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It has recently been argued that people with motor neurone disease (MND) are living longer because of improvements in symptomatic care.1 However, this conclusion is based on an analysis of selected patients recruited into the placebo arm of trials. Population-based studies should be more representative estimates of outcome, and, in a recent systematic review, Chio observed median survival of 30 months from onset to death in patients from registries, but there was little information regarding trends in survival.2 Mateen et al (see page 1144) describe the outcome in patients diagnosed in Olmsted County, Minnesota, between 1925 and 2004. …
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