Two important aspects of the relationship between peer review and innovation includes the acceptance of articles for publication in journals and the assessment of applications for grants for the funding of research work. While there are well-known examples of the rejection by journals of first choice of many papers that have radically changed the way we think about the world outside ourselves, such papers do get published eventually, however tortuous the process required. With grant applications the situation differs in that the refusal of a grant necessarily curtails the possible research that may be attempted. Here there are many reasons for conservatism and reservation as to the ability of a grant allocation process based on peer review to deliver truly innovative investigations. Other methods are needed; although such methods need not be applied across the board, they should constitute the methods whereby some 10–20% of the grant monies are assigned. The nomination of prizes for specific accomplishments is one way of achieving innovation although this presumes that investigators or institution already have available the money necessary to effect the innovations; otherwise it is a question of the selection and funding of particular individuals or institutions and requiring them to solve particular problems that are set in the broadest of terms.