I'd like to have a frank discussion about adderall

[anon900009]

I'd like to talk about adderall, briefly from an admissions standpoint, and then in depth about ethics. This account is a throwaway for obvious reasons but i'll post on it for this discussion. Also to reiterate I do not want the focus to be on the admissions question, mostly on ethics, but it would be nice to have the admissions topic addressed too. And to clarify, I DO HAVE a prescription for the drug, just so nobody delves into that.

So first:
Would it look suspicious on a medical school application/interview/etc. if an applicant acquired an adderall prescription at age 18/19/20, and would an adcom even have any way of knowing this information?

Now the main part of this thread:
How do you feel about people taking adderall to boost there performance in class? This includes people with legitimate prescriptions, people with illegitimate prescriptions, and those without prescriptions. Personally I feel all three of those cases the person is doing the exact same thing, but perhaps one is more deserving of the ability to do it than the others (I really do feel that someone with a legitimate prescription does deserve this advantage without question, but at the same time I feel they are getting an unnatural, yet not unfair for them at least, advantage). We all know that CNS stimulants ABSOLUTELY increase grades; I know personally that they may make my papers come out like ****, but I can learn a WHOLE LOT of math or science very efficiently and effectively while under its effects. All people will have different experiences but I feel most people will be able to use it to improve their grades significantly if they figure out how it works for them.

So to pose the question I would personally like to see discussed: How do you feel about people taking adderall without a prescription or with a prescription but without ADHD?

I know personally that adderall makes my life significantly better even besides grade improvement. I have used it to catch up on work (non-academic in this example), which allowed me to accomplish more and overall improve my quality of life by not getting stuck on some tasks. Also, it makes me much more social in a VERY good way; for someone who struggles with all forms of relationships, being socially savvy is something that I am willing to take a controlled substance to accomplish. And to be honest, I've actually never used adderall in a way that would be against academic integrity policies (to name a few examples, i've never taken/studied for a test under its effects, never written anything I've handed in under it's effects, never done a problem set, etc. under it's effects). But if it were considered acceptable to read a textbook for 4 hours straight while high, well yeah I like to do that because I enjoy it more and the time spent reading is more effective.

So please share your opinions and feel free to tear apart anything I've stated.

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[NYCdude]

If you need it to treat a disease, fine.

If you don't need it but take it to boost performance, not fine.

 

[Komorebi2]

To your point about whether or not AdComs know what drugs you are prescribed: No, absolutely not.

What is not up for debate: If an individual is taking medication not prescribed to him/her, that is prescription drug abuse and is illegal.

 

[Lucca]

The abuse of prescription drugs with whatever aim and especially in order to boost academic performance is ethically defunct.

If you are prescribed adderall legitimately for the management of a disease then that's fine.

 

[karayaa]

To your point about whether or not AdComs know what drugs you are prescribed: No, absolutely not.

What is not up for debate: If an individual is taking medication not prescribed to him/her, that is prescription drub abuse and is illegal.

Borrowing my friends prescribed ibuprofen may be illegal, but I don't see how it is unethical.

 

[hoihaie]

Borrowing my friends prescribed ibuprofen may be illegal, but I don't see how it is unethical.

i'm pretty sure he meant if you're not taking a drug for it's intended medical purpose (not counting where you do it under supervision of a medical professional), then it is not OK.

 

[mcatjelly]

Borrowing my friends prescribed ibuprofen may be illegal, but I don't see how it is unethical.

Apples and oranges here.

If you don't have significant attention issues, you shouldn't be taking Adderall. If you aren't currently recovering from a major physical injury, you shouldn't be taking codeine or vicodin. And so on.

 

[Donthangme]

No one cares about taking adderall as long as its legally prescribed. Don't resell it and you have nothing to worry about.

Go visit a doctor and say you have trouble concentrating; walk out in 5 minutes with a prescription. Even the university student health center in most places can write you one. Literally any kind of attention span problem, major or minor, is treated with it now.

 

[mimelim]

Borrowing my friends prescribed ibuprofen may be illegal, but I don't see how it is unethical.

In what world is borrowing ibuprofen illegal? Ibuprophen is over the counter as well...

 

[efle]

This debate is always centered on the users/abusers needing a level playing field, which is not how this should be viewed (at least from a utilitarian ethical standpoint).

The goal of our lovely little quasi-meritocratic system is supposed to be identifying the most promising group each year to then provide society with the most capable/best physicians and healthcare.

It is not to be fair or even-stevens to people with varying mental/concentration abilities (or disabilities). By that logic, it's unfair to provide extra tutoring to highly capable students who could make decent grades or test scores alone; tutors should be restricted to the students who need the tutors to get passing marks or an average score.

What should be asked is, "are the non-prescription users falsely inflating their apparent worth and hindering access to individuals of greater actual worth?" I think the answer is yes, making it unethical. If Becky normally surpasses Bobby in science courses or MCAT etc., but Bobby starts buying his brother's meds to boost himself past her*, then society suffers some small amount if it selects Bobby over Becky and the utilitarian would call Bobby a no-good stinky unethical cheater.

*Now, this scenario assumes Bobby stops taking the pills after college/med school/whenever and ends up practicing at his non-drugged levels. If Bobby were to have a lifelong use, prescription or no, then his apparent worth reflected his actual worth and society was not hurt. This chain of thought also explains why it is ethical from a uti view for prescription users to get the drug enhancements - not because they need it to be on fair grounds against the other candidates, but because they will be using it indefinitely and are not misleading society when having their performance assessed at drugged levels. (I mean, seriously, who can pull the "this just normalizes me and it's morally right to be equal" argument when there are such massive differences in intelligence? There is no reason to expect equality between minds in any way, only reason to expect honesty from those presenting themselves for service.)

Edits for clarity

 

[efle]

In what world is borrowing ibuprofen illegal? Ibuprophen is over the counter as well...

I think he just wanted to point out illegal ≠ unethical

 

[mimelim]

I think he just wanted to point out illegal ≠ unethical

Kinda ****ty example...

 

[altblue]

I take Adderall so I can do basic things in a timely fashion, like paying my bills, doing short homework assignments, and paying attention to someone for more than one minute - these are things I struggled with before the medication. The medication put me in normal range, meaning that I now only have minor focus and procrastination issues. Because some students needing that A in orgo buy it off the street, it's a controlled substance and I've had to jump through many hoops to get a refill (and was out of luck for a month when my medication was accidentally destroyed) when I moved areas and changed PCPs, so I'm understandably a bit bitter and also about the pill's reputation as a smart drug.

That said, I'm sure that other premeds cycle it for cramming sessions and set the curves.

Is it unethical to lie for medication, where the majority of students you indirectly compete with won't do so, to do better in your classes? I'd say so.

 

[amazing tekkers]

Adcoms would have no way of knowing. Some schools do drug test (long after you're accepted and started school) so you'll need to show your prescription then.

And if you don't have a prescription?

 

[Promethean]

No one cares about taking adderall as long as its legally prescribed. Don't resell it and you have nothing to worry about.

Go visit a doctor and say you have trouble concentrating; walk out in 5 minutes with a prescription. Even the university student health center in most places can write you one. Literally any kind of attention span problem, major or minor, is treated with it now.

I call BS. Not every doctor is a pill mill, not even at university health centers. I do have attention issues and broached the topic with my PCP a few years back and was told sternly no. And I came to accept that and to agree with her, but even if I wanted to try to doctor shop, I think I would be very hard pressed to find someone willing to randomly write an adderall script based on a single visit worth of interaction. At the very least, I'd need to find a psychiatrist and commit to monthly med checks, and psychiatrists are in terribly short supply these days. There is a 8-12 week wait at minimum, if you can even find one that is taking new patients.

 

[xffan624]

And if you don't have a prescription?

Then by definition you're using an illegal substance.

 

[medic86]

I call BS. Not every doctor is a pill mill, not even at university health centers. I do have attention issues and broached the topic with my PCP a few years back and was told sternly no. And I came to accept that and to agree with her, but even if I wanted to try to doctor shop, I think I would be very hard pressed to find someone willing to randomly write an adderall script based on a single visit worth of interaction. At the very least, I'd need to find a psychiatrist and commit to monthly med checks, and psychiatrists are in terribly short supply these days. There is a 8-12 week wait at minimum, if you can even find one that is taking new patients.

Heh. I think you'd be surprised.

 

[Donthangme]

I call BS. Not every doctor is a pill mill, not even at university health centers. I do have attention issues and broached the topic with my PCP a few years back and was told sternly no. And I came to accept that and to agree with her, but even if I wanted to try to doctor shop, I think I would be very hard pressed to find someone willing to randomly write an adderall script based on a single visit worth of interaction. At the very least, I'd need to find a psychiatrist and commit to monthly med checks, and psychiatrists are in terribly short supply these days. There is a 8-12 week wait at minimum, if you can even find one that is taking new patients.

5 minutes is exaggerated, but a single doctor's visit is not unrealistic at all.
http://www.wsj.com/articles/SB10000872396390444301704577631591596516110
When the rate of diagnosis of "ADHD" grows by 5% a year, you know something is up. Yes, not every doctor is a pill mill, but many are indeed very prescription-happy and try to write as many as they can.

 

[Planes2Doc]

Using non-prescribed stimulants is a very slippery slope. First, let's cut out the whole ethics discussion. How many pre-meds are consciously thinking about what is "fair" to their peers or not?

When I was an undergrad, I knew people who bought Adderall illgally to cram for things. They used it sporadically, and it definitely was effective in helping them reach their goals. Now, these papers and tests weren't every day things. The sporadic use of Adderall allowed their dopamine receptors to function normally. Now as a pre-med, things might be harder, and continued use can lead to dopamine receptor downregulation. Now once you become tolerant to the med, you need more and more just to feel normal! Alright, pre-med isn't even that bad, and you may get away with it...

So Adderall use might help you kick ass in your pre-med courses and MCAT, but then what?

Well then there is medical school. There is more material and exams than you ever thought was humanly possible. Unless you can do this without stimulants (assuming you do not have ADHD or attention deficit), you are buying a one-way ticket to drug dependency. You will get more screwed than you can ever imagine once tolerance hits.

These drugs do have "magical" effects. Their euphoria can give you super human study abilities. You can get killer grades with them. If you use them, I doubt you give a crap as to whether it's fair or not to fellow classmates. But that's not what we're talking about. What we're talking about is that these good times won't last forever. Tolerance and dependency will bring you down so fast that you won't know what hit you. It's not worth it.

Nothing lasts forever, not even cold November rain. And neither do stimulants' magical effects.

 

[bluetovah]

In response to the ease of getting a prescription-
I know some people who have gotten an "emergency stash" from their PCP. Not for a medical condition. Just to abuse legally. They've simply said, hey school is a lot of work and I want a small stash so I don't have to buy from my friends. But I know other people who tried this with their docs and gotten denied. So make of that what you will.

And to be honest, I think it's cheating. Obviously not if it truly is medically needed, but if someone is too lazy to just buckle down and do what they need to do? It's cheating.

 

[mehc012]

In response to the ease of getting a prescription-
I know some people who have gotten an "emergency stash" from their PCP. Not for a medical condition. Just to abuse legally. They've simply said, hey school is a lot of work and I want a small stash so I don't have to buy from my friends. But I know other people who tried this with their docs and gotten denied. So make of that what you will.

And to be honest, I think it's cheating. Obviously not if it truly is medically needed, but if someone is too lazy to just buckle down and do what they need to do? It's cheating.

Define 'medically needed'. Is the ability to focus somehow a prerequisite to modern life that I missed? Will they die if they continue to have ADD? No, they simply won't be able to perform at the level required to reach some particular goal they have, whether that be graduating college, teaching, or going to med school. At some seemingly arbitrary point, however, we seem to decide that it is no longer ethical to address that inability. So I'm curious...how is it determined which level of attention is 'not as good as it should be' vs 'not as good as it could be'? Is there a magical 'ethical/unethical', 'necessary/unnecessary' line in the sand?

 

[Mac&Me]

Illegal is not unethical. I respect a person's choice to consume whatever they wish, as it does not directly affect the health and safety of others. My morality prohibits me personally from using the drug, but I do not impose that on others. The issue I can see people having would be attributed to someone else having an unfair advantage due to the performance enhancing nature of the compound. This is an unfortunate reality, but should have no bearing on our personal decisions; we should not engage in a behaviour that conflicts with our morality simply because others are doing it.

What is unethical is gaming the system by lying to a health care professional in order to obtain a drug. This violates the trust and confidence of a system put in place to help people in need. This is complicated, however, as there is no standard measure or threshold required to decide who should and should not be taking the drug.

 

[Heisenberg 41]

Seemed relevant.

 

[sliceofbread136]

Would you trust your doctor less if you knew he used drugs to pass his licensing exams?

 

[mehc012]

Would you trust your doctor less if you knew he used drugs to pass his licensing exams?

Honestly? Probably not. I wouldn't care how they learned the damn stuff, just that they had. The information doesn't get deleted after being learned just because one person learned it the 'right' way and another the 'wrong' way. I also have little faith that the person who didn't use drugs is any smarter/more dedicated than the one who didn't, or that the person with the prescription started in any different place than the person using it without one. Besides, people use drugs to study all the time...it's called caffeine.

 

[sliceofbread136]

Honestly? Probably not. I wouldn't care how they learned the damn stuff, just that they had. The information doesn't get deleted after being learned just because one person learned it the 'right' way and another the 'wrong' way. I also have little faith that the person who didn't use drugs is any smarter/more dedicated than the one who didn't, or that the person with the prescription started in any different place than the person using it without one. Besides, people use drugs to study all the time...it's called caffeine.

I've been thinking about it and I think I'd prefer the doctor who didn't take adderal or whatever to pass step. Chances are he isn't on drugs anymore, so his score might not be an accurate representation of his critical thinking and medical abilities in a non-drugged state.

 

[mehc012]

I've been thinking about it and I think I'd prefer the doctor who didn't take adderal or whatever to pass step. Chances are he isn't on drugs anymore, so his score might not be an accurate representation of his critical thinking and medical abilities in a non-drugged state.

Most of the people I knew who ever used adderall did so while studying or pulling an all-nighter. It wasn't a critical thinking enhancer so much as a 'focus and get this work done' type deal. I just don't think it works the way your explanation represents it.

More to the point, you don't choose your doctor based on his step score. You don't even know your doc's step score, and while it is a factor in which residency program they attend, that's pretty much where its oomph factor ends. If your doc sucks at dealing with actual patient scenarios rather than tests, regardless of the reason (aka drugs or just normal factors), that will be apparent during residency and before sitting for the boards.

 

[ShadyLane]

I think prescription drug abuse of adderall hurts those who legitimately can't focus and don't agree with my peers who do it. That being said, I wouldn't base my trust/respect of a physician on whether they illegally used it during their schooling. I think if they succeeded in school with the help of the drug, they had that potential in the first place but weren't utilizing it. Their history of practice would weigh more heavily.

 

[Salt Salt]

What should be asked is, "are the non-prescription users falsely inflating their apparent worth and hindering access to individuals of greater actual worth?" I think the answer is yes, making it unethical. If Becky normally surpasses Bobby in science courses or MCAT etc., but Bobby starts buying his brother's meds to boost himself past her*, then society suffers some small amount if it selects Bobby over Becky and the utilitarian would call Bobby a no-good stinky unethical cheater.

*Now, this scenario assumes Bobby stops taking the pills after college/med school/whenever and ends up practicing at his non-drugged levels. If Bobby were to have a lifelong use, prescription or no, then his apparent worth reflected his actual worth and society was not hurt. This chain of thought also explains why it is ethical from a uti view for prescription users to get the drug enhancements - not because they need it to be on fair grounds against the other candidates, but because they will be using it indefinitely and are not misleading society when having their performance assessed at drugged levels.

I admire your logic! Although, one argument that comes to mind is: what about the non-prescription users who plan to continue the drug indefinitely? And by your logic, do the prescription users have a moral obligation to continue to use the drugs even after they have decided they want to stop taking it?

 

[Salt Salt]

If you need it to treat a disease, fine.

If you don't need it but take it to boost performance, not fine.

It's telling that the most-'liked' comment on this thread is also the most reductive and simplistic. Many of the other comments on this thread have been in the same vein: a moral pronouncement, not followed up by any reasoning. Sorry to single you out, NYCdude---you were just an example

So far the consensus in this thread seems to be against non-prescription use. The tone is very angry. But is using it really that bad? Why would it be wrong?

1. Because it's illegal? No, most of us would agree that unethical ≠ illegal (never mind the example of sharing ibuprofen). Laws are just manmade consensus, and besides, we can all think of laws that ban things that we think are morally permissible (like jaywalking or, historically, interracial marriage).

2. Is it wrong because it gives someone an unfair advantage? No, for several reasons. First, if the reason that prescribed Adderall is okay is because it "levels the playing field," it follows that we should make the people at the other end of the spectrum (those with naturally high attention) take some sort of drug that would reduce their focus. The truth is that we don't care about truly "leveling the playing field." Similarly, if anything is unfair, it's the idea that most of us are just supposed to use whatever God gave us, and some of us are allowed to use drugs. Second, it isn't an unfair advantage because anyone can try to acquire the drug. If you're upset that someone who doesn't have a prescription is using drugs to improve their studying skills, why don't you just get some of the drugs yourself? Yes, there are risks and difficulties---but the other person is facing them too.

To be clear, I don't personally espouse the position that Adderall is morally permissible for non-prescription users (or even prescription users!). In truth, I'm undecided. I just wanted to make sure both sides were getting represented.

 

[WingedOx]

I've been thinking about it and I think I'd prefer the doctor who didn't take adderal or whatever to pass step. Chances are he isn't on drugs anymore, so his score might not be an accurate representation of his critical thinking and medical abilities in a non-drugged state.

Seems like a bit of an over the top way to put it. What would your opinion be of an MD who took a few hits of the bong on Friday nights?

 

[NYCdude]

It's telling that the most-'liked' comment on this thread is also the most reductive and simplistic. Many of the other comments on this thread have been in the same vein: a moral pronouncement, not followed up by any reasoning. Sorry to single you out, NYCdude---you were just an example

So far the consensus in this thread seems to be against non-prescription use. The tone is very angry. But is using it really that bad? Why would it be wrong?

1. Because it's illegal? No, most of us would agree that unethical ≠ illegal (never mind the example of sharing ibuprofen). Laws are just manmade consensus, and besides, we can all think of laws that ban things that we think are morally permissible (like jaywalking or, historically, interracial marriage).

2. Is it wrong because it gives someone an unfair advantage? No, for several reasons. First, if the reason that prescribed Adderall is okay is because it "levels the playing field," it follows that we should make the people at the other end of the spectrum (those with naturally high attention) take some sort of drug that would reduce their focus. The truth is that we don't care about truly "leveling the playing field." Similarly, if anything is unfair, it's the idea that most of us are just supposed to use whatever God gave us, and some of us are allowed to use drugs. Second, it isn't an unfair advantage because anyone can try to acquire the drug. If you're upset that someone who doesn't have a prescription is using drugs to improve their studying skills, why don't you just get some of the drugs yourself? Yes, there are risks and difficulties---but the other person is facing them too.

To be clear, I don't personally espouse the position that Adderall is morally permissible for non-prescription users (or even prescription users!). In truth, I'm undecided. I just wanted to make sure both sides were getting represented.

Sounds like you're just salty (get it?) about the number of likes I got.

Haha, but you make some interesting points. At the end of the day, Adderall is a drug, and not apple juice. It shouldn't be floating around with anyone being able to take it on a whim.

 

[C.S. Peirce]

I understand that this is a discussion about the morality (not the science) of cognitive enhancement, but I want to point out that everybody is just assuming that these drugs do boost performance among people with normal cognitive function. This is far from the current scientific consensus:

http://www.neurorexia.com/2013/04/18/do-smart-drugs-actually-make-you-smarter/

The blog post is a summary of two studies (one from 2011 and one from 2012) on the effects of amphetamine and methylphenidate on people with and without attention deficit disorders. What they suggest is that there's no significant increase in cognitive performance among people who already have average/above average abilities: the benefits to memory and cognitive control are significant among those who score very low in assessments of those faculties, but among those with average and above average abilities to begin with, there are (very) slight gains.

Furthermore, those gains are the same whether someone takes the drug or takes a placebo that they think is the drug. Looked at in this light, all the anecdotes in these threads about adderall's power as a study aid amount to little more than the membership's experience with placebo. (Granted, the drugs reduce fatigue...but if all we're having is a conversation about the morality of artificially reducing fatigue, we're going to need to expand the conversation to include coffee, tea, etc)

The metaphor everyone jumps to when thinking about these drugs is "mental steroids." No matter how jacked you are, the steroids help you get bigger. But this metaphor seems to be flawed: the benefits don't seem to be consistent across the population, but are instead limited to those members who are already deficient. It seems better to think of them like we think of anti-depressants: invaluable for bringing those with deficits into a normal range, but of little use to anyone else.

 

[xffan624]

I understand that this is a discussion about the morality (not the science) of cognitive enhancement, but I want to point out that everybody is just assuming that these drugs do boost performance among people with normal cognitive function. This is far from the current scientific consensus:

http://www.neurorexia.com/2013/04/18/do-smart-drugs-actually-make-you-smarter/

The blog post is a summary of two studies (one from 2011 and one from 2012) on the effects of amphetamine and methylphenidate on people with and without attention deficit disorders. What they suggest is that there's no significant increase in cognitive performance among people who already have average/above average abilities: the benefits to memory and cognitive control are significant among those who score very low in assessments of those faculties, but among those with average and above average abilities to begin with, there are (very) slight gains.

Furthermore, those gains are the same whether someone takes the drug or takes a placebo that they think is the drug. Looked at in this light, all the anecdotes in these threads about adderall's power as a study aid amount to little more than the membership's experience with placebo. (Granted, the drugs reduce fatigue...but if all we're having is a conversation about the morality of artificially reducing fatigue, we're going to need to expand the conversation to include coffee, tea, etc)

The metaphor everyone jumps to when thinking about these drugs is "mental steroids." No matter how jacked you are, the steroids help you get bigger. But this metaphor seems to be flawed: the benefits don't seem to be consistent across the population, but are instead limited to those members who are already deficient. It seems better to think of them like we think of anti-depressants: invaluable for bringing those with deficits into a normal range, but of little use to anyone else.

We just had our neuro lectures including ADHD and treatment and that was pretty much the message from our lecturer. If your pre-frontal cortex has issues with maintaining the necessary neurotransmitter levels for sustained attention, then they will benefit you and bring you in the range necessary for proper concentration. If you don't, you will overshoot and not be as effective.

 

[sliceofbread136]

Most of the people I knew who ever used adderall did so while studying or pulling an all-nighter. It wasn't a critical thinking enhancer so much as a 'focus and get this work done' type deal. I just don't think it works the way your explanation represents it.

More to the point, you don't choose your doctor based on his step score. You don't even know your doc's step score, and while it is a factor in which residency program they attend, that's pretty much where its oomph factor ends. If your doc sucks at dealing with actual patient scenarios rather than tests, regardless of the reason (aka drugs or just normal factors), that will be apparent during residency and before sitting for the boards.

Yes, I don't really know the effects of adderall very well so my opinion may be of little value, but all else being equal I would still prefer the doctor who didn't take drugs to do well. It wouldn't make me absolutely refuse to be treated by that doctor though.

And when I choose a doctor I actually do look at where they did their training, where step score does matter. I know most people don't do this, which is why I posed it as a hypothetical scenario.

Seems like a bit of an over the top way to put it. What would your opinion be of an MD who took a few hits of the bong on Friday nights?

I don't think that's the same since it isn't positively effecting his performance.

All else being entirely equal between 2 physicians, I would choose the who does not use marijuana. It isn't something I would care too too much about though, much like adderall

 

[mehc012]

Yes, I don't really know the effects of adderall very well so my opinion may be of little value, but all else being equal I would still prefer the doctor who didn't take drugs to do well. It wouldn't make me absolutely refuse to be treated by that doctor though.

And when I choose a doctor I actually do look at where they did their training, where step score does matter. I know most people don't do this, which is why I posed it as a hypothetical scenario.



I don't think that's the same since it isn't positively effecting his performance.

All else being entirely equal between 2 physicians, I would choose the who does not use marijuana. It isn't something I would care too too much about though, much like adderall

I think that of all the things I could rank a physician on, 'have they ever used drugs' is just not on the list.

My point, insofar as how you don't use step score to determine who is a good physician, is that you don't know their step score. Odds are, you don't even know which residencies were good for their specialty when they were training. So even if you look at residency, it's not guaranteed to tell you about their score. Beyond that, however, is that everyone who makes it through xyz residency has one thing in common: they made it through xyz residency. That, in itself, is a wholly different feat than passing a standardized test. If you presume that they don't use those drugs for daily doctoring, then it's likely that they didn't use them to get through residency itself. If they did, well, why would they have stopped afterwards? Regardless, they advanced through residency in whichever drug-using status is applicable, and performed well enough to currently be your doctor.