With all due respect to Shakespeare, the impact of nomenclature should not be underestimated. Words are both effective and affective. They send a signal to the listener but may have an even more pronounced effect on the mind of the speaker. During a four-year stint I finished in 2010 on the National Institutes of Health Recombinant DNA Advisory Committee, the committee was repeatedly reminded that we should not speak of “gene therapy.” “Gene transfer research” (the preferred terminology) was resurgent in those years as the science made progress in safety and efficacy, and some time had passed since the tragic death of Jesse Gelsinger as a direct result of his participation in such a study. But by no means was the language of treatment considered appropriate—at least according to the powers that be at NIH. I suspect that investigators and patients who were considering enrollment on gene-transfer clinical trials might have had a different opinion. The former were attempting to develop treatments for a variety of diseases, and the latter wanted to benefit from the clinical science. Fast forward to August of 2017, when the Food and Drug Administration approved chimeric antigen receptor T cell (CAR-T) therapy for relapsed childhood acute lymphoblastic leukemia (ALL). This ex vivo genetic manipulation of a patient's own T-lymphocytes marks a major success in translational research, a landmark in cancer history, and a sign of good things to come in personalized medicine. Unfortunately, since CAR-T infusion is often associated with a life-threatening cytokine release syndrome, the approval was limited to a small number of centers with the expertise to manage this toxicity. Despite the risk, this is the most dazzling clinical science to come along in the nearly thirty years since I started my fellowship in pediatric oncology. And yes, with the imprimatur of the FDA, it is now acceptable in this case to use the term “gene therapy.” The question of what to name this activity reflects a longstanding debate in research ethics. Is it ever correct to talk about “therapeutic research?” What are the risks of promoting false hopes? During the era in which many aspire to build a learning health care system, perhaps one size does not fit all. High-risk, high-reward research like that which led to the development of CAR-T therapy seems to me to be categorically different from low-risk population-based research that leverages the electronic medical record and the power of big data. Thoughtful attention to such distinctions and to key transition points like FDA approval is the foundation for thinking about research, innovation, progress, and treatment in biomedicine. So, as long as there is a commitment to quality informed consent processes, count me in as comfortable talking about “therapeutic research.” The story of CAR-T doesn't end here, though. The cost is slated to be $475,000 per treatment course, with the expectation that one infusion will be sufficient. The chutzpah of charging a patient that much for getting an infusion of his or her own cells (albeit transformed) is considerable. Other recent breakthrough drugs for cystic fibrosis and hepatitis C have also been triggers for sticker shock. What are the justifications for such pricing, and how, if at all, might we think about limiting the cost? With a commitment to free-market approaches to drug development, we may be moving inexorably toward creating unobtainable cures. Progress against cancer happens in fits and starts. CAR-T represents a double-edged sword, a seemingly miraculous start coupled with a cautionary tale of clinical risk and cost. Having cared for many children who have died of ALL and having also seen how the late effects of our best treatments can impair quality of life, I pray that in the coming years we can maximize the benefits, minimize the cost and the harm, and help cancer patients survive and thrive. I would call that success.