How do modules compose with respect to syntax? I remember encountering a big frustration in Common Lisp when I used two libraries that depended on defining '[' as a reader macro for pretty syntax. Whichever library I allowed to use the '[' reader macro, my usage of the other library became verbose and hard to read.
Not to mention that neither altering a module's source nor depending on the sequence of module loading is scalable across many modules.
And people wonder why Perl is known as a "write-only" language!
Rails is running into the same problem with overuse/abuse of monkey patching, method_missing etc. that perl ran into with overuse/abuse of rich syntax.
It's sad. But it's really nothing to do with either language. They just handed a large chunk of power to a developer community that grew too large too fast for most of the membership to have learned how to use that power responsibly.
Perl 6 has an advantage in that most of the tutorials and examples aren't full of bad examples and muddled thinking like most of the Perl 5 tutorials and examples are. I don't expect that to last, but hopefully some thoughtful language design will make abusing the language much more difficult.
Perl's not alone here, you can do the same thing with C++ using operator overloading, but Perl actively encourages this to an order of magnitude greater extent.
I actually think describing Perl 6 as "having macros" is accurate, but gives the wrong impression. It doesn't "have" macros, it's made of macros. The whole language is made of macros and you are nearly begged to extend it with more grammar. Or you can throw theirs away and write your own for something. Or you can throw theirs away, take some of it as a base, and extend it.
It's a wild, wacky experiment that needs to be done. Whatever happens, we'll learn a lot. My intuition says "collapses under its own complexity" (especially after trying to add a few grammar-modifying CPAN modules) is the most likely result, but I fully support with no sarcasm someone trying this out in case my intuition is wrong. It's not just Lisp redux, it's something new.