The patient advocate group Radiotherapy Action Group Exposure (R.A.G.E.) has become a strong supporter of the START initiative over the years, with 2 members represented on the Trial Management Group. Issues relating to radiotherapy fractionation have emerged repeatedly in the media over the last 20 years. The understanding of scientific issues by the majority of lay people and a minority of professionals has been poor. The trial has achieved a high public profile across the UK including a discussion on Panorama. A highly productive debate has changed the climate, with the importance of evidence based medicine acknowledged by all parties.