Are U.S. Math Students Just Average or Mediocre?

A new research study, Reassessing U.S. International Mathematics Performance: New Findings from the 2003 TIMSS and PISA, re-examines U.S. student's performance on international examinations by comparing their scores to the other 11 developed countries who participated at all three levels, 4th, 8th grades and 15-year-olds reports. Their findings show that within this group of these 11 countries, U.S. 4th graders where 8th overall and the other two groups were 9th.
There recommendations are to strengthen instructional in foundational skills, but can this be accomplished when far too many of the teachers teaching math do not have the "Profound Understanding of Fundamental mathematics (PUFM)" as reported by Liping Ma in her interesting book and a must read for every stakeholder in mathematics education, The Teaching and Learning of Elementary Mathematics?