Yes, there is substantial evidence and widespread agreement among patient advocates, charities, and some independent analyses that most ME/CFS research proposals face inherent structural and systemic disadvantages that make it extremely difficult for them to reach the "equal merit" threshold required to benefit from the MRC's prioritisation mechanism.
The MRC's priority area notice (in place since 2003) only provides a boost when proposals achieve the same median ranking score as others in a funding round after peer review. In practice, this tie-breaker rarely comes into play for ME/CFS because far fewer proposals even make it to that competitive stage, and those that do often score lower due to entrenched barriers. Here's why this happens, drawing from documented criticisms and data:
- Very low volume of applications: Historical data (e.g., from 2003-2023 analyses shared in ME/CFS research communities) shows an average of only about 2-5 genuine ME/CFS-focused proposals submitted to the MRC per year in recent decades, with many being
"false hits" (e.g., projects on general fatigue or overlapping conditions). The MRC's overall grant success rate is around 20% (roughly 1 in 5 funded), so statistically, you'd need at least 5 high-quality submissions annually to expect even one funded-but the submission rate has remained vanishingly low. This scarcity means few opportunities for any to reach "equal merit" comparisons.
- Inherent disadvantages in proposal quality and scoring:
- Lack of preliminary data: ME/CFS is an understudied field with no widely accepted biomarkers, limited large cohorts, and historical stigma framing it as psychosomatic. Funders (including MRC panels) often demand strong pilot data, preliminary results, or proof-of-concept evidence. Emerging or exploratory proposals (common in a nascent field) struggle here, as researchers can't easily generate that data without prior funding-creating a catch-22.
- Peer-review biases and expertise gaps: Panels may include reviewers without ME/CFS expertise who apply standards from better-established fields (e.g., expecting large sample sizes or clear mechanisms that don't yet exist due to underfunding).
Historical examples (including UK and international parallels like NIH panels) show occasional outright bias, where proposals are dismissed as "psychosomatic" or scored lower due to unfamiliarity with the condition's complexity.
- Stigma and researcher deterrence: The field's reputation (influenced by past controversies like the PACE trial) discourages top researchers from entering, reducing the pool of experienced applicants who could produce highly competitive proposals. This perpetuates a cycle: fewer strong applications → lower average scores → fewer tie-breakers triggered → continued
In short, the prioritisation is real on paper but largely theoretical in practice for ME/CFS—most proposals never hit "equal merit" because of these baked-in hurdles. This is why advocates push for structural changes like ring-fenced pots, dedicated RFAs (requests for applications), or bias-mitigating measures to level the playing field and kickstart the field. Without them, the mechanism alone can't overcome decades of neglect.