generally [are] not helpful," wrote one respondent. This sentiment was echoed by others: "The peer review process is increasingly idiosyncratic, with the review being conducted by junior investigators who have little experience in research," and "No real helpful input as to how to make the proposal fundable, and a very impersonal experience. No direct communication or discussion." Another respondent described proposal review as a "triage process" whereby staff make decisions regarding whether proposals fit RFAs, thereby limiting the number of proposals that advance.

Many others, however, offered praise for the peer-review process. "Excellent program directors," wrote one respondent, who continued: "Weakness of numerous staff changes over [the past] six years but quality of support is excellent." "Comments were helpful," wrote another and the, "Executive Secretary was helpful."

Significantly, several respondents pointed to aspects of peer review and the priority-setting process that are particularly problematic for minority researchers or those studying issues relevant to minority and medically underserved populations. Among the comments that reflected this point: "I believe in the peer review process for the most part. In times of budget constraints, funding decisions are sometimes skewed toward the more established scientists. This is not good for budding investigators." "[The] process [is] not supportive of community-based and community-driven research." "Big drawback [of the peer review process] is focus on researchers who have already done this—NIH reinforces success, [making it] very hard to get started." "Program staff and contracting staff were helpful…. However, few at the top understand the need to fund research adequately or address the resource issues that (minority) researchers face in conducting cancer research in minority and medically underserved communities." ''Good in general. Sometimes [there exists] a perception that connections and old school ties are more important than science." Several others felt that it was particularly difficult for investigators at historically black colleges and universities (HBCUs) to successfully compete for funding.

Few respondents reported attempting to provide input into the NIH research priority-setting process, but several commented on the process. Some comments reflected a theme similar to that described above: that minority investigators feel "shut out" of the process. "This is an 'old boys' network [and] it is difficult for a minority woman to…approach," wrote one respondent. "Have more of the review[ers] coming from HBCUs and breaking 'good-old-boy networks' among large white institutions," wrote another. Still others advocated that the level of representation of researchers from minority and medically underserved communities on NIH advisory and policy boards should be increased. "Appoint more minority investigators and administrators to key advisory committees and review

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