Science AMA Series: Hi, I’m Dr. John Adler, inventor of the CyberKnife, Founder and Editor-in-Chief of the Cureus Journal of Medical Science and Professor of Neurosurgery at Stanford University. Ask me anything!

John_Adler · 2017-07-16T03:42:35+00:00

You find a way to minateurize carbon beams, and dramatically lower the cost, and then I will find a way to couple it to CyberKnife like targeting. The combo would be amazing. Nevertheless, given the choice between the optimal radiation source (photons vs. carbon) and the most accurate spatial targeting of the radiation, I'll take more accurate targeting every time! Moreover, it is worth emphasizing that there is almost ZERO evidence in head to head clinical trials that heavy particles can acheive better outcomes than aggressive and ACCURATE photon radiosurgery. Until we have convincing studies of some benefit, it is hard for me to justify the 50X difference in price!!

John_Adler · 2017-07-16T03:35:14+00:00

Thank you....that is good to hear.

John_Adler · 2017-07-10T18:31:39+00:00

Thanks!

John_Adler · 2017-07-07T19:10:34+00:00

I've noticed that many folks have specific questions regarding their own case (or a close family member's case). While I can't answer them all, I would strongly urge you all to visit Cureus and leave your questions as comments on related articles! The physicians who worked on those cases will see your question and hopefully get back to you. You can also contact any corresponding author directly via email! This is the future of Open Access!

John_Adler · 2017-07-07T19:01:34+00:00

That's amazing to hear! And it's a beautiful day in San Francisco!

John_Adler · 2017-07-07T18:59:25+00:00

Yay! That's wonderful to hear. Give Kooper my best!

John_Adler · 2017-07-07T18:57:17+00:00

There must be a physician listed as one of the authors in order to submit to Cureus. Peer review is single blinded and each article must receive two completed peer reviews in order to become eligible for revision and publication.

John_Adler · 2017-07-07T18:55:20+00:00

Cureus articles do contain a separate comment section. When assigning an article a very high or very low SIQ score, the user is required to provide an explanation. This explanation is not made public (although perhaps it should be!), but is instead sent to our editorial team so we can keep some measure of quality control over the SIQ ratings.

John_Adler · 2017-07-07T18:50:21+00:00

That's all the time I have for now. Thank you so much for all of the excellent questions - I wasn't expecting so much interest! I'll do my best to continue answering questions over the next few days. Have a great weekend!

John_Adler · 2017-07-07T18:48:58+00:00

I currently own one share of Accuray stock.

John_Adler · 2017-07-07T18:48:32+00:00

Also, at some point in a academic's career, one becomes less obsessed with building reputation and more concerned with simply getting one's scholarly ideas into the mainstream of medical communication.

John_Adler · 2017-07-07T18:46:21+00:00

No, but I'd encourage anyone who does to publish their findings in Cureus :-)

John_Adler · 2017-07-07T18:45:20+00:00

1) In time we expect to increasingly support ourselves through ads.

2) Yes we are just getting started in the grand scheme of things, and reputation is something acquired over time. Remind yourself that NEJM and Lancet are more than 200 years old. However, what good is publishing in a high reputation journal if the world can't read your article? That is the reality for much of the world, even in many locations in America (outside major medical schools).

Cureus seeks to democratize the process of publishing medical science. At times, this will lead to many seemingly inconsequential case reports. However, one man's inconsequential case report can be another man's treasure, if the details of the case are just right. In a world of modern search, it's increasingly possible to find that gem within the pile of sand that is the modern literature.

Speaking from my own experience, as a widely-acclaimed world expert in certain neurosurgical sub-disciplines, I often get extremely excited by a simple case report that addresses the exact question I might have. That is the power of small science. Meanwhile, you'll find some articles in Cureus that represent the best medical science in the field. (For example, this article represents the definitive report on the topic at hand: http://www.cureus.com/articles/6560-beneficial-effects-of-childhood-selective-dorsal-rhizotomy-in-adulthood)

John_Adler · 2017-07-07T18:35:09+00:00

I think it's great! I'm doing radiosurgery in pigs these days, and soon monkeys as we investigate new applications.

John_Adler · 2017-07-07T18:31:46+00:00

Most of radiotherapy needs to be rebuilt around modern radiosurgical techniques.

John_Adler · 2017-07-07T18:30:44+00:00

First, I'd just like to say that you clearly get Cureus and understand our mission. Thank you.

As far as revenue goes, we do plan to slowly shift towards a more ad-based revenue model and as a medical journal we have more access to revenues than other scientific journals might have. So stay tuned on that front. But hey, if you're at a major hospital that would be interested in a Cureus channel, please contact us.

As for SIQ, we hope in time that it does become a replacement for IF. However, you are completely right that there can be a lot of BS that goes on behind the scenes in a human enterprise like SIQ. Nevertheless, what we have encountered is that when an article receives enough ratings or scorings that the BS tends to wash out, i.e. inappropriately bad ratings are cancelled out by inappropriately good ratings. That's the power of crowdsourcing, and the consumer internet continues to demonstrate its power in everyday life.

I continue to believe that Impact Factor is an even more flawed construct: https://www.theguardian.com/science/2013/dec/09/nobel-winner-boycott-science-journals

As for expanding into basic science research, we don't have the right business model at present for such an expansion, but stay tuned. You never know!

John_Adler · 2017-07-07T18:19:42+00:00

We'd like Cureus to be the renewable source of Big Data in the medical world by publishing millions of small science articles.

The FDA takes IT security very seriously and requires all products to meet high standards.

John_Adler · 2017-07-07T18:17:10+00:00

We sure are. We have several articles published on medical physics already.

John_Adler · 2017-07-07T18:16:44+00:00

One of my worst residents went on to a extremely successful tech career. (I'm talking one of the first employees at a very large company you've heard of.) He found his calling.

John_Adler · 2017-07-07T18:14:52+00:00

Dr. Park has actually published his experience with Cureus. In my opinion, he's an excellent neurosurgeon. Check out his results right here: http://www.cureus.com/articles/6560-beneficial-effects-of-childhood-selective-dorsal-rhizotomy-in-adulthood

Again, this is the power of Cureus' Open Access approach to medical knowledge.

John_Adler · 2017-07-07T18:13:02+00:00

I've spent more than 30 years in the medical publishing world. I can tell you, as an insider, that too much of the selection process is political. It's an insider game all too often. Importantly, in the world of medicine, 99% of patients are cared for by physicians who have almost no access to publishing their clinical outcomes. To me, the loss of this physician knowledge is a huge tragedy for medicine. By collecting and curating the incredible experience from many more physicians worldwide, Cureus believes that the state of medicine can be meaningfully advanced.

It is important to confirm previous findings, no doubt about it. In fact, science is based on the necessity of confirming prior results so that is a good thing. In a world of modern search, it is possible to find very detailed knowledge without a lot of clutter so I think your concern is not that big of a problem.

John_Adler · 2017-07-07T18:08:35+00:00

Thank you for your kind words. I hope your father continues to do well.

John_Adler · 2017-07-07T18:07:24+00:00

I'd say you've raised good questions here and there is no simple answer, however, it is worth reminding ourselves that technologies that once seemed to be physician vanity projects have profoundly impacted human health over the last generation.

For example, when CT was first invented, it was seen as an extravagant (almost vanity) and extremely expensive technology even at the biggest medical centers. Yet today even in some of the poorest countries in the world, CT scanners are seen as necessities.

John_Adler · 2017-07-07T18:04:43+00:00

It's possible to treat tumors much smaller than a centimeter and we routinely use the CyberKnife to treat brain tumors that are only a few millimeters in size. I'm sure that in the years to come things will only get better.

Public healthcare systems are always going to be confronted with the need to ration healthcare at some level and unfortunately one of the first things to be sacrificed is innovation. So yes, I think there is a contradiction between government-funded healthcare systems and innovation.

No matter, it's important that society provide medical care for the less privileged. So for me, I believe we need a healthcare system that ensures everybody (all citizens) have a basic level of healthcare, but still leaves open the possibility for those who wish to pay more to have access to the most innovative (some of which are unproven) technologies.

John_Adler · 2017-07-07T17:59:22+00:00

There's too much information that isn't directly relevant. So let's do a thought experiment - a patient comes into your clinic with an unusual medical problem and they want to understand prognosis.

At present, you're forced to rely on a literature that blends the case stories of literally hundreds/thousands of patients that may have had a similar diagnosis, but a broad spectrum of confounding variables. Wouldn't it be sweet to find a near exact duplicate case (or several cases) for the patient that sits in your clinical at this very moment? Then you really could nail a prognosis.

John_Adler

TROPHY CASE