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Executive Summary The Lucille P. Markey Charitable Trust was created as a 15-year, limited-term philanthropy to support basic medical research in compliance with the will of Lucille P. Markey, who died on July 24, 1982. Mrs. Markey wished that a trust be established "for the purposes of supporting and encouraging basic medical research." The trustees, who provided governance for the Markey Trust, directed the Trust's programs to specific needs in the biomedical sciences, where funding could make the biggest difference. These areas, which emerged over the life of the Trust, covered support of young researchers in the biomedical sciences; establishment, reorganization, or expansion under able investiga- tors of major biomedical research programs or centers; and training opportunities in translational research for graduate and medical students. The Markey trustees were also aware that their mode of philanthropy could provide a model of philanthropy that others could follow, for ex- ample, distributing all the assets of the Trust over a limited period of time, thereby allowing more funds to be distributed in a given year and larger awards to be offered; operating with a small core staff, thereby reducing administrative costs and allowing for a higher proportion of funds to be awarded to grantees; and 1

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2 BRIDGING THE BED-BENCH GAP . providing funds with a minimum of required reporting, thus free- ing recipients from burdensome paperwork often associated with grants. These three mechanisms of operating a grant-making program may inform others in the philanthropic community about approaches for fund- ing research and training programs in the sciences. However, future fund- ers of graduate training programs should ensure that a comprehensive program evaluation and prospective monitoring of outcomes is an inte- gral part of the overall design of the project. During the 15 years following its creation the Lucille P. Markey Chari- table Trust spent over $500 million on three grant programs in the basic biomedical sciences to support the education and research of predoctoral students, postdoctoral fellows, junior faculty, and senior researchers. In response to a request by the Markey trustees the Committee on the Evalu- ation of the Lucille P. Markey Charitable Trust is evaluating the Markey Trust's grant programs in the biomedical sciences. This evaluation ad- dresses two questions: "Were the Trust's funds well spent?" and "What can others learn from the programs of the Markey Trust both as an ap- proach to funding biomedical research and as a model of philanthropy?" MARKEY GRANT PROGRAMS The Markey Trust awards reflect the main stages of a biomedical research career: basic training, development of young faculty, and re- search by experienced scientists. The three categories of grants are (1) General Organizational Grants, (2) Markey Scholars and Visiting Fellows Awards, and (3) Research Program Grants. Some grants overlap two or more categories, and for evaluation purposes have been somewhat arbi trarily assigned. General Organizational Grants A growing gap between biomedical research and its clinical applica- tion has been recogriized. The Markey Trust funded the following types of awards to provide training in translational research to diminish this gap: (1) programs that provided significant opportunities for M.D.s to engage in basic research during and immediately following medical school and residency and (2) programs that provided significant clinical exposure for Ph.D.s while they were predoctoral or postdoctoral students. General Organizational Grants were funded for approximately five years and were not renewable.

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EXECUTIVE SUMMARY 3 Markey Scholars and Visiting Fellows Awards The Trust adopted several mechanisms to fund selected scholars early In their careers. The two most important were (1) the Scholar Awards in Biomedical Sciences with which 113 Markey scholars were supported for up to three years of postdoctoral training followed by five years of sup- port as a junior faculty with both salary and research funding provided and (2) the United Kingdom and Australian Visiting Fellows awards, which supported outstanding young scientists from the United Kingdom and Australia who spent two years as postdoctoral fellows at U.S. re- search institutions. Research Program Grants Research Program Grants were designed to enable established inves- tigators to address important issues in the biomedical sciences through development of new approaches or expansion of continuing approaches to the study of basic biomedical research questions. In some instances the awards permitted new program development or the complete reorgani- zation of existing programs. In other cases the awards enhanced existing programs and research endeavors. Assessing the General Organizational Grants Program This report assesses only the General Organizational Grants program. Future reports will assess the Markey Scholars and Visiting Fellows pro- gram and the Research Program Grants. Unfortunately only the Markey Scholars program lends itself to a data-driven comparison with another group. Formal evaluation was not built into the planning for the hetero- geneous awards that constitute the Markey Trust programs. The Commit- tee is well aware, therefore, of the limitations that are intrinsic to render- ing judgments based on information that can be collected by such activities as site visits and workshops. The Committee used several approaches to assess the General Orga- nizational Grants Program: (~) a workshop titled "Training Programs in Patient-Oriented Pathobiology for Basic Scientists," which brought to- gether six awardees who had provided translational training to Ph.D. scientists; (2) site visits to grant recipients who had provided training in basic research to young physicians; and (3) Committee-commissioned papers by Irwin Arias and by Leon Rosenberg and Tim Ley to provide context to the issue of training in translational research. This report is based on information that emerged from the workshop, site visits, com- missioned papers, as well as other sources.

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4 BRIDGING THE BED-BENCH GAP The Committee's Conclusions and Observations The Committee finds that expert review is the only feasible approach to assessment of the General Organizational Grants program. Strong Gen- eral Organizational Grants funded by the Markey Trust had six character- . . . Sacs In common. 1. Leadership and collaboration that bridge the basic and clinical sci- ences among academic departments; 2. Mentoring, including dual mentors, to bridge clinical and basic sciences; 3. Identification of competitive candidates to recruit the best trainees; 4. A defined, carefully structured program with attention to elements of training, defined course work, mentorship, networking opportunities, and research experience; 5. Protected time for the physician trainees; and 6. Sustainability of some programs with either internal or external funding. Based on these observations the Committee drew several conclusions about the impact of the Markey Trust's method of operation. The terms of Mrs. Markey's will have been fulfilled through the vision and focus of the trustees. Over $500 million was distributed to fund biomedical research in a 15-year period. The funds were distributed appropriately for training and organi- zational change. The Markey Trust took funding risks with potential rewards, and many of them paid off through institutional changes and better training opportunities. In addition, the Committee was able to generalize about the effect of the General Organizational Grants. The Committee simply could not evaluate the General Organiza- tional Grants program quantitatively because of the heterogeneity of its central theme and the absence of more stringent data reporting. In the future, funders should build such evaluation processes into their grants. Despite the above limitations the Committee strongly felt that this program was an invaluable asset to participating institutions. About half of the General Organizational Grants awardees continued to operate Markey-supported programs after external support was com-

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EXECUTIVE SUMMARY 5 pleted. These large, up-front, and flexible funds provided the "venture capital" that was critical to long-term success. Moreover, these programs were able to use Markey funds to leverage other sources of funding. There is still a strong national need to ',bridge the bed-bench gap" between biomedical research and its clinical application. The Markey awards contributed importantly to this effort and helped maintain an awareness of the problem over the past two decades. In the long run, however, a larger effort, funded by the federal government and philan- thropies in partnership, will be required to address the critical issue more fully. Fortunately such initiatives are now under way.