Digitized case studies
The Cureus Journal of Medical Science, modeled on TurboTax, is the first and only peer-reviewed publication that offers authors step-by-step article templates. Its design is intended to speed up publication times dramatically, and to thereby build the most comprehensive library of medical case studies in the world.
This journal highlights an ongoing conflict between medical research and the practice of medicine. The former relies upon long-term trials, large cohorts, and well-funded research to ensure that the majority of treatments will be successful for the majority of patients. In contrast, practical medicine is focused on individual outcomes. Case reports — the detailed descriptions of each patient’s symptoms, diagnosis, and outcome — are therefore the focal point for practitioners, but little more than outliers for researchers. So what place should case reports occupy in the medical literature?
Practicing physicians value case reports for their educational properties and, often, their ability to influence practical outcomes. Furthermore, although an individual outcome in a case might seem like an outlier while actually being part of a pattern — one that is never recognized if no one records it. Now, however, the digitization of peer-reviewed publishing means that case reports can in fact be published and searchable.
Global digital medical community
Most journals that publish case reports are open-access, and charge authors publishing fees. These are typically a few thousand dollars, and are supposed to cover overhead for the publications such as editors' salaries. However, according to Wayne State University Biomedical Research Specialist Katherine Akers, who is also editor-in-chief of the Journal of the Medical Library Association, journals engaging in predatory practices such as extracting large fees and failing to review work are commonplace — amounting to around half of all medical case report journal publishers. Akers notes that Cureus looks safe, except for one red flag: review times.
The article review process for most reputable biomedical journals takes about three hours. However, Cureus says that its easy-to-use form ensures that reviews take no more than an hour. “That’s really fast,” Akers told WIRED. “Usually that’s a warning sign that these articles aren’t being looked at that rigorously.”
However, Cureus argues that the review process for case studies is — and should be — somewhat different than it is for standard medical research, which means it's okay if it takes less time. The review for case studies focuses only on the report's basic scientific credibility, rather than things like reproducible results. After all, many cases are admittedly one-offs; that's the nature of case studies.
“[T]hese rare one-offs could become really interesting if they were all reported, instead of just passed around by word of mouth,” Stanford University Medical Center chief of pediatric neurosurgery Gerald Grant told WIRED. “I don’t think it dilutes the literature at all.”
Cureus creator and neurosurgeon John Adler is relying on the law of averages to resolve this problem. He aims to publish tens of millions of articles annually through the platform, and has developed the rating and comments features to see that the larger community of clinicians will ensure better data for all. In that sense he is hoping to crowd-source both practical solutions physicians can use, and a system for quality control. If he succeeds, Cureus could become a major prediction engine for practicing doctors, offering them billions of medical lessons to share and learn from.
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