“Global technological competitiveness” is widely acknowledged, but the challenge is to go beyond this recognition to develop empirical indicators of important transitions. These may concern particular technologies, the competitive position of particular organizations, or national/regional shifts. For decades, the US has been the world leader in biomedical technologies, with attendant implications for organizational priorities in terms of R&D location and market targeting. Recent years have seen a tremendous acceleration in Asian research in most domains, including biomedical, particularly visible in China. This paper investigates comparative patterns between the US and China in a promising emerging area of biotechnology — Nano-Enhanced Drug Delivery. It then explores indicators of, and implications for, future transitions at the national level — an approach we label “Forecasting Innovation Pathways.”