What do we know about Amyotrophic Lateral Sclerosis? Perhaps in popular culture, we have heard of the 'ice-bucket challenge"? Perhaps it is through the inspirational Stephen Hawking (or the charming Eddie Redmayne in "The Theory of Everything"?) It turns out that we know very little about ALS - a form of motor neuron disease - but research has shed light between environmental factors and ALS. Here we present to you an appraisal of the original research (2016) and the viewpoint (2020) as published in JAMA Neurology.