Physicians and professional groups warned that proposed US changes to federal research grant allocation could shift peer review toward a pre-issuance political screen tied to administration priorities. The concern is centered on an Office of Management and Budget proposal affecting guidance on federal financial assistance that would constrain merit-based review. In a statement, the American College of Physicians argued the proposal could hinder the ability to advance scientific discovery by making it harder for clinicians, health systems, researchers, and policymakers to access knowledge needed for patient care. The dispute reflects a broader tension between transparency/accountability goals and scientific independence—an issue that can materially affect biomedical innovation pipelines that rely on stable NIH- and NSF-linked funding.