Reading the macros first helps. They must be defined at top of program or module, if I recall sweetjs.org's design correctly, for the staged hygienic expansion to work well.

Aside from that, you're right. But JS has higher order functions and objects with ad-hoc methods, so it can be used according to many paradigms, which can make it hard for a reader unfamiliar with the dominant paradigm in code at hand.

This is not a deal-killer for macros, although with sweet.js as the prototyping tool, your assertion about "This is the job" is satisfied. Sweet.js works with node to do AOT macro expansion at present. There's effort to integrate it in the browser too, but this will be easier with ES6 module loaders (not yet prototyped in SpiderMonkey or V8).