The new U.S. president’s administration has promised sweeping governmental reforms, with health-related agencies at the forefront. One area that may impact the content of this journal are changes to health services research funding enterprises, including the National Institutes of Health, the Agency for Healthcare Research and Quality, the Centers for Disease Control and Prevention, and others.
A recent report highlighted concerns about potential biases, sparking widespread debate about the fairness and transparency of the NIH’s grant review process. Criticism has focused on the systemic favoring of well-known researchers and prestigious institutions, as well as the potential stifling of innovation in favor of safer, more established research paths. These revelations underscore the urgent need for reform to ensure that funding decisions are based solely on the merit of proposed science rather than the reputation of its proponents.
The federal research funding system, a cornerstone of scientific advancement, has long relied on peer review to allocate resources. While this approach has ensured that experts evaluate proposals, its susceptibility to bias demands urgent reform. I argue for the adoption of a double-blind, two-phase review process to mitigate biases stemming from investigator and institutional prestige preferences, ensuring a more equitable and merit-focused allocation of federal research funding.
Biases in the Current System
The peer review process, as currently structured, inadvertently perpetuates inequities. Studies reveal that proposals from prestigious institutions and well-known researchers are often favored, regardless of the intrinsic quality of the science presented. Any form of systemic bias undermines the principle of meritocracy and discourages participation from less-established investigators and institutions. Moreover, the tendency to prioritize safe, incremental science over innovative, high-risk ideas is another consequence of entrenched biases. Such conservatism stifles creativity and limits the potential for groundbreaking discoveries. In an era where diversity of thought is paramount, these shortcomings hinder the progress of science.
Economic and Time Inefficiencies
The current system imposes significant economic and time burdens on both applicants and reviewers. Researchers spend an inordinate amount of time crafting proposals, often tailoring them to perceived reviewer preferences rather than scientific priorities. Reviewers, in turn, are tasked with evaluating extensive documentation, leading to superficial assessments in some cases. This inefficiency exacerbates the challenge of distinguishing between good and excellent proposals, particularly in highly competitive funding environments.
A Two-Phase, Double-Blind Solution
To address these issues, I propose a two-phase, double-blind review system that separates the evaluation of scientific merit from the review of investigator and institutional qualifications. The double-blind review process is similar to the one used by most scientific journals when reviewing research that comes from grant programs. Furthermore, it would be a relatively minor shift in process with potentially large impacts on biases.
Phase 1: Blind Review of Scientific Merit
In the first phase, reviewers would evaluate proposals without access to information about the investigators or their institutions. Phase 1 would focus exclusively on the specific aims, hypothesis, methodology and potential impact of the research. Anonymizing proposals in this manner would level the playing field, allowing ideas to stand on their own merit.
Phase 2: Investigator and Institutional Assessment
In the second phase, a smaller pool of short-listed proposals would be reviewed for the qualifications of the research team and the institutional capacity to execute the project. This step would ensure that the necessary expertise and resources are in place to achieve the proposed objectives, while preserving the integrity of the initial merit-based evaluation.
Benefits of Reform
A double-blind phased approach offers several advantages:
- Reduction of bias. By anonymizing proposals during the scientific review phase, this system minimizes the influence of institutional prestige and investigator reputation.
- Promotion of innovation. Neutral evaluations encourage the funding of bold, unconventional ideas that might otherwise be overshadowed by safer proposals.
- Enhanced diversity. Early-career researchers and smaller institutions gain a fairer opportunity to compete, fostering a more inclusive research ecosystem.
- Optimized resource allocation. Focusing reviewer efforts on de-identified scientific merit improves the accuracy and efficiency of funding decisions.
Addressing Implementation Challenges
While the proposed system introduces complexities, these challenges are surmountable. Anonymizing applications requires robust technological solutions, and reviewers must be trained to effectively assess de-identified proposals. Additionally, transparent communication about the two-phase process is critical to maintain trust among stakeholders. Concerns about accountability can be addressed by ensuring that Phase 2 evaluations are rigorous and transparent. Furthermore, incorporating feedback mechanisms for applicants and reviewers can enhance the overall fairness and credibility of the process.
Federal research funding agencies have a responsibility to ensure that their review processes are fair, efficient and conducive to scientific advancement. Adopting a double-blind, two-phase review process represents a pivotal step toward eliminating systemic biases, promoting diversity and fostering innovation. By prioritizing the merit of ideas over the prestige of applicants, we can create a more equitable and effective funding landscape.
The time for reform is now. As stewards of public trust and resources, funding agencies must lead the charge in advancing equity and excellence in research. Implementing a double-blind review process will not only enhance the integrity of grant allocations, but also empower a new generation of researchers to pursue transformative science.
Eric W. Ford, PhD, is editor, Journal of Healthcare Management.
Editor’s Note: This content has been excerpted from “Aligning Federal Grant Review Processes with Academic Standards: A Call for Reform,” Journal of Healthcare Management, vol. 70, no. 1.