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Competing Interests: Competing interests: We have read and understood BMJ policy on declaration of interests and declare that we have no competing interests.

Objective: To quantify randomness and cost when choosing health and medical research projects for funding., Design: Retrospective analysis., Setting: Grant review panels of the National Health and Medical Research Council of Australia., Participants: Panel members' scores for grant proposals submitted in 2009., Main Outcome Measures: The proportion of grant proposals that were always, sometimes, and never funded after accounting for random variability arising from differences in panel members' scores, and the cost effectiveness of different size assessment panels., Results: 59% of 620 funded grants were sometimes not funded when random variability was taken into account. Only 9% (n = 255) of grant proposals were always funded, 61% (n = 1662) never funded, and 29% (n=788) sometimes funded. The extra cost per grant effectively funded from the most effective system was $A18,541 (£11,848; €13,482; $19,343)., Conclusions: Allocating funding for scientific research in health and medicine is costly and somewhat random. There are many useful research questions to be addressed that could improve current processes.

Objective: To evaluate changes in the role of academics and the sources of funding for the medical research cited most frequently over the past decade., Design: Database analysis., Data Sources: Web of Knowledge database., Methods: For each year from 1994 to 2003, articles in the domain of clinical medicine that had been cited most often by the end of 2004 were identified. Changes in authors' affiliations and funding sources were evaluated., Results: Of the 289 frequently cited articles, most had at least one author with a university (76%) or hospital (57%) affiliation, and the proportion of articles with each type of affiliation was constant over time. Government or public funding was most common (60% of articles), followed by industry (36%). The proportion of most frequently cited articles funded by industry increased over time (odds ratio 1.17 per year, P = 0.001) and was equal to the proportion funded by government or public sources by 2001. 65 of the 77 most cited randomised controlled trials received funding from industry, and the proportion increased significantly over time (odds ratio 1.59 per year, P = 0.003). 18 of the 32 most cited trials published after 1999 were funded by industry alone., Conclusion: Academic affiliations remain prominent among the authors of the most frequently cited medical research. Such research is increasingly funded by industry, often exclusively so. Academics may be losing control of the clinical research agenda.