''Whether for lack of time, expectation of greater funding, more ability to control variables or other reasons, the physician-investigator has turned away from involvement in human research. Obtaining funding for human studies is considered so difficult that many investigators are discouraged and in some instances, bitter."4

"Concerns of insufficient access to research support have been voiced by a variety of individual surgical investigators. Frustrated by a perceived inability to successfully compete for NCI grant support, some surgical oncologists have criticized aspects of the current NCI peer-review mechanisms for awarding grants."5

"It is essential to understand that in 1988 it is effectively impossible for an individual investigator to obtain NIH funding for human investigation."6

"If I leave here (Intramural Program) I will leave research" [because its impossible to get a grant for clinical research].7

"Friedman told the board that clinical investigators do complain that is very difficult to get RO1 grants: 'The perception is that they receive poorer priority scores and inferior funding', he remarked. 'If one looks at...comparisons by program...it's evident, that year by year, there are inferior funding rates for the clinical proposals compared to the preclinical proposals' Friedman stated. 'This does not indicate whether the proposals are good or not'; 'I would argue that some of them are [good]. What we need is [the submission of] more good clinical proposals.'"8

The evidence to support these concerns is mixed. Different studies, using different data bases and or time periods, have produced different results. A study conducted at NIH in the early 1980s showed that between 1976–1981 only 63 percent of clinical applications were approved compared with 74 percent of basic science applications. The study also found that approved clinical applications received poorer priority scores than did those dealing with basic research.9 M.D. applicants in 1985 had a higher disapproval rate (9.1 percent) than Ph.D. applicants (6.8 percent). During the decade 1975–1985, Ph.D.s had consistently slightly better priority scores than M.D.s on competing RO1 applications. 10 Recent NIH data, however, indicate that between 1987 and



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