To the Editor Dr Emanuel ascribed much of the blame for increasing health care costs to biomedical research, and cited increasing costs as a major reason for the decrease in real dollars for NIH funding. He pointed out that the NIH must demonstrate its ability to lower costs. The true picture is far more complex. First, Emanuel used bevacizumab as an example of an expensive, noncurative drug. Other examples of noncura-tive drugs that have had a major effect on health are statins and antiretrovirals. These drugs do not cure coronary artery disease or human immunodeficiency virus but do prolong life. Even the example that Emanuel cited as a triumph, the Hemophilus influenzae type B vaccine, could be seen as increasing costs because individuals saved by this vaccine could eventually develop expensive diseases as the population ages. Second, a major factor in the cost of new drugs is expenditures for drug development, which need to be recouped. The average cost of drug development in the United States is in the hundreds of millions of dollars. Regulatory costs are the major contributor. In fact, the cost has become so high that advances that are made by NIH-funded research often never make it to early pharmaceutical development because even though the research shows efficacy in animal models, it is it still too risky for pharmaceutical companies to invest in the novel technology. To remove the risk of drugs in development, pharma-cokinetic and toxicology studies must be performed but there are few funding mechanisms for this. Third, Emanuel discussed the politicization of science. An additional approach would be to emphasize the role of NIH research in stimulating small business development. Additional small business means increased economic growth, and economic growth is vital to addressing the budget deficits. The economic growth potential of biomedical research can be used to compete for funding with other priorities.
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