Hair analysis is a test in which a sample of a person’s hair—typically from the back of the neck—is sent to a laboratory for measurement of its mineral content. In some countries hair analysis reports are referred to as mineralograms. This article concerns elemental hair analysis in which a single test is used to determine values for many minerals simultaneously. This type of analysis used by chiropractors, “nutrition consultants,” physicians who do chelation therapy, and other misguided practitioners who claim that hair analyses can help them diagnose a wide variety of health problems and can be used as the basis for prescribing supplements. Bioresonance hair testing, which uses a quack radionics device to test hair, is discussed in a separate article.
A Sampling of Proponent Views
Keri Dennis-Fulmore, a Canadian who refers to herself as a “medical intuitive” and “functional medicine specialist,” describes hair analysis as “a Road Map for Discovering what is happening inside your body .
Biochemical Laboratories, of Edgewood, New Mexico, claimed that abdominal pain, hypertension, anemia, hypoglycemia, anxiety, impotence, depression, infertility, diarrhea, joint pain, learning, disorders, fatigue, headache, and premenstrual syndrome all result from “chronic metal imbalances,” which, presumably, can be diagnosed with hair analysis and treated with dietary supplements.
Trace Elements, Inc., of Dallas, Texas, has promoted “balancing body chemistry through hair tissue mineral analysis.” The company claims to have developed “a precise nutritional therapeutic approach based on the recognition of eight individual biochemical types using elemental analysis of hair.” It has also sold “metabolic supplements synergistically formulated” for each of these types. It markets primarily through chiropractors.
Trace Mineral Systems, of Alexandria, Virginia, touted its hair analysis as “the test that helps body chemistry” and marketed it directly to the public. A 1998 magazine ad claimed that its test reports would show “the body’s excesses, deficiencies & toxicities and the diseases associated with them.” 
Another marketer states that, “hair element analysis is a valuable and inexpensive screen for physiological excess, deficiency or Contribute of elements. It should not be considered a stand-alone diagnostic test for essential element function, and should be used in conjunction with patient symptoms and other laboratory tests.”
Proponents claim that hair analysis is useful for evaluating a person’s general state of nutrition and health and is valuable in detecting predisposition to disease. They also claim that hair analysis enables a doctor to determine if mineral deficiency, mineral imbalance, or heavy metal pollutants in the body may be the cause of a patient’s symptoms. These claims are false.
- Hair analysis is not reliable for evaluating the nutritional status of individuals. In 1974, the AMA Committee on Cutaneous Health and Cosmetics noted: “The state of health of the body may be entirely unrelated to the physical and chemical condition of the hair . . . Although severe deficiency states of an essential element are often associated with low concentrations of the element in hair, there are no data that indicate that low concentrations of an element signify low tissue levels nor that high concentrations reflect high tissue stores. Therefore . . . hair metal levels would rarely help a physician select effective treatment.” 
- Most commercial hair analysis laboratories have not validated their analytical techniques by checking them against standard reference materials. The techniques typically used to prepare samples for analysis can introduce errors for many of the elements being determined.
- Hair mineral content can be affected by exposure to various substances such as shampoos, bleaches and hair dyes. No analytic technique enables reliable determination of the source of specific levels of elements in hair as bodily or environmental.
- The level of certain minerals can be affected by the color, diameter and rate of growth of an individual’s hair, the season of the year, the geographic location, and the age and gender of the individual.
- Normal ranges of hair minerals have not been defined.
- For most elements, no correlation has been established between hair level and other known indicators of nutrition status. It is possible for hair concentration of an element (zinc, for example) to be high even though deficiency exists in the body.
- Hair grows slowly (1 cm/month), so even hair closest to the scalp is several weeks old and thus may not reflect current body conditions for purposes of health diagnosis.
- The use of a single Elements hair analysis test as the sole means of diagnosis violates basic tenets of medical practice that laboratory findings should be considered together with the patient’s history and physical examination, and that the practitioner should keep in mind that laboratory errors occur.
For these reasons, Elements analysis of human hair is not a valid technique for identifying an individual’s current bodily excesses or deficiencies of essential or nonessential elements. Nor does it provide a valid basis for recommending vitamins, minerals, or other dietary supplements [4,5].
In the mid-1980s, about 18 laboratories were doing commercial hair analysis in the United States. Today there are fewer. Some laboratories have belonged to the American Society of Elemental Testing Laboratories (ASETL). In 1982, ASETL began a program in which a well-known proficiency-testing service received and tabulated the data from analyses of identical hair samples sent to seven member laboratories. However, at the end of the year, the testing service refused to continue because the data were inconsistent and appeared to have no clinical significance.
In 1983 and 1984, I sent hair samples from two healthy teenagers to 13 of the commercial laboratories . In 1985, I sent paired samples from one of the girls to five more labs. The reported levels of most minerals varied considerably between identical samples sent to the same laboratory, and from laboratory to laboratory. The laboratories also disagreed about what is “normal” or “usual” for many of the minerals, so that a given mineral value might be considered low by some laboratories, normal by others and high by others. Most of the reports contained computerized interpretations that were voluminous and potentially frightening to patients. The nine labs that included supplement advice in their reports suggested them every time, but the types and amounts varied widely from report to report and from lab to lab. Many of the items recommended were bizarre mixtures of vitamins, minerals, nonessential food substances, enzymes, and extracts of animal organs. One report diagnosed 23 “possible or probable conditions,” including atherosclerosis and kidney failure, and recommended 56 supplement doses per day. Literature from most of the laboratories suggested that their reports were useful in managing a wide variety of diseases and supposed nutrient imbalances. I concluded that commercial use of hair analysis in this manner is unscientific, economically wasteful, and probably illegal, and that even if hair analysis were a valuable diagnostic tool, it is doubtful whether the laboratory reports themselves were reliable.
In 1985, the public affairs committee of the American Institute of Nutrition/American Society for Clinical Nutrition issued a position paper on hair analysis. The paper concluded that although hair analysis may have some value for comparing population groups as to status of various minerals or assessing exposure to heavy metals, assessment of individual subjects appears to have “almost insurmountable difficulties.” For this reason, said the paper, hair analysis might best be reserved for experimental studies designed to evaluate its potential as an indicator of nutrition status and perhaps for some public health surveys. Noting that about 100 articles a year were published on hair analysis, one nutritionist who reviewed the position paper suggested that the test’s inherent limitations made much of the research useless .
The FDA’s current policy on hair analysis—adopted in 1984 and reaffirmed in 1994, is:
The AMA opposes chemical analysis of the hair as a determinant of the need for medical therapy and supports informing the American public and appropriate governmental agencies of this unproven practice and its potential for health care fraud .
Some hair analysis proponents claim that hair analysis can detect allergies. The claim is completely senseless. In 1987, the Lancet published a study in which the ability to diagnose allergic disease was studied in 9 fish-allergic and 9 control subjects, who provided specimens of blood and hair for testing. All fish-allergic subjects had previously been shown at Guy’s Hospital to have a positive skin prick test to fish. The specimens were submitted as coded, duplicate samples to five commercial laboratories that offered to test for allergy. All five laboratories were not only unable to diagnose fish allergy but also reported many allergies in apparently non-allergic subjects and provided inconsistent results on duplicate samples from the same subject .
A subsequent 2-year study of students exposed to fumes from metal welding found that hair analysis did not consistently reflect blood levels of 11 heavy metals .
In 1999, researchers from the California Department of Health located nine laboratories and sent identical samples to six of them. The reported mineral levels, the alleged significance of the findings, and the recommendations made in the reports differed widely from one to another. The researchers concluded that the procedure is still unreliable and recommended that government agencies act vigorously to protect consumers . An editorial accompanying this report in JAMA provided additional information about why hair analysis cannot provide a reliable basis for “nutritional counseling.” 
In 2001, German researchers did a study similar to mine in which they sent hair samples from two volunteers to seven commercial hair analysis laboratories. They found inconsistencies in both both the results and the laboratory reference ranges and concluded that “hair mineral analysis from these laboratories is unreliable.” 
In 2004, three cases were reported of children who, based on hair analysis, were diagnosed with heavy metal poisoning and offered chelation therapy. In each case, the child was taken to another doctor who obtained appropriate blood tests, which were normal, and concluded that no toxicity existed. The authors concluded:
Diagnosis of heavy metal poisoning should be made only after meticulous investigation. . . . In our opinion, hair metal analysis does not even qualify as a screening tool. Hair analysis should be considered only as an exploratory research method, and the results should not be relied on to diagnose heavy metal poisoning and nutritional deficiency. This practice is both dubious and potentially dangerous 
Insurance companies do not knowingly cover the use of hair analysis for nutritional analysis. Aetna, for example, considers chemical hair analysis “experimental and investigational, except for diagnosis of suspected chronic arsenic poisoning.”  CIGNA does not cover it for any reason . A review published in 2008 concluded that determination of arsenic in hair and nails has been most useful in epidemiological studies performed to evaluate environmental exposures of populations to inorganic arsenic but is less useful in the evaluation of an individual patient .
Many studies have been done to see whether variations in hair substances are associated with various disease states and conditions. As Aetna points out, for example, some suggest that the hair conentration of cortisol (an adrenal hormone) might be related to stress or depression . However, even if relationships can be established, I doubt that they will have much use because problems of this type are obvious and do not need laboratory tests to detect or diagnose them.
If a hair analysis report says that the level of a “toxic mineral” as high because the amount is near the top of its “reference range,” this merely means that the specimen contained more than most other specimens handled by the lab. It does not mean that the level is abnormal or that the level within the patient’s body is dangerous. In a 1998 paper, the leading marketer acknowledged that “compared to interpretation of commonly measured analyses in blood or serum, interpretation of elemental analyses from hair seems primitive.” Despite, this, the authors claimed that it would be prudent to “adopt a reference range consistent with what is observed in 95% of a healthy population.”  As far as I know, insufficient data are available to do this.
Government Regulatory Actions
Hair analysis was involved in a case prosecuted in 1980 by the Los Angeles City Attorney’s Office. According to the official press release, Benjamin Colimore and his wife, Sarah, owners of a health-food store, would take hair samples from customers in order to diagnose and treat various conditions. Prosecution was initiated after a customer complained that the Colimores had said she had a bad heart valve and was suffering from abscesses of the pancreas, arsenic in her system, and benign growths of the liver, intestine, and stomach-all based on analysis of her hair. Two substances were prescribed, an “herbal tea” which turned out to be only milk sugar, and “Arsenicum,” another milk-sugar product that contained traces of arsenic. Another sample of hair was taken when the customer returned to the store five weeks later. She was told that the earlier conditions were gone, but that she now had lead in her stomach. A government investigator received similar diagnosis and treatment. After pleading “no contest” to one count of practicing medicine without a license, the Colimores were fined $2,000, given a sixty-day suspended jail sentence, and placed on probation for two years.
In 1985, in response to a petition by the Federal Trade Commission (FTC), a federal judge issued a permanent injunction against Arthur, Ethel and Alan Furman and any business through which they might act. The order forbids “holding themselves out . . . to persons other than health professionals, as being able, on the basis of hair analysis, to measure accurately the elemental content of a person’s body or to recommend vitamin, mineral or other dietary supplements which can correct chemical excesses and deficiencies in a person’s body.”  Arthur Furman, who had practiced dentistry in Maryland, had surrendered his dental license in 1984 after the Maryland Board of Dental Examiners began disciplinary procedings after a conviction for mail fraud that involved submitting fraudulent claims to insurance companies .
As a result of the FTC action, the Furmans’ laboratory closed, but the agency decided to ignore the laboratories that worked only through practitioners, because it felt that practitioner misconduct should be regulated by state agencies. Until the Internet became popular, few laboratories offered hair analysis directly to the public. Today, direct offerings abound, but the FTC doesn’t seem to care.
Gary Pace, who sported a “Ph.D.” degree from non-accredited Donsbach University, practiced as a nutrition consultant in New York City. In 1985, New York State Attorney General Robert Abrams filed a civil suit accusing Pace of practicing medicine without a license, false advertising, and illegal use of educational credentials . Pace’s schemes, said Abrams, induced hundreds of consumers to pay him for improper physical examinations, worthless laboratory tests (including hair analysis and herbal crystallization analysis), bogus nutritional advice, and unnecessary vitamin, mineral, and herbal supplements. The case against Pace was supported by affidavits from thirteen aggrieved clients and two undercover investigators, all of whom had been advised to take supplements. Some of the female clients reported that Pace had examined their breasts or genitals. Several clients underwent significant expense to obtain medical reassurance that they did not have various diseases that Pace said they had. One was advised by her medical doctor to stop taking vitamin A because her palms had become yellow as a result of overdosage. Abrams said that at least 251 clients had paid Pace an average of $307 during the previous four years. Many had been attracted by his ad, which was the largest of eleven listings in the “Nutritionists” section of the Nassau County Yellow Pages. Pace also taught in the extension division of a local community college and hosted a radio program. The investigators discovered that the “free consultation” promised in Pace’s Yellow Page ad was merely the brief telephone conversation in which he advised prospective clients to make an appointment. The case was settled with an injunction forbidding Pace from engaging in the unlawful practice of medicine or using “Ph.D.” or “Dr.” in dealings with the public unless he obtains a degree from an institution recognized by New York State. Pace agreed to pay $2,000 to the state and to make restitution to dissatisfied clients. He also agreed not to do further “nutritional counseling” unless he obtained proper credentials or posted a $150,000 bond .
In 1986, Analytical Research Laboratories (ARL) of Phoenix, Arizona signed a consent agreement with the New York State Attorney General to stop “soliciting and accepting hair specimens for laboratory examination where the purpose is to determine possible excesses of deficiencies in nutrient mineral levels or toxic metal levels in the body.” The Attorney General acted because a health food store proprietor had been using hair analysis as the basis for recommending vitamin and mineral supplements. ARL had not been licensed to operate within New York State, and hair analysis for the purpose of determining nutrient levels was not legal there.
Hair analysis has helped to fuel controversies in at least three communities. During the 1960s and 1970s, a company that did chrome-plating had dumped liquid waste containing chromium into a nearby lagoon in Clarks Summit, Pennsylvania. Corrective measures were taken, and state and federal agencies did many studies and determined that there had been no significant contamination of the drinking water supply . However, community fears were aroused when a chelation therapist (relying on hair analysis tests) falsely diagnosed a few residents with “chromium toxicity” and recommended chelation therapy. Press reports aroused widespread public concern, and Erin Brockovich’s attorney even said to be considering whether to file suit. In 2000, Senator Arlen Specter (R-PA) asked federal officials to sponsor a town meeting that would provide science-based information about the situation. Shortly before the meeting I had the opportunity to examine three hair analysis test reports done by the hair analysis laboratory used by the chelationist. One said that the patient had a “high” antimony level, another found “high” levels of lead and tin, a third found “high levels” of antimony and bismuth, and all three reported well above average “total toxic representation.” At the meeting, public health officials described their studies, Dr. Robert S. Baratz reassured that no risk from chromium-6 exposure existed, and he and I debunked hair analysis and chelation therapy. We also met with reporters and the individuals who were most concerned about the situation. Our educational efforts succeeded in calming down the community’s fears.
In 2001, largely in response this controversy, the Agency for Toxic Substances and Disease Registry (ATSDR) convened an expert panel to examine whether hair analysis is a useful clinical test. The panel concluded:
Before hair analysis can be considered a valid tool for any particular substance, research is needed to establish better reference ranges, gain a better understanding of hair biology and pharmacokinetics, further explore possible dose-response relationships, establish whether and when hair may serve as a better measure or predictor of disease than other biological samples (e.g., blood or urine), and learn more about organic compounds in hair .
In 2003, in a fact sheet prepared for the general public, the ATSDR stated:
Unfortunately, no widely accepted standards specify how hair samples should be collected, stored, and analyzed, and different laboratories use different methods when conduct analysis result is unusually high or low. Because of these information gaps, doctors and other health professionals rarely use hair analysis to evaluate health problems. It is possible that future research will help us better understand what hair analysis results mean. Until this research is done, however, hair analysis results (with few exceptions) will not provide useful information about possible health problems .
In 2008, Boca Raton, Florida’s fire chief John Luca, who had been having unexplained neurologic symptoms, consulted Leonard Haimes, M.D., a chelationist who sent a hair sample for analysis. When the test reported an elevated antimony level, the fire fighters union encouraged its members to undergo testing and 29 of them did so. The resultant reports said that all 30 had antimony levels much higher than the test’s “reference range.” Twenty-three of the firefighters also underwent urine testing for “toxic metals” and were told that their mercury levels were high. Because antimony oxides are used to make the textiles for fire-retardant uniforms, many firefighters concluded that their uniforms were responsible for the test results—and about 80 of them filed workers compensation claims. As these events unfolded, news media and fire fighter Web sites reported the story and aroused national concern over the safety of the uniform pants.
In October 2008, Luca asked the U.S. Centers for Disease Control and Prevention (CDC) to conduct a health hazard investigation. After questioning the fire fighters, CDC investigators conducted appropriate urine tests and compared the results and health status with those of other groups of fire fighters, some of whom used similar uniforms and some of whom did not. CDC’s urine tests showed that none of the fire fighters had a significant antimony or mercury level and that the urine antimony levels of both groups of fire fighters were actually lower than those of the general population. The investigators concluded that the uniform pants posed no hazard from antimony exposure and that both the urine and hair tests were untrustworthy [26-28]. One report—aptly titled “Pseudo-outbreak of antimony toxicity in firefighters”—criticized hair analysis this way:
This investigation highlights the importance of using validated methods for toxicity determination. Urine testing is the most reliable validated test for measuring antimony concentrations. The decision to perform laboratory testing for heavy metals should be based on whether symptoms are consistent with toxicity from these metals and whether a likelihood of exposure exists. Hair testing is not reliable or valid for measuring heavy metals in the body (except for methylmercury) and does not predict toxicity. Standards on methods of hair collection, storage, and analysis are lacking. No regulation or certification of laboratories conducting hair analysis exists. Different laboratories have reported different results for hair samples collected from the same person and use different reference ranges. Hair analysis cannot distinguish between internal (substances inside one’s body) and external (substances that might stick to hair, such as ash or hair-care products) exposure. These limitations render hair analysis results uninterpretable .
After the CDC investigation was completed, most of the Boca Raton firefighters were reassured and withdrew their workers compensation claims. The rest of the claims were dismissed by the city, but the financial and/or emotional damage to the participants was considerable. To begin with, at least 30 fire fighters spent about $500 each for their worthless evaluations by Dr. Haimes. The improper assessments caused widespread concern among the fire fighters, many of whom sought further medical evaluation elsewhere. Although most feel reassured, some have lingering doubts about what to believe. The City of Boca Raton, which it self-insured, spent money processing the worker’s compensation claims. And the manufacturer of the fire-retardant pants lost sales of a perfectly good product.
A very expensive proceeding took place in Brazil. In 2014, in response to charges that company employees had been exposed to toxic amounts of benzene and heavy metals, a Labor Court judge in Brazil ordered Eli Lilly’s Brazilian subsidiary and a successor company to pay damages of 300 million reals. The order also called for medical care for the allegedly affected workers and their offspring, plus other measures, that could cost an estimated 700 million more. Lawsuits with similar claims were also filed by an American laboratory or its affiliated Brazilian entities. Lilly contended that (a) there was no evidence that the site had dangerous levels of the identified chemicals and (b) it was well established that hair analysis cannot be used as a sole basis for diagnosing heavy metal poisoning—as was done by the doctors who diagnosed these patients .
Lilly Brazil appealed the judge’s verdict. During the appeal proceedings, Lilly filed a 28 U.S. Code § 1782 discovery action in Chicago’s federal court to obtain the workers’ test reports plus documents that explained the test’s methodology. As part of its response, the lab issued a report stating that it “strongly concurs with Lilly that the use of mineralograms to diagnose heavy metal toxicity (poisoning) from occupational exposure is improper and unsupported by all responsible authority” and that “if the primary, if not exclusive basis of diagnoses of health problems due to heavy metals were hair analyses reports, then the ‘experts’ against Lilly deviated from occupational exposure standards promulgated by almost all the world’s experts in heavy metal toxicology.” 
The Bottom Line
Hair analysis is worthless for assessing the body’s nutritional status or serving as a basis for dietary or supplement recommendations. Nor should it be routinely used to screen people for heavy metal toxicity. Should you encounter a practitioner who uses hair analysis for any of these purposes, run for the nearest exit and complain to your state attorney general!
For Additional Information
- Aetna Clinical Policy Bulletin on Hair Analysis
- CIGNA HealthCare Coverage Position Statement on Chemical Hair Analysis
- Mercury Testing in Hair
- Why Bioresonance Hair Testing Is Preposterous
- Ordering your hair analysis kit. HairAnalysisKit.com Web site, accessed May 26, 2017.
- Trace Mineral Systems. Alternative Medicine Digest, Aug/Sept 1998, p 99.
- Lazar P. Hair analysis: What does it tell us? JAMA 229:1908-1909, 1974.
- Hambidge KM. Hair analyses: Worthless for vitamins, limited for minerals. American Journal of Clinical Nutrition 36:943-949, 1983.
- Klevay LM and others. Hair analysis in clinical and experimental medicine. American Journal of Clinical Nutrition 46:233-236, 1987.
- Barrett S. Commercial hair analysis: Science or scam? JAMA 254:1041-1045, 1985.
- Fosmire GJ et al. Hair analysis to assess nutritional status. AIN Nutrition Notes 21(4):10-11, 1985.
- Hair analysis: A potential for medical abuse. Policy number H-175.995,(Sub. Res. 67, I-84; Reaffirmed by CLRPD Rep. 3 – I-94)
- Sethi TJ and others. How reliable are commercial allergy tests? Lancet Jan 10;1(8524):92-94, 1987.
- Teresa M and others. Trace-element concentration in blood and hair of young apprentices of a technical-professional school. The Science of the Total Environment 205:189-193, 1997.
- Seidel S and others. Assessment of commercial laboratories performing hair mineral analysis. JAMA 285:67-72, 2001.
- Steindel SJ, Howanitz PJ. The uncertainty of hair analysis for trace minerals. JAMA 285:83-85, 1999.
- Drasch G, Roider G. Assessment of hair mineral analysis commercially offered in Germany. Journal of Trace Elements in Medical Biology 16:27-31, 2002.
- Poon WT and others. Use of hair analysis in the diagnosis of heavy metal poisoning: report of three cases. Hong Kong Medical Journal 10:197-200, 2004.
- Aetna clinical policy bulletin on hair analysis. Revised May 27, 2016.
- CIGNA Medical coverage policy: Complementary and alternative medicine. Revised Aug 15, 2016.
- Goldman RH. Arsenic exposure and poisoning. Waltham, MA: UpToDate, 2008.
- Druyan ME and others. Determination of reference ranges for
elements in human scalp hair. Biological Trace Element Research
- Barrett S. Hair analysis laboratory shut down (1985). Casewatch, Aug 31, 2018.
- Case files. U.S.A. v Arthur Furman, D.D.S. U.S. District Court for the District of Maryland, Criminal No. 4-80-0432, 1984.
- Order to show cause with temporary restraining order. People of the State of New York against Gary V. Pace. Supreme Court of the State of New York, County Court of New York, Index No. 42131.85, filed July 22,, 1985.
- Consent order. People of the State of New York against Gary V. Pace. Supreme Court of the State of New York, County Court of New York, Index No. 42131.85, Dec 27, 1985.
- Pa. Dept. of Health. Public Comment. Health consultation No 8. Past exposure to contaminated groundwater, surfacewater, soil, sediment, air and answers to community questions. CERCLIS No. PAD052676631. ATSDR, Atlanta, Sept 7, 2000.
- Summary Report. Hair Analysis Panel Discussion: Exploring the State of the Science,
June 12–13, 2001. Prepared for the Agency for Toxic Substances and Disease Registry, Division of Health Assessment and Consultation, and the
Division of Health Education and Promotion. Prepared by the Eastern Research Group. Lexington, MA, Dec 2001.
- Hair sample testing: What can hair sample testing tell us about environmental exposure? ATSDR fact sheet, April 2003.
- dePerio MA, Durgam S. Evaluation of antimony and mercury exposure in firefighters. Health Hazard Evaluation Report
HETA 2009-0025 and HETA 2009-0076-3085. National Institute for Occupational Safety and Health, June 2009.
- dePerio MA and others. A health hazard evaluation of antimony exposure in fire fighters. Journal of Occupational and Environmental Medicine 52:81-84, 2010.
- Pseudo-outbreak of antimony toxicity in firefighters—Florida, 2009. MMWR 58:1300-1302, 2009.
- Initial memorandum of law in support of Lilly Do Brazil LDTA’s application for an order of judicial assistance pursuant to 28 U.S.C. §1782. In re application of Eli Lilly do Brasil Ltda. to obtain discovery for use in various proceedings of the Courts of São Paulo State and Paranà State, Brazil.
- Fields D. Report to Eli Lilly Do Brasil LTDA, issued in 2015.
This article was revised on August 31, 2018.