"Massage therapy is unusual as compared to most therapies in that its effectiveness is greatly out of proportion to its potential risk for causing harm."

"Reports in the medical literature of injury from massage have been rare in the past. This can be readily understood in terms of the practice and training norms that prevail throughout most of North America... Relaxation massage and general rather than specific therapeutic effects are emphasized.  Also, although there has been a great increase in public interest in massage therapy and other forms of complementary health care in recent years, information presented at a recent meeting of the National Certification Board for Therapeutic Massage and Bodywork (May 19-20, 1999) indicated that a majority of US practitioners do not provide treatment in a medical context and receive few if any medical referrals. It was estimated that fewer than 25% of all practitioners in the US currently do any medically oriented massage that involves treating clinically diagnosed conditions. The three most often cited reasons for  receiving massage therapy by US consumers are relaxation (27%), relief of muscle soreness, stiffness or spasm (13%), and stress reduction (10%). Outside of BC [British Columbia], both physicians and the public have tended to approach massage therapy treatment with caution, and primarily for relaxation and other general therapeutic benefits. Patients with musculoskeletal injuries and disorders typically receive treatment from MDs or other health care professionals rather that massage therapists. This is not a pattern of massage therapy associated with a significant risk of harm."

I would appreciate it if you would please:

(a) Comment on my following critique of CMTBC's July 6, 2000, submission (to the Health Professions Council) entitled Further Commentary on the Risk of Harm Associated with the Practice of Massage Therapy. A Supplemental Response to the Health Professions Council's February 1999 Preliminary Report on the Massage Therapists Scope of Practice, and

(b) Give me permission to publish your comments in the Massage Law Newsletter

Inadequate evidence of harm

The evidence that CMTBC presents on the potential risk of harm associated with medical massage is inadequate because CMTBC has not presented  epidemiological data on harm caused by non-registered massage practitioners and other bodyworkers in British Columbia.

How is the risk of harm defined?

The risk of harm is not  determined by the potential for harm to occur. The risk of harm is defined (epidemiologically) by how many people are actually harmed annually, how serious that harm is, and how likely that serious harm is to occur.

Unlike tuberculosis, for example, massage harm is not contagious. If one student in a school is diagnosed as having active tuberculosis, all teachers and other students who have had close contact with that individual, are considered to be at risk because they have been exposed.  This is why a  single case of TB (and any other serious infectious disease - such as meningitis) is considered a serious health hazard.

CMTBC has not provided acceptable epidemiological data which is needed to determine whether non-registered massage practitioners and other bodyworkers in British Columbia pose a serious threat to the health, safety, and welfare of the public in British Columbia. Citing several isolated cases of harm is no substitute for definitive data on harm which is epidemiologically significant.

A homework assignment

To validate its allegation of harm, CMTBC needs to provide the following information:

1. What is the estimated number of non-registered massage therapists and other bodyworkers in British Columbia?

2. What is the estimated number of clients whom these unregistered practitioners treat annually?

3. What is the estimated number of those clients who have contraindications?

4. What is the estimated number of treatments that the non-registered practitioners provide annually?

5. How many of those treatments resulted in serious injuries that were the direct result of the treatments, and what well-documented evidence established that direct cause and effect relationship?

6.  How many of the serious injuries were associated with contraindications, and what contraind-cations were involved?

7. What is the epidemiological significance of that harm? In other words, how many serious injuries have non-registered practitioners in British Columbia  caused annually per 100,000 treatments, for each of the past five years? In several southeastern states in the U.S., there was only one complaint of possible harm in 19,240,000 massages in one year. (Spiritual Massage Ministry Newsletter. Volume 3, Number 2. 1998. <www.healingandlaw.com>)

Does this low incidence of possible harm justify the alleged need for state regulation of all massage therapists to protect the health, safety, and welfare of the public?

7. How does the estimated incidence of harm caused by nonregistered practitioners compare with the incidence  of harm caused by registered massage therapists in British Columbia? George K. Bryce referred to harm caused by registered massage therapists in his August 20, 1998, letter to me, copies of which were sent to Mary McCrea and David. MacAulay at the Health Professions Council.

Without the above-mentioned epidemiological data, CMTBC has no legitimate reason to assume that unregistered massage therapists and other bodyworkers in British Columbia are any more of a threat to the health,  safety, and welfare of the public than massage therapists in the U.S. are.

1. How many people in British Columbia, who  need such vaginal and rectal work, are presently unable to obtain that treatment?

2. What well-documented evidence is there that British Columbia presently has a shortage of practitioners who are qualified to provide rectal and vaginal treatment?

3. How serious is this shortage of qualified practitioners in terms of the public health, safety, and welfare in British Columbia?

____________

cc: Mary McCrea and David MacAulay

      at the Health Professions Council.

      Vancouver, BC