Support of research to facilitate translation of scientific discoveries
to the prevention and treatment of human disease is a high priority for the
US National Institutes of Health (NIH). Nevertheless, a perception exists
among clinical investigators that the NIH peer review process may discriminate
against clinical research.
To describe recent trends and outcomes of peer review of grant applications
to NIH requesting support for clinical research.
Design and Setting
Peer review outcomes of grant applications submitted to NIH by MDs were
compared with those of non-MDs, and outcomes of applications involving inclusion
of human subjects were compared with those not involving human subjects. Analyses
were carried out using an inclusive definition of clinical research and after
stratifying clinical research into specific categories.
Main Outcome Measures
Median priority scores and funding rates.
Between 1997 and 2002, on average, 25.2% of total grant applications
(ranging from 27 607 to 34 422 per year) were submitted by MDs,
and 27.5% of awards (ranging from 8495 to 10 769 awards per year) were
made to MDs. Median priority scores (239.0 vs 250.0) and funding rates (31.4%
vs 29.1%) reviewed in 2 grant cycles in 2002 were more favorable for MDs than
for non-MDs (P<.001). However, median priority
scores (254.0 vs 244.0) and funding rates (23.9% vs 28.1%) were less favorable
(P<.001) for R01 applications for clinical research
(n = 7227 applications) than for nonclinical research (n = 10 209). This
trend was most convincingly observed for clinical research categorized as
mechanisms of disease (P = .006) or clinical trials
and interventions (P = .001). Similar trends were
observed for grant mechanisms other than R01. Concerns about safety and privacy
of human subjects may have contributed to the less favorable outcomes of clinical
Although physicians compete favorably in the peer review process, review
outcomes are modestly less favorable for grant applications for clinical research
than for laboratory research.