Tucked in among the multipage, multicolored ads touting medications for baldness, hypertension, and assorted infections in the New England Journal of Medicine on November 17, 1988, was a one-column notice in plain, black and white describing an innovative research grant program. The ad, placed by the Cystic Fibrosis Foundation (CFF) of Bethesda, Md., called for proposals from investigators whose grant applications to the National Institutes of Health had received the NIH’s dreaded verdict of approved—but with anonfundable priority. According to the journal ad, if the “good-but-not-quite-good-enough” proposal pertained to cystic fibrosis, CFF might be willing to fund it. As far as CFF is aware, it is the first foundation to try this approach in a formal, systematic way.

The experiment comes not a minute too soon for some researchers in the biomedical community. In recent years, NIH has been able to fund fewer and fewer of the applications it approves...

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