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Peer reviewers for the National Institutes of Health are faced with the impossible. They are asked to evaluate applications that are too complex and too long in an amount of time that is too short. The process requires them to provide a score with a level of precision that is not defensible, and calls for consensus about topics that usually do not allow for definitive positions. It is not surprising, therefore, that the system does not work well in identifying innovative projects. It does, however, work effectively in funding established investigators proposing reasonable, if obvious, projects.

Most NIH grant applications run 15 to 25 pages and contain highly technical and arcane descriptions of a proposed investigation in small, single-spaced type. A typical reviewer receives five to 10 of these proposals for each of three meetings-per-year. They are expected, in a month's time, to prepare...

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