Since the dawn of the consumer movement in the 1960s, perhaps the most important tool of consumer advocates has been the class action lawsuit. The class action combines thousands of small claims into one lawsuit, permitting recovery for nickel-and-dime chiseling that would not be practical to redress in individual lawsuits. It also helps vulnerable or unsophisticated individuals who may not recognize that they have been harmed or fleeced. Class actions have resulted in refunds to consumers for fraudulent HMO, credit card and telecom billing practices; free medical check-ups for persons exposed to toxic substances; and most importantly, changes to business practices that cheated or threatened the health of consumers.