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THE OPERATIONS, management, and even time-honored peer-review process of the National Institutes of Health (NIH) are likely to be adversely affected by policy changes undertaken as part of the President's Management Agenda "to reduce duplication of effort by consolidating administrative functions and eliminating management layers to speed decision-making."1(p9) Two separate but interrelated initiatives are especially threatening to the NIH: consolidation (also referred to as centralization) and outsourcing (or privatization). Federal directives that have begun implementing these policy changes are already negatively affecting NIH activities. This should be cause for alarm within the scientific community.

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