In Reply I agree with Dr Moyé’s point that it is important that thebusinessof researchbea smallerproportionof theNIHdollars. But it cannot simply be that research institutions absorb more costs. The NIH too must try to streamline the paperwork and bureaucracy of actually receiving a grant and complying with all of its requirements. This would be consistent with PresidentObama’s executive order to reduce the burden of regulations.1 Mr Ma asserts NIH funding is such a small proportion of biomedical research funding that it is not responsible for much of the costly technology that drives up health care costs. If true, this claim would undermine the very argument to increase NIH funding. Assuming Ma’s viewpoint, opponents of NIH funding could argue that because the NIH covers such a minor part of biomedical research funding overall, cutting it will not hinder the important progress of medicine. In other words, NIH funding could be cut without worrying that new discoveries will be foregone. This seems a terrible defense of NIH funding. In addition, I didnot argue that theNIH should focus only on funding research into cost-lowering advances. Instead I argued that cost-lowering advances should be part of the NIH focus in away that it has never been. It currently plays no role in deciding what research projects to fund. My view is that it ought to be a criterion in evaluating grants for funding moving forward. Dr Arbiser seems to think that I argued against bevacizumabbecause it is anoncurativedrug. But that iswrong. The problem with bevacizumab is that it has minimal effectiveness. It is not its noncurative properties that worry me. Imatinib does not cure chronicmyeloid leukemia, but it is nevertheless avaluable addition to theanticancer armamentarium.2 If bevacizumab prolonged the life of cancer patients an average of 5 years, but cured no person of cancer, it would still be worthwhile. But unlike antiretroviral drugs for human immunodeficiency virus or imatinib, bevacizumab gives patients with metastatic colorectal cancer about an extra 4months of life at costs of more than $100 000 per quality-adjusted life-year.3 And for other cancers (such as lung) bevacizumab adds even fewer months, and costs can exceed $500 000 per quality-adjusted life-year.4 Unlike Arbiser, I would not advocate strongly that on averageNIH funding creates jobs and thriving small businesses. Doubtless therehavebeen several successful startupbiotechnology companies such as Amgen and Genentech that have generated large profits and good jobs. However, taken as a whole, thebiotechnology industry is still a net financial loser.5 That is, more capital has been poured into the failing companies than theeconomic returnsgeneratedby thesurvivingsuccessful companies. Furthermore, the current evaluations suggest that growth in health care costs have been an economic drag, not an economic boon.6 Themorehigh technologyused inmedicine, suchasbevacizumab, thehigherhealthcarecosts, and the slower theUSeconomygrows.Theargument that biomedical research has been good in fueling economic growth is simply wrong.