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DO's and MD's to take same boards

Discussion in 'Medical Students - DO' started by DO Boy, Jun 30, 2000.

  1. DO Boy

    DO Boy Senior Member 10+ Year Member

    Jan 23, 2000
    I came upon a discussion on an internet website from a guy at TCOM who really wishes that DO's and MD's would have the same boards (eg USMLE + osteopathic addendum).

    I couldn't have agreed more when I read it.

    It makes so much sense since I've heard that they are very similar tests just like the two professions are in practice. The proposal I read was for something like a USMLE + Osteopathic addendum for DO students.

    Let's face it, these days, the only thing that separates DO's from MD's is OMM and not many DO's are employing it anyway. MD's are just as inclinced to "treat the whole patient". At least by having a unified standarized boards, the public will have further evidence that DO's and MD's are similar but have additional training in OMM (read: additional knowledge/benefits).

    Someone needs to tell the AOA that having one test for DO's/MD's is a good thing and not bad.

    Any thoughts on this? Or am I too far on the left?

    DO Boy
    TCOM 2004

    [This message has been edited by DO Boy (edited 06-30-2000).]

    [This message has been edited by DO Boy (edited 06-30-2000).]
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  3. Vagabond

    Vagabond Junior Member

    Jun 18, 2000
    Nope you are right on the money. Why the AOA continues to view osteopaths as different I will never know. They are hindering their own public acceptance...
  4. drusso

    drusso Physician Moderator Emeritus Lifetime Donor Classifieds Approved 10+ Year Member

    Nov 21, 1998
    Over the rainbow
    DO's can take the USMLE and many do. I did. I think that if one wants to pursue an ACGME-appproved residency in a non-primary care area it is generally a good idea to do so. I've heard from countless DO students that if one is interested in FP, IM, psych, peds, even EM, one can compete quite well for ACGME-approved residencies without the USMLE. The tests are very similar and studying for both is easy. Moreover, independent review by outside psychometrists have demonstrated that the COMLEX is just as valid and predictive as the USMLE.

    The National Federation of State Medical Boards currently supports a recommendtation for a single "pathway" for physician licensure. However, "pathway" can be defined very broadly. Just like there are two widely recognized pre-college entrance exams (the SAT and the ACT), which are considered "separate but equal", there is still only a single pathway to college entrance. Why can't there be two physician licensure exams too? What possible logic can one have for favoring one exam over another when both have been shown to be equally good?

    When I applied to college, I took the ACT and not the SAT because I did better on it on practice exams. I had friends who did just the opposite. Does this mean that the ACT was an "easier" exam? No, but I do think that its content was a little broader and better tested my knowledge. No one has ever falted me for only taking the ACT and not the SAT. In college, I did better in some classes than students who took the SAT. If one goes to a DO school and takes both the COMLEX and USMLE, would you expect that the DO student should perform a little better on the COMLEX than the USMLE? Does this mean that it was an easier exam if he did? (By the way, I do know people who did do better on the USMLE than the COMLEX! Does this mean that the USMLE was an easier exam?)Moreover, there are DO interns and residents, who only took the COMLEX, who out-perform MD interns and residents in ACGME-programs.

    There is some history to the old COMLEX vs. USMLE issue: It used to be that each state developed their own licensing exams. Back in the bad old days, some states wouldn't let DO's sit for their state's exam. So, the profession developed its own licensing exam and by passing state-specific laws got DO's licensed in states by circumventing the politics of individual state medical boards. Then, states got tired of administering their own exams and some states would recognize FLEX, which was the forerunner of the USMLE, in lieu of their own state's exam. FLEX let DO's and MD's take the exam. So, you had a situation where some states would recognize the FLEX and others wouldn't and some DO's could get licensed in a state with the FLEX but couldn't by taking the state's own exam. It was a real mess...

    So, along comes the USMLE in order to standardize the process and replace the FLEX and the individual state examinations. The NBME, which writes the USMLE, was very rude and condescending (so the rumor goes) in dealing with the osteopathic medical profession when developing the USMLE. Basically, they were reluctant to include a proportional number of DO's on the development committee and use them as test question writers. Then, there was the whole issue of OMT...The osteopathic profession does have an obligation to the public to ensure that DO's are competent in OMT even if few DO's actually use it consistently. One potential compromise was to have a separate "osteopathic-specific" section to the USMLE that only DO's would take, and only DO's would write, that would cover OMT. This might have been a viable compromise had the NBME been a little more diplomatic in its dealings with the osteopathic medical profession. But, given their prior interactions with the osteopathic profession, some felt like the NBME was "ghetto-izing" DO's to an "add-on" status. So, in a real way, its the NBME own fault that there are two national medical licensing exams instead of one. Perhaps, if they would have been a little more cordial and cooperative, the osteopathic profession just might have gotten on board. The old saying is "you'll get more with honey than vinegar..."

    And, then there is the separate issue about the osteopathic profession's own autonomy. DO and MD parity wasn't achieved by giving into every demand that the larger majority MD profession made. The MD profession didn't just wake up one day and say, "fine, you guys are equal." It took an enormous amount of politicking and legal fighting. The underlying legal premise of many of these fights were than MD's, having no knowledge and having outrightedly rejected osteopathic principles, could not tell DO's what to do. If we are to really be our own autonomous profession, then we need to police ourselves through our own autonomous mechanisms which include licensing, accreditation, and certification. And, so the argument goes, we don't need MD's telling us how to do it...

    It's a different world today and relations between MD's and DO's have never been better. Still, old remnants of these legal shinangins remain. In general, I think that it's good for DO's to take the USMLE and do ACGME-approved residencies. I think it helps raise the public's awareness of DO's. I'm not convinced that doing ACGME-approved residencies makes one less "osteopathic" in their approach to patient care. I know some DO's who did ACGME-approved residencies who use OMT more frequently than DO's who did AOA-approved residencies. I even support creating a pathway for MD's who want to learn OMT and do AOA-approved residencies. As it stands, it is unfair that DO's can matriculate into ACGME-approved residencies, but MD's cannot matriculate into AOA-approved residencies.

    Still, I believe that throwing in the towel and scrapping the COMLEX is not a good idea. As it stands, under the current system, DO's have more options for graduate medical education than do MD's. However, I'll wager that within 5 years that this will be a non-issue. There is simply no compelling reason left for the National Federation of State Medical Boards to favor one licensing exam over the other, just as few colleges really care which college entrance exam you take as long as you take (and do reasonably well on) one or the other.

    Can you think of one?

    [This message has been edited by drusso (edited 07-01-2000).]
  5. Future DOc

    Future DOc Senior Member 10+ Year Member

    Nov 30, 1999
    Thanks for the input, Drusso!!! That was very insightful! [​IMG]

    MS III

    ADRIANSHOE Senior Member 10+ Year Member

    Mar 14, 2000
    actually drusso, YOUR points make a VERY COMPELLING reason for ONE exam.

    IF as YOU say the exams are comparable.

    Then what possible logic is there to having the confusion of two separate tests?
    what possible efficiency gain is there from such a system?
    IT ONLY HURTS THE DO STUDENTS, without having ANY negative impact on the MD students (actually it benefits the MD students, as they arent faced with the same biases that DO students are at some of the ACGME residencies (NOTE: I DID NOT SAY ALL!!!!) ANY biases due to the comlex that result in any decreased percentage of DOs getting into MD programs is an argument for a single testing format. The osteopathic/OMM portion could be a separate requirement, but there is NO logic to the MEDICINE portions of the test being maintained in a separate but ostensibly equal environment...this logic is similar to the two toilets for blacks and whites....hey as long as the toilets are equal.....didnt make sense then and it doesnt make sense now...IT BENEFITS US DOS to demand a single test format as it levels the playing field and forces us to live up to our claims of well we should!
    How does the two test format help the DO student who comes up against the MANY program directors who DONT feel the COMLEX is a good comparison?
    There is absolutely NO logic to keeping two tests other than the PRESERVATION OF THE DO IDENTITY...and that is the political goal of the powers that be in the DO up on this issue would be a form of surrender for them, so they will fight against all logic and/or enemies imagined and real and as a result MANY DO students will continue to have to take BOTH tests to A: compete for spots at the HIGH LEVEL ACGME programs and B: to meet the DO SCHOOL GRADUATION REQUIREMENTS.

    [This message has been edited by ADRIANSHOE (edited 07-01-2000).]
  7. DO Boy

    DO Boy Senior Member 10+ Year Member

    Jan 23, 2000
    Wow. What a post, DRUSSO!

    I don't think that having a USMLE+DO Addendum would be giving in to the majority MD nor would it be "gettoizing" the osteopathic profession. Whatever happened b/t the NBME and the DO community fortunately isn't so bad anymore. I think we should take advantage of this fact.

    I can understand due to the friction b/t the two professions how COMLEX would arise (excellent history lesson that I had no idea about. thanks). However, yes the times have changed, and I think that there are specific advantages to having one test for the DO profession.

    1. Having one test becomes further (strong)evidence of how DO's and MD's are similar. The PR work to get the public to know what DO's are would be that much less. And we all know that no one knows what DO's are and because of this, they may question DO's or not prefer them at all (I'm sure we've all seen this in one form or another).

    2. The addendum then becomes that extra bit of knowledge that distinguishes DO's as well-rounded, "holistic" (or whatever) physicians. It would be more readily seen that DO's know that much more about patient care by having the same boards + a DO addendum. What a great selling point.

    3. Having one test would in effect help to formalize the good spirits b/t us and our MD collegues since history shows that bad diplomatic relations is one reason why one test never materialized in the first place.

    4. Less resources would have to be spent to administer the COMLEX. This would include administration, having to do validity studies of COMLEX, and all the other resource intensive actions that go with making a test. Now, if COMLEX is a profit thing for the AOA or whomever, this point would not support what I'm saying. But then again, I wouldn't want to be taking a test that had a large profit motive and would just as soon pay a "due" if a non-comlex world would cause the testing organiztion (AOA? or AACOM?) to fold (and then I would wonder who's doing the finances).

    5. Students would only have to take one test whether going into ACGME or AOA approved residencies. AND, residencies would not have to determine how to interpret different scores from different tests. Also, having one test is a very valid reason for other people to think of DO's as equals in the medical field (yes, i understand that legally DO's are considered equals, but that's not what I'm talking about here).

    6. States would not have to deal with having to set policy to determine which exams will license physicians.

    7. By having one exam, the DO and MD profession can be readily compared. This is a strong point especially if (as many say) that DO students do better on the USMLE than on the COMLEX. Of course, if board scores by DO students are less, this might be more damaging to the PR of the DO profession, and I wonder to myself if this is the real reason why two exams exist. Just remember that DO schools can address the problem of a lower test score and improve on it as they should. Anyways, DO students have to learn a lot more than their MD counterparts due to the OPP thing (not to be making excuses). Also, test scores are not necessarily predictive of becoming a "good doctor".

    8. If the USMLE and COMLEX are similar like you and everyone else says, what in the world is the logical reason for having two similar tests? If anything, this shows how seperatist and illogical the DO community is. Wow, this point really gets me angry!

    Having one test I concede may not be easy, however. I can imagine that one problem of having one test would be the integration of OPP stuff which is supposed to run throughout a DO's mindset and cannot be tested in the USMLE part of a USMLE+DO addendum test. Still, what MD doesn't think holistically and treat the whole patient these days? Also, I can't see why a DO addendum would make it impossible to test OPP stuff.

    SO those are the reasons why I think one test b/t DO's and MD's would be beneficial to the DO community. Basically, the benefits of having one test come from the better PR for DO's and the incresed unity b/t DO's and MD's. Who wouldn't want that?

    It's time to end this silly charade and really work to show how equal and important the DO profession really is. This means that not everything DO has to be completely separate but equal.

    [This message has been edited by DO Boy (edited 07-01-2000).]

    ADRIANSHOE Senior Member 10+ Year Member

    Mar 14, 2000
    Well said.
  9. drusso

    drusso Physician Moderator Emeritus Lifetime Donor Classifieds Approved 10+ Year Member

    Nov 21, 1998
    Over the rainbow
    What confusion? DO's take the COMLEX as their route to PRIMARY licensure (but have the option of taking the USMLE) and MD's take the USMLE has their route to primary licensure. I've spoken to several DME's (directors of medical education) and none have complained about being confused about this system. Scoring at the 80%tile on the COMLEX means you did better than 80% of DO students taking the exam. From my experience, DME's are very knowledgable about how to interpret %tile scores.

    Now, with respect to comparing scores ACROSS exams, yes, this is difficult. There is no conversion factor to turn COMLEX scores into USMLE scores, just as there is no conversion factors to turn ACT scores into SAT scores. Just as there is no conversion factor to turn scores on the Zung depression inventory into comparable scores on the Beck depression inventory. In fact, when it comes to measuring complex things like "achievement", "competence", "academic potential" or even "depression" it is possible to have several competing instruments or exams that tap into different dimensions of the domain being meaured and are still equally valid and reliable. The COMLEX and USMLE are both equally valid and reliable examinations for establishing thresholds of basic science and clinical science mastery. By the way, there is an important distinction between achievement tests (like the MCAT, SAT, ACT, PSAT, etc) and licensing exams (like the COMLEX, USMLE, or many others). The latter are not strictly designed to stratify performance (although they get inappropriately used by residency directors to for this purpose). They are only designed to identify students who have not mastered basic material. That's why someone with board scores in the 99+%tile can still be complete idiot on rotations...

    How does it HURT them? I think that DO students might be HASSLED by having to choose whether or not to take both exams, but actively HARMED?? I took both and hardly feel that any great harm has come to me.

    Or, it's an argument for educating residency directors about how to interpret COMLEX scores; or, it's an argument for DO students doing their homework and finding which programs want USMLE scores and which could care less; or it's an argument for the entire medical profession to rethink how board scores should be used in applicant selection in general.

    I find it curious that some people believe that residency programs will be less biased against a DO if they have USMLE scores. Biases are usually not rational things. If a program director is, in general, biased against DO's, then why would they be LESS biased against a given DO if he has USMLE scores? Does that make him less of a DO? I'm confused...I don't think I would want to attend a program that didn't value my profession's licensing exam. That probably hints at other "issues" in the program.

    Well, it comes back to MEDICINE being one of those inherently complex domains to measure in the first place, like "achievement", "academic potential", or "depression." There is more than one way to measure mastery of basic concepts in MEDICINE just as there is more than one way to measure the dimensions of the other domains listed above. What matters less is that the two systems are strictly equivalent (which would be impossible, even if a conversion factor were available, because of the overall complexity of measuring things like "mastery" and "achievement"), than that the two ways of measuring the same things are make similar kinds of predictions (which the USMLE and COMLEX have been shown to do.) Those who do poorly on either test are more likely to have difficulty applying fundamental basic science and clinical principles to real life patient encounters.

    No, not really, because DO's can use either toilet. We can take the USMLE too. We can apply to ACGME-approved residencies. If anything, it's the MD's who are really victims here because they can't take the COMLEX (which is a requirement for applying to AOA-approved residencies). But, I haven't heard too many (although a few) MD's complain about this.

    If DO's want to show their equality, then take the USMLE! However, I'm almost certain that it will do NOTHING to change the biases of residency directors. Good candidates get turned away from residency programs for all kinds of reasons, some of which reflect the inherent biases of the person doing the interviewing. Yes, in a strictly logical world where two candidates, a DO and a MD, applying to a given program with identical board scores on identical exams, with identical GPA's, identical letters of rec., and identical interviewing performance, you would be right. But, you over-estimate how logical program directors are: If there is only one spot, the program director will make a decision probably based on some whimsical preference or "gut feeling" that has nothing to do with any predictive data in his possession and everything to do with factors that he or she might not even fully comprehend.

    Well, the fact of the matter is that no one is really complaining about this too much except a proportion of DO students. It's not like ACGME residency program directors are calling the AOA and screaming, "My God, we're so confused. We really want to take your students in droves, but just can't figure out how to interpret this darn COMLEX thing. You think you could change it??" And, every year, just about every DO student in the nation matches into a residency program. The majority of those I've spoken to are pleased with their decision. They basically look at all programs on their own merits and rank them accordingly. If it's AOA-approved fine; ACGME-approved, that's good too.

    I'm not Pollyanna-ish about this whole matter. I think that some students need to take the USMLE to feel like they measure up to MD students. I do believe, and sincerely advise, DO students to take the USMLE if they're applying to non-primary care residencies or especially geographically competitive areas of the country. But, I don't think that taking it makes one a shoe-in for a program. If a program director is biased against DO's, they're not going to be less biased against a DO with USMLE scores.

    ...But, you do raise an interesting point about the responsibility that a given profession has for maintaining its identity and policing itself. Osteopathic medicine was founded as a social reform movement. All social reform movements have political agendas. People rail against the politics of the AOA and its political agenda, but what about the politics and agenda of the AMA? I think they're both bad guys. It just so happens that the AOA is more or less our bad guy. Remember, it is the stated policy of the AMA that there is only "one house of medicine", "one federation of medicine." The AMA was founded to absorb and assimilate competing systems of medicine. Kind of creepy, eh? Reminds me of the whole "one China" policy. How does it feel to be Tiawan? -530.948.HTM

    The AOA was founded to advance a competing system of medicine. Naturally, there is going to be some tension here.

    By the way...I'm a member of both! And, just to go on the record, I support and would actively work to create a new national physician licensing organization that was an amalgam of the NBME and the NBOME It could be the National Board of Physican Examiners (NBPE). Its Board of Govenors would consist of PROPORTIONAL representation of MD's and DO's, it's test-writers would be recruited from both DO and MD schools. It would write one single exam, and, yes, there would probably be a separate section for OMM. But, I wouldn't hold your breath. I've heard no one at either the NBME or NBOME complain about the redundancy and inefficiency of the current system. It would take some pretty hard negoiating to get the two to merge. But, if there is enough will among future physicians on both sides of the practice pathway, anything could happen.

    [This message has been edited by drusso (edited 07-02-2000).]

    ADRIANSHOE Senior Member 10+ Year Member

    Mar 14, 2000
    of course if we only had one test, neither of us would have to type very much.
  11. dcdo

    dcdo Senior Member 10+ Year Member

    Jan 26, 1999
    Let's also not forget that for those who feel compelled to take both tests(California, competitive specialties) it is possible to get "test burnout" leading to impaired performsnce on the test taken second.
  12. spunkydoc

    spunkydoc Senior Member 10+ Year Member

    May 2, 1999
    chicago, IL usa
    New ideas always meet with opposition.

    Granted, the AOA is probably the MOST INADEPT organization for defense of a profession that I have ever encountered.

    I am not a die-hard DO --to me, medicine is medicine and i have an extra tool in my bag that i sometimes like to use and that makes me often a better doctor.

    However, it seems clear to me that in order for osteopathy to survive as a profession, there must be something different about us. however that comes about, it is a necessary evil.

    i elected not to take both exams. in my experience, many residency directors do not know how to interpret comlex, mostly b/c they are ignorant or too lazy to try to figure it out---

    on the flip side, the AOA does not do a good job of helping residency directors interpret the comlex.

    still, my feeling is, that if a program is going to discriminate against you as a candidate b/c you took comlex and not usmle, or require you to take usmle, likely they will discriminate against you as a DO in some shape or form once you are in the program.

    i would rather join a residency that recognizes my "special" abilities and accepts them, than one who insists on trying to stuff me into a box in which i don't fit for whatever reason.

    nuff said.
  13. EZEK

    EZEK Member 10+ Year Member

    Mar 15, 2000
    If history is any lesson, in the 1960's when the ability to get a license as a DO was lost in California, all DO's were offered the chance to buy an m.d. degree for $75.00. The use of a little "m" and a little "d" were not a mistake. It was the way to distinguish the DO's who became MDs. So, if we want one licensing exam, then we're saying there is no philosophical difference and their is no reason to have a separate identity. Therefore, we can become little m.d.'s.

    ADRIANSHOE Senior Member 10+ Year Member

    Mar 14, 2000
    That's a pretty "absolute" point of veiw...
    maybe what we are saying is:
    hey we take the same boards, AND we also take an osteopathic manipulation board....ergo, we not only have the same MEDICAL qualifications as witnessed by us passing the exact exam and not some other questionable exam, but we also have an additional modality to add due to our unique origins....this seems as equally compelling an argument.
    THERE IS NO argument ABOUT equality if we score equally on the same exam....its really a no brainer. having a separate "medical" exam is what continues to leave us open to question.
  15. DO Boy

    DO Boy Senior Member 10+ Year Member

    Jan 23, 2000
    I guess an offshoot of this question about having only one test is that it is further evidence of the DO's identity crisis.

    I can understand this argument completely -- a USMLE + DO addendum would suggest that the medicine portion is the same as an MD and that the only difference b/t DO's and MD's are the letters after a doctors name besides a little extra bit of knowledge on OMT. Furthermore, if the testing merges into one, then the doors for merging other "things" will be more open (I leave you to come up w/your own ideas).

    But, the reason for having only one test is to facilitate a better understanding of what a DO knows -- to the ACGME residency directors, to the people who shun DO's, and to the public. Since DO's have a terrible PR problem (e.g. no one knows what a DO is; DO's are often looked down upon), having one test is one way to address this PR problem, logically and economically speaking.

    Which is why having one test reaches into the DO identity crisis. I think the real question is whether or not there really is a difference b/t DO's and MD's.

    I'm afraid that these silly slogans that the AOA wants everyone to wear as a button on their white coat (e.g. "treating people, not just symptoms", etc. etc. etc.) are silly because they are non-existant. I'm sorry -- some MDs really do this too. And, not all DO's practice it either. These two facts alone make the "differences" imaginary. The TRUE difference is in the 250+ hours of learning OMT.

    So maybe this whole point of one test is moot b/c like I said one test would imply no differences b/t DO's and MD's and would not be acceptable to the old school AOA board members.

    But then again why don't we just accept this similarity truth, have one test, stop being so silly promoting imaginary differences, and focus on the strength of OMT and medicine (for those that use OMT!)?

    Let's just have one test, make it easier for everyone, make us look less silly, and move on.

    [This message has been edited by DO Boy (edited 07-05-2000).]
  16. jmor702

    jmor702 Member 10+ Year Member

    Dec 6, 1998
    Sapulpa, OK , USA
    I applied only to colleges of osteopathic medicine. I do no want to be just an MD. I want to practice osteopathic medicine. If you think the only difference is OMM, maybe you don't know enough about OM to begin with.

    It is not just OMM, but a different approach to the application of medical principles to the patient.

    I much prefer to be treated by an osteopathic physician. I can tell the difference between a DO and an MD without having having OMM administered.

    Excuse me for ranting,

    but I don't want one profession with some practicing OMM on the side, I want to be an osteopathic physician holistically.
  17. DO Boy

    DO Boy Senior Member 10+ Year Member

    Jan 23, 2000
    good for you. i'm glad you can tell the difference. we need more DO's who think like you and not like me. maybe that's what DO schools need to check for.

    also, what's the diff. b/t say a DO neurosurgeon and an MD neurosurgeon as far as clinical medicine is concerned?
  18. sailingdo

    sailingdo Junior Member 10+ Year Member

    Jun 2, 2000
    Philadelphia, PA
    I personally do not have a strong feeling about these two tests one way or the other.

    It is interesting to think about the human cost that would result from ending one test or the other and how that might motivate the politics of medicine. Positions in these organizations are people's jobs and security. Often orginizations take on a life of their own and refuse to die even when they have become redundent.

    It is also interesting that no one suggested eliminating the USMLE as an option.

    ADRIANSHOE Senior Member 10+ Year Member

    Mar 14, 2000
    perhaps no one mentioned getting rid of the usmle as a legitimate issue is because it isn't a legitimate issue.
  20. Pilot

    Pilot Senior Member 10+ Year Member

    Mar 4, 2000
    Here's my two cents. I kept waiting for someone else to mention it, but no one did. DO Boy started came the closest, but veered off before getting to this point.

    I believe that having one licensing exam is an idea that will never come to fruition for one simple reason: MD's would have to acknowledge that DO's have more training. If we take the same basic exam, plus have a DO addendum which the MD's do not take, then the implication is that DO's receive training beyond their MD brethren.

    The AMA would never allow this to occur. The only solution to this dilemma would be to discard the idea of a DO addendum, which the AOA would never allow, or add OMM into the standard exam, which the AMA would again argue against.

    Alas, we will continue to have two licensing exams far into the future. Let's not worry about it. If a DO student is really worried about being preceived as "less" by their MD brethren, then by all means take the USMLE as well as the COMLEX.
  21. DO Boy

    DO Boy Senior Member 10+ Year Member

    Jan 23, 2000
    I sure do agree w/u Pilot.

    What you mentioned about DO's having additional training over MD's is the beauty of having one test, and is in one respect a formal way of announcing DO legitimacy to the world.

    Maybe it would never happen...

    But for all those aforementioned reasons, wouldn't it be really nice if there were just one test?

    (never say never though)


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