JSB Special Issue-4

Journal of Spiritual Bodywork

Special Issue No. 4                          ISSN 1079-8390                                 December 1997   

FOLLOW THE MONEY TRAIL TO FIND OUT WHY

SCARE TACTICS TELL US SECULAR MASSAGE IS HARMFUL

Albert Schatz

CONTENTS

    Part 1: The money trail

    Part 2: The trail to harm leads to no harm

    Part 3: Massage is safe

    Appendix A: How to discuss harm intelligently

     Appendix B: Alexander's research

    Appendix C: More evidence that there's no harm

    Appendix D: Massage training

    Appendix E: Missing references

    Appendix F: A unique experience

    Appendix G: Why discuss harm?

    References

What I write is influenced by what I have seen through two lenses. One is the lens of my having done scientific research for more than half a century. The other is the lens of my having done research on massage and other kinds of bodywork for 15 years.

One of my guiding principles in research is the advice of Claude Bernard, the famous French physiologist: "When you meet with a fact which is opposed to a theory, you must adhere to the fact and abandon the theory, even though the theory is associated with the names of accepted authorities."

The relevance of this report on secular massage therapy to spiritual massage healing is discussed in Appendix G: Why discuss harm?

PART 1: THE MONEY TRAIL

It seems that proponents of licensing are hopeful that a state license would mean more money, status, and power.1 - 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.2 - Don Schwartz, Executive Director, The Trager Institute

The corporatization3 and

monopolization of massage

When people promote state regulation of massage, they don't present data on the  total estimated cost of state regulation to all massage therapists and other bodyworkers.

The 21 states which have massage laws presently collect fees amounting to almost $3,000,000 annually from massage therapists and other bodyworkers.27 The $3.000.000  was calculated from the renewal fees and the total number of licensed, certified, or registered bodyworkers in states which have already implemented their laws.

The National Certification Examination has taken in millions of dollars.25

Additional fees for certification, continuing education, and insurance; and other costs may be three to four times the state fees.

Massage therapists and other bodyworkers are now paying from $12,000,000 to $15,000,000 annually. But this is only the beginning. As more states regulate massage, and as requirements are increased, massage therapists and other bodyworkers may eventually pay $40,000,000 or more annually.

Voluntary title protection12

decorporatizes and demonopolizes

massage

With voluntary title protection, all massage therapists would not have to pay  millions of dollars annually for the privilege of earning  a living by doing massage.

Voluntary title protection is the only kind of state regulation that is democratic. It enables massage therapists, who want a state credential, to get one. It permits massage therapists, who don't want to be state-credentialled, to do massage without being required to get a state credential.

With voluntary title protection, two titles avoid confusion, on the part of the public, as to who is and is not state-credentialled. Only those who are credentialled would be permitted to use the title State-Certified Massage Therapist. Others, who are not credentialled, could use the title Massage Therapist. Non-credentialled massage therapists do not harm people.

PART 2: THE TRAIL TO HARM

LEADS TO NO HARM

Harm popped up in Pennsylvania when the Pennsylvania Licensure Coalition promoted state licensure "first and foremost" to protect the public from harm.3-7,12  The Coalition reported that:

1 "Licensure is first and foremost to protect the public from harm."

2 "State licensing will ... create educational requirements for that public protection."

3. "We are working to create a bill which protects the public from harm."

What harm?

1. Why has the Coalition ignored repeated requests to provide information about the harm from which it is wants to protect the public?

2. If the Coalition knows that harm occurs, why doesn't it tell us what that harm is?

3. If the Coalition does not know that harm occurs, why doesn't it admit that?

4. If there's no harm, why has the Coalition promoted  licensure to protect the public from harm that does not exist?

5. What evidence does the Coalition have that its educational requirements will protect the public from harm if the public does indeed need that protection?

With no harm, there's no need

for Pennsylvania Senate Bill 1171

If Pennsylvania had a Sunrise Process,8,9 Senate Bill 1171, which resulted from the Coalition's promotion, would never have seen the light of day.

The Sunrise Process  applies to those who promote bills to protect the public from harm by professions which are allegedly harmful. The Sunrise Process requires that promoters of such bills  provide convincing evidence that:

1. The unlicensed profession is a serious danger to the public health and safety.

2. State licensing will adequately protect the public health and safety.

3. No other means can also protect the public

health and safety.

How much harm

occurs in California?

The California Coalition on Somatic Practices concluded that "We injure very few clients. As a result ... we will have difficulty meeting the Sunrise criteria without manipulation of the data." The Coalition refused to falsify data to meet the state legislative requirement for evidence that unlicensed massage practitioners endanger the public.10

Why does the Pennsylvania Licensure Coalition assume there is sufficient harm to justify licensure in Pennsylvania when there is insufficient harm in California where there are more bodyworkers, more clients, and therefore more opportunities for injuries to occur?

More people are killed bylightening

 than are injured by massage

According to Actual Facts,  published by the National Safety Council in 1994: 75  people were killed by lightning in the United States in 1989, 89 were killed in 1990, and 75 were killed in 1991.

"Glen Pierce of Northeastern University's Center of Applied Science calculated that the risk of a white woman being struck by lightning in Massachusetts is one in 4,000,000."11

Massage training compared to

training for first aid and cardiopulmonary

 resuscitation (CPR)

 

People who administer first aid and CPR frequently treat individuals with life-threatening problems. The American Red Cross offers 4 and 9-hour trainings for first aid and for CPR.

State-required 500 to 2,200-hour trainings for massage therapists are:

6,000% and 25,000% greater than the 9-hour trainings, which the American Red Cross considers adequate for first aid and CPR.

12,000% and 55,000% greater than the 4-hour training which the American Red Cross considers adequate for first aid and CPR.

WHY do massage therapists, who should not work on clients with life-threatening health problems, need SO MUCH TRAINING?

THERE'S NO HARM IN THE

PROVINCE OF ONTARIO

It was difficult  for massage therapists in Ontario to convince the Schwartz Commission that massage should be regulated. An account of how they finally got regulation tells us, "It was a 10-year battle. We had this commission where they made us all come forward to them and basically grovel on the ground to prove why we needed to be registered.

"We had to prove to the Schwartz Commission that there was significant risk  of harm to the public and that was why you needed to be regulated."29

Note that the massage therapists presented information about risk (potential harm), but did not report harm which had actually occurred. The Schwartz Commission would have been more impressed by cases of actual harm, but the massage therapists obviously had no actual harm to report.

"Rolfers and Trager therapists ... went forward to the Schwartz Commission and they could not prove significant risk of harm to the public to be regulated. The Schiatsu people had tried very desperately to become regulated, but they still could not fulfill the criteria of proving risk of harm to the public."29

I do not understand why there is more risk of harm from massage therapy than from Rolfing, Tragerwork, and Shiatsu. Those who practice these modalities work on people who have the same kinds of health problems which are potentially harmful.13,19,20 Also Rolfers and Shiatsu practitioners use much more forceful manipulations than massage therapists do.

If Rolfers, Tragerworkers, and Schiatsu practitioners pose no risk of harm to the public in the Province of Ontario, why should those modalities be regulated to protect the public from harm anywhere else?

THERE'S NO HARM IN THE

PROVINCE OF QUEBEC

As a scientific researcher, I recognize and appreciate good research. The research, conducted by the Office des professions of the Province of Quebec, is outstanding. It is a well-designed, objective, broad and comprehensive, in-depth, study that considered the problem from different points of view. Because the research was done so competently, the conclusions are definitive.

That  research, which we discussed in detail, in our 1993 publications,21,22 provides convincing evidence that state regulation of massage is not needed to protect the public from harm.

An important letter

 from Quebec

I am grateful to Thomas J. Mulcair, President of the government Office des professions of the Province of Quebec, who sent me the following communication on June 13, 1993:

"We are in receipt of your letter dated May 10th, l993, concerning massage therapy.

"I would like to inform you that in the Province of Quebec, the title and the activities of massage therapists are not regulated.

"The Office des professions conducted, in l990 and l99l, an extensive research project on the need to regulate alternative professions in Quebec. A part of the study covered manual therapies and massage.

"A research report and the position of the Office des professions [submitted] to the Minister Responsible for the Application of Professional   Laws, which are enclosed, were released in April 1992.

"One of the main recommendations is that it is not necessary to regulate alternative therapies, including massage therapy, because they do not represent any serious risk of harm to the public.

"This recommendation is based on the fact that none of the 38 groups that we consulted specifically on manual therapies was able to demonstrate or document any  prejudice or damage caused by incompetent massage therapists."

Scope of the research

The research in Quebec involved 38 private and governmental organizations. These included four massage schools and associations of massage schools, seven professional massage organization with a total of approximately 1600 members, the Office of Consumer Protection, the Administration of Safety in Sports, the Ministry of Public Safety, the Ministry of Higher Education and Science, the Ministry of Health and Social Services, the Bureau of Insurance, and the Canadian Association of Personal Insurance Companies.

No comparable research has ever

been done in the United States 

The research in Quebec highlights the absence of any comparable research in the United States, and elsewhere is Canada. The two reports of that research should be translated into English and studied by state legislators in the U.S. They should also be required reading for students in all massage schools as an example of well-designed research with definitive results.

Those who allege that massage therapy is harmful (but don't document their claim with  specific reports of harm) seem to be blissfully unaware of the research is Quebec. I have not seen it discussed or even mentioned in any publications on harm. 

Two published reports of

the research

The research report, published in French, consists of 83 pages. This report is dated May, 1991. The recommendations, also published in French, are in a separate volume of 25 pages. This report is dated  April, 1992.

The research report informs us, among other things, that the Province of Quebec has different categories of massage professionals. These include massage therapists and massage practitioners, each with its own training..

Additional information

The research in Quebec also provides the following additional information:

1. In one school, a masseur is required to take only 120 hours of training for Swedish Massage.

2. The Academy of Massage Science offers a course with 300 hours of unsupervised practice and only 40 hours of supervised practice.

3. Only one massage school is accredited by one of the seven professional massage organizations. (Training at an accredited school is  not required to practice massage.) 4. One does not need a diploma recognized by the Ministry of Higher Education and Science to practice massage

PART 3: MASSAGE IS SAFE

The "relative safety"

of massage

 In 1992, Alexander did a Medline literature survey, of medical reports, published in English, to see how safe massage is because: "Massage therapy is generally considered to be a very safe type of health intervention. Even among those who doubt its effectiveness, there is seldom any fear that it may actually harm someone. However, there has been no attempt to explore how safe massage therapy is and thereby make it even more safe. We owe it to the health care consumer and to ourselves, to explore this issue."13

Alexander's survey  uncovered only 30 cases of harm associated with massage over a 25 year period. Not a single injury was caused by a massage therapist. Alexander concluded, "The small number of references [30 cases of harm] pulled up in the search does suggest the relative safety of massage."

I don't understand why Alexander concluded that his results only suggested  ... "relative safety." Nor do I understand why he used the term relative because that raises the question, "Relative to what?"

Alexander summarized the results of his survey as follows: "Analyzing the articles [about harm]13 produced the inescapable conclusion that massage has been documented to be dangerous in two types of situations20 ... when it is applied as a medical specialty by a medical doctor or when it is used as a folkloric remedy by a lay person."13 

Does this tell you that massage therapists harm people?

"A Tale of Two Cities"

The Pennsylvania Licensure Coalition has provided no evidence to justify its allegation  that licensure is needed first and foremost to protect the public from harm.

Alexander, in Ontario, has done research on harm, and has published the information he obtained, along with his conclusions.13,19,20 He clearly understands the difference between actual harm and potential harm (discussed later in this report), and has also considered emotional harm which results when clients are  sexually harassed by massage therapists.

However, Alexander did more than the literature survey. His 1992 report ended with this   comment for his readers:" There will be more information in the next newsletter about an upcoming contest for articles relating to contraindications in massage therapy. Think back through your practice to see if you have any therapeutic misadventures (or near mishaps) from which your colleagues could learn. We owe it to ourselves and our patients/clients to become better educated."13

Alexander and I both agree that massage therapists do not harm their clients. Despite the fact that we may not agree in other  areas, I respect him for the research he has done and I appreciate his publishing the information he unconvered.  The history of progress is, in large part, the history of disagreement.

I do not understand how the Pennsylvania Licensure Coalition, if it did indeed do research, could have found sufficient harm to justify its promoting licensure first and foremost to protect the public from  that harm.

I also do not understand why the Coalition, if it found sufficient harm, has not published information about that harm.

APPENDIX A: HOW TO

DISCUSS  HARM INTELLIGENTLY

Reports of "harm"

in Pennsylvania

Here are four reports of so-called harm, which are all I have been able to obtain during the past several years. The individuals who told me about the third and fourth cases got their information second-hand, and could not provide me with or tell me where I might obtain additional information. My informants considered the so-called harm to be acceptable evidence that licensure is needed to protect the public from harm. 

1. One individual told me that he recently had major surgery on his back, and might be seriously injured if he were worked on by an incompetent massage therapist. This is not a report of harm which has occurred, but of fear that harm may occur. The pain and discomfort he described would have made it difficult for him to disrobe, get on and off a massage table, and then dress without assistance. I do not understand why anyone who recently had major surgery on his back and was in his condition would get a massage.

2. Someone informed me that he had a long list of anecdotal reports about people who were injured by massage therapists. He refused to give me any more information.

3. One man complained of a bad backache after a massage.

4. One individual got a bad case of poison ivy after a massage.

I obtained the following information about poison ivy from the College of Physicians of Philadelphia which culled it from Clinical Reference Systems. p. 1639. December, 1994.

"Contagiousness: The fluid from the sores themselves is not contagious. However, the oil or sap from the poisonous plant may remain on a pet's fur or on items such as clothes or shoes. The oil or sap is contagious for about a week. Be sure to wash it off clothes or pets with soap and water."

In view of this information, I do not understand why anyone would assume that the "bad case of poison ivy" was directly caused by the massage per se.

Let us assume, however, that someone actually did get poison ivy from exposure to the oil (of a poison ivy plant) on the clothes or shoes of the massage therapist, or on the fur of her dog or cat.

Does this one case of poison ivy and the three other cases of so-called harm justify the Pennsylvania Licensure Coalition's promoting  state licensure to protect the public from harm?

What do I mean

by "no harm"?

When I say, "Massage causes no harm." I mean there is no convincing evidence that a  sufficient number of people have actually been harmed with sufficiently serious injuries which were shown to be directly caused by massage therapists. 

What does

"sufficient" mean? 

What is meant by "sufficient" and "sufficiently" is a matter of definition. Legislators, who consider a bill for licensure to protect the public from harm, have to decide what these terms mean. For example, if (over a period of five years) only one person reported a stiff neck, for which she did not seek medical treatment, and there is no proof that the stiff neck was actually caused by a massage therapist, that is not sufficient evidence to justify establishing  a state bureaucracy to protect the public from harm.

This example illustrates what the California Sunset Process (already discussed) is concerned with. The Sunset Process requires that those who promote state regulation provide state legislators with convincing evidence that there is sufficient harm from which the public needs to be protected

Two questions

about harm

1. Does massage actually harm people?

2. Is massage potentially harmful?

Two kinds of harm

If we want to discuss something intelligently, we have to communicate effectively.14 This means that in a discussion about harm everybody must know that everybody is talking about the same kind of harm at any given time. If people don't realize that some of them are focusing on actual harm (which has already occurred) while others are concerned with potential  harm (which may or may not occur), the discussion is meaningless because it is grounded in confusion.

Harm, for the purpose of this report, is a physical injury that has actually occurred. It has affected people adversely because they experienced it personally.

Potential harm is not actual harm because it does not injure anybody physically. People experience potential harm, not as a physical injury, but as concern, worry, anxiety, and fear that harm may occur.

Actual harm versus

potential harm

Contraindications for massage are physical conditions that are potentially dangerous because the quality (nature) of those conditions is such that harm may occur. Or, it may not occur. Potential harm is therefore a qualitative term which tells us what kinds of  harm are possible. It does not tell us how likely it is that harm will occur; that is, what harm we can expect.

Risk, which tells us how likely harm may occur, is a quantitative consideration of harm. It is quantitative because it tells us how much harm we can expect. Risk is the  probability of actual harm. It is the probability that people will actually be harmed.

The dictionary definition of the term actual means existing in act (in fact) and not potential. The term actuarial, in life insurance, refers to statistical considerations of life expectancy based on deaths that have occurred at different ages. Automobile insurance is based on the numbers of accidents that have actually occurred with drivers of  different ages. Insurance for massage therapists is relatively inexpensive because the risk of  clients' actually being injured ranges from zero to negligible.

People can only be exposed to but not physically injured by potential harm. Potential harm may therefore be viewed as theoretical harm because it exists only as a concept that may or may not be transformed into reality. Insurance companies would not exist if they had to pay for claims of exposure to potential harm because people would be filing claims every day for exposure to all kinds of potential harm. 

Evaluating actual harm

caused by massage

To decide how serious actual harm is, we have to know how many people have been injured by how many massage therapists, how serious the injuries were, whether the injuries were actually caused by massage therapists, and if so how much training and experience the massage therapists had.

No one has had to be rushed to an emergency room because of injury caused by a massage therapist. No one has ever been killed by a massage therapist. There are no reports that massage therapists have harmed a sufficient number of people and that the injuries have been sufficiently serious to justify a need for state regulation of massage therapists to protect the public from harm.

If personal injury claims have been filed against massage therapists, that in and of itself is no proof that the plaintiffs were actually harmed by the defendants. It is not uncommon for insurance companies to settle claims when it is less costly for them to do so rather than litigate, even though they may be confident of a favorable court decision.

It is especially important for state legislators to know whether those who promote licensure are telling them about actual harm or potential harm; and whether a direct cause-effect relationship has been unequivocally established between massage and whatever actual harm was attributed to massage.15

Contraindications

That there are contraindications for massage is evidence that massage is potentially harmful. But contraindications, in and of themselves, are not proof that harm has actually occurred.

Massage therapists can avoid injuring their clients by familiarizing themselves with contraindications, which are danger warnings, and by asking their clients questions about serious health problems they may have. Information about contraindications and how to avoid harming clients is available from the Associated Bodywork and Massage Professionals. Their report concludes with the following:

"Always use common sense: WHEN IN DOUBT, REFER IT OUT. Take a thorough client history, communicate with the client's primary health care provider, and always place the client's best interests first. In our opinion, both gentle and deep massage, bodywork, or somatic therapy techiques are probably among the most powerful therapeutic applications available for reduction of chronic pain and stress. For the vast majority of the population, massage of some form is certainly indicated and most beneficial. We hope this article will be helpful to you in recognizing situations when massage can be harmful."16

We are exposed to

 many kinds of harm

The fact that massage is potentially harmful does not, in and of itself, tell us whether massage actually causes harm. The serious injuries and  deaths which millions of people suffer daily from many causes stand in stark contrast to the few if any injuries that occur as a result of massage.

People have been harmed during birth; by breathing polluted air, drinking impure water, and eating contaminated food. People have been injured and sometimes killed while they were walking across streets when the WALK signal was on; traveling in cars, busses, railroads, airplanes and boats; and riding bicycles.

People have been injured by walking up and down stairs; getting in and out of bath tubs; being exposed to bright sunlight; playing tennis and basketball; diving into pools; shovelling snow; working at computers; working for a living; residing in areas where there are earthquakes, tornadoes, hurricanes, and floods; and in many other ways.

Children have been killed in playgrounds,26 in school, going to and from school, and on the street in front of their homes.

People have been killed by medical care. Research at Harvard University revealed that conventional medicine is the fourth leading cause of death in the United States. It comes after heart disease, cancer, and stroke.17

In 1991, the following injuries required emergency room treatment

400,000 football injuries and 400,000 baseball injuries, excluding injuries in professional sports.

580,000 injuries  associated with bicycles.

82,000 skateboard injuries.

98,000 injuries associated with roller skates.

33,000 injuries associated with shopping carts. Half of these injuries involved children under the age of four.18

WHY HASN'T THE PENNSYLVANIA LICENSURE COALITION PROVIDED STATISTICS ON HOW  MANY PEOPLE HAVE BEEN INJURED BY MASSAGE THERAPISTS?

Theoretical statistics

If injury by massage therapists does occur to any significant extent, it should be easy to detect because there are so many massage therapists, so many clients, and so many massages.

Let us assume there are 200,000 massage therapists in the United States. These include individuals who are trained in accredited and non-accredited schools, who are self-taught, who have and have not taken the National Certification Examination, and who are and are not state-credentialled.

Let us further assume that these massage therapists give an average of five massages a week. This amounts to 1,000,000 massages a week and 52,000,000 massages a year. Let us now assume that one in every 10,000 massages causes injury. This amounts to 5,200 injuries a year, 100 injuries a week, and 14.3 injuries a day.

It is inconceivable that many people would not be aware of that many injuries. The literature, which has innumerable reports on the benefits of massage, would certainly publish reports on the incidence and nature of injuries, and provide information about the training (or lack of training) of the massage therapists who allegedly caused the injuries.

Massage therapists are by far the most numerous group of bodyworkers. If injuries occur, they would be most numerous and most likely to be reported for massage.

Our research indicates that there is little if any risk of harm associated with massage. We therefore conclude that state licensure is not needed to protect the public from harm by massage therapists. If that is true for massage, it is also true for other kinds of bodywork which have fewer practitioners.

What is obvious to me 

1. Massage therapy is considered safe because we don't hear about people who have been injured by massage therapy.

2. We don't hear about such injuries because they don't occur.

3. Because such  injuries don't occur, massage therapy is safe.

4.  If we don't find reports in the literature that massage therapy has harmed people, that supports the belief that massage therapy is safe.

5. If massage therapy is safe, it's not harmful.

Insurance offers more protection

than state regulation

Those who are concerned about protecting the public from harm should focus on insurance, not state regulation.

The relatively low premiums for insurance, which may be required for employment of massage therapists, indicates that client injuries rarely occur. If a client is seriously injured, insurance protects the massage therapist and also provides an injured client with the possibility of receiving compensation for the injury.

On the other hand, state regulation of massage does not prevent injuries, does not protect the massage professional in a personal injury claim, and does not pay the injured client any compensation. Insurance therefore provides more protection for all concerned than state regulation does.

 APPENDIX B: ALEXANDER'S

RESEARCH

Alexander's Medline survey covered medical reports in the English language. The two reports of research in the Province of Quebec were published in French. Nonetheless, I assume Alexander knew about those research reports because I discussed them, in English, in  one22 of my two publications,21,22 both of which Alexander cited in  one19 of his two 1994 reports.19,20

Alexander did not include the reference to his 1992 research13 in either of his two 1994 publications.19,20 These two reports also do not refer to the research in Quebec, which is the most comprehensive research ever done on harm, and reveals that harm does not occur. The Quebec reports, released in 1992, two years before his two 1994 reports, support his conclusion about the safety of massage in his 1992 report.13

In 1992, Alexander

considered massage "relatively safe"   

I have already pointed out that Alexander's Medline literature survey did not uncover a single case of  injury caused by a massage therapist. Alexander therefore concluded that, "The small number of references [30 cases of harm] pulled up in the search does suggest the relative safety of massage."13

Who caused the harm?

The harm which Alexander uncovered was caused by people who were not massage therapists.

1. Doctors harmed patients whom they massaged on parts of the body which massage therapists avoid.

2. One husband, massaged his wife who had thrombophlebitis.

3. In India, bone-setters and lay masseurs, may or may not have been responsible for harming people who had bone problems in their elbows.

4. In New Zealand, indigenous polynesian people may have been responsible for fetal deaths because they allegedly used traditional Pacific Islander massage techniques or other means to induce abortions.

5. A physiotherapist reported that one patient experienced "a hypersensitve reaction to ice massage."

Alexander considered this "The only case I could find that relates relatively directly  to a group such as massage therapists."

I do not understand how this case relates relatively directly or in any way to massage therapists. Here Alexander again used the term relatively, and it again raises the question, "Relative to what?"

Aside from that, how serious was the hypersensitivity? Was it necessary for the patient to get medical treatment? How many massage therapists use ice massage?

Alexander summarized the results of his survey as follows: "Analyzing the articles [about harm]13 produced the inescapable conclusion that massage has been documented to be dangerous in two types of situations20 ... when it is applied as a medical specialty by a medical doctor or when it is used as a folkloric remedy by a lay person."13

To avoid harm

 by massage

If you want to avoid harm from massage, don't get a massage from a medical doctor, from bone setters and lay masseurs in India, from indigenous polynesian people in New Zealand, or from husbands who massage their wives who have thrombophlebitis.

You are safer going to any massage therapist, regardless of her training, what her test score on the National Certification Examination was, and whether she is or is not state-certified.

Two important aspects of

Alexander's research

During the 25 years (1966 to 1991) prior to the  Medline survey which Alexander published in 1992,13 there probably were

1. many states in the U.S., provinces in Canada, and countries where massage was not regulated.

2. many self-taught massage therapists in the major English-speaking countries.

Despite the wide scope covered  by his Medline survey and the fact that there were many self-taught and unregulated massage therapists, Alexander uncovered only 30 cases of actual harm. And these 30 cases did not include a single report of harm caused by a massage therapist. 

Although Alexander's Medline search covered only reports published in English, that does not mean his survey was restricted to reports published by people in countries where English is the official language. In Japan, India, Norway, Sweden, Denmark, Germany, France, Italy, Spain, and other countries where massage is done, many people in the health professions have published reports in English.

Readers should therefore not assume that Alexander's survey was restricted to countries in which English is the official language.

 

Alexander provided evidence

 that massage is safe

Juxtaposing Alexander's 1992 publication vis-a-vis his two 1994 publications reveals that:

1. Alexander did not report a single case of actual harm caused by a massage therapist in his 1992 report and in his two 1994 reports.

2. All the conditions which Alexander associated with a potential for harm, in his two 1994 publications, existed during the preceding quarter of a century (1967-1992) covered by his 1992 survey.

3. Consequently, the potential of harm by message therapists was essentially the same in 1994, as it had been from 1967 to 1992.

Question

Why did Alexander refer to "the relative safety of massage" in 1992,13 and then conclude in the winter of 199419 that massage "can, in fact, be physically and medically dangerous"?

Answer

In 1992, Alexander was primarily concerned with actual harm, but in 1994, he focused on potential harm.

Alexander's two reports, in the winter 199419,20 issue of Massage & Bodywork Quarterly,  were his response to two reports (by my colleagues and me) which appeared in the fall 1993 issue of that periodical.

Our two reports pointed out that massage caused no actual harm, and concluded that state regulation was therefore not needed to protect the  public from harm.19,20

Alexander's 1992 report, in which he referred to the "relative safety of massage" on the basis of actual harm, was in accord with what we had concluded about actual harm in our two reports which appeared in the fall of 1993.

We had focused on actual harm in the fall of 1993,19,20 as Alexander had done in 1992.13 But in 1994, Alexander focused on potential harm. The existence of potential harm, no matter how potentially serious it may be, is not proof, in and of itself, that harm will actually occur. That is why we focused on actual harm in our reports.

Therefore, Alexander's potential harm does not disprove what we concluded on the basis of actual harm, which is essentially what he had originally concluded, in his 1992 report,13 on the basis of actual harm.

APPENDIX C: MORE EVIDENCE THAT THERE'S NO HARM

In 1993, I wrote to the directors of the State Board of Massage (or the equivalent agency) in 17 states which at that time regulated massage. I asked them to direct me to research or other documented information which provides convincing evidence that state credentialling of massage therapists results in more competent massage therapists, protects the public from harm, or is advantageous in any other way.

Seven individuals, to whom I wrote, did not reply. Five sent copies of state laws and other documents which did not provide the information I requested. Five individuals provided the following information:22

"The Department has not compiled any data with regard to your questions." - Joseph J. Gillen, Ph.D., Section Chief. Applications, Examinations & Licensure. Division of Medical Quality Assurance. Connecticut  Department of Health Services. (May 5, 1993)

 

"I am unaware of any research report or documented studies which indicate that credentialling results in more competent massage therapists, protects the  public or is advantageous in any way."- Theresa A. Jarvis, R.N., Health Facilities Coordinator. Bureau of Health Facilities Administration. New Hampshire  Department of Health and Human Services. (June 2, l993)  

"We do not have the information you requested;  however, we are forwarding your request to the [two] professional associations in this state who may be  able to help you." - Sharon E. Streechan. Program  Representative. Professional Licensing services. State Board of Massage. Washington Department of  Health. (May 10, 1993) I wrote to but never received any reply from the two professional associations.

"I am not aware of any studies regarding the  improvements in treatment delivery which you  mention." Russell J. Spaight. Administrator. Professional Regulating. Rhode Island Department of  Health. (May 13, 1993)

"This is in response to your questionnaire concerning  massage therapists. I am not aware of any research in a scholarly journal concerning the regulation of massage therapists. Becky Berryhill. Program Administrator. Massage Therapy Registration Program.  Professional Licensing and Certification Division. Texas Department of Health. (May 6, l993)

On July 13, 1993, Karen Carlson wrote to Deborah Worrad, Registrar of The Board of Directors of Masseurs in Toronto, Ontario, because that province requires 2,200 hours of training. Her letter read, "We are particularly interested in obtaining research reports or other information which indicates that laws which require credentialling of massage therapists result in more competent massage therapists, protect the public from harm ..." Her reply of July 26, 1993, stated: "The Board has not conducted specific research and therefore does not have hard data on the topics to which you referred." 28

APPENDIX: D

MASSAGE TRAINING

Discussions of licensure and harm invariably focus on training. Alexander wrote, "I am inadequately trained to steer myself away from trouble all the time." And "I need to know a lot more than I was taught in massage school."13

I assume Alexander had 2,200 hours of training because he is in the Province of Ontario which requires 2,200 hours. Alexander did not say how many hours of massage school training would be adequate. If 2,200 hours do not provide adequate training, what training is adequate? Will 5,000 hours or 10,000 hours provide adequate training?

What is adequate

training?

Alexander doesn't tell us what adequate training is. If there is a valid definition of adequate training, what is that definition?

By a valid definition, I mean a generally accepted definition which is based on or derived from well-designed research that clearly shows a direct relationship between the training and competence in terms of on-the-job performance.

If there is no valid definition of adequate training, how do we know what inadequate training is? How do we know what we are we talking about when we discuss adequate training?

Alexander refers to his training as inadequate with respect to preventing harm. But since he didn't cause any actual harm, why was his training inadequate?

There are no reports of harm by practitioners who had only a month or two of training, who learned massage in a one-to-one tutorial which may have taken a month or two, and who were self-taught. Yet they have not harmed anybody, and have satisfied clients. Isn't their training adequate? If their training is not adequate, why isn't it adequate?

How many hours of

training are adequate?

After more than four-and-a-half centuries of state regulation, there is no research which tells us how many hours of training are adequate.

The four-and-a-half centuries is obtained by adding up the number of years that states have had massage laws. This gives the total number of state massage-law years. For example Ohio, which began regulating massage in 1916, has 81 (1997 minus 1916)  state massage-law years. For all 21 states that now regulate massage, the total number of state massage law-years amounts to more than four and a half centuries.3

The fact that state-required trainings vary from 500 to 2,200 hours is convincing evidence that nobody knows how many hours constitute an adequate training.

Two categories:

trained and untrained

Alexander divided the people who, his survey reported, caused harm13 into two categories. These  categories are (a) "medical doctors performing highly specialized manipulations which most massage therapists would avoid,"19 and (b) "when [massage] is used as a folkloric remedy by a lay person."13

Because medical doctors are not trained to do massage,  Alexander's categories are really one category. This one category includes all people who are not trained to do massage.

Training for massage can be obtained in different ways. Some massage therapists are self-taught. They train themselves by applying information they obtain from books and videos, and by getting massages from different people. Others find experienced massage therapists who are willing to teach them on a one-to-one basis. This is apprenticeship.

Another way to learn massage is to take a course from someone who teaches small groups in an informal way. Finally, one may get formal training in a massage school. Whether massage schools are state-accredited or not, they vary in the number of hours of training they require.

There is no one

right way

There is no one right way to learn massage, and no one right kind of training. Educational research has shown that different people learn the same thing is different ways. This poses interesting questions:

1. What evidence is there that self-taught massage therapists are not as competent as massage therapists with 500 or more hours of training?

2. What evidence is there that, in a particular school, the widely accepted 500 hour training  is more  adequate than a training of 400 or 300 hours?

3. What evidence does Nebraska have that its 1,000 hour training is more adequate than trainings of 800, 600, or 400 hours?

4. What evidence does the Province of Ontario have that its 2,200 hour training is more adequate than trainings of 2,000, 1,000, or 500 hours?

The fact that state-required trainings vary from 500 to 2,200 hours is convincing evidence that nobody knows how many hours constitute an adequate training.

Why some research on

training cannot be done

Research cannot be done to determine whether massage therapists with adequate training (whatever that may be) or with  inadequate training (whatever that may be) are more likely to cause harm. This research cannot be done for two reasons:

1. There is no harm.

2. There is no valid  definition of what adequate training is.

What definitive information

do we have on training?

What we do know about massage training is:

1.  The required number of hours of training has been increasing. It has never decreased.

2. As  the required number of hours of training has increased, massage therapists have had to pay more and more $$$$ to earn a living by doing massage. 

From a $$$$ point of view, is an adequate training one which gives massage schools that are state-accredited maximum income? If so, we're back to The Money Trail.

THE MONEY TRAIL

It seems that proponents of licensing are hopeful that a state license would mean more money, status, and power.1 - 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.2 -  Dr. Don Schwartz, Executive Director, The Trager Institute

Massage therapists and other bodyworkers are now paying from $12,000,000 to $15,000,000 annually. But this is only the beginning. As more states regulate massage, and as requirements are increased, massage therapists and other bodyworkers may eventually be paying $40,000,000 or more annually.

APPENDIX E: MISSING

REFERENCES

Alexander's missing

 reference

I have already pointed out that Alexander did not refer, in 1992,13 to the two reports from the Province of Quebec which revealed that no harm occurred. That is understandable because his survey was restricted to publications in English and the reports in Quebec were published in French.

However, Alexander did not include, in the   bibliographies of either of his two 1994 reports19,20 (where he considers how potentially dangerous massage is), the reference to his 1992 report in the OMTA (Ontario Massage Therapy Association) Newsletter.13

Without the reference to his 1992 publication, readers of his two 1994 articles may not know that his 1992 report exists. This means they will not know that in 1992 Alexander considered massage to be "relatively safe."13

I have already pointed out that Alexander was concerned primarily with actual harm in his 1992 report, but with potential harm in his two 1994 reports. I was able  to do that because I had a copy of his 1992 report when I read his two 1994 reports. If I did not have his 1992 report, I would not have known it existed because it was not listed in the bibliographies of his 1994 reports.  

Spack's missing

reference

John Fred Spack was upset by one of my publications.21

Spack's critique was published  in the Summer, 1994, issue of the AMTA newsletter Hands-On which included his Government Relations Brief Surf and Turf.

Spack was then Chair of the Government Relations Committee of the AMTA (American Massage Therapy Association). His Surf and Turf referred to my report which he described as "an article from eastern Pennsylvania (that shall remain unnamed) appearing last fall in several journals."

According to Spack, that unnamed article "raised quite a ruckus." Some AMTA members were "worried about it."  And the AMTA and other organizations had "some concern about [its] impact."

These comments clearly reveal that the article had been persuasive, to put it mildly.

Spack was therefore motivated to discredit the article. But he did not tell his readers who the authors were, what the title of the article was, and where it had been published.

If Spack was confident that his criticism of my publications was valid, why didn't he cite the references  to the article so that AMTA members could read it, and draw their own conclusions?

I recognized the article which Spack said "shall remain unnamed." because I wrote it.21  That article appeared in the September/October, 1993, issue of the Journal of Well-Being  (published in Wilmington, Delaware), and in the Fall, 1993, issue of Massage & Bodywork Quarterly.21

It was published in two journals, not "several journals," as Spack incorrectly reported.

Thank you, John

 My colleagues, with whom I put the article together, and I were pleased to learn that our article was so effective in the ways you enumerated. We appreciate your telling us it had the impact we hoped it would have.

 APPENDIX F: A UNIQUE

EXPERIENCE

To be treated by  Spack as if I did not exist, is a new experience for me. I am 77 years old, and have been doing scientific research for more than half a century. My name and the research I did when I discovered the antibiotic streptomycin are known throughout the world.

Streptomycin was the first effective treatment for tuberculosis, also known as TB and The Great White Plague. This disease has killed an estimated one billion people during the past two centuries. Streptomycin was also the first effective treatment for pneumonic plague, the most deadly form of bubonic plague, known as The Black Death

People are customarily identified, whether they are alive or dead, when they are blamed or thanked for what they wrote. For someone to criticize a publication without revealing who wrote it and where it was published is unprecedented.

If Spack meant that our article "shall remain unnamed" for his readers, he was censoring information.

If Spack  meant that our article "shall remain unnamed" beyond the scope of his readership, he was disregarding reality. The article had already been published, as he himself acknowledged, and had a title. In other words, it had already been named. How can something which has a name remain unnamed?

Some of the terms Spack used to describe the contents of the article are poor logic, erroneous presumptions, and faulty definitions. He also considered some definitions in the article to be uniquely personal, and pointed out that the word idiot, of Greek origin,  means one's own, personal.  

Spack's disapproval of definitions in the article is his personal opinion. That does not mean the definitions were wrong or inappropriately used.

Spack did not substantiate a single one of his criticisms of the article with which he took issue..

APPENDIX G:

 WHY DISCUSS HARM?

Why does the Journal of Spiritual Bodywork  present evidence that secular massage therapy does not harm people? Because it's important to protect the identity and sanctity of spiritual massage healing. One way to do this is to correct erroneous information which may be detrimental to spiritual massage healing.

For example, some people assume secular massage therapy is harmful, and state regulation is therefore needed to protect the public from that harm.3-7,12 (This assumption is not true.)

Those, who don't know spiritual massage healing is different from secular massage therapy,24 might  assume that state regulation is also needed to protect the public from harm by spiritual massage healing. (This assumption would not be true.)

Spiritual massage healing is very different from secular massage therapy. But, like secular massage therapy, it does not harm people.

In spiritual massage healing, the laying on of hands is, in and of itself, a form of prayer 24 "The term massage is derived from the Greek masso - [meaning] I knead and from the Arabic mass [meaning] to press softly."30 The Bible does not specify whether, during the laying on of hands, one touches an individual with or without moving one's hands. A spiritual massage healer may do either or both. If the healer's hands move, they may lightly slide over the skin or move parts of the individual's skin and muscles.

Compassionate massage. "I am awed that the most wondrous of all the massage strokes is that of simply 'resting' - resting my hands , resting my intentions, resting my heart as one would rest in contemplative prayer. Compassionate massage, then, is also embodied contemplation. Silently, I am here, sheltering you through my hands with my own vulnerable and wounded loveliness. This is touch raised to the art of anointing, the art of prayer and the sacrament of caring."31 - Finch

The term massage is used in spiritual massage healing only because some of the movements (derived from the biblical laying on of hands) which a spiritual massage healer does may, to the uninformed, appear to have some resemblance to certain manipulations of secular bodywork.

Many spiritual massage healers believe God has ordained them. Ye have not chosen me, but I have chosen you and ordained you . (John 15:16). They believe they are God's ministering spirits, sent forth to minister. (Hebrews 1:14). They believe they should Be doers of the word and not hearers only.James 1:22) They believe God guides their spiritual massage healing work. They believe God will guide them away from harming anybody.

 References

1. Green, J.A. Money, status & power: by licensure or affiliation. The Rub 1(1):4, June 1996. (The Rub is published by Rob Mullog Enterprises. P.O. Box 459. Berkeley, CA 94701.)

2. Schwartz, D. Guest Editorial. The tragedy of skilled touch and movement in the United States. Massage Magazine. Issue 64. pp. 8. November/December 1996.

3. Schatz. A., and Brewster, M. The corporatization of massage. An economic perspective. Massage Law Newsletter. 2(2):1-7. 1997.

4. Schatz, A., and Brewster, M. Why is the Pennsylvania Licensure Coalition (PALC) promoting state licensure to protect the public from harm? Will PALC please tell us how many people have been harmed by bodyworkers in Pennsylvania and how serious their injuries were? Journal of Spiritual Bodywork. 2(4):7-10. 1996.

5. Schatz, A. More people are struck by lightening than are harmed by massage. Why regulate massage which does not harm people? Massage Law Newsletter. 2(3):1-2. 1997.

6. Another letter to the Pennsylvania Licensure Coalition.  Massage Law Newsletter. 2(2):7-8. 1997.

7. Schatz, A. Pennsylvania does not need Senate Bill 1171 to regulate massage. Pennsylvania needs deregulation. Massage Law Newsletter. 2(4):1-4. 1997.

8. Greenwalt, II, Charles E. Issue Brief. Sunrise Legislation - a New Curb on Bureaucracy. February 1993. The Commonwealth Foundation for Public Policy Alternatives. 600 North Second Street. Suite 300. Harrisburg, PA 171791-1032.

9. The Regulatory Request Questionnaire in Rule 22 of the California Senate [Legislature's] Committee on Business and Professions; and the California state's Government Code Sections 9148 et seq which concerns how the legislature should evaluate the need for new professional licensure.

10. Special Report. California Coalition on Somatic Practices. September, 1996.

11. Sklar. H. Chaos or Community. Seeking Solutions, Not Scapegoats for Bad Economics. South End Press. Boston. 1995.

12. Schatz, A., Tillotson, A., and Brewster, M. Since massage does not cause harm, why license massage therapists to prevent harm? All that glitters is not gold. Spiritual Massage Ministry Newsletter. 2(2):1-8. 1996.

13. Alexander, D. How safe is massage? OMTA  (Ontario Massage Therapy Association) Newsletter. pages 1 and 10. February/March 1992. Reprinted in the Newsletter of the Saskatchewan Massage Therapy Association . 5(1):13-14. April 1993.

14. Schatz, A., and Kuhl, G. National Certification Exam, Letter to the Editor. Massage & Bodywork Quarterly. pp. 31-32. Fall 1996.

15. Brewster, M., and Schatz, A. Massage harm: fact or fiction? Letter to the Editor. Massage Magazine. p. 11. July/August 1997.

16. Contraindications of massage, bodywork & somatic therapies. Successful Business Handbook. Associated Bodywork & Massage Professionals. Evergreen, CO. 1997.

17. Dr. Julian Whitaker's Health and Healing. Tomorrow's Medicine Today. (newsletter). Vol. 6. page 1. January 1996.

18. Blumenthal, M. How safe are herbal products? Health Counselor. pp. 14-15. October 1991.

19. Alexander, D. Professionalism and licensure in massage. Massage & Bodywork Quarterly. pp. 77-80. Fall 1994.

20. Alexander, D. Staying current with contraindications: an expression of effective caring. Massage & Bodywork Quarterly. pp. 29-31, Winter 1994.

21. Carlson, K., Barbera, R.A., and Schatz, A. Is state regulation of massage illegal? Massage & Bodywork Quarterly. 42-52. Fall 1993.

22. Carlson, K., Barbera, R.A., and Schatz, A. The public doesn't need state regulation of massage. So who does want it and why? Massage & Bodywork Quarterly. pp. 83-86/ Fall 1993.

23. A career in massage and bodywork. Touch Training Directory. Associated Bodywork and Massage Professionals. pp. 2-5. 1997.

24. Schatz, A. The Church for Spiritual Healing and Health. Spiritual massage healing. Journal of Spiritual Bodywork. 1(1):1-53. 1994.

25. Schatz, A. Some thoughts and questions about the $3,000,000 National Certification Examination. One man's point of view. Spiritual Massage Ministry Newsletter. 2(2):1-5. 1996.

26. Vance. W. W. How to Survive a  Homeowner's Association. 24331 Muirlands Blvd. Suite  4-148. Lake Forest. CA. 92630. 1992.

27. Massage Laws Nationwide. Massage Magazine, p. 131. November/December 1997.

28. Carlson, K. Letter to the Editor. Massage & Bodywork Quarterly. 9(4):46. Fall 1994.

29. Cowell, E. A rose by any other name: AMTA sponsors Title Debate. Part II. Massage Therapy Journal. pp. 43,44, and 45. (two comments by E. Cowell). Spring. 1994.

30. Haehl, R. Massage. Its History, Technique and Therapeutic Uses. Dunlap Printing. 1306-8-10 Filbert Street. Philadelphia, PA 1898. Reprint from the Hahneman Institute)

31. Finch. M. A. In praise of hands: Massage as contemplation and compassion. Personal communication.

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