Funding Biomedical Research Programs: Contributions of the Markey Trust (2006)

The Lucille P. Markey Charitable Trust was created as a 15-year, limited-term philanthropy in support of basic medical research by 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, targeted its programs to specific needs within the biomedical sciences where funding could potentially make a difference. Three main categories, which emerged over the life of the Trust, were targeted to the following:

1. Supporting of young researchers in the biomedical sciences

2. Funding the establishment, reorganization, or expansion of major biomedical research programs or centers led by established investigators

3. Providing training opportunities in translational research for graduate and medical students.

The Markey Trustees were also aware that their approach to philanthropy could potentially provide a model for others. Their approach had the following key attributes:

• Distribute all of the assets of the Trust over a limited period of time, allowing more funds to be distributed in a given year and larger awards to be offered;

• Operate with a small core staff, thereby reducing administrative

costs and allowing a higher proportion of funds to be awarded to grantees; and

• Provide funds with only a minimum of required reporting, thereby freeing recipients from the burdensome paperwork often associated with grants.

These three mechanisms for operating a grants program were successfully used by the Markey Trust and provide a model for other foundations. However, future funders of programs in the sciences should consider comprehensive program evaluation and prospective monitoring of outcomes as an integral part of the overall design of a project.

During the 15 years following its creation, the Lucille P. Markey Charitable Trust spent more than $500 million on three basic biomedical sciences grant programs that supported 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 is evaluating the Markey Trust’s grant programs in the biomedical sciences. This evaluation addresses two questions: (1) Were the Trust’s funds well spent? and (2) What can others learn from the programs of the Markey Trust both as an approach to funding biomedical research and as a model of philanthropy?

The Markey Trust made awards reflecting the three main stages of a biomedical research career: basic training, development of young faculty, and research by experienced scientists. These three categories became referred to as the following: (1) General Organizational Grants, (2) Markey Scholars and Visiting Fellows Awards, and (3) Research Program Grants. However, some grants do not fall neatly into one of these categories and for evaluation purposes were assigned to one or another of the programs.

The growth of a gap between biomedical research and its clinical application has been recognized. The Markey Trust funded awards to provide training in translational research to diminish this gap, including (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 Grant programs were funded for approximately five years and were not renewable.

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, by which a total of 113 Markey Scholars were supported for up to three years of postdoctoral training followed by five years of support 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 to spend two years as postdoctoral fellows at American research institutions.

Research Program Grants were awarded to enable established investigators to address important issues in the biomedical sciences by developing new approaches or expanding continuing approaches to the study of basic biomedical research questions—in short, providing flexible dollars for innovation and growth. In some instances, the awards permitted the development of new programs or the complete reorganization of existing programs. In other cases, the awards enhanced existing programs and research endeavors.

This report covers only the Research Program Grants program. The General Organizational Grants programs were assessed earlier and can be reviewed in Bridging the Bed-Bench Gap: Contributions of the Markey Trust, published by the National Academies Press. The committee will publish a report in 2006, giving its assessment of the Markey Scholars and Visiting Fellows program. This is the only Markey program that lends itself to a data-driven, prospective evaluation with a comparison group. Unfortunately, formal evaluation was not built into the planning for the heterogeneous awards that constitute the programs funded by the Markey Trust, the subject of this and the previous report. In the case of these two reports, the committee is well aware of the limitations that are intrinsic to rendering judgments based on information that could be collected by such activities as site visits and progress reports but believed that its expert judgment would be useful to other funders of scientific work.

The committee sought to understand whether the grants made to develop centers or programs resulted in program creation and development, program sustainability, research productivity, and faculty development, and positively integrated the funded program with the host institution. Unfortunately, the committee was not able to assess adequately the scientific quality or impact of the Research Program Grants on biomedical research or the impact of the program on the research centers and projects

that it funded. This inability stems from one of the Research Program Grant’s strengths, its flexibility in not imposing stringent reporting requirements on grant recipients. As a consequence, information that would be useful to an evaluation of the impact of the Research Program Grants was not systematically collected.

The committee used three approaches to assess the Research Program Grants. First, all grantees were required to submit annual progress reports to the Trust. Although there was little uniformity among these progress reports, the committee was able to use them to document some milestones for the grantees, including data on staffing changes, construction and renovations, and purchase of major equipment.

In addition, the committee and NRC staff made 19 site visits; conducted 12 telephone interviews with principal investigators, some of whom also received site visits; and analyzed letter reports from two grantees. These data provided the committee with valuable insights into how funds were used within a particular institution. However, the committee found that it was difficult to generalize the insights garnered from these sources, although it was clear that in almost every instance funds had been used to fund good scientists, buy needed equipment, and develop programs.

The third source of information came from analysis of the Lucille P. Markey Charitable Trust Records. As the Trust was entering its final years, it arranged for all Trust documents to be stored at the Rockefeller Archives Center in Sleepy Hollow, New York. Following the conclusion of the Trust in 1997, all of its documents were transferred to the center, classified, and microfilmed. These archival data are a rich source of information on all aspects of the Trust and will be made available to the public in 2007.

The Committee used its expert review combined with assessment of annual reports, site visits, and review of the Markey Trust archived records to evaluate the Research Program Grants program and arrive at the following conclusions and observations.

• The Research Program Grants were an appropriate mechanism to carry out the wishes to invest in the biomedical sciences articulated by Mrs. Markey to spend down her trust with minimal administrative overhead. Through this mechanism, more than $325 million in funding was awarded to 92 principal investigators in academic medical centers, hospitals, research universities, and research institutes or centers.

• By design, awards made through the Research Program Grants

award mechanism differed from those made by the National Institutes of Health (NIH) and National Science Foundation (NSF) in terms of both the size and flexibility of the award and in the selection process used to make the grants. The process focused on people with established records of success in science rather than the research proposal per se.

• Dollars provided by the Research Program Grants were invested in recruiting young scientists and provided start-up packages. These grants also funded equipment, infrastructure development, and research by leading scientists. However, it is impossible to assess the outcomes of individual awardees.

• The size and focus of Research Program Grants awards changed during the tenure of the Trust. A program of large awards to enhance infrastructure development and create new programs at academic medical centers evolved into one where smaller awards were made to individual investigators to further their research.

• The Trust developed procedures that maximized the flexibility of the awards, and this flexibility—according to those interviewed—led to efficient uses of Trust funds. The Trust focused on minimizing the bureaucracy in its administration of Research Program Grants awards.

• The committee believes that the Trust’s goal of funding high-risk biomedical research, research that would not ordinarily be funded by NIH, NSF, or other funders, was met. Although examining the portfolio of grants in terms of whether they were high risk was beyond the scope of this evaluation, the committee noted that a number of grants supported research programs in their nascent stages.

• Finally, the committee believes that a number of aspects of the Markey model of philanthropy, including its design as a limited-term trust, are worthy of consideration by other funders interested in fostering biomedical research.

Through the Research Program Grants, the Markey Trust created a program that identified established leading scientists with promising ideas and models, provided them with substantial funding, and minimized administrative barriers in order to maximize their potential to take risks, support good young scientists in their labs, buy equipment, and build infrastructure to advance biomedical research. The need still remains for funding basic biomedical research whose outcomes are neither ensured nor predictable.