For massage therapy, the requirements and the cost of meeting those requirements are determined by a massive economic superstructure. This superstructure is sustained by the money massage therapists pay the components of that superstructure. The components include state regulating agencies, local (city and county) governments that have ordinances allegedly to control prostitution, state-accredited massage schools, national certification, continuing education providers, insurance companies, and producers of massage tables and other products.  

National certification

Continuing education

Insurance

$$$$$

The name change from AM&TA to AMTA in 1983 may have been motivated by state physical therapy practice acts, such as the one enacted in Pennsylvania in 1975, which specifically exclude non-therapeutic massage from the domain of physical therapy, but include [medical] massage therapy. The change from AM&TA to AMTA in 1958 may have been an attempt to stake out symptom-directed, medically-oriented massage as AMTA territory, and enable massage therapists, with less education than physical therapists, to do some of the work that physical therapists do.

In the late 1980s, the AMTA initiated the move for national certification which became part of the massage industry.

$$$$ $$$$ $$$$ $$$$. Before 1916, when Ohio was the first state to regulate massage, anyone could do massage even if she was self-taught. Nobody had to pay to go to a state-accredited school, and pay for national certification, continuing education credits, and other things which are now required. In states which regulate massage, the massage industry has become a big business that includes state agencies, local (city and county) governments which enact ordinances allegedly to control prostitution, national certification, insurance companies, sponsors of continuing education, and manufacturers of massage tables, chairs, and other products. One thing all components of this industry have in common is that money flows to them from massage therapists.

The massage industry continues to expand because massage therapists have to pay to meet requirements to enter the profession and must then keep on paying to stay in business. Moreover, it is becoming increasingly costly to get in and stay in. Despite the fact that many massage therapists drop out because they don't earn enough money to keep going, others keep coming in.

MORE THAN  FOUR AND A HALF CENTURIES OF STATE REGULATION. Adding up the number of years that states have had massage laws gives the total state massage-law years. For example Ohio, which began regulating massage in 1916, has 81 (1997 minus 1916)  state massage-law years. For all states that regulate massage, the total number of state massage law-years amounts to more than four and a half centuries. This means that massage therapists have been paying for the privilege of practicing a modality with little if any risk of harm for more than four and a half centuries.

AFTER ALMOST HALF A MILLENNIUM OF STATE REGULATION, no research has yet been done which provides convincing evidence (a) that state regulation results in more competent massage therapists in terms of on-the-job performance, (b) that massage therapists cause harm from which the public has to be protected, and (c) that state massage laws could protect the public from harm if the public needed that protection. There has also been no adequate research on the total amount of money that massage theorists have had to pay during all these years.

The corporatization of medicine by HMOs has resulted in less and lower quality health care in order to maximize profit for insurance companies. Doctors now work for insurance companies. (Is that what massage therapists want to do?) Medical care has become an industry, which is precisely what it should not be. According to Joseph Califano (Secretary of Health, Education and Welfare in the Carter administration), At its core, health care is a ministry, not an industry. If we lose sight of this essential characteristic, the worthy goal of affordable quality (health) care for all will once again get trampled in the melee over money.  This is precisely what has happened.

Because of the uncertainty of what the medical model is, many massage therapists are understandably concerned about how that model will affect them. Why would a profession like massage  permit itself to be modelled on something, without having a clear definition of what the something is?

Medicine has begun to recognize the importance of spirituality. The Harvard University  Medical School and the  Deconess Hospital have jointly offered courses in Spiritual Healing in Medicine on December 3-5, 1995, and December 15-17, 1997.

What massage therapists do need. If the massage profession needs a model, it should develop its own model based on its identity, its needs, and its contribution to and its role in society.

Massage therapists also need to understand that the only state regulation which would serve them and the public most effectively, most professionally,  and most inexpensively is a title protection act with voluntary compliance. An appropriate title protection act would provide  certification for those who want it and allow them to use the title state-certified massage therapist.

Others who do not want state certification would be permitted to do massage (without being state-certified) but would not be allowed to call themselves state-certified massage therapists. They could call themselves simply massage therapists. There is precedence for this because we have accountants (who are not certified) and certified public accountants.

Who benefits from the superstructure? What we have discussed ineluctably leads to the question, "Who or what benefits from the massage superstructure?" To answer this question, one has to follow the money trail. Does it lead to special interest groups? If so, what are these groups and to what extent does each of them benefit?

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

We do not understand why those who promote state regulation of massage, allegedly to protect the public from harm, do not "tell the whole world" about any and all harm caused by massage. If that harm exists and is significant, it would be convincing  evidence for the need  to regulate massage. Conversely, if it does not exist, there is no need to regulate massage to protect the public from harm. One indisputable fact about harm is that in states, where massage is unregulated, consumer protection agencies are not lobbying legislators to enact laws to protect the public from harm by massage therapists.

"Massage harm" is a unique kind of harm The harm allegedly caused by massage is unique because it is ephemeral. It seems to occur when it is needed to convince state legislators and others that massage should be regulated to protect the public from harm.  "Massage harm" is like a verbal shell game. "Now you see it. Now you  don't." But we can't find out where (under which shell) it is. Information about how many people have been harmed and how serious their injuries were is kept as secret as if it were stamped  NATIONAL SECURITY. A remarkable case where relatively safe massage was transformed into potentially dangerous massage is reported in the write-up about Ontario on page 10.

Better late than never Why has so much of the massage superstructure existed for so long without any or sufficient research to justify it? Is it because research might reveal that the superstructure, including state regulation, is not justified and therefore not needed?

The research, which should now be done, should cover the past 10 to 20 years. If estimates have to be made in some cases, that is better than having no information at all. The data which that research provides will enable us to objectively evaluate the need for state and other requirements. All requirements which are not justified by research should be discarded.

1. What have the tuition and other fees been annually at accredited massage schools in states which regulate massage, before and after regulation was enacted? How much more rapidly (at what rate) have tuition and other fees increased after state regulation was enacted, than before? How do these fees compare, year by year, with fees in schools in states which do not regulate massage?

2. If all state massage laws were voluntary title protection acts, how many massage therapists would choose to be state-credentialled?

3.  What research provides convincing evidence that state massage law requirements  (e.g., the number of hours of training at a state accredited school, national certification, continuing education credits, etc.) assure an individual's competence in terms of on-the-job- performance?

4. If the competence of a massage therapist is on-the-job performance, how is that competence evaluated? Who is most qualified to evaluate it, and why? If the competence of a massage therapist is not on-the-job performance, what is it? When we read articles about massage that refer to competence or "expertise," which the author does not define, do we know what he is talking about? Does the author know what he is talking about?

5. How many hours of training are required by different states in the U.S. and in Canadian provinces? Why does this wide variation in the required number of hours of training exist? How many hours of training are really needed, and why? If there is no answer to this question, why not?

6. How many state massage laws have been enacted allegedly to protect the public from harm? Are the numbers of people who have been harmed and the nature of the injuries sufficiently serious to justify the need for state regulation to protect the public from harm? What convincing evidence is there that state massage laws requirements could protect the public from harm if that protection were needed?

7. During the past 20 years, how many massage therapists have been state-certified, registered, and licensed annually throughout the U.S.? How much have these massage therapists had to pay annually to states, to state-accredited massage schools, for national certification, for continuing education credits, etc.- from 1916 to date? We need to know the amounts paid annually in each of the above-mentioned categories and the total amounts paid to date. This will provide information about the rate at which the fees that massage therapists have had to pay have been increasing.

8. What is the average gross annual per capita income and the average gross annual per capita cost of required fees that massage therapists have paid during the past 20 years? Are fees increasing more rapidly than income? What evidence, if any, indicates that any educational requirements are responsible for the increase in  income?

9. During the past 10 years, how much money has been paid by insurance companies to how many clients for Injuries caused by massage therapists,? What was the nature of these injuries, and how serious were they?

10. How many cities and counties have local ordinances regulating massage therapists, allegedly to control prostitution? How much money have massage therapists had to pay annually and to date since these ordinances first went into effect? What research provides convincing evidence that local ordinances have decreased prostitution? And, if so, to what extent?

11. If the National Certification Examination were voluntary, how many people would take it? How much money have massage therapists paid to take the National Certification Examination since it began? Does this examination test for competence in terms of on-the-job performance? Is there any correlation between the test scores of clients who passed and those who failed this examination and how their client's rate them, in whatever ways the clients chose to do so?

12. What evidence is there that each of the claims which members of the massage industry make about the advantages and benefits of their products, for massage therapists and the public, are justified?

With respect to the above-mentioned considerations, the only significant difference between massage therapists and psychotherapists is that a live massage therapist must be present whereas a live psychotherapist need not be.

APPENDIX

Many others who do healing by anointing with oil and the laying on of hands, and in other ways, have never had any training in a state-accredited massage school. Nor have they passed any written examination. But they have obtained good results. Many Therapeutic Touch practitioners have not studied anatomy, physiology and pathology. Many people who do massage competently are self-taught, or learned massage from others or in schools that were not state-accredited..

"Every one of us is a healer because every one of us at heart has a love for something, for our fellow-man, for animals, for nature, for beauty in some form. And we, every one of us, wish to protect and help it to increase. Every one of us also has sympathy with those in distress, and naturally so because we all have all been in distress ourselves at some time in our lives. We are all healers, and with love and sympathy in our natures we are also able to help anyone who really desires health." - Edward Bache, M.D.

"To heal, one must become attuned to that universal power … a force  that has order as its basis… It does not require intense effort or long years of study, but rather a strong desire to heal and an opening up to your sensitivities. Those simple visualizations, and those relaxed thoughts of letting the energy pour through you are examples of just how simple it is. Firmly plant your beliefs and your will in helping the ill, then open yourself up to the energy of universal power and visualize the light flowing through you - that is the simple truth of real healing. - Dora Kunz

"People who have a  deep inner yearning to give of themselves in healing the sick, to take away pain and stress, who possess compassion and sympathy for those who are afflicted and are willing to sacrifice their time without any pecuniary reward; people who are generous in their nature, and who render willing service for good causes are those who possess the spiritual qualities which mark the healing gift. This healing potential, then, needs only the development of the faculty of atunement with the spirit source of healing and the opportunity to give it practical expression…

"One cannot develop the gift [of spiritual healing] by study.... The gift of healing cannot be conferred by a degree, by ordination, or by the wearing a white coat. It functions when those who have the faculty establish atunement with God's healing ministers in Spirit who indeed are the intelligent administrators of the beneficent power." - Harry Edwards.

References

2. Schatz, A. The Church for Spiritual Healing and Health. Spiritual Massage Healing. Journal of Spiritual Bodywork. 1(1):1-53, 1996.

3. Schatz, A. The Church for Spiritual Healing and Health may now ordain spiritual massage healing ministers. Journal of Spiritual Bodywork. 2(1):1-4. 1996. 4. Edwards, H. The Power of Spiritual Healing. The Harry Edwards Spiritual Healing Sanctuary Trust. England. 1978.

5, Brewster, M. A search for an appropriate philosophy of massage. Part 3: Bodyworkers can help heal the planet. Spiritual Massage Ministry Newsletter. 2(4):1-2, 1997.

6. Schatz, A. A. Worldwide ecological damage threatens our survival as a species. Journal of Spiritual Bodywork. Special Issue No. 3. pp. 1-5. 1997.

7. Eabry, S. Guest Editorial. Massage magazine. No. 58. pp. 22-25. Nov/Dec 1995.

8. Schatz, A., Tillotson, A., and Brewster, M. Since massage does not cause harm, why license massage therapists to prevent harm? Spiritual Massage Ministry Newsletter. 2(2)1-7. 1996.

9. Brewster, M., and Schatz, A. Massage harm: fact or fiction? Massage Magazine. p. 11. July/August 1997.

10. American Massage Therapy Association. 1996-1997 Membership Registry. Evanston. IL.

11. Health & Healing. Tomorrow's Medicine Today (Dr. Julian Whitaker's newsletter). 6:1-3. January 1996. Phillips Publishing, Inc. Potomac, MD.

12. Schatz, A., and Kuhl, G. National  Certification Exam. Massage & Bodywork. pp. 31-32, fall 1996.

13. 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.

14. Should physicians prescribe prayer for health? Spiritual aspects of well-being considered. American Journal of Medicine. 273:1516-1517. 1996.

15. Schatz, A. , and Carlson, K. We need  new kind of national health care. More of the same won't work. Journal of Well Being. 9(4):19-27. 1994.

16. Schatz, A., and Brewster, M. Massage does not cause enough harm in California to justify regulation. Journal of Spiritual Bodywork. 2(4):6-7. 1996.

17. Schatz, A. Some thoughts and questions about the $3,000,000 National Certification Examination. Spiritual Message Ministry Newsletter. 2(1): 1-5. 1996.

18. Baron, C.H. Licensure of health care professionals: the consumer's case for abolition. American Journal of Law & Medicine 9:335, 1984

The one-page brochure which PALC distributed raises questions about important issues. I would appreciate your providing information, in writing, which answers these questions. May I also please have your written permission to publish your reply in the next issue of our Journal of Spiritual Bodywork. If you think any of our comments about PALC are inaccurate, please let us know and we shall publish corrections.  

Mission Statement. The brochure refers to a "Mission Statement" of "April 1994" which reads, "The following policies and standards will be codified and endorsed by our members:

1. "Criteria for membership in the Coalition will be explicitly stated.

2. "A code of ethics and common scope/standards of practice will be explicitly stated.

3. "The mechanism by which the Coalition creates itself to be the liaison between the collective memberships and the governing body will be explicitly stated."

Mission statement. More than two years have elapsed since the "Mission Statement" was drafted in April, 1994. I assume that during this time the Coalition has "explicitly stated" the above-mentioned (a) "criteria," (b) "code." and (c) "mechanism."

I would appreciate your sending me copies of the Coalition's "explicit" statements of the (a) "criteria," (b) "code of ethics," and (c) "mechanism." I assume the Coalition will agree that I and other members of the bodywork community are entitled to this information. If the Coalition disagrees, would you please explain why, in writing.

What  is meant by "the liaison between the collective memberships and the governing body"? Does  this "liaison" include accountability? If so, what is this accountability? Please define it? If it does not include accountability, please explain why it does not.

What is "the governing body," and how does it govern? Is it the Coalition? If not, what is it? Who authorized it to function as "the governing body"? What, how, and whom does it govern? It is certainly not "governing" me. It is also not "governing" the Pennsylvania legislature.

Why is there is date on this brochure?

Final legislation. The brochure includes the following statement, "The final legislation will be agreed upon by our members." Who are these "members"? Are they the members of the Coalition? Or members of the Pennsylvania bodywork community? In either event, this statement is patently incorrect. The state legislators, not the members of the Coalition or the PA bodywork community, will decide what "the final legislation is."

Faceless bureaucracy. The brochure includes the following statement, "We will determine our fate - not some faceless bureaucracy. " What "faceless bureaucracy" has "determined" the "fate" of massage therapy or any other kind of bodywork? When, where, and how was that done? Which kinds of bodywork had their fate determined by tfaceless bureaucracies? 

Complementary versus alternative. The brochure includes the following statement, "We may now reasonably be considered 'complementary' rather than 'alternative.'" This statement reflects a myopic view of reality. If massage is the only treatment an individual receives, then massage is not complementary because there is no other treatment which it complements.

If massage is prescribed by a primary health care provider, such as an osteopath, it is complementary to the treatment by the osteopath who is the primary health care provider. If an individual chooses to be treated by a massage therapist and sees a physician only to check her progress, then massage is the primary health care and the physician provides a complementary health care service. For these reasons, the above-mentioned statement in the brochure has only a limited relationship to reality.

Restraint of trade. The brochure reads as follows, "We protect ourselves from restriction of trade." Specifically, who or what is causing "restriction of trade" in Pennsylvania, who in Pennsylvania will be protected, and what evidence is there that that protection is needed?

An estimated 90% of massage therapists do what the Physical Therapy Act of Pennsylvania defines as "non-therapeutic"...  massage. This Act specifically excludes "non-therapeutic ... massage" from the domain of physical therapy. Therefore, these estimated 90% of massage therapists do not need a state massage law to protect them from a "turf war" with physical therapists, because physical therapists have no legal right (according to the Pennsylvania Physical Therapy Act) to interfere with the "non-therapeutic...  massage" which these massage therapists do.

Also, with respect to restraint of trade, has the Coalition seriously considered that the bill it is drafting may itself be restraint of trade? In this respect, have the members of the Coalition read the following publications:

1. Baron, C.H. Licensure of health care professionals: the consumer's case for abolition. American Journal of Law & Medicine 9:335, 1984.

2. Havighurst, C.C., and King, N.M.P. Private credentialing of health care personnel: an antitrust perspective. Part one. American Journal of Law & Medicine 9:131, 1983.

3. Havighurst, C.C., and King, N.M.P. Private credentialing of health care personnel: an antitrust perspective. Part two. American Journal of Law & Medicine 9:263, 1983.

I believe the Coalition has a responsibility to reply to my requests for information. If you disagree, I would appreciate your informing me, in writing, why you disagree.

        Sincerely yours,

You create your own reality. ( New Agers) - Michael Parenti

When I say, "Everybody says so." I mean I say so. - Ed Howe

When I want your opinion, I'll give it to you.  - Ed Howe

Alternative means something other than what is usual or customary. But whether something is alternative depends on the perspective from which it is viewed. Alternative health care modalities are considered alternative because that is the way conventional medicine views them. They are something other than conventional medicine.

Then medicine came up with the term complementary  health care. Complementary means that alternative health care is acceptable to conventional medicine only when the alternative complements (is added to) conventional medical care.

From this perspective, conventional medicine is always the core of health care, with or without any alternative. Medicine does not see itself other than the core or center of all health care* because, if it is not the center, it is not in control. And if it is not in control, it does not determine how much money doctors get..

Conventional medicine, which used to oppose alternative health care, became interested in it because of an article in the New England Journal of Medicine. This article reported that people were spending 13.7 billion dollars a year on unconventional therapies, and paying 75% of this money out of their own pockets. That was a major economic loss for medicine.

Doctors then realized they could get some of this money if they learned about alternative health care and offered it to patients who wanted it. This is how and why what medicine had formerly pooh-poohed and considered ineffective, harmful, and in some cases qackery, suddenly became acceptable medicine.

This occurred because of the large amount of money involved. That money converted what had formerly been rejected as illegitimate medicine into legitimate medicine. Convincing evidence that alternative health care was indeed effective has been available for many  years, but had been ridiculed and/or ignored by the medical establishment.

Now let's get back to the importance of perspective. Some people are so disenchanted with conventional medicine that they have little and preferably nothing to do with doctors. For them, conventional medicine is an alternative to the treatment they get from practitioners who are not doctors, and they reject that alternative. Their practitioners are their primary and only health care providers. Some people will not even consider conventional medicine as complementary to the treatment they get from their practitioners. So, what is alternative and complementary depends on the perspective of those who use these terms.

The following are declarations of the importance of freedom of choice in health care. Note the source of each comment.  

Freedom, consent, and individual responsibility are fundamental to our system. In the field of medical care, this means that the traditional relationship of the physician and his patient and the right of the individual to elect freely the manner of his care in illness must be preserved. - President Dwight D. Eisenhower  

Every human being of adult years and sound mind has a right to determine what shall be done with his own body. -  U.S. Supreme Court Justice B. N. Cardozo

Every human being, regardless of race, color, or creed, has the inalienable right to life and health, and to choose the type of medical care he or she wishes to receive, provided the choice does not interfere directly with the life and health of others. - Andrew Ivy, M.D.  Dr. Ivy, a world-renowned scientist and physician, was chosen by the allied powers, Great Britain, France, the United States, and the Soviet Union, to investigate the Nazi experiments on humans for the Neurenburg Trials. He concluded that those experiments produced no useful information.

The Constitution of the Republic should make special provision for Medical Freedom as well as Religious Freedom. To restrict the art of healing to one class of men and deny equal privileges to others will constitute the Bastille of medical science.  All such laws are un-American and despotic. They are fragments of monarchy and have no place in a republic. - Dr. Benjamin Rush, Surgeon General of the Continental Army of the United States and one of the Signers of the Declaration of Independence.

"In the four cases ...  two of the massage therapists under  investigation had been licensed through the apprenticeship route and two through the school route.  All four therapists had been licensed for over two years prior to the allegation."

2. Schatz, A., Tillotson, A., and Brewster, M. Since massage does not cause harm, why license massage therapists to prevent harm? Spiritual Massage Ministry Newsletter. 2(2)1-7. 1996.