The card does get dinged in reviews for being too noisy, but most GPU buyers probably won't care much. That's why I post this explicitly in the architecture thread.
But I'm sure the AMD cares: this GPU seems to be hitting thermal limits quite often. It needs a very noisy cooler and it inevitably has voltage regulator cost and complexity consequences too. Improve the power efficiency by 22% and it'd blow the Titan completely out of the water with a die that's ~15% smaller too. (Or they could have grown the die for an even bigger lead.)
My understanding is that 20nm won't give a huge improvement in terms of power (can somebody confirm?), so in the pathological case of no power related architecture fixes, all they can do is reduce die size.
So, yes, some people care: the AMD engineers. And they're probably working very hard right now to fix it.