This is our fifth report on the controversy over state regulation in Minnesota. The previous reports, in the Massage Law Newsletter (Vol 6, No. 2; Vol., 7. Nos. 1 and 3; and Vol. 9, No. 4) are on our website <www.tiac.net/users/maryella/>.
I invite proponents of regulation to submit well-documented evidence that Minnesota needs to regulate massage therapists to protect the public from harm, to control prostitution, or for any other reason. I will publish such well-documented evidence in the Massage Law Newsletter to provide our readers with the other side of this controversy.
My memos to Jackson Pertersburg and Gayle E. Burdick in Minnesota are in the Appendix. Petersburg is the Executive Director of the Northern Lights School of Massage Therapy in St. Paul. Burdick, also in St. Paul, is Chair of Govern-ment Relations in the Minnesota Chapter of AMTA; and a member of the Coalition for State Regulation of Massage Therapy and Oriental Bodywork.
This fifth report is my reply to Burdick's June 10, 1999, letter to me.
I don't think we're not talking
about the same thing
Your letter refers to "the potential for harm." By that, I assume you mean potential harm. However, I am concerned with harm that has actually occurred. This harm includes sexual harassment and physical harm that has actually occurred.
A mini-lesson in potential harm
Something is potentially harmful if it may cause harm. Therefore, potential harm is harm which may or may not manifest itself as harm that has actually occurred.
Because potential harm may or may not actually occur, potential harm is by definition only potentially harmful. It therefore follows that potential harm is also not serious, but only potentially serious. Only harm, which has actually occurred, can be serious. This is common sense and simple logic.
A quiz about potential harm
Have you ever heard of anyone (with a contraindication) who filed a personal injury claim (with an insurance company or in a court of law), not because a massage therapist had actually harmed her, but because she (the client) might have been harmed since (a) contraindications are potentially harmful, and (b) the massage therapist (who knew she had a contraindication) worked on her.
Would such a personal injury claim (in which no harm had actually occurred) be taken seriously? Would an insurance company pay for such a claim? For what reason would a judge find the massage therapist guilty, and guilty of what?
Have you ever heard of anybody who filed a malpractice claim against a physician, not because the physician had actually harmed him in any way, but because the physician had done something that was potentially harmful; that is, something that might have harmed him. As a matter of fact, physicians routinely do things that are potentially harmful. Potential harm is inherent in the practice of medicine.
Have you ever heard of a pedestrian who sued an auto driver not because the auto driver had actually harmed him in any way, but because the auto driver had done something that was only potentially harmful; that is, something that might have harmed him. As a matter of fact, driving a car is fraught with the possibility of harming pedestrians, and is therefore potentially harmful. Potential harm is inherent in driving a car.
Potential harm is inherent in going for a walk, playing tennis, dancing, working out in a health spa, going up a flight of stairs, working for a living, eating in a restaurant, going on vacation, traveling (by car, bus, taxi, subway, trolley, train, and air), getting out of bed and out of a bathtub, eating food that is contaminated, breathing air that is polluted, visiting a friend in a hospital, and many other things that we so frequently do.
As matter of fact, potential harm in inherent in many things we do. As long as we're alive, we are repeatedly exposed to potential harm. Therefore, living; i.e., the state of being alive, is potentially harmful.
A mini-lesson in contraindications
I have acknowledged in several of my reports that contraindications are potentially harmful. To me, this means that contraindications may or may not be responsible harm that has actually occurred.
There is no well-documented information which tells us how many people, who have each contraindication, have been harmed because of that contraindication; and how serious their injuries were. Without such well-documented infor-mation, there is no acceptable evidence that contraindications pose a serious epidemiological problem. This leads to the conclusion that contraindications are potentially harmful, but not significantly harmful per se.
Significant harm is well-documented harm that has actually occurred in a sufficient number of people and is sufficiently serious to justify the need for state regulation to protect the public from that harm. Without well-documented evidence of significant harm, there is no justification for state regulation to protect the public from harm.
The harm that is important is the harm
that has actually occurred
Your letter reads, "I am sure you understand the importance regarding the potential for harm as part of the Coalition's strategy with the Minnesota Legislators." I clearly understand that potential harm is the basis of the Coalition's strategy. But does the Coalition understand that potential harm is also its Achilles' heel because more and more legislators are no longer biting the potential harm bait. By focusing on potential harm, you are not addressing the issue to which I have been directing attention for the past several years; that is, "What harm has actually occurred, and how serious has it been?"
In both my February 16, 1999, memo to you and Jackson Petersburg and my May 5, 1999, memo to you, I clearly requested well-documented evidence of harm that has actually occurred. Those memos did not refer to potential harm. Your letter of June 10, 1999, does not refer to harm that has actually occurred. You cannot use potential harm to invalidate my position which is based on the question "What harm has actually occurred, and how serious has it been?"
Have you read our reports - on our website <www.tiac.net/users/maryella/> - about the two-year research project in the Canadian Province of Quebec, and the research which a Georgia Senate Committee conducted? Do you understand why the Georgia senators rejected the evidence of harm that the Georgia AMTA Chapter submitted?
In both Quebec and Georgia, researchers sought well-documented evidence of harm that had actually occurred. They were not interested in potential harm. Since no harm had actually occurred in Quebec and in Georgia, why would harm occur in Minnesota?
Have you also read my report which provides well-documented evidence that more clients may be actually harmed by massage therapists in states which regulate massage than by unregulated massage therapists? How does your Coalition explain that? Does the Coalition understand that:
1. People are not injured by potential harm, but by harm that has actually occurred.
2. The risk of harm is determined not by potential harm, but by the amount and seriousness of harm that has actually occurred.
This is why our published reports focus on harm that has actually occurred. With respect to the alleged need for state regulation to protect the public from harm, the harm that is important is harm which has actually occurred. Therefore, with what well-documented information can your Coalition answer these two questions:
1. How many allegedly inadequately trained practitioners have actually harmed how many people and how serious were their injuries, in Minnesota?
2. How many people have to be injured by how many allegedly inadequately practitioners and how serious do the injuries have to be in order to justify the alleged need for state regulation to protect the public from that harm, in Minnesota?
In one report, I estimated that there was one case of possible harm in 19,240,000 massages (Spiritual Massage Ministry Newsletter. Vol. 3, No. 2. 1998). Does this small amount of possible harm justify the alleged need to regulate all massage therapists to protect the public from so little harm?
The Harm Shell Game.
Now you see it. Now you don't.
The Harm Shell Game and the Prostitution Shell Game are parts of the State Regulation Game. The games are played this way. Proponents of regulation tell people, including state legislators, that state regulation is needed to protect the public from harm, to control prostitution, and/or for other reasons.
Then those of us, who are opposed to state regulation, try to find well-documented evidence of harm or well-documented evidence that justifies other reasons why state regulation is allegedly needed. But we can't find that evidence.
First we see it - the alleged harm. Then, we don't because there's no well-documented evidence that it really occurred.
Mary Brewster's Letter to the Editor (on page 4 in the latest issue of Massage & Bodywork) reported a well-documented case history of the "Harm Shell Game."
Contrary to your refusing to share certain information with me, as your June 10, 1999, letter states. I want to share all my information with everybody. That's why it's all on the internet <www.tiac.net/users/maryella/>.
I do not "understand" why the Coalition "will not be sharing [its] information with" me "at this time." If you provide me with well-documented information about harm which has actually occurred in Minnesota and which meets the two above-mentioned requirements to justify state regulation, I will publish that information in the Massage Law Newsletter. I will also reevaluate my opposition to state regulation in Minnesota.
Is it therefore not to the Coalition's advantage to provide me with its well-documented evidence of harm that has actually occurred, if the Coalition has such evidence? Is it also not to the Coalition's advantage to know what holes I may shoot in its evidence before the Coalition submits that evidence to legislators? "To be forewarned is to be forearmed."
Until someone provides me with well-documented evidence of harm that has actually occurred in Minnesota, I have no choice but to assume that such harm, if it has actually occurred, is insufficient to justify the alleged need for state regulation to protect the public from that harm, in Minnesota.
Sheila Sweeney and Sister Rosalind Gefre have not answered questions I asked them in the Massage Law Newsletter (Vol. 6. No. 2; and Vol. 7, No. 3). You have not answered questions I asked you in the Massage Law Newsletter (Vol. 9, No. 4). When I ask questions about harm and other aspects of state regulation and offer to publish the replies, why don't people respond? Is it because they are unable to justify their promotion of state regulation? If that is not the reason, what is?
My offer to publish information from you, Sheila Sweeney, and Sister Rosalind Gefre is still open.
The Coalition should do research
As a research scientist and a Professor Emeritus of Education, I suggest the Coalition do the following research.
1. Estimate the number of allegedly inade-quately trained massage therapists in Minnesota, the number of clients they massage annually, and the total number of massages they give annually.
Then use the number of cases (you have) of well-documented serious harm that has actually occurred in Minnesota to calculate the incidence of harm; i.e., how many people have been actually harmed:
1. per 1,000 allegedly inadequately trained practitioners annually in Minnesota; and
2. per 100,000 or 1,000,000 massages given annually by the allegedly inadequately trained practitioners in Minnesota.
A mini-lesson in epidemiology
This is how proponents of state regulation (to allegedly protect the public from harm) should report epidemiological morbidity associated with massage. But proponents of regulation have not reported harm, allegedly caused by allegedly inadequately trained massage therapists, this way.
Harm, associated with massage, is morbidity. Epidemiology is concerned with morbidity (e.g., in how many people in a defined population have the same health problem), and with mortality (e.g., how many people, in a defined population, have died from the same cause).
Massage seems to be petrified in potential harm, like insects are petrified in amber. So much attention has directed to potential harm, but there is so little if any well-documented information about harm that has actually occurred.
That situation with massage and harm is comparable to warning 500,000 people that they are in danger of being infected with a serious disease which has not yet actually infected any of them. Nor has it occurred in other populations from which it may spread to them. Both epidemiology and common sense tell us such a warning is nonsense.
COMTA can play a useful role
The Commission on Massage Therapy Accreditation (COMTA) should require that all accredited programs devote at least 10 clock hours to instruction about contraindications from the point of view of the important difference between potential harm and harm that has actually occurred. The fact that contraindications are potentially harmful does not mean ipso facto that they actually cause significant harm. Lightning is potentially harmful, but how many people are actually harmed by lightning?
The 10 clock hours of instruction should also cover the above-mentioned basics of epidemiology. There's no need to use statistical analysis to determine whether well-documented, serious harm, associated with message is significant because there's so little, if any such harm.
More research for the Coalition to do
For the research projects outlined below, use the data you calculated on the incidence of well-documented harm, that has actually occurred in Minnesota, in the first research project outlined above.
1. Assume 95% of the clients, in Minnesota, drive to allegedly inadequately trained massage therapists. Find out the incidence of auto accidents in Minnesota. Are people more likely to be injured in an accident (while they drive to and from their allegedly inadequately trained massage therapists) than actually harmed by their allegedly inadequately trained massage therapists? People who are injured in auto accidents are actually harmed. They do not suffer potential harm.
2. Find out the average number of people who were struck by lightning annually in Minnesota during the last five years. Are people more likely to be struck by lightning than actually harmed by their allegedly inadequately trained massage therapists? People who are struck by lightning are actually harmed. They do not suffer potential harm.
3. Check the statistics on how many people are bitten by dogs annually in Minnesota. Are people more likely to be bitten by dogs than actually harmed by their allegedly inadequately trained massage therapists. People who are bitten by dogs are actually harmed. They do not suffer potential harm.
I assume you distinguish between harm that consists of serious injuries in contrast to ephemeral aches. Mary Brewster's above-mentioned Letter to the Editor (Massage & Bodywork) notes this distinction.
4. In states which regulate massage, find out how much massage schools increased their tuition one, two, and three years after regulation was enacted. Also find out the increases in tuition for the same years in comparable massage schools in states which have not regulated massage. Report the increase of fees in dollar amounts and in percent increases based on tuition during the last year before regulation was enacted.
I suggest this $$$$ project because many people believe.rightly or wrongly, that massage schools are major promoters of state regulation.
Please submit your results, from the above-mentioned research, for publication in the Massage Law Newsletter.
Finally, can you tell me how many people are injured annually in Minnesota by falling off massage tables when they are with allegedly adequately and allegedly inadequately trained massage therapists? People who are injured by falling off massage tables are actually harmed. They do not suffer potential harm.
I am NOT "a devoted opponent to state regulation."
I AM a "devoted opponent" to monopoly control.
I AM a devoted proponent of democracy in massage.
I AM an open-minded skeptic.
Your letter refers to me as "a devoted opponent to state regulation" That is incorrect. My published reports clearly reveal that am not opposed to all state regulation. In fact, I am a devoted proponent of democracy. I will support voluntary title protection which provides freedom to practice and freedom to choose. This means that everybody can do massage, and people may choose titled or an untitled massage therapists.
I am an open-minded skeptic. I have been actively doing scientific research for more than half a century, and have always been open to evidence which may require me to reevaluate my position. I have carried this modus operandi over into my research on state regulation. This is why I have invited you and others to prove me wrong, so to speak. I am not paid for the research I do and publish on state regulation. I pay my own way. I have a vested interest in objectivity and facts.
I am opposed to the promotion of state regulation as something that is allegedly needed to protect the public from harm without any well-documented evidence that the allegation is valid. Why does any state have to regulate all practitioners to protect the public from harm that has not actually occurred?
Why deny people the right
to earn a living by doing massage?
I object to state regulation which (a) prohibits practitioners (who have had many satisfied clients for many years, without harming anybody) from continuing to earn a living by doing what they have been doing.; or (b) requires them so spend considerable time and money (which many of them cannot afford) to meet arbitrarily determined requirements which are not justified by well-documented evidence.
I have discussed this in detail and at length in several reports on the internet. Especially at a time when our country is now attempting to find work for people who are no longer eligible for welfare aid, it makes no sense. to me, to put massage therapists out of business because they have not met or cannot afford to meet arbitrarily determined requirements for which there is no no well-documented justification.
That is monopoly control, to which I am a "devoted opponent. " When I was a professor at the University of Chile, I learned this proverb, Aunque la mona se vista de seda, mona se queda. This says, Dress a monkey as you will, it remains a monkey still.
When state regulation is dressed up to look like something that protects the public from harm. I say, Dress a monopoly as you will, it remains a monopoly still.
Why doesn't your Coalition promote (a) the self-regulation which British Columbia and Ontario have (that avoids monopoly control), and (b) the state-wide permit system that Barbara York proposed which protects both the public and practitioners (and also avoids monopoly control)?
A mini-lesson in monopoly
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
The Monopoly Game
"Whom the gods would destroy, they first make mad."
Massage has adopted a so-called medical model at a time when increasing numbers of people have abandoned conventional medicine (which is the fourth leading cause of death) for alternative health care, and when more and more doctors want to leave medicine and earn a living another way because medicine has been corporatized and HMOgenized by HMOs.
The Monopoly Game has corporatized, homogenized, and medically-modelized mas-sage. State-regulated massage therapists provide the money which keeps the Game going.I