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Grant Programs The Markey Trust made awards in the three stages of a biomedical research career in which "supporting and encouraging basic medi- cal research" can occur. 1. The General Organizational Grants sought to improve the educa- tion and training of Ph.D.s and M.D.s who were planning careers in bio- medical research to better prepare them for basic clinical research and research in molecular medicine. 2. The Markey Scholars and Fellows awards supported outstanding younger researchers in the biomedical sciences and provided them with long-term financial assistance early in their careers. 3. The Research Program Grants provided funding opportunities for established scientists with proven records of excellence in biomedical re- search. A few grants fell outside the above stages and are categorized as miscellaneous. The distribution of funding for all four programs is shown . hi- ~ In figure 1. The Markey Scholars and Visiting Fellows awards and the Research Program Grants are briefly described below. They will be the subjects of later full-length evaluative reports. 13

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14 General Organizational Grants 12% Scholars and Fellows Awards 13% BRIDGING THE BED-BENCH GAP Miscellaneous Awards 10% \ Administrative and Investment Costs / 7°/n 'I: \ i: \ : ~ :: : Aim: ::~ Research Program Grants 60% FIGURE 1 Distribution of Markey Trust programs and grant making. MARKEY SCHOLARS AND FELLOWS The Markey trustees recognized the importance of providing funding to young biomedical scientists as they launch their careers. The Trust dedicated $63,093,900 to fund the Scholar Awards in Biomedical Sciences and the United Kingdom and Australian Visiting Fellows. Scholar Awards in Biomedical Sciences By establishing the Markey Scholars program in 1984 the trustees recognized that top priority should be given to support young research- ers as Key moved from postdoctorate into junior faculty positions. The goal was to enable the scholars to conduct independent research early in their careers. Between 1985 and 1991, 113 Markey scholars were sup- ported for up to three years of postdoctoral training, followed by five years as beginning faculty members. This support included both salary and research funding. Scholar awards ranged from $570,000 to $711,000, depending on the length of their postdoctoral experience. The Markey Trust was unique in providing support for young scientists for up to eight years. The total funding for Markey scholars was $59,795,900. United Kingdom and Australian Visiting Fellows The trustees also supported outstanding young scientists from the United Kingdom and Australia by enabling them to spend two years as

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GRANT PROGRAMS 15 postdoctoral fellows at U.S. research institutions. Thirty-six visiting fel- lows 26 from the United Kingdom and 10 from Australia were se- lected between 1986 through 1994, and support amounted to $3,298,000. Research Program Grants The largest Markey awards in terms of funding amount and number of projects were the Research Program Grants. These grants were de- signed to enable investigators to address important issues in the biomedi- cal sciences by developing new approaches or expanding continuing ap- proaches to the study of basic biomedical fields. A wide range of activities was funded through Research Program Grants, which could be used to fund predoctoral and postdoctoral sti- . ~ Fends, renovation of laboratories, purchase of major equipment, and re- cruitment of additional staff. Generally, grants were awarded for five years. Because of the limited term of the Trust, awardees were advised that the grants were not renew- able. The Trust made 92 Research Program Grants between the years of 1986 and 1995 amounting to over $322,248,175. In 1996 the Trust made supplementary awards of $3,090,000. MISCELLANEOUS AWARDS During its tenure the Markey Trust made a number of awards that did not fit into the three major award categories. These awards continued the support provided by Mrs. Markey during her lifetime, funded en- dowed chairs, afforded scholarships to biomedical researchers, and funded related research support. These award programs, totaling $53,606,232, are listed below. Lucille P. Markey Basic Medical Research Funds To memorialize the Trust's support for the training of biomedical scientists, endowments totaling $14 million were made to seven institu- tions. These institutions established permanent endowments, known as the Lucille P. Markey Basic Medical Research Funds, to provide support for promising predoctorals, postdoctorals, and junior faculty.3 3These seven institutions were Harvard university; Johns Hopkins university; Rockefeller university; Stanford university; university of California, san Francisco; university of Michi- gan; and university of Texas Southwestern Medical center.

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16 Markey Predoctoral Fellows BRIDGING THE BED-BENCH GAP In its early years the Trust provided $9.4 million to 15 academic insti- tutions to assist predoctoral students in biomedical science programs. These graduate students were known as Markey fellows. Other Grantsfor Career Development The Trust provided $3,030,000 to six research institutes to fund sum- mer seminars and short courses for potential scientists in basic medical research. Continuation of Programs Initiated by Mrs. Markey These awards were made in 1984 and 1985 to Me University of Ken- tucky and University of Miami and totaled $8.7 million. Endowed Chairs Between 1985 and 1996 the Markey Trust provided $11.5 million to fund endowed chairs at seven universities. Research Support and Related Grants Between 1985 and 1997 the Trust provided $6,976,232 to fund 56 mis- cellaneous grants for support of smaller research projects and to encour- age or facilitate basic medical research. GENERAL ORGANIZATIONAL GRANTS By the end of the 1970s a serious gap between fundamental biological research and clinical research had developed (Wyngaarden, 1979~. The nation was no longer producing as many clinical researchers as it needed to translate the discoveries of biomedical science into practical medical practice, a problem experts referred to as the '`bed-bench gap." These experts urged that more students be encouraged to pursue translational research. Trustee Louis Hector recognized this problem in the early stages of the Markey Trust. He had read seminal articles about this issue, includ- ing the James Wyngaarden article [1979~. The Markey Trust as it began operations confirmed the gap as it reviewed applications for scholarships and other research assistance. In 1987 the University of California, San Francisco, proposed an ex- tensive reorganization of its graduate programs in biomedical sciences.

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GRANT PROGRAMS 17 Under this proposal the programs in biochemistry and molecular biology, cell biology, immunology, neurobiology, and genetics would be merged into a new Program in Biological Sciences. This was followed by an appli- cation from the Rockefeller University for a program to fund university fellows in developmental biology. Neither of these proposals was for biomedical research projects that the Trust normally funded; however, the Trust was interested in funding such proposals, and these two became the first of what were to become General Organizational Grants. In 1989 the Trust held another "think tank" session during which input was sought from a number of biomedical scientists on directions for Trust funding during its remaining term. Workshop participants advised that there was general concern in medical schools about the bed-bench gap and that plans were emerging in many universities to develop new curricula and teaching techniques to close the gap. The Trust decided to be responsive to proposals that sought to de- velop training programs designed to bridge the bed-bench gap. The Trust received a number of proposals that fell into two categories: (1) those that provided significant opportunities for M.D.s to engage in basic research during and immediately following medical school and residency and (2) those that provided significant clinical exposure for Ph.D.s while predoc- toral or postdoctoral students. The first of these awards, also known as General Organizational Grants, was made in 1992. These grants were intended to close the widening gap between rapid advances in our under- standing of biological process and the translation of that knowledge into techniques for preventing diseases (Lucille P. Markey Charitable Trust, 1995). General Organizational Grants were funded for approximately five years, although many grant recipients were able to extend the grant's duration because of the flexibility of the Markey grants. Because of the limited term of the Trust, General Organizational Grants could not be renewed. Between 1988 and 1995 twenty-two General Organizational Grants were awarded, amounting to $62,121,700 as seen in Table 1. The average amount awarded was about $2.8 million, but award amounts ranged from $50,000 to $13,750,000. General Organizational Grants were awarded using a tiered peer re- view process. It was not an open competitive process; instead institutions selected on the basis of their track record in biomedical research and training were identified by the trustees and were asked to submit applica- tions. These applications were reviewed by the trustees and a committee of experts consisting of lames E. Darnell, M.D., Gordon N. Gill, M.D., and James B. Wyngaarden, M.D. Applications were received from 45 institu- tions. Of these, 22 received awards. The trustees and selection committee

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8 BRIDGING THE BED-BENCH GAP TABLE 1 Number and Value of General Organizational Grants Awards by Year Fiscal Year Number of Awards Total Funded 1988 1 $13,750,000 1989 2 5,400,000 1992 6 20,371,700 1993 6 11,500,000 1994 6 11,050,000 1995 1 50,000 Total 22 $62,121,700 SOURCE: Data compiled from Lucille P. Markey Charitable Trust (1996). requested that applicants prepare major revisions of nearly every pro- posal that was accepted, some extensively. For example, of the 22 award recipients 20 were asked to submit revised proposals. The funding level was reduced in 18 cases and increased in two cases.