The National Institutes of Health (NIH) peer review system has been viewed as the best way to guarantee the scientific independence of biomedical research in the United States, and it has been emulated internationally. The system, however, is subject to a variety of stresses, and these have always been exacerbated at times of flat NIH funding, as in the past five years. To address several of these stresses, NIH first conducted a "diagnostic self-study" of the peer review system and then implemented a number of changes. Costello, in a Perspective in this issue of Academic Medicine, argues that two of these changes, special consideration for new investigators and emphasis of the criterion of "innovation," undermine the stated goal of funding the "best science by the best scientists." In this commentary on Costellos Perspective article, the author examines the issue of NIH funding of new investigators from a historical perspective, in the context of overall NIH priority setting in resource allocation. The related issue of innovation as a criterion in NIH peer review is also addressed, and the commentary concludes with an affirmation of the need to measure outcomes in assessing the impact of changes in the NIH peer review system.
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