A thoughtful editorial from Hal Sox, the outgoing editor of the Annals of Internal Medicine entitled Medical Journal Editing: Who Shall Pay? discusses the intense editorial process at the Annals and raises the question whether such a process is ultimately sustainable and if so who should pay. Annals is a subscription journal, which also, as Sox notes, derives income from pharmaceutical advertising - both of which revenue streams are decreasing for many journals. Though of course the subscription model is not the only one that can work for journals, it is true that professional editors in all types of journals have an important role to play, including for example in setting and maintaining standards in publication ethics. He ends by noting "The main lesson of my tenure at Annals is the importance ofprofessionals—volunteer reviewers and editors—whoread manuscripts critically, discuss them, and help authorsto improve them."