In Hard Times, NIH Reviews Peer Review

When he was president of Princeton University, Woodrow Wilson concluded that it was easier to move a cemetery than it was to change a college curriculum. The same might be applied to the peer review system of the National Institutes of Health (NIH), which is undergoing a gargantuan review involving a cast of thousands, with the aim of doing better at distributing NIH’s many, but always insufficient, billions of dollars.

The introspection comes at a time when NIH’s purchasing power has stagnated for four successive years, approval rates for grants are in a slump, and young investigators are especially aggrieved by the paucity of their budget share under reigning peer review methods. Meanwhile, senior researchers are wary of changes that might affect their fortunes, and, in increasing numbers, are declining service on peer review panels, complaining that the funds available for promising research are far too inadequate to make the task meaningful. Peer reviewing NIH style is a heavy duty activity, requiring attendance at three two-day meetings annually in Bethesda, MD, on top of home-based assessment of piles of grant applications. Electronic submission and discussion of applications has made slow headway at NIH.

The review of the review system, which got under way last June after lengthy planning, is designed to recognize the givers and receivers of NIH’s largess, the so-called stakeholders, with separate working groups drawn from inside and outside NIH. Regional meetings have been held, and an open solicitation for information and opinions has drawn thousands of responses.

Given the variety of interests and the elephantine nature of the NIH bureaucracy, radical change appears unlikely. Behind the whole enterprise is NIH Director Elias Zerhouni, who, in a recent conversation with the Chronicle of Higher Education, brushed aside the suggestion that peer review should rely on past performance – essentially a star system, rather than a case-by-case approach. “Peer review is the cornerstone of our system and is mandated by Congressional statute, and we support its preservation fully,” he declared, adding, “Nonetheless, it is fair to ask ourselves at regular intervals how it is performing given changes in science…. My stated goal is that peer review should fund the best science by the best scientists at a minimum bureaucratic burden.”

The first and so far only indication of where the review is headed came in December when the outside Working Group on Peer Review publicly discussed its deliberations at a meeting of its parent body, the Advisory Committee to the Director of NIH. Ideas – they might be considered trial balloons – included requiring service on peer review panels as a condition for receiving NIH support, a kind of conscription to bring in the senior scientists who shun the job. Reducing the maximum page allowance for grant applications, from the current 25 down to 7, was discussed. Also mentioned was adoption of the method that scientific journals employ for reviewing manuscripts – i.e., sending them out for review by recognized specialists. Still to be heard from is the inside group, the Steering Committee Working Group on Peer Review. Reports by the two groups are scheduled for delivery to Zerhouni this month [February 2008].

The peer review exercise is taking place while the political clock is running out on the Bush administration, raising the question of whether Zerhouni will stay on as NIH director in the next presidency. The NIH director is a presidential appointee, subject to Senate confirmation, without a fixed term. When Bill Clinton took office in 1993, he followed the custom of requesting resignations from all presidential appointees. The then-NIH Director, Bernadine Healy, appointed by the first President Bush, made it plain that she wanted to remain at the helm of NIH and declined to resign. The White House insisted, however, and on June 30, she left. The preferences of Zerhouni and the next president, whoever he/she may be, are unknown.

But any serious changes in NIH peer review practices are likely to be put on hold until the new administration settles in and the directorship is determined.