Panel Members

IRVING L. WEISSMAN (Chair), Professor of Pathology, Department of Pathology, Stanford University School of Medicine, Palo Alto, California

JAMES ALLISON, Howard Hughes Medical Investigator and Professor, Cancer Research Laboratory, University of California, Berkeley

FREDERICK W. ALT, Howard Hughes Medical Investigator and Professor, Children's Hospital, Harvard Medical School, Cambridge, Massachusetts

HAROLD VON BOEHMER, Professor, Faculte de Medicine Necker – Enfants Malades, Institut Necker, Institut National de la Santé et de la Recherché Medicale, Paris, France

MAX D. COOPER, Howard Hughes Medical Investigator and Professor of Medicine, Pediatrics, Pathology, and Microbiology, University of Alabama, Birmingham

IRWIN FELLER, Director, Institute for Policy Research and Evaluation and Professor of Economics, Pennsylvania State University, University Park

LAURIE H. GLIMCHER, Irene Heinz Given Professor of Immunology, Harvard School of Public Health, and Professor of Medicine, Harvard Medical School, Department of Immunology and Infectious Diseases, Cambridge, Massachusetts

DAVID V. GOEDDEL, President and Chief Executive Officer, Tularik, Inc., South San Francisco, California

HUGH MCDEVITT, Professor of Microbiology and Immunology, Stanford University School of Medicine, Palo Alto, California

DIANE MATHIS, Director de Recherches, Institut de Genetique et de Biologie Moleculaire et Cellulaire Institut National de la Santé et de la Recherché Medicale, Strasbourg, France

GUSTAV NOSSAL, Professor Emeritus, Department of Pathology, University of Melbourne, Australia

ROGER M. PERLMUTTER, Senior Vice President, Merck Research Laboratories, Rahway, New Jersey

CRAIG B. THOMPSON, Howard Hughes Medical Investigator and Professor, University of Chicago, Illinois

DON C. WILEY, Howard Hughes Medical Investigator and Professor, Department of Molecular and Cellular Biology, Harvard University, Cambridge, Massachusetts

Project Staff

DEBORAH D. STINE, Study Director

TAMARA ZEMLO, Research Associate

NORMAN GROSSBLATT, Editor

1.1. How Important Is It for the United States to Lead in Immunology Research?

Immunology encompasses fundamental scientific discovery at all levels of biological organization. It is also a practical field that provides, for example, highly specific molecular entities (antibodies) that are the basic tools for identifications (as in diagnosis) and separations in biology, medicine, and industry. Disorders of the immune system are frequent causes of human disease, ranging from congenital and acquired immunodeficiencies, such as AIDS, to autoimmune and inflammatory conditions, such as insulin-dependent diabetes and rheumatoid arthritis. The normal functions of the immune system reject transplanted cells, tissues, and organs. Pharmaceutical and biotechnological interventions to dampen immune responses in autoimmunity, inflammation, and transplantation are important segments of the pharmaceutical industry and clinical medicine, as are attempts to amplify or augment components of the immune system to help eliminate infections, cancers, and parasites that have evaded immunosurveillance.

Institutions that have robust programs of research, training, teaching, and application in immunology have had (and probably will continue to have) opportunities to take advantage of immunology as a science that enriches other biomedical endeavors, to enhance the role of immunology in medicine, and to use immunology in entrepreneurial and industrial efforts. It is therefore a vital US interest to be in a position of leadership in immunology, so that the intellectual, medical, and financial benefits of immunology will be available.

1.2. What Is Immunology?

Immunology has been described as the branch of life sciences that is involved in distinguishing self from nonself. All multicellular (metazoan) organisms are prey to infection or invasion. With the specialization of cells within organisms into organs and tissues that serve distinct functions, subsets of cells that survey other cells or elements for self or nonself markers have evolved to serve immune functions. In humans, as in other vertebrates, the cells that make up the immune system include some that are similar to the innate immune systems of prevertebrates and others—called lymphocytes—that appear to constitute a vertebrate invention, and are responsible for most of the adaptive immune functions of vertebrates.

There are two major classes of lymphocytes: T cells, which develop in the thymus; and B cells, which develop in the bone marrow. Those two classes have different immune functions. For example, in an immune response to a viral infection, B lymphocytes are triggered by the virus to differentiate into mature effector cells that produce and secrete molecules called antibodies. Antibodies can bind to and inactivate or eliminate specific viruses before they enter cells of the body. Viruses can penetrate cells and cause them to use the viral genetic material as templates and instructions to produce more viruses. Once viruses enter the cells, they are largely hidden from circulating antibodies.

To protect the organism against the intracellular phases of viral infection, several populations of lymphocytes, including a subpopulation of inflammatory and killer T cells, collectively isolate and eliminate virus-infected cells. T cells recognize virus-infected cells by means of cell-surface receptors (called T-cell receptors or TCRs) that adhere by molecular complementarity to "flags" on the surface of infected cells. The flags are a class of molecules that make up what is called the major histocompatibility complex (MHC), which picks up degraded fragments (about nine amino acids long) of viral proteins within the cells and bring them to the surface to be detected by TCRs on inflammatory and killer T cells.

Both the magnitude and the quality of the immune responses by these types of T and B cells are regulated by helper T cells. During the course of an infection T and B cells with virus-specific receptors undergo many rounds of cell division; some cell progeny are destined to be immediate effectors of the response, and others are retained as "memory" cells. Long after an infection (or vaccination), the expanded number of memory cells guarantees that a second exposure to the same virus will be met by an expanded response which develops more rapidly, providing effective immunity before serious consequences of the infection develop. During development of the T and B lymphocytes from their precursors, members of the population that have receptors to self are usually eliminated, inactivated, or not expanded. Thus, the adaptive immune system usually ignores self and responds to nonself by providing early and effective immunity and lifelong immune memory. Much is known about this complex system, but much is yet to be learned, so immunology is still an attractive subject for training and research. For example, many immune diseases are known to be the result of mutations or alterations in particular components of the system, whereas others have an unknown etiology.

Immunology attracts diverse life scientists. Perhaps because the cells of the immune system are easily obtained, the system has often been used as a leading-edge subject for studies in other disciplines. Study of homogeneous lymphocyte populations, for example, leads to research in many aspects of signal transduction, wherein cell-surface receptor engagement signals cells to divide, differentiate, or die. It can be argued that we know more about vertebrate developmental immunology than about any other developmental system, including the first isolated stem cell in any system. Much of what is known about cell-surface adhesion and recognition receptors, the genes that encode them, and the evolution of these genes comes from studies of cells of the immune system. That cells can communicate by secreted protein messages called cytokines was elucidated largely through study of cells and cytokines of the immune system.

1.3. Immunology as an Academic Discipline

Immunologists are at work in virtually every life science department or division. But there are very few departments of immunology in academe. The multidisciplinary nature of immunology research is probably a major reason that immunology is so well connected with the more traditional subjects (such as biochemistry, genetics, and microbiology), whose approaches define their disciplines. It also explains the ready translation of discoveries in immunology to such clinical subjects as rheumatology, surgery (in transplantation), endocrinology (in diabetes), neurology (in multiple sclerosis), and allergy.

Although those connections have served immunology and the other subjects well and have probably protected immunologists from the isolation that their jargon could lead them into, immunology might be less of a force in academic politics and less of a presence in the undergraduate and graduate curricula of many universities than it would otherwise be because it does not have departmental status at most institutions. Not being or being in a discipline with departmental status, immunology and immunologists are unevenly distributed in the totality of US academic institutions. Entrepreneurial and clinical efforts in immunology largely have the same uneven distribution.

1.4. What Is the International Nature of Immunology?

Excellent research in immunology is conducted throughout the world. Researchers are part of a tightly knit and highly collaborative international community and hence, immunology as a discipline has become an international effort. International collaboration in the different subfields of immunology has facilitated exchanges in information that have enabled exciting breakthroughs to be made. Factors that have contributed to international collaboration have been the training of young scientists from around the world in graduate institutions in the United States, training of young US scientists in foreign immunology centers, internationally attended scientific conferences, the increasing facility of electronic forms of communication, and the use of English as the standard tongue of communication.

1.5. What Are Some Caveats?

Immunology is an essentially multidisciplinary field, and immunological research overlaps with many other disciplines, including molecular and cellular biology, genetics, and biochemistry. Immunology serves as a foundation for the design and testing of varied biologic hypotheses. Therefore, this benchmarking assessment will be valuable not only to the field of immunology, but also to other biological disciplines. Conversely, although this is a definitive strength of this report, it must be noted that it was sometimes difficult to identify and characterize specific attributes that apply solely to immunology.

Additional caveats apply to the method used in this analysis. Given the lack of quantitative data that can be compared on an international basis, the panel used a number of techniques and, looked at the degree to which the results conformed to develop its conclusions. The panel was not able to assess this question in an objective way, but it used the expertise and judgment of its members and the limited information and data available to develop its conclusions. More details on the methods and the limitations of each are provided in Chapter 2.

1.6. Panel Charge and Rationale

The panel was asked to conduct a comparative international assessment to answer three questions:

• What is the position of the US research in the field relative to the research performed in other regions or countries?
• What key factors influence the US performance in the field?
• On the basis of current trends in the United States and abroad, what will be the future relative position of the United States in the field in the near term and the longer term?

The panel was asked only to develop findings and conclusions not recommendations. Its primary objective was to obtain a comprehensive overview of the field of immunology that included characterizing the key factors of the field, assessing the resources necessary for conducting and supporting immunologic research, and identifying trends in the types of research being done in the field. The panel strove to maintain an international perspective as it collected and analyzed the data for this report.

The panel assessed the current position of the United States relative to leadership in four subfields of immunology, and the benchmarking results themselves are presented in Chapter 2 of this report. The determinants of leadership that have influenced US advancement in the field are discussed in Chapter 3. Chapter 4 assimilates past leadership determinants and current benchmarking results to predict future US leadership status in the field.

2.1. Methods

The assessment of a country's relative standing in research performance is subject to multiple complexities. Many measures could be used to evaluate the position of US-based research in immunology, but each suffers from generic or specific limitations. Such limitations include the collaborative and international scope of immunological research, which makes the drawing of national lines somewhat arbitrary; the inequality inherent in comparing a large, common enterprise with multiple smaller ones; and the difficulties of shifting information on the specific field of immunology from that on related research fields in large, aggregate databases. In addition, in the case of this panel's operations, budget and time constraints effectively ruled out any major undertakings to generate new data sets.

Within those constraints, the panel's strategy was to use three mainstream performance measures: reputation survey, citation analysis, and journal publication analysis, it then relied on the convergence of findings to compensate for the specific shortcomings of each measure. Although these measures have some independence, the degree of independence could not be assessed because the panel could not compensate for all of the shortcomings of the methodology.

As shown in Figures 2.1 and 2.2, the United States is clearly dominant in number of papers published in immunology. It produced 63% of the world's high impact (i.e., most cited) papers in immunology in 1981-1996; no other country produced 10%, and only one produced even 5%. Thus, comparisons are made in terms of the United States versus the rest of the world instead of on a country by country basis.

Figure 2.1

Contribution of United States and other nations to high-impact immunology papers in 1981–1996. Source: Calculated from data obtained from the Institute for Scientific Information database on high-impact papers in immunology.

Figure 2.2

Percentage of world's high-impact papers in immunology from 1981–1996, by country. Source: Calculated from data obtained from the Institute for Scientific Information database on high-impact papers in immunology.

2.1.2. Citation Analysis

To identify the most frequently cited authors of immunologic research articles, a ''high-impact" immunology database was commissioned from the Institute for Scientific Information (ISI). (See http://www.isnet.com/products/rsg/impact.html for more information on "high-impact" paper methodology.) The ISI database was scanned over the years 1990-1997. For each year, the 200 most-cited papers in journals relevant to the field of immunology were listed. The authors having more than five papers on the list were ranked according to average number of citations per paper (174 authors ranging from 70.2 to 638.5/paper), and the country of the laboratory of each was listed. In addition, panel staff determined whether each author was also cited on the virtual-congress lists.

The contribution of the United States and other nations to immunology citations from 1981-1997 is shown in Figure 2.3 . Of the 174 authors identified in the scan of the ISI database, 72% including the top 112 authors identified were in US-based laboratories. The ISI database indicates that US laboratories produced 63% of the papers, which garnered 66% of the citations, in journals relevant to immunology during the period 1981-1997.

Figure 2.3

Contribution of United States and other nations to high-impact immunology citations in 1981-1997. Source: Calculated from data obtained from the Institute for Scientific Information database on high-impact papers in immunology.

The major strengths of this mode of analysis are its relative objectivity and its providing a basis of comparison with the virtual-congress polling data. However, the analysis suffers from some flaws related to the organization of the ISI database. Data from several of the top-level general journals (such as Cell) and immunology journals (such as Journal of Experimental Medicine) were not included. In addition, the list of authors is truncated after the first 15 names, possibly excluding authors who participated in large clinical trials. An additional limitation imposed by the database was that there was no breakdown according to subfield and sub-subfield of immunology.

2.2. Results

Although the three criteria for evaluating US research efforts in immunology were quite distinct and had different strengths and flaws they led to basically the same conclusion: immunology research in the United States is pre-eminent in the world. The data supporting that conclusion are summarized below and in the following tables.

2.2.1. Reputation Survey

The data-collection measures for the different sub-subfields proved highly variable, including the number of pollees (3-17), the fraction of US-based pollees (41% -83%), and the number of names cited per pollee (a few to more than 20). In addition, the database for the individual sub-subfields was far too small to permit any kind of statistical analysis. Those points are partially illustrated by some of the entries in Table 2.1. The panel decided to emphasize the data pooled by subfields in which there was generally much less variation in the data-collection measures, although attention was still paid to findings in the context of the sub-subfield groupings for any nuances of interest.

TABLE 2.1

Immunology International Reputation Survey Results.

In all four subfields, a clear majority of the names cited were investigators directing US laboratories 60-70% in all cases. However, the position of leadership was not so evident in some domains, for example:

• In cellular immunology, the sub-subfields of lymphocyte development and self-nonself recognition.
• In molecular immunology, the sub-subfield of NK receptors.
• In immunogenetics, the sub-subfield of inherited immunodeficiency.
• In clinical aspects of immunology, the sub-subfields of tumor immunology and transplantation and immunosuppressive drugs.

In those domains, the proportion of US-based investigators was closer to 50%. The statistical significance of the differences could not be tested, but in general they correspond well to the collective opinion of the panel numbers.

2.2.2. Citation Analysis

The results of the panel's citation analyses are shown in Figure 2.4 and Table 2.2. As shown in Figure 2.4, the top 3 countries for the immunology field based on percentage of the world's citations from 1981-1997 in immunology are:

Figure 2.4

Percentage of world's citations to high-impact papers in immunology in 1981-1997, by country. Source: Calculated from data obtained from the Institute for Scientific Information database on high-impact papers in immunology.

TABLE 2.2

Relative citation impact of high-impact papers in immunology, by country, 1981-1997.

1.

United States

2.

England

3.

Switzerland

Another measure that can be used is relative citation impact (RCI). RCI is the country's share of the world's citations in the field, divided by its share of world publications in the field. It can be thought of as a comparison of a country's citation rate for a particular field with the world's citation rate for the field. A relative citation impact greater than 1 shows that the country's rate for the field is higher than the world's. Some believe RCI is a measure of both the influence and the visibility of a country's research (as disseminated through publications) and it gives some indication of the quality of the average paper. As shown in Table 2.2, the top 3 countries based on relative citation index for 1981-1997 are:

1.

United States

2.

Belgium

3.

Australia

A bit disconcertingly, only 54% of the authors identified in the ISI Immunology high-impact citations were also cited in the survey conducted by the panel. The discrepancy can probably be attributed to flaws in the two approaches, in particular such defects in the ISI database as the exclusion of critical journals such as Cell and the Journal of Experimental Medicine.

2.2.3. Journal Publication Analysis

The results of the journal publication analysis are shown in Tables 2.3-2.7. US-based investigators produced about three-fourths of the immunology papers published in the journals Cell, Science, and Immunity in 1995-1997. US-based researchers contributed about two-thirds of the immunology papers published in Nature in 1995-1997. In contrast, scientists in countries other than the United States published more immunology articles in Blood than US-based researchers in those years (54% and 46%, respectively). The immunological subfield in which an international presence was especially strong was immunogenetics for the papers published in Cell and Blood. However, in Nature, Science , and Immunity, US-based researchers published more papers in immunogenetics than non-US-based researchers. The United States had more papers published in all five journals in the subfield of molecular immunology. The subfield of cellular immunology and clinical aspects were dominated by US-based researchers in all journals examined except Blood. Because of its extensiveness, only 6 months of the Journal of Experimental Medicine was analyzed, as shown in Table 2.8.

TABLE 2.3

Authorship of Immunology Papers in Blood, 1995-1997.

TABLE 2.7

Authorship of Immunology Papers in Science, 1995-1997.

TABLE 2.8

Authorship of Immunology Papers in the Journal of Experimental Medicine, February 1996-July 1996.

TABLE 2.4Authorship of Immunology Papers in Cell, 1995-1997

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Subfield	No.(%) U.S.	No.(%) Non U.S.	Total
Cellular immunology	14(60.9)	9(39.1)	23
Molecular immunology	45(75.0)	15(25.0)	60
Immunogenetics	0(0)	1(100)	1
Clinical aspects	12(75.0)	4(25.0)	16
TOTALS	71(71.0)	29(29.0)	100

Source: Original analysis conducted for this report. Panel members reviewed tables of contents and decided subfields of immunology of each paper.

TABLE 2.5Authorship of Immunology Papers in Immunity, 1995-1997

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Subfield	No.(%) U.S.	No.(%) Non U.S.	Total
Cellular immunology	113(72.9)	42(27.1)	155
Molecular immunology	145(78.3)	40(21.6)	185
Immunogenetics	32(72.7)	12(27.2)	44
Clinical aspects	26(81.2)	6(18.7)	32
TOTALS	316(76.0)	100(24.0)	416

Source: Original analysis conducted for this report. Panel members reviewed tables of contents and decided subfields of immunology of each paper.

TABLE 2.6Authorship of Immunology Papers in Nature, 1995-1997

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Subfield	No.(%) U.S.	No.(%) Non U.S.	Total
Cellular immunology	37(68.5)	17(31.5)	54
Molecular immunology	48(61.5)	30(38.5)	78
Immunogenetics	6(66.7)	3(33.3)	9
Clinical aspects	9(64.3)	5(35.7)	14
TOTALS	100(64.5)	55(35.5)	155

Source: Original analysis conducted for this report. Panel members reviewed tables of contents and decided subfields of immunology of each paper.

2.3. Summary

According to all three evaluation methods, US-based research in immunology plays a dominant role in the worldwide effort. Within the limitations of each measure and the limits of the panel's use of them, the data produce a strikingly consistent outcome: all three approaches assigned a 2:1 to 3:1 dominance vis-a-vis the rest of the world. Of course the dominance needs to be weighed in relation to the relative richness of the United States in numbers of investigators, institutions and resources.

3.1. Funding

Both the US and foreign members of the panel generally agreed that the structure and financial-support mechanisms of the major research institutions in the United States and the structure and mechanisms for provision of research-grant support by government and private granting agencies constitutes a major factor in the success of the US scientific enterprise in immunology and in almost every field of biomedical research.

The reasons have to do with the organization of higher education and research in contrast with the situation in the United States. Many foreign countries, US universities, medical schools, and research institutes are either privately supported or supported by individual state governments-separate administrative units, under the federal system in the United States. Thus, there is a great diversity of private institutions and a great diversity of mechanisms and approaches for funding state-supported institutions and philanthropically supported institutions throughout the United States. Most important the management, regulation, and governance of private institutions are determined by the institutions, and are therefore somewhat removed from the direct effects of federal funding decisions and federal granting agencies.

In contrast, in Europe, Japan, Australia, and several other countries, the central government supports research institutions, universities, and medical schools and allocates research-grant support for specific research projects of specific people. Government regulation of hiring, personnel practices, and many other aspects of operating research laboratories are therefore centrally controlled and do not permit the diversity that is characteristic of the US scientific enterprise. In addition to the diversity of US institutional organization and support, many research programs throughout the United States have enjoyed a greater degree of support from pharmaceutical and biotechnology firms than is true in Europe.

A second major factor in fostering innovation, creativity and rapid development of new technologies is the National Institutes of Health (NIH) model of research-grant allocation and funding: almost all research (except small projects funded by contracts) is initiated by individual investigators, and the decision as to merit is made by a dual-review system of detailed peer review by experts in each subfield of biomedical science.

In this system, a grant is given to an individual investigator, essentially regardless of the investigator's academic rank or position, as long as he or she is given principal investigator status by his or her institution. Almost all institutions grant principal investigator status to scientists at the beginning of their independent careers, almost always after completion of a postdoctoral fellowship. Individual investigators in universities, medical schools, and research institutions are thus empowered to be individual entrepreneurs. They are not subject to any type of review or control of their chosen research subjects by department chairs, other faculty colleagues, or other scientific colleagues in their institutions. This system has prevented the development of hierarchical research groups of the sort that are seen in many other countries, and it has fostered innovation and independent research initiatives to an amazing degree.

Another major source of funding of immunology (and other biomedical subjects) is the Howard Hughes Medical Institute (HHMI). HHMI-selects and retains investigators (rather than projects) largely on the basis of their track record. HHMI-selected investigators are widely regarded as among the most distinguished and productive in the field at both the senior and junior investigator levels. A key to the process has been the selection of external reviewers solely on the basis of their scientific accomplishments and their standing in the field. HHMI provides superb infrastructure for its scientists, who are staff members of HHMI, but whose laboratories are integrated into major academic and research institutions, mainly in the United States. The HHMI scientists are much freer to follow their imaginations and to change the course of their projects than NIH funded investigators, in that the principal evaluation of HHMI investigators is based on productivity, whereas NIH evaluates progress mainly on prescribed projects. The funding of HHMI investigators has substantially enhanced their productivity and has relieved the pressure on NIH to fund meritorious other projects. Additional private sources of immunology funding in the United States are the American Cancer Society, the Juvenile Diabetes Foundation, the Arthritis Foundation, and the Multiple Sclerosis Society.

Funding for training grants for predoctoral fellows and postdoctoral fellows also comes from a wide variety of institutes of NIH and from private sources. Both types of funding have, over the last 40 years, influenced how science is organized in the United States. There are two major results of this entrepreneurial, individual-based system:

• It has led to the development of multiple centers of excellence in immunology and many other fields of biomedical research at many centers around the country.
• Many key research centers are based in or closely attached to large medical centers. This stimulates the expansion and application of immunology to many clinical problems and the study of many problems in basic immunology.

Because immunology research in the United States is based largely in medical institutions and because research, training, and clinical activities go on in parallel in these institutions, interdisciplinary research, development of clinical applications, and the application of basic immunology in solving clinical problems have all been fostered.

Further, NIH and several private funding agencies foster basic scientific training for clinically trained people. Many medical schools have people in their departments of medicine, pediatrics, and surgery with both a full clinical background and a basic-research background in immunology and related fields.

The current apparent eminence of US-based immunologists should not be taken as leadership in all aspects of training and immunology research, however. As shown in Table 3.1, important research in immunology rewarded by Nobel Prizes has been carried out by 16 laureates, 12 of whom were not US citizens (though some now conduct their research in the United States).

TABLE 3.1

Analysis of Nobel Prizes Presented for Immunology Research.

3.2. Human Resources

Its flexibility, diversity, and freedom to originate new approaches has made the United States a very attractive environment for talented researchers from other countries. This has given US research institutions a greater ability than foreign institutions to attract graduate students and postdoctoral fellows from other countries.

The flexibility of funding based primarily on peer review and the merit of applications have made the United States a more attractive country for talented researchers at higher ranks to settle and pursue their research careers. There is a much greater flow of foreign researchers into the United States than the opposite direction because of the lack of barriers (other than language) in the United States.

The US secondary-education system has numerous deficiencies. However, the flexibility allows students, particularly talented students, to obtain research experience in their own institutions and through summer programs, such as those at the Jackson Laboratories and the Cold Spring Harbor Laboratories. Despite those excellent opportunities at the predoctoral level for a small subset of students, the percentage of doctorate recipients with US citizenship in the combined fields of immunology, microbiology, and virology has decreased from 88.0% in 1980 to 77.9% in 1995. This drop of 11.5% in the proportion of recipients with US citizenship is not as steep as the drop of 22.1% in all the life sciences combined (82.4% in 1980 to 64.2% in 1995). The percentage of foreign doctorate recipients in immunology that were planning to obtain postdoctoral fellowships has increased from 7.0% in 1976-1985 to 13.0% in 1986-1996¹ .

3.3. Infrastructure

The United States has been fortunate in the development of mouse genetics, inbred strains of mice, and many other variations of the basic inbred strains that have been fostered and developed at the Jackson Laboratories. A result has been that a much higher percentage of US immunology research is carried out on the laboratory mouse than was initially true in Europe and Asian countries.

The capital investment by the NIH, the National Science Foundation, and private research-granting agencies in infrastructure, equipment, and buildings for research has been a major source of growth in immunology and many other fields of biomedical research in the United States.

But European countries have proved more adept at large-scale clinical research projects in immunology than the United States, where the great diversity of institutions and institutional support has balkanized the research effort. This works to the detriment of efficient, large-scale clinical research in the United States, once basic research has led to the development of new therapeutic approaches. The European adeptness is due to many factors. In some cases, it is because of the centralized government control of medical schools and research institutions. In others, it is because physicians are able to maintain a single life-long comprehensive record of patients, which makes it easier to randomize individual patients or practice. Furthermore, in some countries, such as the United Kingdom, clinical-trial methodology has been a special interest of the medical research council and by a national policy that uses randomized trials as a way to introduce new treatment or diagnostic tests.

3.4. Biotechnology and Pharmaceutical Firms

Because of the nature of the venture-capital industry in the United States, the greater flexibility of this industry, and its willingness to fund small biotechnology startup firms, particularly those involved in molecular biology and recombinant-DNA technology, there has been a remarkable growth in biotechnology and a gradual shift of those firms into large pharmaceutical firms. In the last 7 years, although the number of biotechnology companies worldwide has been rather static at approximately 1,275, the amount of money spent on research and development by the industry has almost doubled from $4.9 billion to $9.9 billion (Ernst & Young, 1998a). The result of this phenomenal growth has been the creation of a new source of employment for PhD and MD trainees in immunology, which has attracted many graduate students into immunology.

Industrywide data on the amount of money spent on immunology-specific research are not available, so the panel chose to examine trends in industry-supported research for the entire biotechnology industry. Biotechnology industry support for research is much greater in the United States than in Europe as shown in Tables 3.2-3.3 (Ernst & Young, 1998b). This financing of research and the use of many academic researchers for consultation in biotech firms and large pharmaceutical firms have provided relatively direct avenues for postdoctoral immunologists to obtain employment, to move across disciplines, and to capitalize rapidly on technology developments that are fostered primarily in biotech firms. In addition, the role of many US academic researchers in founding or participating in the founding of biotechnology firms has enhanced the linkage between academic and industrial research in immunology. In some cases (decidedly a minority), the necessity for patent protection has sometimes impeded the flow of information from research developments in biotechnology and pharmaceutical firms. The ability of biotech firms and large pharmaceutical firms to take discoveries from academic research into startup companies and then large firms and into clinical application has been an overall benefit for the development of clinical immunology in the United States. This entrepreneurial approach has also translated into an economic advantage for the United States over other countries. As shown in Figure 3.1, the United States has a net positive trade balance in biotechnology-based products that was in the low $600 million range in 1990, rose to almost $1 billion in 1994 and then decreased to about $650 million in 1996. (NSF, 1998: Appendix Table 6-6)

TABLE 3.2

Biotechnology Industry Comparable Metrics (Ecu in Millions).

TABLE 3.3

Entrepreneurial Life Science Highlights (Ecu in Millions).

Figure 3.1

U.S. net trade balance: biotechnology, 1990-1996. Source: NSF, 1998.

3.5. The Clinical Trial

There is a shortage of people in the United States trained to design and administer large-scale trials of new immunology-based therapies. In addition, the impact of managed care has narrowed the patient base available for this type of clinical research, except in large, nonprofit managed-care organizations, such as the Kaiser-Permanente organization.

4.1. Funding and Resource Limitations

Current optimism as to the sustained US leadership in immunology is based in large part on a positive attitude toward NIH in the US Congress. That attitude is indicated by the proposals in the last year to double the NIH budget in the next 5-10 years. It must be recognized, however, that this could change. A return to the funding situation of the late 1980s and early 1990s, with low pay grades and administrative cuts in funded-grant applications, could possibly harm the US leadership position by driving investigators and students away from biomedical research in general. It must be recognized that, despite important contributions from the biotechnology and pharmaceutical industries, NIH remains the engine that drives immunology.

The current practice of protecting intellectual property has the potential to restrict the two-way flow of information between academic institutions and the biotechnology industry in the life sciences, including immunology. That applies to reduction in sharing both research materials and information. If the situation occurs on a broad scale, opportunities to explore promising research projects might be restricted.

The growth in the number of material transfer agreements (MTA) that are often overlegalistic and protective of the broadest possible outcomes of the use of potentially proprietary materials has spawned technology-office bureaucracies in industry and in academic institutions; these offices can delay material transfer for months. It would be of great use if a simple, direct, legally binding, universal MTA for both industry and academe could be created and ratified by agreement or use.

The increasing cost of maintaining mouse facilities has raised serious concern among academic researchers. Although the cost of the mice is reasonable, as is the cost of the component of their care that includes husbandry, housing, feeding, and cleaning, as long as the charges match the costs on a species-specific basis, very large increases in charges often result for the following reasons: specialized veterinary care, which for all species is usually distributed in a species-nonspecific fashion, as are administrative and staff costs; the increased personnel efforts that are required to meet regulatory-compliance needs; and Office of Management and Budget (OMB) indirect-cost allotments.

For example, one US biomedical institution switched from nonspecies-specific allocation of costs to species-specific allocations (using an independent accounting firm) and lowered mouse charges by 30-40% (Stanford Medical School, 1998). Its former assessed charges exceeded by a factor of 2-5 the actual costs at institutions that use only mice for their research. The high mouse charges are common in the United States, but most laboratories in Europe and Japan are costed more directly or are subsidized. If this trend continues, many US researchers will have great difficulty in financially supporting mouse facilities.

Actions by major funding agencies could relieve much of the burden: First, all costs and resulting charges could be strictly species-specific. Second, cost-accounting for simple husbandry could be separated from that for veterinary-intensive care. Third, efforts to simplify (and, when appropriate, eliminate) regulatory-compliance requirements could be undertaken. Fourth, the A-21 set of guidelines from OMB regarding indirect cost charges for federally-funded research could be reevaluated as to whether animal facilities can be removed from the special-services category, so that indirect costs could be lowered.

4.2. Increased Competition from Europe and Other Countries

In many countries, there appears to be a trend away from the customary hierarchical systems of funding, research, and employment of scientists toward the US system of competitive peer review. There also appears to be a trend toward better funding from government and private agencies and an increasing emergence of the biotechnology industry in many European countries. Together, those factors will enhance the quality of non-US immunology and make it more competitive.

4.3. Clinical Immunology and the Shift toward HMOs

The clinical impact of immunology has long been limited by clinical subspecialization. For example, although the clinical practice of allergy is separate from other aspects of clinical immunology (such as rheumatology), basic and clinical research in the two fields overlap extensively. Until recently, clinical immunology barely existed as a definable field. Although the situation had shown signs of improving, reports (May et al. 1997; Campbell et al. 1997) indicate that the increasing dominance of HMOs in funding medical care in the United States potentially has an increasingly adverse effect on clinical research in general and clinical immunology in particular. This are several reasons. For example, HMOs compete for patients with academic clinicians, and this means that fewer patients are available for academic clinical trials; this poses a loss of a source of income that has traditionally been a source of funding for academic clinical research and a concurrent loss of jobs and opportunities for training of clinical immunologists.

Figure 4.1 shows the number of US citizens and permanent resident PhD students in immunology, and Table 4.1 and Figure 4.2 show the degree to which they are supported by NIH. As shown in Figure 4.1, the number of PhD students in immunology research has roughly doubled over the last 20 years. The percentage of these students supported by NIH has varied between 30 and 40% according to Table 4.1 and Figure 4.2.² Foreign students are not eligible to receive NIH training grants. The panel believes that this level of funding combined with the increasing time to degree and low wages influenced the quality of US students who entered immunology programs.

Figure 4.1

Number of PhD students in immunology in the United States, 1977-1996. Source: Analysis conducted by National Research Council's Office of Scientific and Engineering Personnel of Survey of Doctorate Recipients for this study.

TABLE 4.1

NIH Trainee and Fellowship Support in Immunology.

Figure 4.2

Percentage of US citizen and permanent-resident PhD students in immunology supported by National Institutes of Health, 1977-1996. Source: Analysis conducted by National Research Council's Office of Scientific and Engineering Personnel of Survey of Earned (more...)

4.4. Training of US Students

Panel members perceive the quality of US graduate students and postdoctoral fellows in immunology to be declining. Several factors might contribute to a decline in quality. The trend toward department structures in which students are admitted into a large multidisciplinary program before choosing a specialty offers more varied opportunities for students. Because immunology is often, although inaccurately, viewed as too specialized and less interdisciplinary than other fields, students might be choosing other fields that are considered more general. Graduate study (of 5-7 years) followed by 3-5 years of postdoctoral training at salaries less than those of technicians might lead many talented young US citizens to choose other fields of endeavor. There is also a loss of MD talent in the field because of the cost of education and the salary differentials after completion of degree work.

In the United States, while there has been a downward trend in the number of PhD immunologists in academic positions, there has been a steady increase in the number of non-tenure-track appointments as shown in Table 4.2. In the early 1980s, 50% of immunologists with academic appointments had tenure or were in a tenure-track. In 1995, the proportioned had decreased to about 40%. In the last 15 years, there has been an even more rapid increase in immunologists in industrial careers. Only about 10% of PhD immunologists went into industrial positions after completing their training in 1981, and almost 25% in 1995. The unemployment rate has remained very low³ . Data for comparisons with other countries were unavailable.

TABLE 4.2

Employment Status of Doctorates in Immunology.

5.1. The United States Is the World Leader in All the Major Subfields of Immunology But Is Only Among the World Leaders in Some Specific Sub-Subfields.

On the basis of the results of three benchmarking methods—a virtual-congress survey, citation analysis, and publication counts—the United States appears to be preeminent in immunology. Furthermore, it leads in all four of the subfields examined: cellular immunology, molecular immunology, immunogenetics, and clinical aspects of immunology. That is not a surprising result, given the size of the US enterprise, which writes some 60% of the immunology papers published each year. However, what is of greater interest, given the size of the enterprise, is that in some sub-subfields the United States is only among the world leaders: lymphocyte development and self-nonself recognition, inherited immunodeficiency, tumor immunology, and transplantation and immunosuppressive drugs.

The inherent flaws of each method make rigorous and exact assessment of US leadership impossible. However, these approaches do yield an estimation of the present standing of the United States in immunology. Because the exploration of immunology is an international endeavor, the high degree of cooperation and collaboration among US and non-US scientists should be highlighted.

Current US leadership has been documented by a number of quantitative and semiquantitative measures, but these measures do not show the breakthrough discoveries that are recognized by such awards as the Nobel Prize (half the immunology awardees were non-citizens). Nor do they reveal that a very significant fraction of the leading US scientists received some of or all their training in non-US institutions, mainly as nationals in other countries; several of these were Nobel laureates for research done outside of the United States.

5.2. Flexibility to Pursue Original and Innovative Research Ideas Has Attracted Both Domestic and International Human Capital. Federal, State, and Private Funding have all Contributed to a Climate Ripe for this Innovative Research.

The United States has been able to attract talented foreign students to be both graduate and postgraduate investigators in immunology laboratories to a greater degree than other countries have been able to attract US students. That is in part due to the research opportunities available within the United States for these students as they seek to advance their careers. In the United States, more than in other countries, high-school and college students have the opportunity to gain research and analytical experience by working in laboratories and attending specialized science programs.

The NIH has been the major federal funding agency for immunology research. The strength of this system is that it is largely an investigator-initiated, peer-reviewed, and merit-based system of awarding grants. Critically, it is the individual investigator—rather than the department chair or other research colleagues, as it often is in many European countries—that has the authority and autonomy to pursue a specific research interest. Unlike many foreign countries, the United States supports research institutions and medical schools through state governments and private foundations, and this allows the freedom and flexibility to develop innovative research programs.

5.3. Industrial Interests Have Fostered Many Striking Breakthroughs in Immunology.

Substantial funding of the biotechnology industry by venture capitalists and other investors has resulted in the successful generation of many products to sell in the international market. Venture-capital financing of the biotechnology industry increased by 11.7% from $697 million in 1996 to $790 million in 1997. (BIO, 1997; BIO, 1998) In addition to creating an economic benefit to the United States, the success of the US biotech industry has resulted in the creation of new jobs for immunology graduates. And, the collaboration between academic and industrial researchers has allowed scientific discoveries to be rapidly developed and commercialized, in contrast with what has been observed in many other countries.

5.4. A Scarcity of Large-Scale Clinical Trials in Immunology Can Be Attributed to Shortages of Funding and of Qualified Personnel. In Addition, Increasing Dominance of Managed Care Means That Fewer Patients Are Available to Academic Institutions for Clinical Trials.

The expense of a large-scale clinical trial often proves prohibitive, especially when there is fierce competition among institutions and between research interests for limited funding dollars. European countries, because of their centralized government control of medical schools and research institutions have been able to support large-scale clinical trials more successfully than the United States. Anecdotal evidence indicates a decrease in trained clinical immunologists to serve as principal investigators for such trials in the United States. Lack of funding and training opportunities has contributed to the growing scarcity. Furthermore, the advent of the managed care has decreased the patient base for this type of clinical research.

5.5. Shifting Federal and Industry Priorities, a Potential Reduction in Access to Domestic and Foreign Talent, and the Increasing Cost of Maintaining Mouse Facilities Could Curtail US Ability to Capitalize on Leadership Opportunities.

Continued US leadership in the various subfields of immunology is not guaranteed. It depends on trends and sudden changes in the United States and abroad in funding, human resources, and infrastructure support. NIH has received increases in its annual budget from Congress, and the increases have resulted in the funding of more investigator-initiated grants in many fields of research, including immunology.

The trend of creating multidisciplinary graduate programs at large universities has resulted in competition for immunology graduate students and postdoctoral fellows. In addition, there is a substantial decrease in medical doctors seeking to specialize in immunology, in part probably, because of the cost of such an education and the low salary offered during the training period. Other countries, particularly those in Europe, seem to be moving away from the restrictive funding and tight employment environments that have been characteristic of their scientific research institutions. That raises the possibility that foreign students will elect to seek training and jobs in their own respective countries. The loss of talented students in immunology, both domestic and international, would have profound implications for the ability of the United States to maintain its leadership role.

One subject of particular concern to the panel was the lack of adequate funding and specific cost-based accounting for maintaining mouse facilities at most research institutions. Because much immunology research involves the use of mice, this resource is critical to the development of the field.

Panel

Irving L. Weissman (Chair) received his MD from Stanford University in 1965. He pursued training in experimental pathology at Oxford University and continued his postgraduate fellowship at Stanford University. Dr. Weissman is the Karel and Avice Beekhuis Professor of Cancer Biology, professor of pathology, professor of developmental biology, and, by courtesy professor of biological sciences at Stanford University. He has received the Outstanding Investigator Award from the National Institutes of Health, the Pasarow Award for Outstanding Contribution to Cancer Biology and the Harvey Lecture, and the Montana Conservationist of the Year Award. He is a member of the National Academy of Sciences, the American Association for the Advancement of Science, the American Academy of Arts and Sciences, the California Academy of Medicine, and the Israel Immunological Society. He has served as president of the American Association of Immunologists. He was the cofounder of the biotechnology companies Systemix, Inc., and Stem Cells, Inc.

James Allison received his PhD from the University of Texas, Austin in 1973. He did postdoctoral work at the Scripps Clinic and Research Foundation in La Jolla. Dr. Allison is professor of immunology, director of the Cancer Research Laboratory, and a Howard Hughes Medical Investigator at the University of California, Berkeley. Selected awards and honors include a merit award from the National Institutes of Health and, election into the National Academy of Sciences and the American Academy of Microbiology. He serves as a councilor to the American Association of Immunologists and is a member of the Board of Scientific Counselors for the National Cancer Institute.

Frederick W. Alt received his PhD in biological sciences at Stanford University, where he worked with Robert Schimke and discovered the phenomenon of gene amplification in the context of cellular resistance to anticancer drugs. In 1982, he joined the faculty of the College of Physicians and Surgeons of Columbia University in New York, where he became professor of biochemistry and molecular biophysics and, professor of microbiology. In 1987, he became a Howard Hughes Medical Investigator at Columbia University. In 1991, Dr. Alt became senior investigator at the Center for Blood Research in Boston, in addition to serving as a Howard Hughes Investigator at Boston's Children's Hospital. He is professor of genetics and pediatrics at Harvard Medical School, chair of the NIH allergy and immunology study section and of the Irvington Institute Scientific Advisory Board. He is a member of the National Academy of Sciences, the American Academy of Microbiology, and the American Academy of Arts and Sciences. Among his many honors are the Irma T. Hirschl Career Scientist Award, the Searle Scholars Award, the Mallinckrodt Scholar Award, and an NIH Merit Award.

Harald von Boehmer studied medicine at the Universities of Gottingen, Frieburg and Munich and prepared his medical thesis at the Max Planck Institute for Biochemistry. He is an adjunct professor in the Department of Pathology, University of Florida, Gainsville, and professor of immunology, University of Basel, and, Faculte de Medecine Necker Enfants Malades, Descartes University, Paris. He is the director of 373 of the National Unite Institute of Science and Medical Research, France. He is a member of the Institut Universitaire de France, Academia Europaea, the European Molecular Biology Organization, the New York Academy of Sciences, Gesellschaft fur Immunologie, the American Association of Immunologists, and the Scandinavian Society for Immunology. Dr. von Boehmer has been awarded the Louis Jeantet Prize for Medicine, the Avery-Landsteiner Prize for Immunology, the Paul Ehrlich and Ludwig Darmstaedt Prize, and the Korber Prize for European Science. He chairs the Executive Committee of the European Journal of Immunology.

Max D. Cooper received his MD (1957) and training in Pediatrics (1958-1960) at Tulane Medical School. He was a house officer and research assistant at the Hospital for Sick Children, London(1960-1961), and a pediatric-allergy fellow at the University of California, San Francisco Medical Center (1961-1962). His postdoctoral research in the laboratory of Robert Good (1963-1967), led to the definition of separate T-and B-cell lineages. Dr. Cooper is professor of medicine, pediatrics, pathology, and microbiology at the University of Alabama at Birmingham; senior scientist at the University of Alabama Comprehensive Cancer Center; professor of medicine and director of the Division of Developmental and Clinical Immunology at the University of Alabama; and a Howard Hughes Medical Investigator. He is a member of the National Academy of Sciences and in 1990 was elected to the Institute of Medicine. He was inducted as a fellow in the American Association for the Advancement of Science. Dr. Cooper served as president of the American Association of Immunologists and of the Clinical Immunology Society. Among his awards are the 3M Life Sciences Award, the Sandoz Prize for Immunology, and the American College of Physicians Award.

Irwin Feller is the director of the Institute for Policy Research and Evaluation and professor of economics at the Pennsylvania State University, where he has been on the faculty since 1963. Dr. Feller was an American Society for Mechanical Engineering Pennsylvania State Fellow for 1996-1997. Dr. Feller's research interests include the economics of academic research, the university's role in technology-based economic development, and the evaluation of federal and state technology programs. He was chair of the Committee on Science, Engineering, and Public Policy, American Association for the Advancement of Science.

Laurie H. Glimcher received her MD at Harvard Medical School in 1976. She was an intern and resident at Massachusetts General Hospital and a postdoctoral fellow under the direction of William Paul at the National Institutes of Health. Dr. Glimcher is a physician in the Division of Rheumatology and Immunology at Brigham and Women's Hospital, professor of medicine at Harvard Medical School, and Irene Heinz Given Professor of Immunology at the Harvard School of Public Health. She received a Merit Award from NIH, was elected into the American Academy of Arts and Sciences, and received the Lee S. Howley Award from the Arthritis Foundation. She serves on the corporate board of directors for Bristol-Myers Squibb. She is a councilor of the American Association of Immunologists.

David V. Goeddel received his PhD in biochemistry in 1977 from the University of Colorado in Boulder. He was a postdoctoral fellow at the Stanford Research Institute. Dr. Goeddel is the president and chief executive officer of Tularik, Inc. He is a fellow of the American Association for the Advancement of Science and a member of the American Academy of Arts and Sciences, the National Academy of Sciences, and the American Academy of Microbiology. Dr. Goeddel serves on the editorial review boards of Immunity and Nature Biotechnology. His research interests include cytokine signaling mechanisms and small-molecule therapeutics that act through regulation of gene expression.

Hugh McDevitt received his MD from Harvard Medical School in 1955. He was an intern in medicine at Peter Bent Brigham Hospital, a resident in medicine at Bellevue Hospital, and a postdoctoral fellow in the Department of Bacteriology and Immunology at Harvard Medical School. Dr. McDevitt is professor of medicine and of microbiology and immunology at Stanford University School of Medicine. He has received the 3M Life Sciences Award, the Paul Erlich Prize, and Outstanding Investigator Award from NCI and NIH, the Barbara Davis Diabetes Award, and the Paul Klemperer Award from the New York Academy of Sciences. He became a member of the National Academy of Sciences in 1977, of the Institute of Medicine in 1983, and of the Royal Society of London in 1994.

Diane Mathis received a doctorate in biology from the University of Rochester, New York in 1977. She is the director of research, INSERM, LGME, and Institut de Genetique et de Biologie Moleculaire et Cellulaire (IGBMC) in Strasbourg, France. She serves on the editorial boards of the European Journal of Immunology, Immunology Today, Comptes Rendus de l'Academie des Sciences de Paris, Science, Cell, Current Biology, Journal of Experimental Medicine, and Immunity.

Gustav Nossal studied medicine at the University of Sydney and after 2 years of residency at the Royal Prince Alfred Hospital moved to Melbourne to work as a research fellow at the Walter and Eliza Hall Institute of Medical Research, where he received a PhD. Apart from 2 years as an assistant professor of genetics at Stanford University, 1 year at the Pasteur Institute in Paris, and 1 year as a special consultant to the World Health Organization, Sir Nossal's research career has been at the Hall Institute. He was the director of the institute from 1965 until he retired in 1996. Sir Nossal was also professor of Medical Biology at the University of Melbourne. Sir Nossal's eminence in immunology has been recognized by his election as president of the 25,000-member International Union of Immunological Societies. Included among his international honors is his election to the US National Academy of Sciences and his membership in the Academie des Sciences (France). He has also served as president of the Australian Academy of Science and chair of the global programme for vaccines and immunization of the World Health Organization. Sir Nossal was knighted in 1977 and made a Companion of the Order of Australia in 1989.

Roger M. Perlmutter received his MD and PhD from Washington University (St. Louis) in 1979. Thereafter, he pursued clinical training in internal medicine at the Massachusetts General Hospital and the University of California, San Francisco. He was a lecturer in the Division of Biology at the California Institute of Technology, where he studied the genetic basis of antibody repertoire diversification. He joined the departments of medicine and biochemistry and the Howard Hughes Medical Institute at the University of Washington (Seattle), where he became professor and founding chair of the Department of Immunology. In 1997, he left the University of Washington to assume responsibility for drug-discovery efforts at the Merck Research Laboratories in Rahway, NJ. Dr. Perlmutter has served on numerous scientific advisory and review panels and is a councilor of the American Association of Immunologists and a member of the Board of Directors of the Federation of American Societies for Experimental Biology.

Craig B. Thompson received his MD from the University of Pennsylvania in 1977. His internship and residency were at the Peter Bent Brigham Hospital. Dr. Thompson is a professor in the Department of Medicine and Molecular Genetics and Cell Biology at the University of Chicago and a Howard Hughes Medical Investigator. He has received the Jerome W. Conn Award for Distinguished Research by a Junior Faculty Member. He serves on the editorial boards of Cell, Immunity, and International Immunology.

Don C. Wiley was an NSF graduate fellow in biophysics at Harvard University and received his PhD in biophysics in 1971. Dr. Wiley is a professor of biochemistry and biophysics at Harvard University, a Howard Hughes Medical Investigator, a research associate in medicine at the Boston Children's Hospital, and an affiliate of the Department of Chemistry and Chemical Biology at Harvard University. He has been elected to numerous honorary societies, including the American Academy of Arts and Sciences, the American Association for the Advancement of Science, and the National Academy of Sciences. Among his awards are the Louisa Gross Horwitz Prize, the William B. Coley Award for Distinguished Research in Fundamental Immunology, the V.D. Mattia Award, the Passano Foundation Award, the Emil von Behring Prize, the Gairdner Foundation International Award, the Albert Lasker Basic Medical Research Award, and the Rose Payne Distinguished Scientist Award.

Staff

Deborah D. Stine is the study director and associate director of the Committee on Science, Engineering, and Public Policy (COSEPUP). She has worked on various projects throughout the National Academy of Sciences complex since 1989. She received a National Research Council group award for her first study for COSEPUP on policy implications of greenhouse warming and a Commission on Life Sciences staff citation for her work in risk assessment and management. Other studies have addressed graduate education, responsible conduct of research, careers in science and engineering, environmental remediation, the national biological survey, and corporate environmental stewardship. Dr. Stine received a PhD in public administration, specializing in policy analysis, from the American University. Before coming to the Academy, she was a mathematician for the US Air Force, an air-pollution engineer for the state of Texas, and an air-issues manager for the Chemical Manufacturers Association.

Tamara Zemlo is a Cancer Prevention Fellow at the National Cancer Institute (NCI), where she is researching the risk factors for the progression of low-grade cervical disease to cervical cancer. She is also participating in analyzing data from the ASCUS/LSIL Triage Study, which is an NCI-sponsored clinical trial designed to determine the optimal management plan for low-grade cervical cytologic abnormalities. She received a PhD in oncology from the University of Wisconsin—Madison, where she studied the transforming properties of papillomavirus replication proteins in tissue culture, and a Master's of Public Health from Harvard University. As part of her postdoctoral training, she has an internship at COSEPUP.