MLN Vol.12.No.2

Massage Law Newsletter

Vol.12,  No. 2                                        ISSN 1073-5461                                      November 1999

WHY IS  "PHYSICAL THERAPY" THE "BUSINESS" OF

 THE AMERICAN MASSAGE THERAPY ASSOCIATION (AMTA)?

WHY DOES AMTA SUPPORT STATE REGULATION?

 

Rev. Mary Brewster, M.Ed. and Rev. Albert Schatz, Ph.D.

PROLOGUE

Questions

"Those in power do not like to be questioned. Yet asking the right questions has always served the cause of righteousness. The very fact that power is challenged makes for more healthy human equations."1

"It is our responsibility as citizens of a democracy to question authority, to probe with our questions the discrepancy between rhetoric and reality, between stated values and practice. Every political organization knows the power of defining the questions framing the debate."1

Questions that  ask for well-documented evidence which justifies the alleged need for state regulation, are in a sense comparable to Jesus' "interrogatory theology."1

 However, state regulation is not a religious belief, and should not be accepted on faith. It should be accepted or rejected on the basis of well-documented objective evidence that it is or is not needed. If it is needed, it must be to protect the health, safety, and welfare of the public. This is one of the essential requirements of Sunrise legislation.  

Gnostic reality

State regulation is controversial because those who support and oppose it have different views of the reality that is involved. The controversy, although secular, calls to mind the religious conflict between the gnostics and the early orthodox Christians.

The gnostic gospels (written "as early as, or earlier than Mark, Mattthew, Luke, and John."2) reveal the basic difference between the two groups.

The gnostics did their own thinking about reality, which they believed each individual is capable of doing.  The orthodox Christians at that time accepted the reality which was defined by authority; i.e., their bishops.

Using our God-given power to discover truth

"God gives personal power to each of us, and each of us chooses whether we will exercise that power or let it be usurped."3

"We must name and claim our power. We must grasp it, nuzzle it, nurture it, speak it, celebrate it, run with it, fly with it ... use it in the best way  we know how."3

 "Discovering the truth behind the veil of popular wisdom is like picking through boxes at a garage sale: you have to toss aside layers of tattered and ragged junk in order to find the yard of pure silk."3

WHY WE WROTE THIS ARTICLE

Albert Schatz received a "thank you" letter after he sent in his dues for the present year. The letter said: "Naturally we value input from supporters of the massage profession such as yourself."  The letter was addressed to "Dear Supporting AMTA Member," and was signed by Marlys Sperger, Executive Director of AMTA.

We were also motivated to write this article by  AMTA President Maureen A. Miller's Editorial on Synergy in the Winter, 1999, issue of the  Massage Therapy Journal. This editorial "sparked" [our] interest ... to participate ... in the vitalization of massage."

We are pleased to be "invite[d] and encourage[d] to contribute in a way that is meaningful to [us]." We are pleased to know that "AMTA ... does ...  seek [our] concerns, ..." [and] "welcomes [our]... diverse talents, experience, and inspiration."  We are pleased to "Come [and] synergistically rejuvenate the profession."

To contribute, we are voicing our concerns about the following two issues:

1. Why is physical therapy AMTA's business?

2. Why does AMTA support state regulation?

Why these issues?

We focus on the first issue because we believe it requires clarification.

Some reasons why we focus on the second issue are set forth in Albert Schatz's Letter to the Editor  in Massage Therapy Journal, This is reprinted on page 5 and 6 of this report. Additional reasons  are in reports published in the Massage Law Newsletter on our website <www.tiac, net/users/maryella>.

WHY IS PHYSICAL THERAPY AMTA's BUSINESS?

AMTA's  Articles of Incorporation (in the AMTA 1999  Membership Registry) reads as follows with respect to physical therapy

"The nature of the business and the objects and purposes to be transacted, promoted and carried out" are, among other things:

"To advance the science of massage therapy, physical therapy and related techniques: to raise the standards of those professions so as to merit the respect and confidence of all people and benefit mankind...?

What are the "related techniques" and "professions" which AMTA considers its business, and why does AMTA consider them its business?

Why is physical therapy AMTA's "business"?

1.  Why is the "science" of physical therapy AMTA's "business"?

2. Why is it AMTA's "business" to "raise the standards" of physical therapy so that physical therapy will "merit  the respect and confidence of all people" and benefit mankind"?

We believe

1. It is the business of the American Physical Therapy Association (and of colleges and universities which offer degree programs in physical therapy) to "raise the standards" of physical therapy so that physical therapy will "merit  the respect and confidence of all people" and benefit mankind"

2. Massage therapy is the business of physical therapy because physical therapists are trained to do massage therapy. But this does not preclude massage therapists' doing massage therapy.

3. Physical therapy is not the business of massage therapy because massage therapists are not trained to do physical therapy.

WHY DOES AMTA SUPPORT

 STATE REGULATION?

Is the king naked?

Does the emperor have no robe?

People - who have been promoting state regulation - have not replied to our requests for well-documented evidence which justifies the reasons for which they allege state regulation is needed. We therefore believe it is logical to conclude that state regulation is not needed for the reasons they allege, or for any other reasons.

If there is no well-documented evidence that justifies the alleged needs for state regulation, we believe it is logical to conclude that massage should be deregulated in states which presently regulate it?

For these and other reasons, we believe "an objective evaluation of state regulation is long overdue, and should be done by a committee whose members  have no vested interest in state regulation." If the committee is unable to uncover well-documented evidence to justify the alleged need for  state regulation, massage therapists should be deregulated.

The evaluation should also include an Environmental Impact Study to determine to whom, how, and to what extent state regulation has been detrimental; and how those who have been adversely affected should be compensated.

The evaluation should also consider whether:

1. State regulation is class warfare because it discriminates against massage therapists who are financially unable to comply with regulatory requirements but who have had many satisfied clients for many years without harming anybody.  

2. State regulation, national certification, school accreditation, and the so-called medical model may legitimately be viewed as The Four Horsemen of the Apocalypse.   

A lot of money - $500,000  

The AMTA Law and Legislation Assistance Program "has distributed more than $500,000 to assist chapters in their legislative efforts." This information is in a form letter addressed to "Dear Auxiliary Member" from  Adela Basayne, former AMTA President. Albert Schatz  received this letter on July 20, 1999.

To find out why AMTA supports state regulation, it is necessary to know what questions to ask and how the questions should be phrased.

A lot of questions

Although the following questions address state regulation, some of them may also refer to national certification and school accreditation by COMTA.

1. What well-documented evidence does AMTA have that justifies its having allocated "more than $500,000 to assist chapters in their legislative efforts?"

2. How has state regulation (which resulted from "legislative efforts" of AMTA chapters) benefited the public by protecting the public health, safety, and welfare?

3. What well-documented evidence does AMTA have that justifies the alleged need for state regulation for any other reason?

4. What well-documented evidence does AMTA have that the number of hours of training required by states which regulate massage therapists is not arbitrarily determined?

5. For example, what well-documented evidence does AMTA have that massage therapists in Nebraska (which requires 1000 hours of training) are more competent than massage therapists in  Texas (which requires  only 250 hours of training)? If massage therapists are more competent in Nebraska, in what ways are they more competent,  and how much more competent are they, in each of those ways?

6. What well-documented evidence does AMTA have that the public enjoys better massage service in states which regulate massage therapists than in states which do not? If so, in what ways and to what extent is the public better served in states which regulate massage therapists?

7. What well-documented evidence does AMTA have that  the public receives a better quality message in states which regulate massage therapists than in states which do not? If so, in what ways and how much better, in each of those ways, is the quality of massage in states which regulate massage therapists?

8. What well-documented evidence does AMTA have that massage therapists are more competent in hands-on work in states which regulate massage therapists than in states which do not?

(a) If so, in what ways and to what extent, in each of those ways, are massage therapists more competent in states which regulate them?

(b) Who is most qualified to evaluate the hands-on competence of a massage therapist, and why?

9. Definitions: One goal of AMTA "To be ...  "a resource for ... definitions." This goal and others are in the "AMTA 1999 Membership Registry. The "AMTA Goals" are "To serve its members, the public, and the profession..." Providing definitions  is one way to serve.

We therefore ask - How does AMTA define and objectively measure massage service, the quality of a massage, and the hands-on competence of a massage therapist?

Having a definition of hands-on competence  will be useful because the final sentence in the "AMTA Goals" is, "In pursuit of the above goals, AMTA will be guided by the values of care and competency."

10. If hands-on competence cannot be objectively measured, how can one differentiate between allegedly competent and allegedly incompetent massage therapists? If one cannot differentiate between allegedly competent and allegedly incompetent massage therapists how can one know whether state regulation assures hands-on competence? If one does not know whether state regulation assures hands-on competence, how can one determine whether state regulation can protect the pubic from harm, if that protection were needed?

11. Standards: Article II of AMTA's Bylaws (in the AMTA 1999 Membership Registry) lists the purposes of AMTA, one of which is to "raise and maintain the standards of the massage profession."

What are these standards, to what aspects of massage education and massage therapy are they applied, and how does AMTA quantitatively determine how high the standards  have been raised? For example, do the standards of the massage profession assure hands-on competence of massage therapists? If so, how and to what extent do they do that?

For what reasons is AMTA for or against regulating massage therapists by national standards? If there is no well-documented need for state regulation, what justification is there for national standards?

Some people assume that national standards will eliminate problems of state  reciprocity which massage therapists have encountered. However, there were no reciprocity problems before states established regulation. There are no reciprocity problems in states which presently do not regulate massage therapists.  If massage is deregulated, reciprocity problems will be eliminated, and massage therapists will not have to pay millions of dollars annually to comply with regulatory requirements, for which there is no well-documented need.

How much well-documented, serious

harm have unregulated massage therapists actually caused?

1. What well-documented evidence does AMTA have that fewer  people are physically injured and sexually molested by massage therapists in states which regulate massage therapists than is states which do not? If so, what are the statistics, and where are they published?

2. What well-documented evidence does AMTA have that more people with contraindica- tions are seriously harmed by massage therapists in states which do not regulate massage therapists than in states which do? Where are these data published?

Well-documented evidence

that there is no harm

A Georgia senate committee disregarded the undocumented evidence of harm which the Georgia Chapter of AMTA had submitted in support of a senate bill to regulate massage therapists. The senate committee then did its own research and concluded:

"There is no documented danger of actual harm to the public.

"The potential for harm to the public appears to be remote and would not be alleviated by licensing."

For these reasons Georgia has not regulated massage therapists.

A governmental agency in the Canadian Province of Quebec conducted an extensive two year research project to determine the incidence of harm associated with massage. The results revealed that massage therapists, regardless of their training, did not cause any harm. For this reason, Quebec has not regulated massage therapists.

Since no harm has actually occurred in Quebec and in Georgia, why would anyone assume that harm has  actually occurred anywhere else? Is state regulation needed to protect the public from harm which does not actually occur?

The Pew Health Professions Commission's 1995 report recommended that "States ... grant title protection without accompanying scope of practice acts to some professions. This would be appropriate for professions (e.g. massage therapy) which provide services which are not especially risky to consumers."

We do not know of any Consumer Protection Agencies which have lobbied state legislators to enact laws to regulate massage therapists in order to protect the pubic from harm by allegedly incompetent practitioners.

The reality is that so many unregulated massage therapists with so many different training have massaged so many people (with so many  contraindications) so many times for so many years - in so many states (which do not regulate massage therapists) and in so many other states before they regulated massage therapists) - with so many well-documented reports of so many benefits, but with so few if any well-documented evidence of serious harm.

With respect to harm, we differentiate between ephemeral soreness and discomfort vis-a-vis harm; i.e., injuries which are sufficiently serious to justify the need for state regulation to protect the public from that harm.

Questions about other issues

1. What well-documented evidence does AMTA have that state regulation and local ordinances have significantly reduced prostitution anywhere? If so, where and to what extent has that reduction occurred, and where are the data published? 

2. What well-documented evidence does AMTA have that the popularity of massage is increasing more rapidly in states which regulate massage therapists than in states which do not? If so, how much more rapidly is that increase in states which regulate massage therapists, and where are the data published?

3. To whom, in what ways, and to what extent for each of these ways has state regulation been detrimental? 

4.  For what reasons does AMTA consider the self-regulation in the Canadian Provinces of Ontario and British Columbia AMTA appropriate or inappropriate for states in the U.S.?

5. For what reasons does AMTA consider it appropriate or inappropriate for state regulation of massage therapists to require practitioners of other non-massage modalities  (such as those in the  New York Coalition of Non-Massage Organizations ) to graduate from a state-approved massage school in order for them to legally practice their non-massage modalities?

This last question was  suggested by statements in the AMTA Code of Ethics (in the AMTA 1999 Membership Registry), which tell us that "Massage therapists shall"

1. "not unjustly discriminate against ... colleagues and work to eliminate prejudices in the profession."

2. "Respect all ethical health care practitioners and work together amicably to promote health and natural healing."

What about monopoly control?

If there is no well-documented evidence that  state regulation is needed:

1. Why are more and more states regulating massage therapists?

2, Who and what are benefitting from state regulation, and in what ways are they benefiting?

To answer the second question (above), the  independent evaluation of state regulation, to which we have previously referred, should research the macroeconomics of massage, the role of massage schools in promoting state regulation, and the extent to which these schools have benefited economically.  Reports in the Massage Law Newsletter have discussed these issues. 

It seems that proponents of licensing are hopeful that a state license would mean more money, status, and power. - Jerry A. Green, Attorney  for the California Coalition on Somatic Practices.

 I think the move toward licensure is regrettable. I believe licensing creates state-sanctioned monopolies ... with the explicit goal of  'protecting the public,' but with the real effect of protecting those who hold the monopolies' respective entitlements, reducing information to the public, and restricting competition. - Don Schwartz.

 Licensing arrangements ...can be characterized less as methods for protecting the public and for providing external social control in the interest of the consumer than as a means for protecting the occupation's market dominance. Indeed, licensing has the unique quality of making a violation of the professional monopoly a punishable crime. - Haug

The great truth is never spoken directly, but anybody in that field with two bourbons in them will tell you that  these boards work primarily to protect the practitioners and have little or nothing to do with protecting the public. - Former Virginia state official

A rigid requirement, one that completely ignores the qualitative aspects of the individual's experience, appears to be more concerned with excluding 'outsiders', no matter how qualified, than with assuring consumers that 1icensed individuals are safe and effective practitioners. - Shimberg

When the right to practice a trade or profession depends not on personal initiative but also on the approval of some agency, ...the industry has laid the foundation for the exercise of monopoly power. No longer may anyone perform legal, medical, accounting, architectural, or other tasks. The first condition for a competitive society - freedom of entry - is gone. - J. K. Lieberman

The usual arguments for licensure, and in particular the paternalistic arguments for licensure, are satisfied almost completely by certification alone. If the argument is that we are too ignorant to judge good practitioners, all that is needed is to make the relevant information available. If, in full knowledge, we still want to go to someone who is not certified, that is our business. - Milton Freedman

"ALL'S WELL THAT

 ENDS WELL"

Ye shall know the truth, and the truth

shall make you free.

The Fall, 1999, issue of Massage Therapy Journal published Albert Schatz's Letter to the Editor, which reads as follows:

"I was pleased to se to see George Gluzinski's letter to the editor [Summer 1999] . I believe an objective evaluation of state regulation is long overdue, and should be done by a committee whose members  have no vested interest in state regulation.

"There is no well-documented   evidence that allegedly inadequately trained massage therapists have caused enough harm in people with contraindications to justify the alleged need for state regulation to protect the public from harm. There is no well-documented evidence that state regulation has protected the public from harm in states which regulate massage therapists.

"There is no well-documented evidence that state regulation assures competence. There is no generally accepted definition of competence for massage therapists, and there is no way to objectively measure that competence. There is no well-documented evidence that anybody needs more than the 250-hour training which Texas requires.

"The fact is that so many massage therapists with do many varied trainings have massaged so many people (with so many contraindications) so many times for so many years, in so many states (which do not regulate massage) with so many well-documented reports of so many benefits, but with so little if any well-documented evidence of harm."

Another letter

Albert Schatz wrote Dr. Griff D. Pitts (Director of the Commission on Massage Therapy Accreditation - COMTA) a letter with  questions about the validity of COMTA's standards and criteria. Those questions were comparable to our questions about state regulation. Dr. Pitts' reply included the following comments:

"Thank you for the keen interest which you have shown in regard to the credibility of the Commission. We commend you for the insight which you have  demonstrated in your questions and the issues upon which they focus."

Both letters were published in the Summer, 1999, issue of COMTA NEWS - The Official Newsletter of the Commission on Massage Therapy Accreditation.

EPILOGUE

If the blind lead the blind, both shall fall into the ditch. Matthew 15:14.

Beware of false prophets which come to you in sheep's clothing. Matthew 7:15.

A popular government without popular information, or the means of acquiring it, is but a Prologue to a Farce or Tragedy... A people who mean to be their own governors must arm themselves with the power that knowledge gives. James Madison

The fact that an opinion has been widely held is no evidence that it is not entirely absurd; indeed, in view of the silliness of the majority of mankind, a widespread belief is more likely to be foolish than sensible. Bertrand Russell 

The struggle against state regulation calls to mind the children's book "The Little Engine that Could whose motto was: 'I think I can; I think I can.' As the story goes, other engines that could have taken the toys to the girls and boys on the other side of the mountain either thought that they were too important, too busy, too old, or too tired.

"But one little blue engine that had never been on the other side of the mountain believed that she could help. As she puffed and chugged, she kept saying, 'I think I can; I think I can.' and she could. The story ends in a roar of cheers for the little engine, and she simply says, 'I thought I could; I thought I could.'"

Many years ago, Albert Schatz enjoyed reading this book to his grandson Nick.

References

1. Myers, C., Dennis, M., Nagle, J, Moe-Lobeda, C., and  Taylor, S. "Say to This Mountain." Mark's Story of  Discipleship. Orbis Books. Maryknoll, NY. 1996.

2. Pagels, E. The Gnostic Gospels. Vintage Books. New York. 1979.

3. Cartledge-Hayes, M. To Love Delilah. Claiming the Women of the Bible. LuraMedia. San Diego, CA. 1990.

4. Kimbrough, M. L. She is Worthy. Encounters with Biblical Women. Abington Press. Nashvile, KY. 1994.

Documentation for much of what this article is concerned with is in reports published in the Massage Law Newsletter.  These reports are available  on the internet <www.tiac.net/users/maryella/>.  Volume 8, No. 1 of the Massage Law Newsletter provides references to relevant reports published in other periodicals.

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