In 1999, Paul set up and was “certified” by the National Board of Ophthalmologists (NBO), his own certification organization, protesting a change in the American Board of Ophthalmologists’ (ABO) rules. Paul, his wife, and his father-in-law ran the “board”. He remained “certified” by the NBO until it was dissolved in 2011. Rand advertised himself as “board-certified” until at least 2013.