Non-Financial Conflicts of Interest in Academic Grant
Evaluation: A Qualitative Study of Multiple Stakeholders
Hendy Abdoul1,2,3*, Christophe Perrey1,3,4, Florence Tubach2,5, Philippe Amiel4, Isabelle Durand-
Zaleski6, Corinne Alberti1,2,3
1AP-HP, Ho ˆpital Robert Debre ´, Unite ´ d’E´pide ´miologie Clinique, Paris, France, 2Universite ´ Paris Diderot, Sorbonne Paris Cite ´, Unite ´ d’E´pide ´miologie Clinique, Paris, France,
3INSERM, CIE 5, Paris, France, 4Institut de Cance ´rologie Gustave Roussy, Unite ´ de Recherche en Sciences Humaines et Sociales, Villejuif, France, 5AP-HP, Ho ˆpital Bichat-
Claude Bernard, De ´partement d’E´pide ´miologie, Biostatistiques et Recherche Clinique, Paris, France, 6AP-HP, De ´partement de la Recherche Clinique et du De ´veloppement,
Unite ´ de Recherche Clinique en E´conomie de la Sante ´, Paris, France
Background: Peer review is the most widely used method for evaluating grant applications in clinical research. Criticisms of
peer review include lack of equity, suspicion of biases, and conflicts of interest (CoI). CoIs raise questions of fairness,
transparency, and trust in grant allocation. Few observational studies have assessed these issues. We report the results of a
qualitative study on reviewers’ and applicants’ perceptions and experiences of CoIs in reviews of French academic grant
Methodology and Principal Findings: We designed a qualitative study using semi-structured interviews and direct
observation. We asked members of assessment panels, external reviewers, and applicants to participate in semi-structured
interviews. Two independent researchers conducted in-depth reviews and line-by-line coding of all transcribed interviews,
which were also subjected to TropesH software text analysis, to detect and qualify themes associated with CoIs. Most
participants (73/98) spontaneously reported that non-financial CoIs predominated over financial CoIs. Non-financial CoIs
mainly involved rivalry among disciplines, cronyism, and geographic and academic biases. However, none of the
participants challenged the validity of peer review. Reviewers who felt they might be affected by CoIs said they reacted in a
variety of ways: routine refusal to review, routine attempt to conduct an impartial review, or decision on a case-by-case
basis. Multiple means of managing non-financial CoIs were suggested, including increased transparency throughout the
review process, with public disclosure of non-financial CoIs, and careful selection of independent reviewers, including
foreign experts and methodologists.
Conclusions: Our study underscores the importance of considering non-financial CoIs when reviewing research grant
applications, in addition to financial CoIs. Specific measures are needed to prevent a negative impact of non-financial CoIs
on the fairness of resource allocation. Whether and how public disclosure of non-financial CoIs should be accomplished
Citation: Abdoul H, Perrey C, Tubach F, Amiel P, Durand-Zaleski I, et al. (2012) Non-Financial Conflicts of Interest in Academic Grant Evaluation: A Qualitative
Study of Multiple Stakeholders in France. PLoS ONE 7(4): e35247. doi:10.1371/journal.pone.0035247
Editor: Erik von Elm, IUMSP, University Hospital Lausanne, Switzerland
Received October 26, 2011; Accepted March 12, 2012; Published April 9, 2012
Copyright: ? 2012 Abdoul et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Funding: This work was supported by a research grant from the French Ministry of Heath and sponsored by De ´partement a ` la Recherche Clinique et au
De ´veloppement, Assistance Publique-‘‘Ho ˆpitaux de Paris (AOM 08 074). The funders had no role in study design, data collection and analysis, decision to publish,
or preparation of the manuscript.
Competing Interests: The authors have declared that no competing interests exist.
* E-mail: email@example.com
Peer review of grant applications is the most widely used
method for evaluating clinical research and has been used in
industrialized countries to allocate research resources since 1950
. Unlike peer review of manuscripts submitted for publication,
the grant-application peer review process has received little
research attention [2,3]. In a 1998 systematic review, Wessely
 noted that a single abstract on grant-application peer review
was presented at the 1997 International Congress on Peer Review.
Today, the situation has not improved: since 2001, only five
abstracts about grant-application peer review have been reported
at this congress (two in 2001, one in 2005, and two in 2009) .
Grant-application peer review is an important step in clinical
research that is upstream from scientific publication and therefore
influences which data will be added to the fund of scientific
Many charges have been made against peer review of grant
applications [2,6–15]. Applicants have reported that cronyism and
other conflicts of interest (CoIs) bias the peer review process . A
CoI has been defined as ‘‘a set of circumstances that create a risk
that professional judgment or actions regarding a primary interest
will be unduly influenced by a secondary interest’’ . CoIs may
be individual, institutional, financial, academic, or personal .
PLoS ONE | www.plosone.org1 April 2012 | Volume 7 | Issue 4 | e35247
They are important because they can impact the fairness of the
peer-review process. To our knowledge, no empirical study has
specifically investigated CoIs in grant-application peer review,
particularly CoIs of a non-financial nature.
The French Ministry of Health funded a research project to
assess the grant-application review process in France. As part of
this project, we conducted a qualitative study to investigate the
perceptions and experience of the various stakeholders in the
process. Of the topics investigated, CoIs emerged as a significant
concern among internal reviewers, external reviewers, and
The objective of this report is to describe the perceptions and
experience of stakeholders regarding non-financial CoIs poten-
tially affecting the grant-application review process, to describe the
management of these non-financial CoIs, and to suggest possible
Materials and Methods
This qualitative observational study did not involve patients and
written consent was not required. Anonymity and confidentiality
of the interviews were guaranteed to all participants. An
information sheet on the research objectives and confidentiality
of study participation was read to each participant at the
beginning of each interview. The participant was then asked to
give oral consent and to allow audio recording of the interview.
The Institutional Review Board of the Paris North Hospitals, Paris
7 University, AP-HP, approved the study protocol, including the
information sheet and oral consent procedure (Nu IRB00006477).
French Grant Application System
The French Health Ministry grant program for hospital-based
clinical research (Programme Hospitalier de Recherche Clinique, PHRC)
is composed of two parts: a national program and seven regional
programs. Research applications may be submitted to either the
national or the relevant regional program. Both the national and
the regional programs involve a review of the applications by
external French-speaking peer reviewers (from any country) and
by a panel composed of a president and several internal reviewers.
We confined our study to the national and Paris regional pro-
grams. In 2009, the national program allocated about 40 million J
with 392 submissions and 176 funded applications, and the Paris
regional program allocated about 4 million J with 92 submissions
and 24 funded applications.
For the national program, the president of the panel assigns an
internal reviewer to each grant application. Then, each applica-
tion is reviewed and rated by at least two external reviewers
selected by the internal reviewer. Grant applicants do not know
the identities of their internal or external reviewers; each external
reviewer knows the identities of the applicant and internal
reviewer but not of the other external reviewer; only the internal
reviewer knows the identity of all four people involved. The
internal reviewer writes a report on the grant application based
on the assessment of the external reviewers. Then, the president of
the panel and all the internal reviewers meet to discuss all grant
applications. Based on the scientific quality of each project,
funding decisions are made during this meeting.
For the Paris regional program, a board composed of the
president, several internal reviewers, and the regional director of
research assigns two internal and three external reviewers to each
application. Grant applicants do not know who reviews their
applications. In addition, internal reviewers are masked to external
reviewers and each external reviewer is masked to the other
external reviewers and to the internal reviewers. Thus external
reviewers report anonymously to the internal reviewers. The
applications given the highest ratings by the reviewers are then
discussed by a panel composed of all the internal reviewers and the
Selection of Study Participants
In 2009, the national and Paris regional programs had 56
internal reviewers and asked 192 external reviewers to review
applications submitted by 487 applicants. Eligibility criteria for
participation in our study were as follows:.
N For internal reviewers, having been an active member of either
the national or the Paris regional committee in 2008 or 2009;
N For external reviewers, having been asked, and having
accepted or refused, to review at least one grant application
for the national or Paris regional program in 2009 and having
reviewed at least one grant application in the last three years;
N For grant applicants, having submitted at least one grant
application to the national or Paris regional program in 2009.
All eligible internal reviewers were asked to participate, whereas
external reviewers and grant applicants were selected by stratified
randomization in order to obtain a broad spectrum of views.
Stratification criteria were medical specialty and academic ex-
perience (i.e., junior vs. senior university-hospital physician),
geographic location (Paris region versus rest of the country),
type of stakeholder and, for applicants, rejection of a previous
application. Interviews were conducted until the saturation point
was reached, i.e., until additional interviews produced no new
information . In this type of study, the saturation point is
usually reached after about 20 interviews. Here, the saturation
point was reached after 38 interviews of internal reviewers, 27 of
external reviewers, and 33 of applicants.
One of us (CP) attended the 2009 national and Paris regional
committee meetings (a three-day meeting for French National
PHRC and a two-day meeting for Paris Regional PHRC) to
observe the interactions and to make notes about the debates.
No audio recordings were obtained. The notes provided direct
information on the review process, as opposed to the rationalized
reconstruction of events provided by the reviewers in post hoc
Access to Documents
During the observation sessions, we obtained access to the
abstracts of the grant applications that were given to the panel
members and discussed in the meetings. For the Paris regional
program, we also had access to the reports by the external and
We designed semi-structured interviews based on key themes
identified from an analysis of the medical and sociological lit-
erature, French grant-application procedures, and official docu-
ments. The final interview guide included open questions on seven
topics (Table 1). Each eligible participant was asked by email to
participate in a study on the overall PHRC peer-review process.
To minimize selection bias, no additional information about the
study objective was given before enrolment. If the request for
participation received no answer, a reminder was sent every 2
weeks, up to a maximum of three reminders.
Non-Financial Conflicts of Interest in Grants
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Interviews were conducted face-to-face at the participants’
workplace or by telephone (36 [37%] interviews) by two of us (CP,
a science sociologist; and HA, an epidemiologist trained in semi-
structured interviewing by CP). Neutrality of the interviews was
ensured by the fact that neither interviewer was involved in the
grant-application review process. The interviews began after the
panel meetings, in June 2009, and ended in November 2010. They
varied in length from 15 to 90 minutes (median, 31 minutes.
The interviews were audio taped and transcribed verbatim
anonymously by an individual who was not otherwise involved in
the study. Two interviewees refused to be recorded during the
interview, and two recordings were of insufficient quality to allow
transcription. The written notes taken during these four interviews
allowed us to analyze them nevertheless. Biographical information
for each participant was collected at the beginning of each
Analysis of Interviews
The transcribed interviews were analyzed and coded by CP and
HA, who used both case-oriented and variable-oriented methods
. Each interview was parsed by theme, and recurring themes
were identified inferentially. Similarities and differences in
thematic contents yielded variables across the cases. The
interviewers and another author (PA, sociologist) discussed the
development of the themes and variables and validated the
process. In addition, cross-validation of the thematic analysis was
undertaken at the same time by HA and CP using the text analysis
software TropesH . The results of the analyses were compared
and discussed with all the authors. Patterns in, and differences
between, interviews were identified. Three topics about CoIs
potentially affecting grant-application peer review were defined:
perception of CoIs, experience with CoIs, and management of
CoIs. The quotes given in this paper were selected by the authors
to represent the range of responses. The results are reported
according to the RATS qualitative research review guidelines
Characteristics of Participants
Of the 205 individuals who were asked to participate, 79 did
not reply, 8 refused (usually because of lack of time), 1 was
unavailable for participation, and 117 were included. Of those, 98
were interviewed, including 38 internal reviewers, 27 external
reviewers, and 33 grant applicants; none declined participation
after receiving oral information on the study. The remaining 19
individuals (2 internal reviewers, 9 external reviewers, and 8
applicants) either canceled or failed to attend the interview
appointment. Table 2 shows the participant characteristics. Most
participants were male (71%) and worked in the Paris region
(66%). Among the 107 non-participants, 7 were internal reviewers,
56 external reviewers, and 44 grant applicants. About half of the
non-participants came from the Paris region (52%) and 79 (74%)
were. Of the 34 applicants who refused to participate, 26 (77%)
had submitted PHRC grant applications that were rejected in
Perception of Conflicts of Interest that Might Affect
Grant-application Peer Review
During the interviews, most participants (79/98) spontaneously
voiced concerns about non-financial CoIs and listed them ahead
of all other biases such as those related to scoring, expertise, or
notoriety. Industrial or financial CoIs were rarely mentioned by
participants and were often viewed as minor or nonexistent in the
PHRC review process: ‘‘Normally, [industrial conflicts of interest]
shouldn’t arise in the kind of proposals submitted to the national or regional
PHRCs’’ (External Reviewer 8 [see Table S1 for external
reviewers’ characteristics]). In addition to financial CoIs, four
types of non-financial CoIs were identified (Table 3).
(1) Disciplinary conflicts (i.e., competition among specialties or
schools of thought) were unanimously listed as the most
frequently occurring CoIs, ahead of personal or institutional
rivalries, political considerations, and cronyism: ‘‘Conflicts of
interest are often disciplinary conflicts. […] That is, each specialty
defends itself against other specialties’’ (Internal Reviewer 16). The
existence of disciplinary CoIs was reported more often by
internal reviewers with the national PHRC than by those with
the Paris PHRC. ‘‘I noticed that there were some disciplines that
supported [their own discipline] a lot. (.) So there were disciplines that
strongly supported their topics, [and for example], according to [the
president of the board], neurologists have given considerable support to
their specialty. (.) So this may seem unfair’’ (Internal reviewer 26
[see Table S2 for internal reviewers’ characteristics]).
During the national PHRC meeting, CP noted a strong
reaction of the group against some of the internal reviewers
who defended their disciplines too strenuously. The president
pointed out to an internal reviewer that not all the projects
he/she had reviewed could be perfect.
(2) Rivalry or cronyism was mentioned by both the applicants
and the reviewers. ‘‘I don’t know whether everyone admits this to you
Table 1. Topics covered in the interviews.
Career and motivation for being involved in the peer review process
Employment status, past and current
History of applicant/internal or external reviewer
Reasons for being an applicant/internal or external reviewer
Experience in PHRCs and other French institutions as applicant or as internal or
Experience in other grant applications as applicant or as internal or external
Management of peer review (for reviewers and internal reviewers)
Methodology and conception of peer review
Problems of reviewing and perception of biases
Perception of biases in the grant-application peer review process
Strengths and weaknesses of the grant-application peer review
Strengths of the PHRC review process and of grant-application review in
Weaknesses of the PHRC review process and of grant-application review in
general and specific question regarding conflicts of interests or other peer
review weaknesses (perception and experience)
Improvement of the process
Suggestions for improvement
Specific questions about blinded peer review, compensation of reviewers,
selection of peer reviewers
Experience with grant applications (for applicants)
Experience with personal applications: failures and successes
Experience with other grant applications
Non-Financial Conflicts of Interest in Grants
PLoS ONE | www.plosone.org3April 2012 | Volume 7 | Issue 4 | e35247
in the same way, but we are all the same, we are much more lenient, well,
we are lenient with the people we know’’ (External Reviewer 10).
(3) Geographic and (4) academic CoIs were particularly likely to
occur in competitions among universities or between the Paris
region and the rest of France and were less often mentioned
by the participants. ‘‘I am concerned when I see that one-quarter of the
country [is represented in the reviewing process] with no counteracting
factors, because sometimes you can see, I don’t know, between Marseille
and Lyon or wherever, there can be petty rivalries, unfortunately, it
happens’’ (Applicant 21 [see Table S3 for applicants’
characteristics]). ‘‘It’s a tremendous problem […] I would say the
Paris teaching hospitals are hugely overrepresented [in the national
PHRC]. they handle all the funds, for patient care, for research, for
teaching, and they have far more professors than the rest of France. which
gives them greater operational capacity with respect to their proposals.’’
Experience with Non-financial CoIs
Applicants could not formally prove the existence of non-
financial CoIs in the grant-application peer review process, but
one-third of them (13/38) reported having personal experience
with such CoIs. Their suspicion that non-financial CoIs had
affected the review process originated occasionally in personal
Table 2. Characteristics of participants.
N N (%)
Internal reviewers, n
External reviewers, n
Grant applicants, n
30 – 398 (8)017
40–4938 (39) 18911
Paris area65 (66) 3114 20
Other regions33 (34)713 13
Medicine 37 (38)147 16
Obstetrics and gynecology4 (4)112
Anesthesia 10 (10)235
Job title 98
Senior teaching-hospital physician79 (81) 372319
Junior teaching-hospital physician3 (3)003
Physician not working in a teaching hospital14 (14)149
Experience with grant application review (years) 65
. 519 (29)613-
First grant application submission33
Funding decision in 200933
Non-Financial Conflicts of Interest in Grants
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convictions, interpretations, and hearsay and more often in
discordances between reviewers’ reports. ‘‘So it is a small world, we
know everyone within the disciplines, and it is human, so there are true scientific
reviews, and then politics, conflicts of interest, rivalries. jealousies but like any
review involving scientific experts, I think we cannot avoid that’’ (Applicant
22);‘‘I don’t have any proof of what I say! I don’t know for sure, I am just
guessing’’ (Applicant 28); and ‘‘What is a little weird sometimes too, is the
gap between two reviewers […], here we will never know.’’ (Applicant 19).
Most applicants were fatalistic about this situation and did not
complain despite their suspicions: ‘‘Of course, we always hear about
applicants who may be well-connected. because. you know. because the internal
reviewers, well the external reviewers who. who are chosen know the applicants
or there are conflicts of interest. It is possible, isn’t it? Yes, we hear about that
but. what can we do?’’ (Applicant 10).
Applicant 29 suspected that an idea was stolen from a previous
application he had submitted: ‘‘That can happen, and according to me…
I made a proposal about a gene and … I saw a database [about that gene] two
years later! It could be a coincidence but it is weird! […] They looked for the
gene I had proposed in a cohort of patients. […] Now I don’t know for sure,
but I have my suspicions.’’
Prevention of Non-financial Cois
While non-financial CoIs were considered either unacceptable
or unavoidable by the various stakeholders, opinions about the
feasibility of preventing CoIs were more contrasted. Some inter-
viewees were fatalistic (‘‘It is human […] I think we cannot avoid it’’,
Applicant 22), while others were quite satisfied with the current
peer review system (‘‘I don’t have any criticisms to make about the peer
review process’’, External Reviewer 22). Moreover, no participants
suggested the peer review system should be reconsidered. ‘‘Is there a
better system?’’ (External Reviewer 16) and ‘‘Who else do you want as
reviewers?’’ (External Reviewer 23).
Other participants considered that CoIs were too variable in
nature to be properly managed: ‘‘It is absolutely unfeasible, because there
are fifty different levels of conflicting interests, disciplinary, geographic,
personal, you see what I mean…. All kind of networks, in every way, so we
can’t manage that… and it goes in all directions, you see what I mean… there
are positive conflicts of interests, negative ones […]. For example, something
that happens all the time is that people trash others’ proposals in order to open
the way for theirs, you see?’’ (Internal Reviewer 30).
Interestingly, even when CoIs were suspected, they were not
always perceived as important by the internal reviewers. ‘‘I don’t
think it matters that much. In practice, it may explain 15% of the variance
[…], that’s all’’ (Internal Reviewer 16). Finally, the internal
reviewers felt that, despite rare exceptions, the best applications
were selected: ‘‘So, after that, from a pragmatic viewpoint, when all is said
and done, we have the feeling that the best proposals are funded’’ (Internal
In addition, external reviewers had no knowledge of the
reporting and management of CoIs during the grant-application
review process. More generally, most of them were unaware of
how their reviews were considered in the final assessment: ‘‘We
don’t have the list of the funded proposals and neither do we get feedback about
the reasons for rejections. So, I don’t know in the end, after providing my
expertise, how my review was used in the process.’’ (External Reviewer 16).
Current Regulation Mechanisms
We found that several mechanisms were used to limit CoIs,
although they were not explicitly described in an official policy
statement. Grant applicants could list the names of experts they
did not want as reviewers of their projects. Experts could, but were
not mandated to, refuse to review projects they felt might involve
CoIs. Each grant application was reviewed by three (national
PHRC) or five (Paris regional PHRC) internal and external
reviewers, whose names were masked to the applicants. Moreover,
the panel members were chosen from a variety of geographic areas
and specialties to ensure that the panel represented the diversity
of the grant applications. Grant applications were discussed
Table 3. Non-financial conflicts of interests in grant-application peer review: perception, experience and management.
Non-financial conflicts of interest (CoI) spontaneously reported
Type of non-financial CoI experienced or suspected
Disciplinary4917 17 15
Rivalry or cronyism 287 1011
Experience with non-financial CoIs
Yes (personal or not)60 14 2224
Personal experience39 11 15 13
Prevention of non-financial CoIs
CoIs viewed as unacceptable 12444
CoIs viewed as unavoidable15654
Management of non-financial CoIs by experts and internal reviewers
Always refuses to review954-
Accepts to review while directing special attention to impartiality945-
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collectively during the panel meeting, and panel members were
free to voice their opinions, although the discussions were in-
fluenced by individual factors such as effectiveness in public
speaking, scientific expertise, desire to share personal convictions,
and willingness to risk expressing disagreement. The panel pres-
ident ensured that internal reviewer(s) who were involved with an
application as investigator were not present when the application
was discussed. During the panel meeting, the president played an
important role in identifying and managing CoIs, for example by
ensuring that internal reviewers did not place excessive emphasis
on applications in their own disciplines to the expense of those in
other disciplines: ‘‘These proposals are certainly excellent, but all the same,
we must consider the others…’’ (observed during the national PHRC
committee meeting in March 2009).
Management of Non-financial Conflicts of Interest
Personal experience with non-financial CoIs was reported by 26
reviewers. Based on the interviews of these reviewers, approaches
to CoI management were divided into three evenly represented
First, some reviewers routinely refused to review grant
applications if they felt they might be biased in favor of or against
the applicant: ‘‘I have already refused to review [a proposal] because of
conflicts of interest’’ (External Reviewer 21) and ‘‘Well, I refused when I
received the first letter about [the proposal]… although I was itching to do
it…’’ (External Reviewer 15). This concern about non-financial
CoIs was often based on the existence of personal relationships –
positive or negative – with the applicant: ‘‘It happened to me once, no,
sorry, twice, to send back a proposal because of conflicts of interest. Twice,
because the person who sent me the proposal didn’t realize that I was part of a
team that was involved in the research project.’’ (Internal Reviewer 14).
Second, some reviewers felt that non-financial CoIs were
unavoidable and should be managed by conducting the reviews
in a strictly impartial manner. They only refused to review
applications for which they felt unable to remain impartial: ‘‘I have
already reviewed an application for which I had [a CoI]., and I tried to
separate myself from any influence of that’’ (External Reviewer 12). The
problem is recognizing the non-financial CoI: ‘‘Where does it begin?
Where does it stop?’’ (External Reviewer 11).
The third group of reviewers adopted a case-by-case approach
to decide whether or not to review each application according to
their subjective understanding of potential non-financial CoIs. For
example, two reviewers said that they refused reviews if they were
biased against the applicant or project, but not if their bias was
positive: ‘‘I am not perfectly honest, because I am too positive, but… in any
case, I do not batter a project for reasons that are not purely scientific.’’
(External Reviewer 14).
Suggestions for Improvement
Among the numerous suggestions for improving the peer review
process (Table 4), masking of applicants was listed most often.
‘‘Obviously, if [my name] had been masked… that would have changed
things…’’ (Applicant 16) and ‘‘It [applicant name masking] would result
in the application being evaluated independently from the research group, its
financial resources, whether it received a PHRC grant last year (…) and so the
review would be based only on scientific quality. I think it would be better’’
(Applicant 19). However, some of the reviewers believed this
method would fail in many cases: ‘‘We can guess who it is. We don’t
know for sure, but we guess or we believe we know’’ (External Reviewer
13). In addition, masking may prevent a valid assessment of the
feasibility of the research project: ‘‘I don’t think anonymity matters that
much, but it can be harmful, because in the reviewing process, you must know
the team (…) if it is blinded, I don’t know who will carry out the project (.)
Sometimes a team can write a good proposal but does not have the resources to
carry it out! Knowing the clinical research network helps me to say ‘if it is this
team or that team, OK, I know it can work’. But if it is blinded, you cannot do
that.’’ (External Reviewer 8).
Regarding the overall reviewer selection process, many
interviewees voiced major concerns about reviewer selection,
especially for specific specialties or research topics: ‘‘Genuine conflicts
of interests result from the choice of reviewers who will assess the applications
and on their relationships, if any, with the applicant’’ (External Reviewer
8). Selecting reviewers from other countries was suggested as a
possible solution by some participants: ‘‘We must stop using self-
assessment and confining ourselves to the French community. We must avoid
the consequences of having French people assess French projects. Other
organizations require that the applications be written in English and send them
to international reviewers. The [peer review] process is influenced by
interpersonal factors. We must steer clear of all relationships that can result
in conflicts of interest.’’ (Internal Reviewer 21). For small disciplines at
greater risk for non-financial CoIs, some of the internal reviewers
suggested the selection of non-clinical peer reviewers, such as
methodologists: ‘‘You will have an external reviewer who is not a specialist,
who is not competing with you, and who will give a more objective opinion’’
(Internal Reviewer 7).
Another suggestion was to give the applicants the opportunity to
challenge the report of the reviewers: ‘‘[We should] have a process for
applicants to acknowledge that a reviewer was objective […] or to refuse that a
Table 4. Participants’ suggestions to minimize non-financial conflicts of interests (CoIs).
All participants, n
No improvements are possible7412
Masking applicant’s identity267712
Careful selection of independent reviewers 21669
International reviewers 181053
Possibility for an applicant to challenge a reviewer6402
Open peer review2200
Enhancement of general transparency procedures 17557
Interactions with the grant applicant during the reviewing process 12147
Public disclosure of conflicts of interest6411
Training of peer reviewers1010
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given reviewer assesses their work [as happens with manuscript peer review]’’
Improving transparency was also suggested: ‘‘[The proposal] is
discussed by the committee, [but] we do not have much transparency about the
discussion, the results, how they talk among themselves, and how they rate the
applications …’’ (Applicant 19). ‘‘It is not transparent at all. When
someone submits an application, he or she doesn’t know what will happen! Of
course, some of us (the reviewers) can tell the applicant [what happened],
because we are members of the committee [….] but that is not official policy.’’
(Internal Reviewer 12). Identifying the reviewers might improve
transparency: ‘‘By conviction and for transparency, I believe it would be
better if the reviewers were identified’’ (External Reviewer 12). However,
reviewer anonymity may also have advantages, as explained by the
same external reviewer: ‘‘Well, nevertheless, I would prefer it to remain
blinded because one can express oneself more easily.[…] And if reviewers were
unmasked, well, we might not provide the full extent of our opinions, to keep
from offending or hurting someone’’. Similarly, according to Applicant
15, ‘‘That’s a good question! Would I like to know my reviewers? No, I don’t
think so, it must stay impersonal. No, no, (…) I think it would bring nothing
but trouble, particularly in the medical community, where we all … you
know… perform favors for one another. I would be embarrassed [to know] that
a colleague refused my application.’’
Other suggestions were made, such as interactions between
applicants and reviewers: ‘‘We should consider, I don’t know, a hearing of
the applicant for example, because there can be things that are easier to discuss
or to talk about face-to-face’’ (External Reviewer 12). ‘‘Peer review by
correspondence, or just by talking and asking questions of the applicant who
would reply ‘No, you misunderstood, I said that and not that’, [would allow us
to] make a more objective review’’ (External Reviewer 9).
Disclosure of CoIs, particularly of a non-financial nature, was
mentioned by many interviewees as an important transparency
procedure that did not appear to be part of PHRC policy: ‘‘I think
[disclosure] is left to the morality of reviewers. Well, we chose a system where we
trust one another, but we should be able to be more objective, it would not be
completely crazy’’ (Internal Reviewer 4). ‘‘Conflicts of interest should be
disclosed formally, as for articles in high impact factor journals, where we must
routinely disclose the presence or the absence of conflicts of interest, and it is
Here, it should be done routinely. I don’t think it is done at present… But for the
conflict of interest.’’ (Internal Reviewer 11).
Finally, one reviewer suggested training of peer reviewers in the
identification and management of CoIs and improved uniformity of
the peer review process: ‘‘Maybe we should have training sessions for
reviewers? […] To see what makes a good application. I think it could be really
useful to invite peer reviewers to a few training sessions; thismight be a good idea?
To increase uniformity of reviewers’ work’’ (External Reviewer 1).
Direct observation of panel meetings and interviews with
various stakeholders identified non-financial CoIs as a major
concern of all parties involved in the process of academic grant-
application review. Most of the interviewees spontaneously
reported that non-financial CoIs were a major source of bias in
the review process and had a greater influence than did financial
or industrial CoIs. This high level of concern about non-financial
CoIs was in striking contrast to the absence of a formal procedure
for non-financial CoI disclosure and management. Although the
various stakeholders usually felt that non-financial CoIs were so
protean and ubiquitous as to be unavoidable, they also felt that
peer review was the best possible evaluation method. The ap-
plicants were generally prepared to accept that the review process
was not perfect. Among the suggested methods for CoI man-
agement two may deserve particular attention, namely, the careful
selection of independent reviewers, particularly from other coun-
tries and among methodologists; and increased transparency
throughout the review process, including a requirement to disclose
Strengths and Weaknesses of the Study in Relation to
To our knowledge, this is the first empirical study that used
observational scientific methods to investigate non-financial CoIs
potentially affecting the grant-application review process.
Few previous studies assessed the opinions of the various
stakeholders in the grant-application review process , and the
originality of our study is its qualitative design. We chose this
design to investigate the participants’ attitudes and views without
influencing their answers. Indeed, our objective was not to obtain
quantitative data or a complete catalog of participants’ views but,
instead, to obtain information that might be useful for improving
the grant-application review process. All participants volunteered
for the interview, and selection biases related to CoIs were
prevented by presentation of our study to eligible participants in
general terms that did not mention CoIs or peer review biases.
However, the non-response rate was high, particularly among
external reviewers. Reasons for refusal to participate included lack
of time, lack of interest in the grant-application peer review
process, or discontent about the lack of credit given to reviewers.
Although our objective was not to obtain a representative sample
of participants, we selected the external reviewers and applicants
by stratified randomization in order to obtain a wide range of
perceptions, experiences, and opinions. The reliability of our
results was ensured by triangulation (i.e., observational sessions,
interviews, and text analysis software) and an analysis by two
researchers not involved in grant-application peer review.
Non-financial CoIs are often listed by editors and scientists as
important biases [22–26]. However, to our knowledge, their
presence and nature have rarely been assessed, and most reports
focused on industrial or financial CoIs, particularly in peer review
by journals [27–30]. These disciplinary, academic, or network
CoIs may affect the reproducibility [2,10,31], transparency, and
equity [4,16,32] of fund allocation.
Our study was not designed specifically to explore CoIs but
addressed instead the overall academic grant-application evaluation
process. Nevertheless, as most participants spontaneously men-
tioned CoIs, this point probably had little impact on information
saturation in this qualitative study. Our focus on a single country
may limit the external validity of our findings. It could be argued
that the French system lacks transparency compared to those used
in the UK (Medical Research Council) and US (National Institutes
of Health), which are often used as models for European grant-
awarding processes. This could be due to the fact that until recently
most of the academic research conducted in France relied on
permanent structural funds from the government [33,34], with
academic grants being used to fund supplementary studies.
Impartiality and honesty on the part of the reviewers are crucial
to the academic grant-awarding system used in France. Official
policies include only very few rules intended to minimize the impact
of CoIs. There are no specific requirements about what to do in
the event of non-financial CoIs, and reviewers often decide on their
own whether to report these CoIs. However, the PHRC system that
was the focus of our study may not be representative of the entire
grant-awarding system in France [35,36].
Non-Financial Conflicts of Interest in Grants
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Efforts to minimize the impact of CoIs focus chiefly on
disclosure, as shown in a recent study of several international
grant organizations . Of 27 organizations, 22 required written
CoI disclosure statements for each grant-application reviewer.
However, disclosure statements may also have limitations, as
competing interests may be underreported or misreported [37,38],
particularly those of a non-financial nature. Thus, even in systems
with a policy of CoI disclosure, the integrity of expertise may
depend on the natural probity of the reviewers. In addition,
requiring CoI disclosure may be perceived as challenging the
integrity of peer reviewers, which may decrease their willingness to
Meaning of the Study Results and Implications for
In France, structural public funds available for research have
diminished substantially in recent years, leaving a greater role for
funding via grants. Consequently, specific measures designed to
minimize the impact of non-financial CoIs are required to ensure
trust in the grant-application review process and fairness of grant
allocation [4,16]. Table 5 synthetizes various proposals of im-
provement drawn from the literature and participants’suggestions.
Improving transparency is without doubt crucial. Suggestions to
improve transparency include mandatory CoI disclosure, trans-
parent review policy procedures, and open peer review:
First, mandatory CoI disclosure would considerably improve
the transparency of the review process. CoI disclosure could be
required of all internal and external reviewers and of applicants,
allowing crosschecking of the information. In practice, most CoI
disclosures are related to financial interests, notably with the
industry [16,39]. In our study, financial CoIs rarely exerted a
major influence on academic grant-application reviews. Thus, the
main challenge may be to ensure the disclosure of non-financial
CoIs in addition to financial CoIs. Non-financial CoIs, related to
professional collaborations or interpersonal relationships, are
more difficult to detect and to describe, and their definition
remains debated . They are usually sought via open questions.
Whether all professional collaborations and interpersonal rela-
tionships should be disclosed, and how the truthfulness of such
disclosures could be checked, are important unresolved issues. The
International Committee of Medical Journal Editors (ICMJE) has
issued requirements for disclosing both financial and non-financial
CoIs . Similar requirements might help grant organizations to
detect and manage CoIs. Another matter of debate is whether
disclosure statements should be available to the public and what
the consequences of such availability might be. Public disclosure
of CoI would improve transparency and alleviate applicants’
concerns about the impartiality of the reviews. However, public
disclosure may also affect the privacy of the reviewers, especially
when non-financial CoIs involve personal relationships or families.
Studies should be conducted to evaluate the feasibility and impact
on review-process perceptions of unrestricted vs. restricted access
to standardized CoI disclosure forms  and to assess the level of
satisfaction of all those involved.
Table 5. Synthesis of proposals for managing non-financial conflicts of interests (CoI) in grant-application peer review.
Proposals drawn from study
results and review of the
literaturePros Cons Authors’ comments
Masking of applicant’s identity Requested by the majority of applicants Useless according to some reviewers
May be harmful (because the identity of
the applicant provides information on the
feasibility and chances of success of the
research project) 
May have no impact on the reviews 
Studies of manuscript and grant-
application reviews produced
conflicting data [1,54]. Further studies
are needed to assess this method in
Enhancement of general
Requested by the majority of applicants
Might restore applicants’ trust in grant
May be costly and time consuming Grant institutions should provide more
information about their process (via the
Internet for example
Public disclosure of Conflicts
of Interests (CoI)
Requested by the majority of applicants
May restore applicants’ trust in grant
Difficulty in defining non-financial CoIs 
May affect reviewers’ privacy
Need to develop requirements for
disclosure of non-financial CoIs
Open peer reviewRequested by a few applicants May impact reviewers’ work and
Further studies are needed to assess
this method in grant review
Interactions with the grant
applicant during the reviewing
Requested by some participants Would
allow applicants to challenge the review of
their project Already used in some grant
Could be costly and time consumingNeed to assess the impact and
feasibility of this method in grant
Elimination of grant reviewBibliometrics to evaluate the applicants
ability to successfully conduct useful
Not requested by the reviewers or applicants
Bibliometric methods have several
Other methods such as a lottery or random
selection are criticized by applicants 
Need to assess the impact and the
feasibility of these methods.
Improvement of reviewer
Selection of international reviewers, for
example with no or few CoIs
Difficulty in finding the best reviewer as
‘‘there is no such thing as the perfect
The reviewers felt to be most appropriate
may refuse to review the project
Need to recognize the importance of
Training of reviewersRequested by a few external reviewers May
increase recognition of reviewers’ work
May be costly or time consuming
May have no impact on grant review 
Need to assess the impact and
feasibility of this method in grant
Non-Financial Conflicts of Interest in Grants
PLoS ONE | www.plosone.org8April 2012 | Volume 7 | Issue 4 | e35247
Second, transparency could be improved by giving applicants
free access to reports by external and internal reviewers, as well as
to the panel meeting discussions. Audio recordings or verbatim
transcripts of the meetings may improve the objectivity of the
review process and have been assessed in some grant organiza-
tions, including the NIH . Meeting minutes or recordings may
help to explain discrepancies between the opinions of the experts
and the final funding decision. The recordings or transcripts could
be prepared in a way that does not reveal the reviewers’ identities.
A third means of improving transparency is open peer review,
i.e., the unmasking of reviewers and applicants. This suggestion
has generated considerable controversy [42,43]. Applicants often
feel that open peer review would improve the quality of the review
process and would lead to greater objectivity of the reviews,
whereas reviewers frequently argue that disclosing their identities
would adversely affect the objectivity of their work and the
independence of their reviews. Open peer review of article
manuscripts seems to have no significant impact on peer review
quality or rate of manuscript acceptance but increases refusals of
potential reviewers to review manuscripts [44–46]. Studies should
evaluate the impact of open peer review on the grant-application
Fourthly, assignment of applications to reviewers also deserves
attention as a means of minimizing non-financial CoIs. Masking of
applicant identity is often suggested by applicants as a means of
improving the objectivity of the review process. However, the
feasibility of a research project may be difficult to assess without
knowledge of which principal investigator and research group are
involved. In manuscript submission to journals, the masking of
applicants’ identities has been shown to reduce biases, particularly
geographic biases and academic CoIs , without improving
peer review quality or manuscript acceptance rates [48,49].
Further studies should evaluate the impact of masking applicants’
identities in grant-application reviews, especially as feasibility is a
key point in the assessment of proposed research projects. Fifthly,
appropriate selection of external reviewers is also important in
minimizing potential non-financial CoIs. For example, for
manuscript reviews, reviewers suggested by authors seem more
likely to write favorable reviews [50,51], and manuscripts by
authors sitting on the editorial board may have a higher
acceptance rate . We are not aware of studies assessing this
issue in the setting of grant-application reviews. In particular, the
risk of non-financial CoIs may be particularly high when reviewers
are selected for a limited area of research that has only a small
number of experts. In these situations, international experts could
be asked to review projects. Another problem is the gap between
the increasing need for reviews and the decreasing number of
reviewers . Failure to recognize the importance of the work
done by reviewers may contribute to explain this decrease [35,53].
Financial incentives or academic recognition have been suggested
to remedy this situation [35,52,53].
Peer review, although often criticized, is the most widely used
method of research grant allocation. Our results indicate the
presence of non-financial CoIs in the grant-application peer
review process used to allocate academic funds. We believe there is
an urgent need to improve transparency, trust, and fairness,
particularly by issuing uniform requirements for non-financial CoI
There is still a paucity of data on the efficacy and quality of the
grant-application peer review process . In the current context of
resource scarcity, research should be undertaken to assess whether
increasing transparency would improve the efficiency of the peer
review process, notably the satisfaction of all those involved.
Whether greater transparency would also increase the rate of
successful studies is another debate.
Characteristics of external reviewers cited in
Characteristics of internal reviewers cited in
Characteristics of applicants cited in the
We thank all those who accepted to participate in our study, Claire
Ughetto for transcribing the interviews, and Karen Brigham for reading
Conceived and designed the experiments: CP FT ID PA CA. Performed
the experiments: HA CP. Analyzed the data: HA CP. Contributed
reagents/materials/analysis tools: HA CP PA. Wrote the paper: HA CP
FT PA ID CA.
1. Jefferson T, Godlee F (2003) Peer Review in Health Sciences. 2ee ´d. Wiley-
Blackwell. 392 p.
Demicheli V, Di Pietrantonj C (2007) Peer review for improving the quality of
grant applications. Cochrane Database Syst Rev: MR000003.
Bornmann L (2011) Scientific Peer Review. Annual Review of Information
Science and Technology. pp 199–245.
Wessely S (1998) Peer review of grant applications: what do we know? Lancet
Peer Review Congress Home Page (2011) Available: http://www.ama-assn.org/
public/peer/peerhome.htm. Accessed 2011 Dec 20.
Chollette VY, Crowley K (2007) National Cancer Institute’s Small Grants
Program for behavioral research in cancer control boosts careers for new
investigators and fulfills NIH research priorities. Cancer Epidemiol Biomarkers
Prev 16: 2459–63.
Finkel E (2006) Peer review. Australia’s proposed U.K.-style merit ranking stirs
debate. Science 312: 176.
Fuhrer MJ, Grabois M (1985) Grant application and review procedures of the
National Institute of Handicapped Research: survey of applicant and peer
reviewer opinions. Arch Phys Med Rehabil 66: 318–21.
Hegde D, Mowery DC (2008) Research funding. Politics and funding in the U.S.
public biomedical R&D system. Science 322: 1797–8.
10. Hodgson C (1995) Evaluation of cardiovascular grant-in-aid applications by peer
review: influence of internal and external reviewers and committees.
Can J Cardiol 11: 864–8.
11. Jaffe K (2008) Grants awarded on the basis of political criteria. Nature 451:
12. Kaiser J (2005) U.S. budget. House « peer review » kills two NIH grants. Science
13. Kernick DP (1999) Research grants and acknowledgment of funding of
published studies. Lancet 354: 870.
14. Mervis J (2007) Grants management. NSF survey of applicants finds a system
teetering on the brink. Science 317: 880–1.
15. Schwartz DA, Mastin JP, Martin M (2006) Improving grant application peer
review for the NIEHS. Environ Health Perspect 114: A270.
16. Field MJ, Practice I of M (US)ConCofIinMR, Education, and (2009) Conflict of
interest in medical research, education, and practice. National Academies Press.
17. Bion J (2009) Financial and intellectual conflicts of interest: confusion and
clarity. Current opinion in critical care 15: 583–90.
18. Glaser BG, Strauss AL (1967) The Discovery of Grounded Theory: Strategies
for Qualitative Research. New York: Aldine Publishing Company.
19. Miles MB, Huberman AM (1994) Qualitative Data Analysis: An Expanded
Sourcebook. 2nd Revised edition. SAGE Publications Inc. 352 p.
Non-Financial Conflicts of Interest in Grants
PLoS ONE | www.plosone.org9 April 2012 | Volume 7 | Issue 4 | e35247
20. Ghiglione R, Landre ´ A, Bromberg M, Molette P (1998) L’Analyse automatique Download full-text
des contenus. Paris: Dunod. 168 p.
21. Clark J (2003) Qualitative research review guidelines – RATS. Available: http://
www.biomedcentral.com/ifora/rats. Accessed 2012 Feb 27.
22. Horrobin DF (1999) Beyond conflict of interest. Non-financial conflicts of
interest are more serious than financial conflicts. BMJ (Clinical Research Ed.)
23. Levinsky NG (2002) Nonfinancial conflicts of interest in research. The New
England journal of medicine 347: 759–61.
24. O’Dowd A (2011) Experts deny claims that peer review system is in crisis. Bmj
25. O’Dowd A (2011) Peer review system needs thorough evaluation, MPs hear.
Bmj 342: d3046.
26. The PloS Medicine, ed (2008) Making sense of non-financial competing
interests. PloS Medicine 5: e199. doi:10.13.71/ journal.pmed.0050199.
27. Cooper RJ, Gupta M, Wilkes MS, Hoffman JR (2006) Conflict of Interest
Disclosure Policies and Practices in Peer-reviewed Biomedical Journals. Journal
of general internal medicine 21: 1248–52.
28. Haivas I, Schroter S, Waechter F, Smith R (2004) Editors’ declaration of their
own conflicts of interest. Cmaj 171: 475–6.
29. Flynn KE, Weinfurt KP, Seils DM, Lin L, Burnett CB, et al. (2008) Decisional
conflict among patients who accept or decline participation in phase I oncology
studies. J Empir Res Hum Res Ethics 3: 69–77.
30. Luty J, Arokiadass SM, Easow JM, Anapreddy JR (2009) Preferential
publication of editorial board members in medical specialty journals. J Med
Ethics 35: 200–2.
31. Hodgson C (1997) How reliable is peer review? An examination of operating
grant proposals simultaneously submitted to two similar peer review systems.
J Clin Epidemiol 50: 1189–95.
32. Bornmann L, Wallon G, Ledin A (2008) Does the committee peer review select
the best applicants for funding? An investigation of the selection process for two
European molecular biology organization programmes. PLoS One 3: e3480.
33. Comite ´ d’e ´thique du CNRS (COMETS) (2010) Avis sur les «Aspects e ´thiques du
financement public de la recherche sur projet». Available: www.cnrs.fr/fr/
organisme/ethique/comets/index.htm. Accessed 2012 Feb 27.
34. European Medical Research Councils (2007) Present Status and Future Strategy
for Medical Research in Europe. Strasbourg, France: European Science
Foundation. 52 p. Available: http://www.esf.org/publications.html?tx
cessed 2012 Feb 27.
35. Schroter S, Groves T, Hojgaard L (2010) Surveys of current status in biomedical
science grant review: funding organisations’ and grant reviewers’ perspectives.
BMC Med 8: 62.
36. Margottini L (2008) Italy. A plea for « transparent » funding. Science 320: 861.
37. Krimsky S, Rothenberg LS (1998) Financial interest and its disclosure in
scientific publications. Jama 280: 225–6.
38. Bero LA, Glantz S, Hong MK (2005) The limits of competing interest
disclosures. Tob Control 14: 118–26.
39. Blum JA, Freeman K, Dart RC, Cooper RJ (2009) Requirements and definitions
in conflict of interest policies of medical journals. Jama 302: 2230–4.
40. The International Committee of Medical Journal (2010) Available: http://www.
41. National Institute of Health (s. d.) NIH Grant Review Process YouTube
Videos. Available: http://cms.csr.nih.gov/resourcesforapplicants/
insidethenihgrantreviewprocessvideo.htm. Consulte ´ 1 mars 2012.
42. Groves T (2010) Is open peer review the fairest system? Yes. Bmj 341: c6424.
43. Khan K (2010) Is open peer review the fairest system? No. Bmj 341: c6425.
44. Godlee F, Gale CR, Martyn CN (1998) Effect on the quality of peer review of
blinding reviewers and asking them to sign their reports: a randomized
controlled trial. Jama 280: 237–40.
45. van Rooyen S, Black N, Godlee F (1999) Development of the review quality
instrument (RQI) for assessing peer reviews of manuscripts. Journal of clinical
epidemiology 52: 625–9.
46. van Rooyen S, Godlee F, Evans S, Black N, Smith R (1999) Effect of open peer
review on quality of reviews and on reviewers’ recommendations: a randomised
trial. BMJ (Clinical research ed 318: 23–7.
47. Ross JS, Gross CP, Desai MM, Hong Y, Grant AO, et al. (2006) Effect of
blinded peer review on abstract acceptance. Jama 295: 1675–80.
48. Justice AC, Cho MK, Winker MA, Berlin JA, Rennie D (1998) Does masking
author identity improve peer review quality? A randomized controlled trial.
PEER Investigators. Jama 280: 240–2.
49. Van Rooyen S, Godlee F, Evans S, Smith R, Black N (1999) Effect of blinding
and unmasking on the quality of peer review. Journal of general internal
medicine 14: 622–4.
50. Schroter S, Tite L, Hutchings A, Black N (2006) Differences in review quality
and recommendations for publication between peer reviewers suggested by
authors or by editors. Jama 295: 314–7.
51. Wager E, Parkin EC, Tamber PS (2006) Are reviewers suggested by authors as
good as those chosen by editors? Results of a rater-blinded, retrospective study.
BMC Med 4: 13.
52. Tite L, Schroter S (2007) Why do peer reviewers decline to review? A survey.
J Epidemiol Community Health 61: 9–12.
53. Davidoff F (2004) Improving peer review: who’s responsible? Bmj 328: 657–8.
54. Lee M, Om K, Koh J (2000) The bias of sighted reviewers in research proposal
evaluation: a comparative analysis of blind and open review in Korea.
Scientometrics 48: 99–116.
55. A summary of Peer Review for Project Grant Applications to NHMRC (2011)
NHMRC. 11p. Available: http://www.nhmrc.gov.au/_files_nhmrc/file/
2012 Jan 24.
56. Callaham ML, Tercier J (2007) The relationship of previous training and
experience of journal peer reviewers to subsequent review quality. PLoS
medicine 4: e40.
Non-Financial Conflicts of Interest in Grants
PLoS ONE | www.plosone.org10 April 2012 | Volume 7 | Issue 4 | e35247