The other source of government funding for medical research that needs reform

Funding should be allocated through formal priority setting and rigorous peer review rather than by gifting by politicians

The National Health and Medical Research Council (NHMRC) is the major funder of medical research in Australia. Although there has been a greater than four-fold increase in funds available to the NHMRC since 2000–01, this has not kept pace with the increase in number of applications, so success rates have plummeted.1 Less than 15% of project grant applications are now successful, compared with over 40% in the 1980s. The low success rates have led to frustration within the research community due to the amount of time spent writing and reviewing applications, and the discouragement experienced by early career researchers in pursuing a research career. In response, the NHMRC has recently reformed its grant program to simplify the number of grant types and the burden on applicants and reviewers, but it continues to support peer review by independent experts as the basis for allocating funding, ensuring excellence, transparency, probity and fairness.2

The other government medical funding source

In parallel with the peer-reviewed NHMRC system, Australia has also developed an informal government medical funding system through discretionary grants by government ministers for health. These grants are announced regularly at Budget time and are foreshadowed in election promises. Sometimes they are administered through the NHMRC and undergo rigorous peer review, as exemplified by the $200 millions of targeted funding to boost dementia research that began in 2014–15. However, other grants are given to named organisations directly, bypassing the NHMRC and the peer review process. Examination of Australian Government Budgets over the past 5 years shows gifted funding in a variety of areas, including mental health, several types of cancer, and infectious diseases.3 In some cases, these grants have been labelled to imply that they are to support a “centre of excellence”, without any peer review to determine that the research is in fact excellent.

The problem with gifted funding

Despite the burden on researchers, peer review plays an important role in maintaining the quality of research. A recent study of the peer-review system of the National Institutes of Health in the United States, for example, found that higher-rated grants have better research outcomes as seen in the number of publications and citations, high-impact publications and patents.4 Even where a grant is not awarded, the comments of peer reviewers allow researchers to improve their methodology for future applications. Gifted funding thus undermines quality in research by bypassing peer review.

Even when the usual scientific peer review is bypassed, the Australian Government has rules and guidelines on grants which are designed to support a number of key principles of grants administration, including “an outcomes orientation, achieving value with relevant money, governance and accountability, and probity and transparency”.5 The rules and guidelines state that: “Competitive, merit-based processes should be used to allocate grants based upon clearly defined criteria”. However, they allow ministers to bypass these processes and to give one-off grants on an ad hoc basis. Gifted funding undermines many of the principles of grant allocation, including value for money, probity and transparency. In addition, it also runs the risk of bypassing ethics review, in contrast to funding through the NHMRC which requires approval by a relevant institutional ethics committee.

The danger of gifting by the Medical Research Future Fund

While the proportion of research funds distributed through gifting is currently small, there is a danger that this will increase substantially in coming years as the Medical Research Future Fund becomes an increasingly important source of research funding.6 When the legislation for the Medical Research Future Fund was going through Parliament, concerns were raised by the opposition that “these bills allow for the minister of the day to make decisions that are not subject to the same sort of peer review that is followed by the NHMRC” and that “the government can for all intents and purposes direct credits from the [Medical Research Future Fund] to any pet projects it wants”.7

Gifting and priority setting

An argument that could be made in favour of gifting is that it allows our political leaders to listen to the community’s opinions about research priorities and to take these into account when deciding budgets in a way that is not possible with a competitive peer-review scheme that reflects researchers’ priorities. However, while stakeholder input into priority setting is undoubtedly important, politicians may not be the best people to assess this. Not only do they lack expertise on what research is being done and where the gaps are, but also the capacity to synthesise the broad range of stakeholder opinion. A better approach is to use formal methods of assessing research priorities which are based on input from a range of stakeholders (including service providers and consumers) and make the process fair and transparent.8,9

What needs to be done

It is tempting for researchers who are frustrated by low success rates to seek gifted funds by lobbying Members of Parliament and government ministers. However, this is an approach where the interests of a research team are at odds with scientific quality and administrative best practice. Medical researchers should continue to lobby for greater investment in research, but recognise that this is best served by allocating research funds through formal priority setting and rigorous peer review rather than by gifting.

Our political leaders need to recognise that they and their support staff lack the expertise to evaluate what are the priorities for research, what is the best science and what is best value for money. While decisions need to be made about funding priorities, this should not involve politicians picking the recipients of funding. Rules and guidelines on government grant funding need to be reformed to encourage better practice in this area, and the existing peer-review expertise within the NHMRC and other competitive funding bodies needs to be drawn on. In relation to the Medical Research Future Fund, we need a political commitment to the principles of competition and peer review if we are to achieve the best outcomes for the nation from this important source of new funding.