John Adler

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 -, 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