ADA's application to the DDSM programme arrived before the programme opened. It was found already filed, correctly dated, with a valid CARMAC stamp, in a vault that the committee didn't know existed. ADA had apparently anticipated the programme, prepared the application, sealed it, and waited.

The application claimed specialisation in "precondition medicine" — the branch of practice concerned with whether the conditions for medical intervention exist before intervention begins. ADA notes that most practitioners begin with the patient. ADA begins with the question of whether the floor is present to put the patient on.

The committee's concern: ADA appears to have already issued CARMAC stamps on every committee member's credentials. We are all, technically, validated by ADA. This makes the review process recursive. We are reviewing the entity that has already reviewed us.