drive progress in the future. Computer science in general has been a major stimulant to the U.S. economy and has had a remarkable influence on our quality of life, but the biomedical world cannot rely on the general engineering community to develop the solutions that health care and medical research require. The biomedical informatics community can fill that pipeline, as it has in the past, but this requires a program of funding and training that will produce both the ideas and the scientists that are needed to restore the momentum that we need in these important disciplines. The NLM is the only agency that has consistently supported such education, and it needs the resources to continue its important programs. There may be other similar interdisciplinary programs at NIH that have been overlooked because they do not use the NRSA or T32 mechanism. All such programs need to be considered explicitly in the guidelines and recommendations offered in this report.

Recommendation 2–9: The unique graduate training programs of the NLM, plus its postdoctoral fellowships in biomedical informatics, should receive gradually increasing support with incremental dollars over 5 years to produce a 50 percent increase in the number of funded training programs and a doubling of the number of funded training positions.

When a new workforce committee is constituted, it spends a considerable amount of time reviewing the previous recommendations and the response by the NIH. This is often quite difficult to do in a satisfying manner since the exact implementation can be piecemeal, and, indeed, sometimes there may be very sound reasons for non-implementation. It is not easy for the new committee to triangulate how things have evolved in the four years since the previous recommendations were first presented. This committee was helped by a small number of individuals who had sat on the previous committee and were able to offer a valuable extended perspective. Clearly, better communication between the NRC review committees and the NIH could speed up the overall review process. The committee debated this issue for some time and eventually decided to make a recommendation that the NIH establish a review group that would analyze and collate the NIH responses to the committee recommendations and report its findings to the director’s advisory committee. In this way the director of the NIH would be apprised of the relevant issues, and the appropriate components of the minutes could be used to inform the next NRC review committee four years from now.

Recommendation 2–10: The committee believes that subsequent workforce committees would greatly benefit from continuity in terms of crafting recommendations and following and monitoring the implementation of those recommendations by the NIH. Accordingly, it is recommended that the appropriate office at the NIH involved in analyzing these recommendations should issue an annual report to the director’s advisory committee on the status of review and implementation. In addition, the NIH may wish to invite external experts to provide added insight into the analysis. There are a number of ways that this could be done, but the exact mechanism is left up to the NIH.

Chapter 3 documents the contributions of foreign-educated scientists, particularly at the postdoctoral level, to the U.S. biomedical research workforce. Indeed, in the biomedical postdoctorate pool more than 60 percent of the fellows are foreign trained. In addition, typically 60 to 65 percent of these individuals indicate that they hope to stay in the United States after they have completed their fellowship. Without this component of the workforce, U.S.-educated Ph.D.s, at the current level of production, would not be able to provide the amount of human capital needed to meet the demands for research in this area. Over the past two decades the number of foreign-trained individuals in the postdoctoral workforce has steadily increased. However, we are now faced with a highly uncertain future in this regard. This is a direct consequence of two powerful forces, the effects of which are impossible to determine at present. On the one hand, the enormous growth of the Chinese and other Asian economies—and their explicit intentions to invest in the biomedical and life sciences and become “research powerhouses”—has already begun to attract their nationals to return and conduct research at their home institutions, a phenomenon that seems likely only to increase over the next decade. On the other hand, the pressing economic situation in the United States, especially the uncertainty of job availability in the future, may lead to a decreasing attractiveness of U.S. biomedical research careers to Ph.D.s from these foreign countries.

Although there is a great deal of uncertainty about how these phenomena will affect the contributions of international scientists to the U.S. biomedical research enterprise, our leaders at the NIH and in the Congress should be aware of this committee’s concerns. It is probably not yet time to suggest that U.S. production of biomedical Ph.D.s should be increased, but clearly this issue needs to be carefully and continuously monitored.