Three papers and a number of commentaries in this month's issue deal with the question of money in medicine. The mix of money or markets with health invariably generates strong intuitions and moral disagreement. The spirit of medicine seems to run counter to the motivations generated by financial gain. In spite of this it would be difficult in the current world to defend the claim that all traces of money should be removed from the day-to-day operation of healthcare and medical research.

The papers in this issue that deal with this question do so from three different perspectives: using tax to incentivise organ donation, paying doctors for their performance and the involvement of the pharmaceutical industry in the media.

Promoting organ donation without an opt-out system

This month's feature article addresses the increasingly difficult problem in the medicine surrounding the numbers of organs that are donated for transplant. Petersen and Lippert-Rasmussen vividly document the problems that the shortfall of donated organs causes. These problems are worse in western countries that have an opt-in system of organ donation but given the political climate in countries like the US, UK and Denmark this is unlikely to change. Petersen and Lippert-Rasmussen begin from this situation and argue for a tax-relief model for incentivising organ donation. (See page 451)

Not only does the lack of donated organs mean that people whose lives could be saved are not but for some organs, it can also mean a general deskilling of the profession. If enough transplants do not take place the opportunities for training new transplant surgeons will be limited as will the ability of practicing surgeons to maintain their technical edge. Particularly in the case of lung and heart transplants, surgeons need to be performing a certain number of procedures …