
stupid clinical report, sure, publish that. It's not that you published it or
not, but what does the community think? The supporters will take that and scoop
it; that will be reflected in the sBIQ scoring process... if the world finds
great value in it, it will rise to the top. The current world is about impact
factor. I was able to fool the Journal of Medicine about that.. and suddenly
now my paper has a high impact factor, it might be fraudulent as many people
has shown. We do believe in this. The real value of the paper will be reflected
by the crowdsourcing concept. It's much more sophisticated than like youtube
practices.

William Gunn: it's great to see this activity in this different sectors. I like
how you are focusing on high-value medical publications. This is high-value,
what is your licensing going to be specifically? The authors get copyright, ...
yes, we are part of Creative Commons movement. He'll come over and steal my
fruit or something. The other question then is if this is open access for
everyone, but, now, what are your plans for long-term preservation?

John: In order to be registered on pubmed, you have to do permanent document
storage. We have to comply with all the pubmed registration requirements.

Thank you sir. Yes I am an old guy, and I am proud of it. The key to a lot of
things on the internet turn out to be, not the application, but using the
feedback mechanism in a good way. Ebay was successful was by feedback. Feedback
is important not only for the researcher or the feedbackers, it's also for ther
eviewers.

John: Absolutely.

The feedback mechanism changes for different evidences. Ebay changed its
feedback mechanism many times. What is your idea is for how to do feedback and
how might it evolve in order to make a stronger case for being able to do very
good, very well qualified and changing feedback for all these reviewers?

I'd do it correct now, but you raise a good point. Intelligent critiques and
ratings and reviewers, we've established a first level of ratings right now,
and over time I hope that the secret sauce that we deliver.. I think our
scholastic impact quotient... what is quality medical science? In the past it
was citation index, and how often it was cited. That's a back-ward looking
metric. Maybe our SIQ can serve this purpose.

Alex H: I just graduated, I'm a basic research guy. It occurs to me that it's
very similar in medical publishing is that when one's whole career is based on
your publication record, you're sort of disincentivized for the drivvel, but,
with a platform for like this where participation is important, there is a
disincentivize or fear of saying something stupid? Do you have a way of
incentivizing, you mentiond gamification to make it fun or engaging, to
incentivize engaging or participation or where being a part of this community
is going to be positive to you in some way, where asking good questions is a
reflection on yuo?

John: To some extent, we already have that, and sometimes your ... depends on
you having a credible CV. We want people to get rewarded for the quality of
reviews that you create. Maybe there is a financial bent to this. My social
bandwidth is running out of this. Brain surgeons are known to be the worst.

Journals also perform an editorial function. Do yo uhave that built in, or do
you have signle editors or what? Second question, journals also provide a
filtering mecahnism, a pick-up nature. If you open it up completely, how do you
let people find interesting things?

We're not going to get a paper that goes into the Journal of Medicine or
Nature. There's a long-tail of 4,000 other journals that we can compete for.
How does the content get there? Well, they submti everywhere else and don't get
in, and then there in the Bulgerian Journal of Cardiology very quickly. I've
spent my life with my ideas, people talk about me now, but for the first 10
years of my career it was every door closed to me. That's just a waste of human
effort. We physicians are busy, we want to be efficient, there's a huge window
of opportunity. We can't dominate the world every night, but right now we can
compete with the vast majority of journals. Every paper has its own set of
reviewers. The editing is self-editing. The review process is the community of
people that share the same keywords as that paper. The cardiology papers will
be reviewed by people interested in cardiology.

So do you think there's an opportunity to provide a mecahnism for peer review
failure, like where to not look for procedures or failures? We support a big
comment section. We are pretty new, we have been in action for only a few
months, but if you go out to the website ad say it's the stupidest idea ever,
or if a patient says that they had this procedure at UCSF and it's a failure,
you're more likely to say that it's something you want to stay away from (I'm
from Stanford, so screw UCSF). The democritization of peer review is good. I
amke references to Wikipedia, but people say Wikipedia is still sometimes not
true, but the cynics still admit great utiltiy to this - you still use
Wikipedia anyway.

How many people are working on your project, and how committed are you to
maintaining transparency to the formula behind SIQ? Not enough people are
working on it. We have about 6 people part of our team. But no, I have no
intention of.. SIQ is our secret sauce. I'm happy to tell people the broad
metrics that we use. The broad metrics are very much about the novelty of
what's being published, the statistics, the standard benchmarks, to distinguish
a quality paper from a bullshit paper. In the end, this can be like a little
like a FICA score. Wait, isn't FICA terrible? wtf john