In his thoughtful ‘reality check’ on the future of healthcare Roy Moynihan lists 10 reasons to be optimistic.1 His first four developments are particularly pertinent to the concerns addressed in Smith and Wessely's paper.2 Moynihan cites the drive for an evidence informed approach as a ‘check to an overconfident medical establishment’. His second reason introduces fairness and justice and the desire to reduce the variation in healthcare—epitomised by the ‘postcode lottery’. He goes on to consider the new emphasis on patient-centred collaborative care and how the focus has shifted from the professionals who deliver the care to the people receiving it. Accompanying this trend, and often driving it, he cites the rise of consumers’, or citizens’ groups and he has a special mention for palliative care which he feels has moved away from an unhealthy emphasis on ‘heroic and unnecessary technological interventions’ in order ‘to turn to simpler forms of care that relieve suffering rather than trade in false promises or miracle cures’.

But …