This text provides a comprehensive review of the ethical issues involved with the development, evaluation, and introduction of new treatments of gastrointestinal diseases.  How several landmark surgical innovations were developed are described to show the challenges faced, and the ethical dilemmas these innovators dealt with.  The challenges of dealing with regulatory issues, and how to work with industry partners, and investors when working on a new therapy is described.  Once a new technology has been brought to the market, standards need to be developed regarding the training, credentialing and adoption of the new technology.  There are insufficient standards of how to balance the desire to provide patients the latest therapy with the obligation that patients receive informed consent about the new technology, and the relationship that the physician may have had with product development.   The book describes the national perspective of paying for new technology, and provides one insurance company’s approach to the introduction of innovative therapy.