Peer review: triumphs and tribulations

By Richard McCarty
Executive Director for Science

For more than 50 years, the peer-review system at the National Institutes of Health has ensured that only grant proposals of the highest scientific merit receive funding. The guiding principle is that scientific peers are best equipped to review the grant proposals of their colleagues. Granted, some members of grant review panels bring their own biases to the table when reviewing a given proposal, and most would hate to receive negative reviews. Yet the underlying motivation of all grant review panels is to screen for scientific excellence, and this clarity of focus helps the system enjoy widespread support within the scientific community.

Consumer advocates and peer review

Recently, the National Institute of Mental Health (NIMH) announced plans to add consumers to its two internal study sections that review clinical and services research grants. Each grant reviewed by these two study sections would have a secondary consumer reviewer and all consumers would be full voting members. NIMH has suggested that consumers members will improve the quality of peer review of these grants by adding a voice for patients and their families and filling in the cracks created by reviews conducted exclusively by scientists. Indeed, some mental illness advocacy groups, including the National Alliance for the Mentally Ill (NAMI), have been pushing for years to break into the peer-review process as a means of influencing funding priorities. However, a major concern of mine is that patient advocacy and scientific excellence may turn out to be incompatible forces.

Lest it seem that I am overreacting to expanded membership on two study sections, consider this: NIMH would not be the first institute to add consumer members to review groups, and several others are considering it. One institute director told me recently, "This is a train that's running NIH-wide."

Consumers and scientists: partners with different roles

If we leave peer review to scientists, does that mean consumers have no voice? In fact, consumers participate at multiple levels to influence the development of research proposals and priority setting at federal funding agencies, including the various NIH institutes. Institutional review boards at colleges and universities are required to include non-scientist members. These boards provide vital input regarding subject recruitment, informed consent, debriefing and participant risks. Many investigators work closely with focus groups and community organizations to ensure that their questionnaires, participant recruitment procedures and interventions will be sensitive to the needs of those they seek to serve. Finally, each NIH institute includes public members on its advisory council. This provides consumers with a powerful voice in research priority setting for the institute and ultimate decisions on which grants are funded. All members of advisory councils have opportunities at each meeting to discuss concerns with the institute director and senior staff. These forms of consumer participation provide guideposts for investigators to develop successful and relevant grant proposals, and for institute directors to be responsive to the needs of the nation. Consumer input could be productively strengthened in multiple places outside of the peer-review process. Is it necessary to add consumer members to study sections in order to assure that the needs and concerns of patient populations are represented?

I was among those invited to address this question at the Feb. 5 meeting of the National Advisory Mental Health Council. Following consultation with leading scientists in APA and my colleagues in other directorates, I took the position that, as important as consumer input is throughout the scientific process, it is also important that the mission of peer review remain a focused, impartial review of scientific merit. I felt strongly that APA scientists would expect those of us representing their long-term interests to do our best to maintain high scientific standards for the peer review of clinical and treatment research, and to minimize the possibility that peer review could be politicized.

My position did not prevail and I didn't really expect that it would. Many feel strongly that adding consumers to study sections is a necessary and positive step and that the grant-review process will be enhanced. I truly hope that turns out to be the case and I don't mind being proved wrong. But if, as I fear could happen without careful oversight, merit review of grant proposals assigned to those study sections becomes compromised in any way, the consumers ultimately served by research advances will suffer the most. Watch your study sections for similar developments in the future. I'll keep you informed of these changes in the coming months.



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