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Health Research Priority Setting: Do Grant Review Processes Reflect Ethical Principles?, Pierson and Millum, 2021

Discussion in 'Other health news and research' started by cassava7, May 4, 2021.

  1. cassava7

    cassava7 Senior Member (Voting Rights)

    Messages:
    985
    https://www.tandfonline.com/doi/abs/10.1080/17441692.2021.1922731

    Most public and non-profit organisations that fund health research provide the majority of their funding in the form of grants. The calls for grant applications are often untargeted, such that a wide variety of applications may compete for the same funding. The grant review process therefore plays a critical role in determining how limited research resources are allocated. Despite this, little attention has been paid to whether grant review criteria align with widely endorsed ethical criteria for allocating health research resources.

    Here, we analyse the criteria and processes that ten of the largest public and non-profit research funders use to choose between competing grant applications. Our data suggest that research funders rarely instruct reviewers to consider disease burden or to prioritise research for sicker or more disadvantaged populations, and typically only include scientists in the review processes. This is liable to undermine efforts to link research funding to health needs.

    Twitter thread

    We look at health research disparities and propose a strategy for better aligning research funding with the global disease burden.

    Most research dollars are spent studying diseases that affect more advantaged populations. An example: research funders spend 10x more per patient with cystic fibrosis than sickle cell disease. Greater research investments lead to better treatments.

    So, research disparities compound health disparities. Our question: people have known about the 10/90 gap—wherein 90% of research dollars are spent on conditions that primarily affect the most advantaged 10% of the global population—for decades, so why hasn't it been solved?

    One decision point is crucial and often overlooked: How do health research funders pick which grants to fund? Most research dollars are allocated in the form of competitive grants, so grant review criteria and processes can affect the overall distribution of research dollars.

    A lot of grants are "untargeted" or "investigator-initiated": there's a pot of money that different kinds of researchers can apply for. If researchers studying different diseases apply to the same grant, choosing to fund one can mean more money is spent researching that disease.

    We analyzed the criteria and processes that ten of the largest government and non-profit funders use to evaluate grant applications. We compared funders’ criteria and processes to widely endorsed principles for research priority setting (e.g., equity). Here’s what we found:

    Many funders do not assess:

    • The magnitude of the health problem a project addresses
    • How medically or socially disadvantaged beneficiaries are
    • Whether the research is a priority for those beneficiaries This may undermine efforts to link research funding to health needs.

    If research funders brought grant review criteria into greater alignment with the global disease burden, it could have positive, far-reaching implications. For example, researchers might direct their research toward more pressing health problems + more disadvantaged populations.

    One way to address health disparities is to address health research disparities. We suggest that revising grant review criteria could help. But questions remain: e.g., should more grants be targeted? Thanks to everyone @NIHBioethics for feedback. Eager to hear others' thoughts!

    ETA: Leah Pierson's biography on Twitter: "MD-PhD student in Global Health & Population @HarvardChanSPH and @HarvardMed | Former fellow @NIHBioethics | she/her"

    https://twitter.com/user/status/1389302384220909571
     
    Last edited: May 4, 2021
    MEMarge, Hutan, Sean and 6 others like this.
  2. Creekside

    Creekside Senior Member (Voting Rights)

    Messages:
    933
    What's the goal of providing funding for medical research? Is it just to boost the public image of the donors or fund allocation organizations? Are unspecified-target donors assuming that their donations will be wisely allocated for maximum reduction of suffering in the world? Are target-specific (ie ME or Alzheimers or whatever) donations being wisely allocated?

    I think it might work better if the donation-handling middlemen presented the research projects in need of funding and let donors choose where their donations go. Of course, that would open up a new set of exploitations and other problems. I can imagine 'researchers' spending most of their funding on big-budget media presentations to get even more funding ... to be spent on media presentations.
     
    Peter Trewhitt likes this.

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