In the United States these days, there are discussions of the moon, precision medicine, targeted therapies, priority review vouchers and moving into the 21st Century. These are all buzzwords that touch directly or indirectly upon the efforts to treat cancer and other diseases in our population. These efforts are intricate and complicated to say the least, and at the end of the day, the childhood cancer advocacy community is playing a game of musical chairs in an effort to find a seat at the table. Ultimately, there is no way of knowing just what role our voices will play, and more importantly, what the overall impact will be upon the childhood cancer community as a result of these initiatives. Nonetheless, the simple fact that there are these potential opportunities to see gains is enough to warrant tempered optimism.