On the other hand, I certainly used ballpoint pens a lot when I was taking primarily handwritten notes or taking exams and I didn't get writer's cramp the way I do today if I write for any length of time. I never really cared for fountain pens and the mass market alternatives weren't available at the time so all the way through high school and college I mostly used ballpoints. I did type in college for papers and articles but notetaking was all by hand.