Game-Changing Focus: Play the First FDA-Approved Video Game - Dr. Adam Gazzaley | 1089 | Dave Asprey

You're listening to the Human Upgrade with Dave Asprey, formerly. You're listening to the Human Upgrade with Dave Asprey. Today we're going to talk about using video games to treat adhd. Okay, well, maybe not, but maybe we're going to talk about distraction and focus and how actually video games, not all of them, not used unconsciously though, might be a benefit to you. And I wanted to do this interview because years ago now I'm going to disclose my calendar age, even though my lab tests don't agree with them. When I was in college in the early 90s, I was the only person who had a laptop because I spent $5,000 in $1990, which is the equivalent of like $5 million of today dollars, because inflation is real. But. And it was the first time I had one. And I started playing a game called Freecell, which is basically solitaire. And I played it all day, every day in class while I was taking a double course load for the first time in my life. And I got a 3.9 GPA that semester, which was the highest GPA of my entire life because of video games. And what I realized was that my brain stayed engaged because I was just doing kind of a mindless card game. And I was still listening. And I would just switch over, type out whatever was important, and then go back to the video game. And then all the other people in class would get really offended and they'd say, dave, how disrespectful to play a video game during class. And then I would look at them and I'd say, how disrespectful to look at my screen that was private, which created usually seizures in those people. But then I would say, would you like a copy of my notes? And magically, my notes were better than their notes because I had a computer, but I could only pay attention to because I was playing a video game, because, yes, I did have adhd. So that is one case that I maybe wrote about in one of my books or I talked about early on in a blog post. But it's the real deal. And so there are many other things like lumosity and things like that. So I wanted to go into some details on distraction and on focus, and I want you to learn some things from this episode. Our guest is the co founder and chief science advisor of the Achille Interactive and Jazz Venture Partners, and he's the David Dolby Distinguished professor of Neurology, Physiology and Psychiatry at ucsf. Welcome to the show.

Thanks for having me here. Really excited about it.

I guess I should also say your name is professor or Dr. Adam Gazelly, although you go by Adam.

Yes, Adam is fine.

I was too distracted. I saw a squirrel.

Get it.

All right, let's get right into the details here. Do you like ice cream? Oh, sorry. Adhd. It just happens. How do you measure attention?

Yeah, that's a great question and a challenging one. And I can tell you the main reason why it's so challenging is what do we mean by attention? Attention is one of these tricky things in that if you, if you use the word, everyone feels pretty comfortable that they know what you're talking about. But I could easily spend an entire hour now and break down attention in so many different ways and from so many different perspectives. And each one of those ways of looking at attention has a different metric and a different measurement tool. So attention is actually incredibly complicated. And of course, and I think everyone appreciates this is sort of built into using the word is that it's important. Really, really, really important. I would say it may be the most important human function. Without it, we're essentially incapacitated by an inability to filter out all the irrelevant information around us and focus on what we're intending to. So I just want to preface that and I'd love to spend an hour talking about attention, but we want to talk about a lot more than that. Usually when people are talking about attention and they just use it quickly, what they're talking about is top down selective attention. And so we have attention systems that allow us to pay attention to things that we're not trying to all the time. Our survival depends upon that type of attention. But when people like, how do you measure attention? They're usually talking about top down. That's goal directed attention and not necessarily sustained attention, although that's another aspect of attention. But how effectively do we focus our limited resources in space and in time and resist the distracting information that threatens to derail that focus? So let's just define attention that way. It's one of many ways and there's lots of different tools. So you can measure it in a lab with quantitative tests. We use many of them. One of them that we use in a lot of our research, including our video game research as an outcome measure is called the sustained focus test or the test of variable attention. And it's looking at two important aspects of attention. Both your ability to focus on what's relevant and resist what is irrelevant and also sustaining over time because it built into attention is some type of temporal dimension that if you're not holding it. It's barely attention. And so there's lots of laboratory tests to do that and quantify that, how fast you respond, also your response time variability. People are familiar with heart rate variability, I'm sure, a lot of your listeners. There's also rtv, RT variability, which is a metric of not just how well you deploy your att, but how variable is it over time, how well can you maintain that focus of attention. And then, of course, there are ways of using neural and physiological recordings to also understand the mechanistic underpinnings of how well you're focusing your attention.

This can be miraculous to understand. I came across this when I got my first brain scan from Dr. Daniel Amen. Today. I'm on his board of directors for Amen Clinics. And I had a SPECT scan in my brain because I was failing out of Wharton Business School. And I could tell something was wrong. It was actually really scary. And I was ashamed at the time because I qualified to get extra time on my test, because I. As soon as I started taking a test, I'd get 100% on the first question, 80% on the second, and after that it was 30%, then zero. And it was like no matter how hard I tried to think, there was just nothing in there. And what we learned was that I was literally shutting down activity in my prefrontal cortex. There was no metabolic activity there. I had mold toxin induced brain damage. And so I went and I did a battery of tests, including, how variable is my attention? What's the response time on attention? What's my TOVA score? And I got really into hacking that so I could learn how to pay attention. And I did. Partly I had Asperger's, partly I had adhd. And. And you can train your ability to pay attention. Just like you can retrain your vision, you can retrain your hearing, all of which I've had to do. And magically, I can pay attention at least to things I care about for long periods of time. And if I don't care about it, instead of just being unable to care, I choose to go do something else. But it's a choice, right? Like, I'll. I'll not finish the book because I didn't think it was worth the time versus I can't finish the book or the lecture or whatever it is. How common is it that people consciously train their attention?

Well, I really liked what you said. In some ways, it's the journey I've been on for the last 15 years is to apply Both rigorous and intentional design of tools to help you accomplish that and then do deep dive research studies to figure out does it work and how can it be better. And so what you described was sort of like my mission. Prior to the last 15 years, I had been working on under understanding attention using functional brain imaging, both FMRI and EEG and all sorts of tests. And you know, my conclusion was, the one that many scientists have reached is that our attention is really vulnerable and fragile to all sorts of interference and our modern world is not making it any easier. I wrote an entire book on this called the Distracted Mind. And it's not like a cheery topic. It's like, wow, we are struggling. And then I was like, man, I do not want to tell that story for the rest of my life. Cause it is a bummer. And it's not in any way activating people besides just alerting them to the challenges. So knowing being aware of your challenges is critical for all sorts of change, but it's not enough in itself. And so can we design tools that selectively target these networks and have the ability to adapt so that you're really challenging at the highest possible level? And that's what I've been working on. So to answer your question specifically, I'd say most people don't train their attention even when they recognize that their attention is suboptimal for what they're trying to accomplish in life. And many people first are aware of their attention challenges, maybe through a teacher at school or their friends or their significant others. And then get a little more clarity, maybe through a doctor that did a TOVA and did an evaluation. And then they discover these letters, ADD or adhd. And all of a sudden they're like, wow, I think I know why I've instruct struggling. And as we all appreciate, one of the main things that we then do is give a drug, usually a stimulant, something like Adderall, to try to restore that sometimes as behavioral therapy, if you can afford it and have access to it. And those are the tools that we have that most people have access to. That's sort of the, I would say the status quo. The paradigm of medicine for the mind in general, and certainly for attention challenges, is a pill. And that doesn't really train attention. I mean, if you strip away that chemical boost, you're back to where you are almost immediately. And so there's no real enduring plasticity in the brain that's leading to sustainable effects. And so most people don't do what you do. They don't have quantitative metrics of their attention that they could follow over time and engage in a program to strengthen those abilities. Like they may strengthen their endurance or their physical muscles or their hearing. And so, yeah, I think it's actually really rare and a missed opportunity, which is why I do everything I do.

Well. Hopefully we can get a million or so people paying attention to this episode for at least a portion of it, right? That'd be wonderful. Now, you mentioned Adderall. When I was at Wharton, I did go on Adderall. In fact, it was funny. The psychiatrist who had been trained by Dr. Amen, he looked at me and kind of like, oh, tech bro wants Adderall. I've seen this before. When he saw my brain scan, he just looked at me and he shook his head and he said, dave, inside your brain is total chaos. I don't know how you're standing here in front of me. You have the best camouflage I've ever seen. And by camouflage, he meant that I could look and act normal, like a warden school attendee, even though my brain was kind of scrambled, right? And I was really, really struggling to pay attention. I could, like, bite my cheek until it would bleed or, you know, pinch my thigh or something and just really, like, effort my way in. But eventually, willpower didn't work. What I found, though, was increasing mitochondrial function. Like, actually the ability of the cells in my brain to make energy really helped me pay attention. And bulletproof coffee. I've had countless people tell me they went off Adderall when they started drinking butter and coffee. Today I do Danger Coffee is my new coffee brand because it's got minerals and electrolytes that I think make a different kind of experience. But what's interesting is the MCT oil makes ketones which power mitochondria in a different way. And it felt like with that, I didn't necessarily need something like Adderall, but I couldn't take Adderall cause it made me want to punch people. Like, it was really a gross feeling. So I switched to Modafinil, which I popularized as a smart drug in nootropic circles over the last 10 years and kind of went on ABC Nightline about it. And I don't have a problem using drugs or supplements. Today I use Modafinil about half the time just because I like it. But I use 50 milligrams or 100 milligrams of low dose. And it feels like it helps me with smoothness and it probably lowers my variability. And in fact, I measured it once that it lowered my variability in my attention. But overall I'm happy with how my brain works on or off the drug as long as I get good food. Do you think nutrition is a major variable that people overlook when it comes to paying attention?

100%. I mean there's lots of variables and you know, we all have our focus areas and you have yours and you know, mine has largely been using interactive experiences both through video games and other approaches in order to fine tune these operations. But that's just one sliver of the conditions that are necessary to be optimized in, in any way. Right. And so nutrition 100%, physical fitness 100%, adequate and efficient. Sleep also critical for this type of functions. I mean, everyone's probably nodding right now because we've really grown to recognize how important that is for attentional function. And then, you know, stress management, I would say not no stress. I think stress is really good to some degree to push the body. That's how we were built both physically and cognitively. We respond to stress. We would not do well in an environment that was completely passive with no challenges. But there is a type of hopeless, helpless, chronic stress that's also very damaging to the brain. So somewhere in there is the sweet spot for each person. And I think dialing all those things in, including social interactions, I would say time and nature, there's a long list. And that's why when as I've moved technologies from my lab and center at UCSF into companies and now we have products and still trying to be very careful and deliberate with my messaging that this is not some holy grail like play this video game, you're fixed. This is one tool on a whole belt that you should be wearing. And we, we intentionally limit the amount of gameplay to just 25 minutes a day, five days a week. Even what we consider a dose is just a month dose because it's not meant to be a replacement of all the other things. Proper nutrition, sleep, physical exercise and time in nature, social interactions that are all important for being a comprehensive, well rounded human being and having good attention.

Does it matter what video game you play?

For sure. And I would say it's the same logic of does it matter what drug you take? Or that's a perfect one, I'll just leave it at that. Does it matter what drug you take? Oh yeah, there are some drugs that'll kill you in a second and other drugs that may change your life or open up your perspective to the world. And there's the full host and games are just like every other category. There's an incredible amount of variability within them. Some will be fun, but won't necessarily have a positive and enduring impact. And that's fine. There's plenty of drugs that are fun too, that might not have that impact. And there is also different types of interactive experiences. I mean, we're talking about video games, but video games are not magic, right? They're a fun, engaging, hopefully digital interactive experience. I mean, that's what they are. And so from that perspective, they're an experience like any other that can change your brain for good or for bad. Right? There's no sort of ethical force in how these things change you. They put pressure depending on how you engage with them. So there are some games that may have certain benefits in some domains of your activity and how you function, and others that may have different ones. And basically anything can be built into a video game. In fact, at Neuroscape, we have just published our third paper on a game that's essentially concentrative meditation. I mean, you play with your eyes closed. All the reward cycles and the mechanics are very much in align what people would think of as vipassana. But it's a game, you know, it has game elements to it at the very least. So we have physical fitness games, games in VR that allow you to like navigate three dimensional worlds. And so the devil's in the details. What game is it, how is it designed, what is it targeting? And then what's the data that it does, what it was intended to do. So all those go into it.

Lt. Col. Grossman came on the show a few years back. He wrote the books on combat and on killing and studied how first responders respond to traumatic situations and school killings. And what he found was a common variable in all of the really bad school shootings was heavy experience with first and shooter video games. In fact, he calls them mass murder simulator training. So the rule for my kids is you can play games where you shoot at robots, but you don't play games where you shoot at humans because it's bad for your soul. Good advice or bad advice?

It's a complicated one and it's not my area of expertise. All of the games that I have ever built and put out there and studied have no violence in them because I don't think it's a necessary ingredient for the effects that we're trying to yield. So why add in something that's so complicated and may have negative benefits, may have negative effects. I think that the data is mixed and it's not necessarily because it doesn't have harmful effects in some people. It's just that there are so many people consuming all sorts of things, from violent TV to all sorts of things. It's very hard to really dial in with conviction what those effects are. But I'm on the same page as you. I have, you know, when we actually met many years ago. I don't know if you remember this. We were at a conference together. I'll have to look. Mind body green. Maybe I have to look.

Oh, yeah, I remember that.

Do you remember that?

It was the only one they put on before all the pandemic stuff and they invited a bunch of interesting thinkers in the Palm Desert. Yeah. Okay.

We did chat. Yep, exactly. We sat.

You look so familiar.

I got that.

Thank you for reminding me.

We sat at lunch together. That was the first time we met each other. I think it's. We haven't seen each other since. And the reason I brought that up is I did not have children in those days. I do now. I have two little kids.

Oh, congratulations.

Thank you. Little ones during COVID So, you know, you can't help but have your perspectives, even as a scientist, colored by your life. And you know, I've talked publicly about video games for so many years and the question of violence in video game comes up. I don't have a super strong opinion on it. It's not what I do in my own work. But I present what I said to you. The data is mixed. But now I have kids. Now I actually have to make a personal decision, not just an academic one. And I feel similarly personally to you that it's nice to have games that are engaging and challenge you and reward you and get your adrenaline going. But extreme violence towards other human like characters is not something that I'd be putting on the list for my little girls anytime soon.

I. I think I would be okay as teenagers if my kids wanted to shoot at zombies. Because it turns out there are actual real zombies in the world walking around right now and. And you should be able to call them out automatically with your nervous system so you can avoid them. Some of them even vote. Oh my God. Now in your work, and I think this is really helpful for listeners to understand how their brain works, how focus works. You talk about top down and bottom up, focus, thinking and how it relates to paying attention. Talk to me about those kinds of thinking and what they do for your attention.

Sure. So bottom up is the more ancient version. More ancient, ancient type of attention. So if you pretty much look across any animal Even animals that have not very well developed brains, they have this bottom up attention. And what bottom up attention is its sensitivity to the environment that automatically, reflexively triggers you to direct your resources, whatever they may be added. And you could imagine the survival advantage and why it was evolutionarily selected for in that you need to find food, you need to avoid toxins. If you're evolved enough, you need to find mates and have babies. And so it's fundamental to the nervous system is this type of attention. Right. A like a flash of light, a loud sound, you're orienting to it. Even if you didn't have the goals, that's bottom up. It's still part of our system. Right. You go to cross street, it's measurable.

Someone who's on drugs or on toxins will have a. Much like someone who's smoked a lot of pot, it's going to be slower, right?

Yeah. There's so many things that alter this from lack of sleep. It varies. It's a state like effect but you know, you know it when you're crossing a street, you're, you're looking at your phone, you're engaged in thought, someone hits the horn, you activate, right. Hopefully. And that's bottom up. That's bottom up. Top down is looking in your phone, being lost in thought. It is goal directed attention. It's not necessarily related to survival, it's not necessarily directed at the things that are most important or most salient in the world. It's how you direct your attention based on choice and decisions. And that's what humans pretty much do very uniquely is that type of attention. And also top down attention can be switched and moved and navig in all sorts of ways. And a lot of our challenges with technology and the modern world in general is a collision of top down and bottom up. Because technology companies and the people that design for them are smart people. And whether or not they were aware of bottom up and top down are certainly aware of tools that they have that can create bottom up sources that pull your attention. Whether it's notifications from buzzes to vibrations to lights to sounds, these are still very powerful syncs for us. And they're used very effectively that way. And we actually, we have to combat against them if we're going to maintain our top down attention.

Okay, is it more helpful to train top down attention or bottoms up attention?

I think that there's value for both. Most people when they feel that their attention abilities are not as good as they should be when they're struggling with it what they're largely talking about is their top down attention. They might be highly sensitive to the environment, but what is getting them in trouble at school or work or in their relationships is they're not holding their top down attention at the level that they want to for as long as they want to. So that's usually what people with ADHD are suffering from is the top down attentional deficits. And that's what the type of things that I've worked on, especially in our video game that's out there now as ADHD treatment is really targeting that specific type of attention.

It's kind of scary. I've seen those videos of classes in China where young kids, I'm guessing seven or eight, all have, it looks like HEG devices on monitoring whether they're bringing blood to their prefrontal cortex and notifying their parents if they're not paying attention enough so they can get yelled at later. Notifying the teacher I've often thought as a teacher I was at the University of California Santa Cruz for five years. I taught like working engineers how to build the first version of the web. And so I was like I would love to know if I'm losing track of my class so I could throw something at them or talk differently or do something like the feedback loop would be great. But it seems like that could be toxic. I mean can you over train attention in kids so that they lose their ability to play or experience joy?

It's a good question. I would say that it's probably unlikely with just training approaches itself. Can you do it with drugs? Sure. And we probably do already accomplish that sometimes. What's the best one for that by over medicating. There are certainly reports of kids on Adderall that feel that they do that. It does impact their joy or their personality in the goal of improving their attention. The powerful thing about training attention, whether it's through a video game or another approach like the video game is something I know well because we've been studying it for 15 years, is that when you play it for long enough you feel a certain percentage of people, around 70% in adults feel that they are better able to focus their attention. That's after like a month or six weeks. It certainly does not happen as quick as like a single dose of playing.

Any or you're saying playing this game.

Of playing our game, Endeavor.

This is a game called Endeavor specifically.

Exactly, exactly.

And what platforms is Endeavor on?

So maybe I'll just slide back for one second and tell you a little bit about the Endeavor story. When we met all those years ago, I had a game that we had published in Nature showing that we can improve attention in older adults. That game was called Neuro Racer and that's what I was there speaking about.

I played it.

Yeah. Yeah. So since then, Achille, the company that I co founded, licensed the technology, the patent essentially behind Neuracer, and built a game called Endeavor. And it's been a decade now and over those years, dozens of research studies have been done in different populations that kept replicating the original finding in nature that playing the game improves your ability to sustain attention outside of the game. So your TOVA gets better. And also now what we've shown in ADHD studies is even your real life focus, as subjectively measured by how well you're able to engage in tasks of daily life, also improve as well. And so that game, after many, many years of clinical trials, including a phase three trial. So a double blind, placebo controlled, randomized, multi site trial in children presented to the FDA was approved during COVID as a Class 2 medical device. So this was the first video game ever approved by the FDA for any medical condition. And in this case it was for children, specifically 8 to 12 year olds with attention deficit disorder.

Hold on a second though. If the FDA approved it, doesn't that mean that it doesn't work and has massive side effects?

This is, is an exception to that.

Okay, got it. Just check in.

I can tell you that taking a video game to the FDA was a unique experience for myself as well. Because you're right, they don't tend to look at what I define as like experiential treatments. This is a very, very new submission for them and it actually went into a category called de novo submissions, meaning that there's no predicate to fall on. It's a completely new category and specific. Thus it spent two years in the review process of going through the data and understanding from hundreds of children that have played it and it was eventually approved. So now a doctor can prescribe it. So that game is called Endeavor Rx. It's a prescription game, it's for children, it is only available via prescription and they can play this with Adderall or as an alternative to it.

So you can actually now get insurance to pay for video games, which is why you went to the fda, which is brilliant by the way. Insurance companies should do something useful. Maybe this is one of the few things that they'll do.

You just really hit a very triggering point to me in a good way. Let me tell you. About that. So I spent over a decade designing this game and then dozens of research studies published in great journals. Two years at the FDA to get that approval and then we bring it to the world and what do we find? Insurance companies really don't want to reimburse for it.

Insurance companies don't want to reimburse for anything. I mean, let's face it.

Exactly. And there is nothing about FDA approvals that makes an insurance company have to approve for it. It's a big problem. And so we've struggled there. We have I think over 15,000 prescriptions written by doctors for children and we have lots of success. Every month more and more children are playing their medicine essentially. But we still struggle with widespread insurance reimbursement. And that is a real burden for any company. A giant drug company can push through this phase, this sort of valley of death between regulatory approval and insurance reimbursement, but for small companies it's very hard to do that. And so that's been an area of struggle. One that we continue to try to push on is the need for insurance companies to say, hey, we have children in need. We have a game that's been through a lot of research that's FDA approved, that has essentially no side effects. This should be something that's reimbursed. And that's something that we are still pushing on, guys.

It's called Endeavor OTC and I'm actually installing it right now on my phone. And I actually knew about Neuro Racer but I didn't understand that was the tech in Endeavor otc. So I'm installing it right now to see if I notice the difference because my intention is very well trained at this point, but I'd be willing to spend.

Yeah, that's great. It is exactly the same as Neuracer from the mechanics point of view that has a much better game envelope around it. But I want to point out a difference there. So what you're downloading now is called Endeavor otc, which stands for Endeavor over the counter. And so what happened several months ago is that given the slow adoption of the prescription treatment for children because of the insurance reimbursement delays and the Dr. Gateway, we did a study on adults and found that it actually improved their attention seven times the level of what we saw in children. And it also has 70% reporting some improvements in a well validated metric of quality of life. And we also know that the number of adults with ADHD has continued to increase, especially through Covid. And so what we release there that you're Downloading is the same game as Endeavor rx but does not require a prescription and is targeted for adults. So it has the same core mechanics, but it doesn't have all the connections with the parent and the doctor and all the other elements that go into the prescription version of it. But the core ingredients, the active sort of the engine of the game is all there in Endeavor otc. So we just released that. We're really excited. We're getting great traction on that and I'm happy that after a decade of writing back to people from their emails and saying how do I get Neuraser? I'm like, well here it is, it's now available.

Thank you. I consider it unethical when the trade union of physicians and drug companies requires you to get a permission slip to buy something, something you want to buy. Like I didn't sign up for having my daddy or my mommy be my government or my doctor telling me what I can and can't do with my own biology. I am a biohacker and I, you know, if I want help or consulting then I hire the right experts. Sometimes they're world class doctors and sometimes they're not and that's up to me. So thank you for, for breaking through that people asking what the price is. It is 25 bucks a month or it looks like 10.83amonth if you do a year subscription. So not crazy expensive. I am going to do the year version and guys, this isn't like pre arranged or anything. I didn't realize this was Neuro Racer because I liked it. It was just too much of a pain in the ass and we don't have a license for 40 years of Zen, which is my neuroscience company and I have, I don't know, a hundred thousand dollars worth of neuroscience gear in my house. So this is cool because it's an affordable way to train your attention. What do you don't have ADHD though? Does it still help your attention if you're already normal or you think you're normal?

It's a great question. So we have lots of data showing that convinces me that this is a tool that improves attention pretty much across the board. And it just so happens that people with ADD as the name would imply in ADHD have a lot of attention problems. But we have data from all sorts of healthy populations. Our Nature paper was healthy older adults that were in that study. We've had data from depression and Ms. And many different clinical indications. So we took one through the fda. But yes, I would think of this as a way of improving attention abilities. And I'm really curious what your listeners think about it when they play it. I do want to note that you might not feel the effects immediately. It's not a drug that's just dumping and changing neurochemistry dramatically. Picture training for a marathon. You got to do a little bit of work here. I could also tell you that game is hard. It's a game, you'll see, you'll tell it's a game. It's cool looking, it's lots of rewards and characters, but it uses a closed loop system. So it's constantly adapting the level of challenge based upon your abilities in real time. It's like the ultimate personal trainer and it's going to kick your butt like a personal trainer would. So bear with that. One other little tidbit. I'll tell you. It's funny, Dave, I expected you to say what you did about sort of the firewall of someone else making a decision. And I actually didn't want to have this conversation with you until we had the occ.

By the way, that's the beginning of the game. So I'll figure out to turn it off now. Didn't mean to interrupt you. It just started.

I loved it. Yeah, no, I wanted to have this conversation with you because I knew that this is the direction we're going to as we released it from that prescription firewall. Because I remember our discussions. I remember meeting you. I know what you do. And I wanted to talk about it when it was available. This would have been a really frustrating conversation for me and maybe probably for you a year ago. And so that's out there. The other thing that I wanted us to include that wasn't there until like a month ago that I also wanted to do before talking to you was that we now have embedded in the game a Focus Score. Oh, cool. Yes. See I. Do you like that. That uses gameplay data on your first visit to give you a baseline and then it uses data to predict where you'll be in six weeks from now. And I could tell you that that Focus Score, although it is.