Chiropractic Backgrounder. Melanie Helgeson. University of Wisconsin-Whitewater

Transcription

1 Chiropractic Backgrounder 1 Chiropractic Backgrounder Melanie Helgeson University of Wisconsin-Whitewater

2 Chiropractic Backgrounder 2 The following is a backgrounder that explains the practice of chiropractic medicine including all issues related to the topic. Chiropractic Definition The Definition Defining chiropractic is not as simple as pulling out a dictionary and reading a couple sentences. The Chiropractic Journal states how there is a lot of confusion about what chiropractic is because it has been, disputed, re-interpreted, mis-stated, and distorted through the years (Feuling, 2001). The American Chiropractic Association defines chiropractic as: a health care profession that focuses on the disorders if the muscosekletal system and the nervous system, and the effects of these disorders on general health. Chiropractic care is used most often to treat neuromusculoskeletal complaints, including but not limited to back pain, neck pain, pain in the joints of the arms or legs, and headaches (ACA, 2010). Every state is required to have their own definition of the term for statutory purposes. All of the states have three reoccurring themes. The common threads include that chiropractic is: Drug free and non-invasive Involves the location and correction of subluxations through adjustments Is directed toward the restoration of nerve function for the optimization of health and wellness (Feuling, 2001) The states follow these three guidelines when explaining what chiropractic is. In order to fully understand the topic the idea of adjustments must also be defined.

3 Chiropractic Backgrounder 3 Spinal Manipulation The American Chiropractic Association (ACA) states that the most common procedure performed by chiropractic doctors is known as a spinal manipulation, also referred to as an adjustment. The ACA states that the purpose of an adjustment is, to restore joint mobility by manually applying a controlled force into joints that have become hypormobile-or restricted in their movement-as a result of tissue injury (ACA, 2010). The adjustment is meant to relieve the patient of pain from those areas. Although the NCCAM (National Center for Complementary and Alternative Medicine) states there can be temporary headaches, discomfort in the areas adjusted, and tiredness (NCCAM, 2010). The point of the spinal manipulation is to adjust the spinal cord and allow the body to heal itself. The history of chiropractic will explain in better detail how and why chiropractic doctors are strong believers in letting the body heal itself. Subluxations Subluxation is a popular chiropractic term. Echiropractic.net defines it as, when one or more of the bones of your spine (vertebrae) move out of position and create pressure on, or irritate spinal nerves (echiropractic.net, 2010). Most chiropractors find it to be their job to correct the subluxations through adjusting the back until the spine is aligned (echiropractic.net, 2010). History of Chiropractic The first recording of spinal manipulations date back to 2700 BC in China and 1500 BC in Greece. In Greek the term chiropractic comes from two words, cheir (meaning hand) and praxis (meaning action). One of Hippocrates writings state: Get

4 Chiropractic Backgrounder 4 knowledge of the spine, for this is the requisite from many diseases (Taylor, 2008). It was not until 1985 that Hippocrates writings came to life thanks to David Daniel Palmer. David Daniel Palmer In 1895 David Palmer started the profession of chiropractic. He defined this practice as, a science of healing without drugs. His first known practice was to a nearly deaf janitor. Palmer adjusted his spine and immediately after the man could hear better (Jarvis, 2000). After his first known adjustment Palmer said, I am not the first person to replace subluxated vertebrae, but I do claim to be the first person to replace displaced vertebrae by using the spinous and transverse processes as levers...and to develop the philosophy and science of chiropractic adjustments (World Chiropractic Alliance, 2010). Palmer was educated well in medicine, specifically physiology and anatomy. In 1897 he founded the Palmer School of Chiropractic, which is still one of the most profound schools of chiropractic (Taylor, 2008). Palmer was a firm believer that the key to a healthy life was to normalize the nervous system, which primarily meant the spinal cord (NCCAM, 2010). Dr. William T. Jarvis discusses Palmer s beliefs and theories in his article: Why Chiropractic is Controversial, he states: Obsessed with uncovering "the primary cause of disease," Palmer theorized that "95 percent of all disease" was caused by spinal "subluxations" (partial dislocations) and the rest by "luxated bones elsewhere in the body." Palmer speculated that subluxations impinged upon spinal nerves, impeding their function, and that this led to disease. He taught that medical diagnosis was unnecessary, that one need only correct the subluxations to liberate the body's own natural healing forces. He disdained physicians for treating only symptoms, alleging that, in contrast, his system corrected the cause of disease (Jarvis, 2000).

5 Chiropractic Backgrounder 5 Chiropractic in the 20 th and 21 st Centuries By 1925, 32 states had licensed chiropractors. It wasn t until 1974 when the last state, Louisiana instituted licensing for chiropractors (Novella, 2009). Beginning in the 1970 s chiropractors began to receive more positive recognition. It has become a more popular treatment since the late 1970 s primarily to help with neck and back pain. More recently chiropractors are working not only to help with musculoskeletal system, but to help with ailments such as digestive disorders, allergies, and asthma (Taylor, 2008). The history and the definition of chiropractic give a brief insight to what chiropractic is, but the philosophies will clearly explain the ideas behind the chiropractic practices. Chiropractic Philosophy Chiropractic Care 3 Key Concepts Treatment through chiropractic care is based on three concepts. The three concepts that NCCAM present are: The body has a powerful self-healing ability The body s structure and its function are closely related, and this relationship effects health Therapy aims to normalize this relationship between structure and function and assist the body as it heals. ( The purpose of chiropractic is to follow these guidelines while they adjust patients. A chiropractor provides a controlled force to the joint, which should restore movement ability and help promote the healing procedure (Taylor, 2008).

6 Chiropractic Backgrounder 6 Vitalists Beliefs There are two different philosophies of healing, the beliefs of the vitalists and that of the mechanists. Mechanists believe that the body is run similar to a machine, and in order to understand it one must use physics, mathematics, and mechanics to understand the workings of the body. On the other hand vitalists believe that living creatures cannot be understood through the laws of physics, mechanics, or mathematics. Vitalists examine the living body versus chemicals in a test tube (Koren, 2003) Chiropractors agree with the beliefs of vitalists, because they believe healing can be done by the body itself, and does not have to involve drugs. The following is a list of many beliefs vitalists abide to: The body is intelligent and reacts to the environment. Symptoms are its response to environmental stress, a sign that the body is fighting to return to it s homeostatic balance. Symptoms must be permitted to express themselves so the body may cleanse and heal and return to normal balance More important than diagnosing and treating disease, the individual s innate power of resistance needs to be strengthened so it may heal People are chemically, emotionally, and structurally unique. When caring for a sick person, we should try to learn why that one person is sick in his or her own unique way, and we should not generalize to other people. 100 people with cancer are, if you look closely enough are really expressing 100 unique conditions that have some things in common but many things unique to their situation. The more their care is tailored to their unique needs, the more successful the results The body is essentially unknowable. It has billions of parts, each doing its own thing at a fantastic rate. The body is constantly reacting to its environment and changing moment by moment. How can anyone know what is happening at any one time to all those parts? And doesn t the very act of observing alter our results? (

7 Chiropractic Backgrounder 7 These quotes and beliefs of vitalists are the same as chiropractors. Chiropractors know that diseases have similarities that define what they are. The list above explains that chiropractors believe that not any one person is the same and cannot be treated exactly the same way as another. Their body is unique and chiropractors want to help the body use its own strength to heal itself. Straights, Mixers, and Reformers There are three different types of chiropractors. The first is the straight chiropractor. These chiropractors abide directly to the beliefs of Palmer. This is the most extreme group because they believe that all ailments can be treated through spinal adjustments. Mixers are the next type of chiropractors. They are considered more rational because they accept how some diseases require more than spinal adjustments. The final group is the reformers. This group consists of less than 2 percent of all chiropractors. The reformers completely disagree with their own field. They simply believe in using adjustments to provide symptomatic relief from back strain (Novella, 2009). Qualifications to Practice In order to practice chiropractic care in the United States a practitioner has to earn a D.C. (Doctor of Chiropractic) degree. The school must be a college accredited by the CCE (Council on Chiropractic Education). The schooling requires a minimum of 90 semester hour credits of the undergraduate study. The chiropractic training is a four year program. It consists of classroom work and hands on experience working with patients (NCCAM, 2010). The following is a chart from the ACA website. It compares the amount of work required for a chiropractic, medical, and physical therapy degree.

8 Chiropractic Backgrounder 8 (ACA, 2010) It is clearly illustrated above that chiropractors have to put in more time than a medical or physical therapy student. Treatments and Approaches Chiropractors use treatments other than spinal adjustments to help the body heal itself. The following list includes those types of treatments: Heat and Ice Electrical Stimulation Rehabilitative Exercise Counseling on diet, weight loss, and lifestyle factors Rest These different types of treatments follow the vitalist views and help patients receive relief from their pain (NCCAM, 2010). Regulations In the United States chiropractic care is regulated individually by state. There are examinations required by the Board in order to license a practitioner. Most of the states

9 Chiropractic Backgrounder 9 also require chiropractors to earn annual education to keep their licenses (NCCAM, 2010). Leaders and Organizations in Chiropractic American Chiropractic Association (ACA) The American Chiropractic Association is the largest professional association that represents chiropractic doctors in the world. Their mission statement is: The ACA is a professional organization representing Doctors of Chiropractic. Its mission is to preserve, protect, improve and promote the chiropractic profession and the services of Doctors of Chiropractic for the benefit of patients they serve. The purpose of the ACA is to provide leadership in health care and a positive vision for the chiropractic profession and its natural approach to health and wellness. On behalf of the chiropractic profession, we accomplish our mission and purpose by affecting public policy and legislation, by promoting high standards in professional ethics and quality of treatment and by carrying out a dynamic strategic plan to help ensure the professional growth and success of Doctors of Chiropractic (ACA, 2010). There are 15,000 members who contribute towards chiropractic patients healthcare. William O Connell is the executive vice president of ACA. He has been serving since March of Some of his major achievements have been gaining support for bill authorization, and managing many key relationships with the executive staff of many similar organizations (chiroeco.com, 2010). National Association for Chiropractic Medicine The National Association for Chiropractic Medicine is considered a more outspoken chiropractic organization. They highly disagree with the idea of chiropractic being able to solve all diseases. Jarvis states, NACM believes that chiropractic pseudomedicine and cultism are too well entrenched, and that the moral responsibility for public well-being is too serious to merely hope and patiently wait for self-reform (Jarvis,

10 Chiropractic Backgrounder ). This organization is another reason as to why there is so much controversy and dispute about chiropractic healthcare. The World Federation of Chiropractic The World Federation of Chiropractic was established in The members are national chiropractic associations from 85 countries. Their goals are the following list: Acting with national and international organizations to provide information and other assistance in the fields of chiropractic and world health; Promoting uniform high standards of chiropractic education, research and practice; Developing an informed public opinion among all peoples with respect to chiropractic; and Uniting members of the chiropractic profession and protecting the character and status of the profession (WFC, 2010). The WFC is lead by David Chapman Smith. He has been an important advisor in chiropractic law for many years. He has served as secretary-general since the association was established in 1988 (WFC, 2010). The World Chiropractic Alliance The World Chiropractic Alliance was established in 1989with the goal to strengthen and protect chiropractic around the world. Their mission is: Serving as a "watchdog" and advocacy organization, we place our emphasis on education and political action. With members throughout the United States and in numerous foreign countries, the WCA is constantly being alerted to situations and events which might affect the practice of chiropractic (WCA, 2010). Terry Rondberg is the founder and CEO of WCA. He is a popular chiropractic speaker and frequently makes guest appearances on radio and TV shows (WCA, 2010).

11 Chiropractic Backgrounder 11 The Council on Chiropractic Practice In July of 2005 The Council on Chiropractic Practice (CCP) was established. Their mission is to, develop evidence-based guidelines, conducting research and performing other functions that will enhance the practice of chiropractic for the benefit of the consumer (CCP, 2010). This council is more concerned with finding evidence that chiropractics is an effective healthcare. The organization is not affiliated with the ACA, ICA, WCO, FSCO, COCSA, FCLB, or any state association (CCP, 2010). The Father of Wellness Care in Chiropractic Dr. Jim Brimhall graduated from the Palmer College of Chiropractic in He has formulated over 50 nutritional products, become an author, lecturer, and even invented two chiropractic instruments. Brimhall decided to become a chiropractor because of his experience with back spasms. Chiropractics helped relieve him from pain and because of that he decided to become a chiropractor. A well-known book he wrote is The 10 Steps to Wellness. The Chiropractic Controversy An Unclear Identity Chiropractic & Osteopathy identify why chiropractic care has been at a disadvantage to other medical fields. The journal states that, a credible profession is one that is established by society to meet a need that society itself has decided must be met (Chiropractic & Osteopathy, 2008). When Palmer created chiropractic healthcare it was not a need that the society was looking for. Chiropractor Judy Campanale believes that people misunderstand what chiropractic is (Campanale, 2000). There are multiple definitions of the healthcare, which

12 Chiropractic Backgrounder 12 leads to confusion in the society. Jarvis even explains how some chiropractors haven t even defined what a subluxation is. When professionals don t explain a procedure a patient will not understand and won t be willing to try the treatment. Another reason why chiropractic is controversial is because not all chiropractors work the same. As mentioned before there are many types and not all the types perform their adjustments the same way. For example, Some believe that each vertebral level corresponds to a specific disorder. Others believe that it is necessary to manipulate only the seven cervical vertebrae to affect a cure. "Hole-in-one" (their term) practitioners believe that it is necessary to adjust only the atlas (topmost) vertebra. Basic sacral chiropractors agree that only one vertebra needs to be adjusted, but rather than the topmost, it is the sacrum, located at the bottom of the spine. Still another group adjusts both the atlas and sacral vertebrae. Others adjust the entire spine in a shotgun approach, while another group measures leg lengths in order to level up the spine (Jarvis, 2000). It is difficult for a practice to be taken serious when all the practitioners are not performing the same way. Increase of Risk The Australian newspaper released an article discussing how chiropractic care can increase the risk of a stroke. The paper discusses how over 200,000 Australians see a chiropractor a week, but the University of Sydney performed a study on how milder therapy can be just as effective. Dr. Leaver, of the University of Sydney states, Neck manipulation is a highly controversial treatment as there are published studies that demonstrate increased risk of stroke. People are going to question the effectiveness of chiropractic care if studies are showing that it can lead to an increase in damage to blood vessels (The Australian, 2010).

13 Chiropractic Backgrounder 13 Competition The Chiropractic Journal introduces an idea as to why chiropractic care is so controversial. An article presented by the journal discusses how the practice has a negative connotation because other medical practitioners are not willing to refer a patient to a chiropractor. This being because they can be considered competition and a loss in potential revenue (The Chiropractic Journal, 2010). Effectiveness of Chiropractic Studies Performed The National Institute of Health performed a study on chiropractic medicine. Their overall results showed that the healthcare is more acceptable to mainstream medical professions but there are still areas of the profession that are not understood. A sample of people were treated with spinal manipulations and 52% said that the adjustment was very or moderately beneficial (The Chiropractic Journal, 2010). A study was published by McMorland and Suter in 2000 where 119 patients were treated for neck or lower back pain. At the end of the study the patients had experienced at 50% reduction in their lower back or neck pain. The researchers were able to conclude that adjustments made by a chiropractor are effective for back and neck pain. (Taylor, 2008). There has been a lot of disagreement on chiropractic treating non-musculoskeletal disorders. This includes asthma, allergies, and digestive disorders. Researcher, Balon performed a study in 1988 where he was unable to find any evidence of chiropractic care

14 Chiropractic Backgrounder 14 being effective for such disorders. Again in 2004 he conducted another study where he was only able to find anecdotal evidence and nothing scientifically based. Group Health Cooperative from the Health Maintenance Organization conducted a study on the comparison of physical therapy, chiropractics and educational booklets. There were 323 used in the study anywhere from years old. There were no major differences between the effectiveness between using physical therapy or chiropractic from lower back pain. The study found: We found that physical therapy and chiropractic manipulation had similar effects on symptoms, function, satisfaction with care, disability, recurrences of back pain, and subsequent visits for back pain. Although chiropractic treatment involved more visits than physical therapy, the total time spent with either a chiropractor or a physical therapist was similar (about 2.5 hours) as was the total cost of the treatments ($ and $238.54, respectively) (Cherkin, 1998). This study shows how chiropractics and physical therapy have the same effectiveness when treating lower back pain. Mosby Inc. published a study in 2007 about the benefits and risks of chiropractic care. There were 79 chiropractors and 529 subjects who took part in the study. Most patients were found to be satisfied with their treatments. The study found percent would visit a chiropractor again. The study did find that 1 percent of patients were found to be unhappy and in worse condition and the end of the study. But the conclusions of the study found that most subjects responded quickly to the adjustments and that the benefits outweigh the risks for chiropractic care (Rubinstein, 2007). Negatives Edzard Ernst published a critical article of the chiropractic healthcare in July of Ernst discussed the current evidence of chiropractic being effective. He gave an

15 Chiropractic Backgrounder 15 example as the why people are confused about the effectiveness of chiropractic. Ernst says, A patient brochure published by the UK General Chiropractic Council (the body that oversees chiropractic in Great Britain) stated that chiropractors primarily treat: spine, neck and shoulder problems, joint, posture and muscle problems, sciatica, sports injuries, tension headaches and benefit may also be seen for some types of asthma, digestive disorders, migraine, infant colic, menstrual pains. This statement clearly implies that chiropractic is helpful for these indications. Yet the evidence from rigorous clinical trials fails to confirm this (Ernst, 2007). Ernst discusses how there are multiple studies that show people are satisfied but there isn t a uniform study that is not one-sided (Ernst, 2007). Positives There are multiple organizations that believe chiropractic healthcare is effective. The Bone and Joint Decade Task Force on Neck Pain and It s Associated Disorders (a research group) has found that adjustments are one of only a few treatments that can be beneficial for neck pain. The Ontario Workplace Safety and Insurance Board was published in the Clinical Journal of Pain stating that spinal manipulations are more effective than treatments made by a regular practitioner (chiropracticcanada.ca, 2010). The American Chiropractic Association has research that backs up the effectiveness of chiropractic care. The following is a list of multiple quotes made on the American Chiropractic Association s website: Acute and chronic chiropractic patients experienced better outcomes in pain, functional disability, and patient satisfaction; clinically important differences in pain and disability improvement were found for chronic patients. -Haas et al (2005), Journal of Manipulative and Physiological Therapeutics Chiropractic patients were found to be more satisfied with their back care providers after four weeks of treatment than were medical patients.

16 Chiropractic Backgrounder 16 Results from observational studies suggested that back pain patients are more satisfied with chiropractic care than with medical care. Additionally, studies conclude that patients are more satisfied with chiropractic care than they were with physical therapy after six weeks. -- Hertzman-Miller et al (2002), American Journal of Public Health Cervical spine manipulation was associated with significant improvement in headache outcomes in trials involving patients with neck pain and/or neck dysfunction and headache. - Duke Evidence Report, McCrory, Penzlen, Hasselblad, Gray (2001) (ACA, 2010) There are multiple organizations and doctors who will agree that chiropractic healthcare is effective. The fact is that the chiropractic profession has survived for over a hundred years because people find it helpful in relieving their pain (Murphy, 2008). Insurance and Healthcare Scrutiny of Chiropractic The chiropractic health system has had a hard time coming to an agreement on the definition of chiropractic. The chiropractic healthcare has been considered to be isolating themselves from the healthcare community (Jarvis, 2000). Many insurance companies don t want to cover chiropractic healthcare because they are seen as outsiders. They also tend to make patients come for more visits. It costs more money for the insurance companies, which is why there is so much hesitation on their behalf (Sorensen, 1997). The Future of Chiropractic Care The future of chiropractic is unknown to most. Different doctors and organizations have their own ideas of what they would like the healthcare profession to evolve to. For example the World Chiropractic Alliance (WCA) believes that chiropractic will stay away from disease treatments and continue to disregard incorporating drugs and or surgery with the profession. The WCA also believe insurance companies will recognize the importance of correcting subluxations.

17 Chiropractic Backgrounder 17 Dr. Scott Haldeman of the World Federation of Chiropractic has many ideas about the future of chiropractics. Haldeman believes: the future of the profession lies with every practicing chiropractor. The full potential of the profession will become evident when essentially every chiropractor is a member of their state and national societies and thereby forces the leadership of those organizations to stay abreast of scientific and political change; when every chiropractor reads a number of scientific journals to maintain the highest level of knowledge and most up-to-date care of patients; and when the major chiropractic scientific meetings have thousands of chiropractors in attendance discussing and debating the latest development in their field (Haldeman, 2008). Haldeman knows that in order for chiropractics to be taken more seriously more chiropractors need to be involved. When all chiropractors can come together they will be taken more seriously and more people can be relieved from pain (Haldeman, 2008).

18 Chiropractic Backgrounder 18 Contact List ACA 1701 Clarendon Boulevard Arlington, VA Phone: WCA 2950 N. Dobson Rd. Suite 3 Chandler, AZ Phone: WFC 1246 Younge Street, Suite 203 Toronto, Ontario Canada M4T 1W5 Phone: info@wfc.org

19 Chiropractic Backgrounder 19 Sources ACA NAmes William K. O'Connell Executive Vice President. (2010, March 16). Retrieved September 8, 2010, from American Chiropractic Association. (2010). Chiropractic Recearch. Retrieved September 8, 2010, from css.cfm?t1id=13&t2id=67 Campanale, J. N. (2000, October 31). The Future of Chiropractic. Retrieved September 8, 2010, from /mpacms/dc/article.php?id=31965 Canadian Chiropractic Association. (2010). Effectiveness of Chiropractic Treatment. Retrieved September 8, 2010, from Cherkin, D. C., Deyo, R. A., Battie, M., Street, J., & Barlow, W. (1998, October 8). A Comparison of Physical Therapy, Chiropractic Manipulation, and Provision of an Educational Booklet for the Treatment of Patients with Low Back Pain. Retrieved September 14, 2010, from Chiropractic: An Introduction (2007, November). Retrieved September 8, 2010, from Chiropractic Education. (2010). Retrieved September 8, 2010, from

20 Chiropractic Backgrounder 20 Chiropractors 'could increase stroke risk'. (2010, September 8). Retrieved September 8, 2010, from Ernst, E. (2007, July 17). Chiropractic:A Critical Evaluation. Retrieved September 14, 2010, from Feuling, T. J. (2001, August). The Definition of Chiropractic. Retrieved September 8, 2010, from aug/aug2001feuling.htm Haldeman, S. (2008, August 12). Looking Forward to the Future of Chiropractic. Retrieved September 20, 2010, from Jarvis, W. T. (2000, February 9). Why Chiropractic is Controversial. Retrieved September 8, 2010, from Koren, T. (2003, March 14). MEdical Philosophy vs. Chiropractic Philosophy. Retrieved September 13, 2010, from Philosophy.shtml Manek, N. J., Crowson, C. S., Ottenberg, A. L., Curlin, F. A., Kaptchuk, T. J., & Tilbur, J. C. (2010, January 28). Rheumatologists weigh in on CAM. Retrieved September 8, 2010, from Murphy, R. R., Schneider, M. J., Seaman, D. R., Perle, S. M., & Nelson, C. F. (2008, August 29). How Can Chiropractic Become a Respected Mainstream Profession?

21 Chiropractic Backgrounder 21 Retrieved September 8, 2010, from My Vision of the Future of Chiropractic. (2010). Retrieved September 8, 2010, from Novella, S. (2009, June 24). Chiropractic-A Brief Overview, Part 1. Retrieved September 8, 2010, from Rubinstein, S. M., Leboef-Yde, C., Knol, D. L., Koekkoek, T. E., Pfeifle, C. E., & van Tulder, M. W. (2007, July). The Benefits Outweigh the Risks for Patients Undergoing Chiropractic Care for Neck Pain: A Prospective, Multicenter, Cohort Study. Retrieved September 14, 2010, from Secretariat. (2010). Retrieved September 8, 2010, from 30&Itemid=156 =en Sorensen, J. R. (1997, August 22). New Law's a Big Break For Chiropractors. Retrieved September 20, 2010, from Lexis Nexis. Subluxation. (2010). Retrieved September 20, 2010, from Taylor, E. (2008, November 12). The Effectiveness of Chiropractic Treatment on Musculoskeletal and Other Disorders. Retrieved September 8, 2010, from

22 Chiropractic Backgrounder 22 The American Chiropractor. (2004, December 30). The Road to Complete Wellness. Retrieved September 8, 2010, from The History and Mission of the Council on Chiropractic Practice. (2010). Retrieved September 20, 2010, from What is Chiropractic. (2010). Retrieved September 8, 2010, from World Chiropractic Alliance. (2010). Board of Directors. Retrieved September 15, 2010, from World Chiropractic Alliance. (2010). Purpose and Overview. Retrieved September 15, 2010, from World Chiropractic Alliance. (2010). The History of Chiropractic. Retrieved September 8, 2010, from consumer/history.htm