Here's freedom to him who would read.
Here's freedom to him who would write.
There's none ever feared
that the truth should be heard,
But they whom the truth would indite.
Robert Burns - Scottish poet (1751-1796)
To: Susan Pomfret. Chair. Arizona Coalition for Massage Therapists and Bodyworkers (hereinafter referred to as theArizona Coalition)
From:Albert Schatz and Mary Brewster. Editor and Associate Editor
To present the "other side," we invite you to comment on this report and on Schatz's previous report,1 and give us permission to publish your comments in the Massage Law Newsletter. If we have misrepresented the position of the Arizona Coalition, we will publish a correction.
The comments quoted in the paragraphs (numbered 1 through 5 on pages 1 and 2) are in the minutes of the April 1, 2000, and July 29, 2000, meetings of the Arizona Coalition
THE ARIZONA COALITION ADMITS
MASSAGE IS SAFE
1. "We generally don't hurt people." (If massage therapists generally don't harm people, massage is safe.) This "makes it difficult" to persuade legislators that regulation is needed.
THE ARIZONA SUNRISE ACT REQUIRES EVIDENCE OF HARM.
The Arizona Sunrise Act requires the Arizona Coalition to provide Arizona legislators with well-documented evidence that enough serious harm has actually occurred in Arizona to justify the need for state regulation to protect the public from that harm.
Schatz's recent report about the Arizona Coalition provides well-documented evidence that Arizona does not need to regulate massage therapists to protect the public from harm.1
THE ARIZONA COALITION HAS NO
EVIDENCE OF HARM
Nobody, at the above-mentioned two meetings of the Arizona Coalition, said anything about any harm that had actually occurred as a result of massage. On the contrary, it was pointed out that information about such harm was needed to justify the need for state regulation to protect the public from harm.
THE ARIZONA COALITION NEEDS
EVIDENCE OF HARM
2. "Legislators are driven by accountability." If they regulate massage therapists, they know "they will impact someone's ability to work ..." This is why they require proof that "they are regulating for public protection."
3. One of the "criteria for legislative regulation" is "risk/harm."
4. Providing evidence that the public needs to be protected is "one of the biggest problems" we face. It's difficult to prove that regulation is needed because "we generally don't hurt people." "Public protection" is the "only reason to regulate. Can't do it for any other reason."
5. The requirements of the Arizona Sunrise Act are a "litmus test" and a "nightmare".
We have a question about the following information in the minutes of the April 1, 2000, meeting (which was held on April Fools Day). These minutes tell us that in the "last 10-12 years" there has been a "100% increase in regulation. - why? Driven from consumer." We challenge the Arizona Coalition to provide well-documented evidence that consumers have been responsible for state regulation. In what states have Consumer Protection Agencies lobbied legislators to regulate massage therapists to protect the public from harm? Is this allegation about consumers an April Fools Day joke?
We now provide more evidence that Arizona does not need to regulate massage therapists to protect the public from harm. The minutes of the September 9, 2000, meeting of the Council of Massage Therapy Educators report that the "low harm factor" is an obstacle to licensure.2
Susan Pomfret (Chair in the Arizona Coalition) has provided evidence that massage is safe. She reported:, "In some areas, poorly trained therapists flood the market."1 But she did not provide any evidence that these allegedly poorly trained therapists have harmed anybody. If these allegedly "poorly trained therapists flood the market", they are quite numerous, have a lot of clients, and do a lot of massages. But Pomfret does not refer to any harm that they caused. Does it make sense for Arizona to regulate these allegedly "poorly trained therapists", who have not harmed anybody, to protect the public from harm?
GEORGIA SENATORS DID THEIR OWN RESEARCH AND FOUND NO HARM
The Georgia Chapter of the American Massage Therapy Association (AMTA) presented undocumented evidence to support an alleged need for Senate Bill 300 to regulate massage therapists and other bodyworkers to protect the public from harm. The Georgia Senate rejected the undocumented allegations of harm (that the Georgia AMTA Chapter submitted), did its own research,3 and concluded that
"THERE IS NO DOCUMENTED DANGER OF ACTUAL HARM TO THE PUBLIC."
"THE POTENTIAL FOR HARM TO THE PUBLIC APPEARS TO BE REMOTE AND WOULD NOT BE ALLEVIATED BY LICENSING."
2,000,000 MORE REASONS WHY
ARIZONA DOES NOT NEED TO REGULATE
To see where the 2,000,000 additional reasons come from, let us begin with the approximately 2,000 massage therapists in Arizona. Then we have to get more information, which we need, from Georgia.
In Georgia, the AMTA Chapter failed to convince senators that state regulation was needed to protect the pubic from harm. The AMTA Chapter did not accomplish its objective because it was unable to provide senators with well-documented evidence that any serious harm had occurred.
But the Georgia AMTA Chapter did provide other information that we can use. The Chapter "estimated "... there are probably 1,000 massage practitioners in Georgia and ... each practitioner performs an average of 20 massages per week." The Georgia senate committee realized that, "This ... translates into over 1,000,000 massages ... performed during a one year period."3
Let us now do the same arithmetic that the Georgia senators did. If each one of the 2,000 massage therapists in Arizona do an average of 20 massages per week (as massage therapists did in Georgia), the 2.000 massage therapists in Arizona do 40,000 massages per week. This amounts to 2,080,000 massages per year, which we round off to 2,000,000.
We now have some of the information we need to answer the question, "What are the 2,000,000 reasons why Arizona does not need to regulate massage therapists to protect the public from harm? The 2.000,000 reasons are the 2.000,000 massages that the 2,000 massage therapists have given in Arizona during the last year. To understand why this is so, we now have to find out how much serious harm massage therapists have caused in Arizona.
What harm is associated with
Contraindications are health conditions which predispose people to being harmed when they are massaged. The medical literature has epidemiological data on the occurrence of each contraindication in the U.S. population. However, neither the medical nor the massage literature has epidemiological data on the incidence of harm associated with each contraindication because there are so few reports of well-documented harm associated with massage.1
Many books on massage refer to contrain-dications. But we are unaware of any book on massage which provides epidemiological data on the incidence of serious and non-serious harm associated with contraindications.
The 489-page book "A Massage Therapist's Guide to Pathology"18 does not include the words "harm": and "injuries" in its index. The authors tell us. "The term 'massage' refers to circulatory-based massage that has a direct effect on blood and lymph flow. If a condition is labeled 'contraindicated,' it is usually because the influence of massage on circulation would have a negative impact on the client. This does not necessarily rule out touch altogether, however, and many conditions that contraindicate vigorous circulatory massage are perfectly appropriate for less mechanically based modalities."
Pages 434-455, in this book, list 155 conditions for each of which information is provided in a column labeled "Is massage indicated or contraindicated?" But the book has no reports of serious or non-serious harm associated with massage in people with contraindications.
I have directed attention to the following misleading statement in this book, "Tuberculosis is an airborne disease [which] requires prolonged contact to be spread from person to person." This is not necessarily true for massage therapists who are in close, arm's length physical contact with their clients for an hour or so. One cough by a client with active tuberculosis, caused by a multiple-drug-resistant strain of the tubercle bacillus, can be a death sentence for a massage therapist.19,20 I am a research scientist. My article about how and why I became interested in massage is in AMTA's Massage Therapy Journal.21
ALICE IN MASSAGE LAND
Since there is no well-documented evidence that any serious harm has occurred in Arizona, let us make believe that some harm, any harm which is not serious, has occurred, and see what that tells us.
We know that the risk of harm is determined by how much harm has already occurred, and how serious that harm has been. The fact that massage has "the potential for harm" (which the Georgia legislators commented on) is irrelevant, as the Georgia senators pointed out.
Let us make believe that the Arizona Coalition has provided well-documented evidence that massage therapists in Arizona have harmed two people; and has also provided information about (a) the nature of the harm which was not serious, (b) the contraindication associated with each case of harm, (c) the training of the massage therapists who caused the harm, and d) how many years of experience they had.
We reiterate, we are dealing with make believe harm. But this is all we have to work with. We have no well-documented evidence that massage therapists have harmed anybody in Arizona.
Now let us make believe we are Arizona state legislators, and let us see what these two cases of harm amount to. What we are dealing with are two harmful massages out of a total of 2.000,000 massages. This amounts to one harmful massage in every 1,000,000 massages.
If the 2,000.000 massages have been overestimated by 100%, then we are dealing with only 1,000,000 massages. In this case, the two cases of harm amount to one case of harm in every 500,000 massages.
Let us now leave the Alice in Massage Land world of make believe and return to reality.
Does the Arizona Coalition seriously believe that Arizona legislators should regulate all massage therapists in the state to protect the public safety, health, and welfare if only one person is harmed in every 1,000,000 massages that are given annually, especially if that harm is not serious?
Is harm, associated with massage, a
serious public health problem?
Harm associated with massage is not contagious. It is therefore very different than, for example, a child (in an overcrowded urban elementary school) who is diagnosed as having multiple-drug resistant tuberculosis This is a potentially serious public health problem.
The Arizona Coalition's above-mentioned two cases of make believeharm, caused by massage therapists, are equivalent to only 104 cases of harm (which is not serious) in all 52 states. As make believe leg-islators, we will compare these 104 cases of harm with the numbers of cases of the following kinds of harm that occurred in one year in the U.S.
33,000 people, mostly young children, injured by shopping carts.4
4.50.000.000 people bitten by dogs.5
400.000 football injuries.6
400.000 baseball injuries.6
580,000 injuries associated with bicycles.6
82,000 skateboard injuries.6
98,000 associated with roller skates.6
1,370 people harmed on amusement park rides.7
170,000 children injured in playgournds.8
9,411 scooter injuries.9
21,096 cheerleaders injured.10
5,000 people killed by food borne infections.11
more than 4,000,000 people killed by cigarettes.12
Finally, doctors killed 250,000 people last year. "Doctors are the third leading cause of death in the U.S."13 In one year, doctors killed more than four times the number of service men (58,193) killed during the 10 years of the Vietnam War.
The American Iatrogenic Association is concerned with "promoting accountability for medical professionals and institutions". It is not concerned about massage therapists' harming people.
MORE TRAINING MEANS MORE MONEY
FOR MASSAGE SCHOOLS
To do massage, why do people need all the hours of training that the Arizona Coalition assumes they do ? What well-documented evidence does the Coalition have that all those hours of training are needed to protect the public from harm? The following two books tell us how much formal school training is needed.
MASSAGE FOR DUMMIES by Steve Capellini and Michel Van Welden. IDG Books Worldwide, Inc. NY. 1999.
About the authors: Steve Capellini was certified after he took a 108-hour massage course in Los Angeles. During the subsequent 16 years, he has given more than 10,000 massages. He has earned a living by massaging people since he was 23. Michel Van Welden was trained at the Physical Therapy Training Institute of Paris, and has massaged people in Bolivia and Africa.
This book tells us, "A fancy, gold-embossed massage license hanging on the wall in a frame is no guarantee that you're going to like a given massage therapists's technique.
On the other hand, someone with no certificate at all may be one of the most highly skilled massage therapists you'll ever meet. When it comes to choosing a pro, go with your heart and your INTUITION."
"Massage is about cultivating the right attitude - the giver's attitude - not just applying mechanical maneuvers which any massage text can teach you. But don't worry. In this part of the book, you're going to discover how to actually give a massage, too. And, you'll see, it's not that difficult.'
"Just follow the instructions, and in no time you'll be reproducing the very same techniques you see being performed by the highly trained models in the photographs. No problem. That's right.
"You can become one of these great people about whom everyone else exclaims, 'What great hands you've got.' Just remember to focus on your 'giver's attitude' as much as your manual skills, and you'll do just fine."
In the section Hippies Save Massage From Extinction, the authors tell us, "As technological revolution swept the planet, it left people high and dry as far as contact goes. The human species was literally out of touch... Somewhere in the 1960s, people began to tire of the soulless way of machines and technology in their lives, and they started to react against it. Those revolutionaries were called hippies or flower children, and they spread out from San Francisco to cover much of the world, taking with them tie-dyed T-shirts, prayer beads, big black vinyl discs called albums, and home made massage tables."
THE COMPLETE IDIOT'S GUIDE TO MASSAGE by Joan Budilovsky and Eve Adamson. Alpha Books. New York. 1998.
This book provides "quick and easy guidance on giving a massage" and "idiot-proof steps for all types of massage, from aroma therapy to Swedish Massage."
The book also tells us, "Sometimes the very best massage therapist for you won't have any kind of formal certification at all.'
Constitutional law and U.S. Supreme Court decisions tell us that the only legitimate justification for state regulation of massage therapists is the need to protect the pubic health, safety, and welfare. What is involved in state regulation are issues of freedom of speech (including commercial speech), freedom of the press, discrimination, arbitrary governmental interference in lawful business, restraint of trade, monopolies, and unfair trade practices.14,15,16
None can love freedom but good men. The rest
love not freedom, but license. John Milton
.If there's no need for state regulation in Arizona to protect the public from harm, there's no justification for the Arizona Coalition's existence.
If there's no justification for the Arizona Coalition's existence, there's no need for the Arizona Coalition to spend time talking about competence and trying to decide what modalities will be regulated, what standards are needed, how many hours of training should be required, whether the national certification examination should be included, what practitioners should be grandfathered in and under what conditions, and anything else.
All these things are non-issues if there's insufficient harm to justify the need for state regulation.
The Arizona Coalition is an example of
THE CART BEFORE THE HORSE
The Arizona Coalition is like the proverbial cart before the horse. The Coalition has been created, and now it has to find enough well-documented serious harm to justify its existence. Those who want state regulation should first have found out whether enough well-documented serious harm had occurred to justify the need for state regulation. Then, if there was enough well-documented serious harm, there would have been justification for creating the Arizona Coalition.
One does not, for example, buy a business and then find out whether it has been sufficiently profitable to justify having purchased it.
Massage therapists are already
regulated in Arizona
The fact is that massage therapists are already regulated in Arizona. They are regulated by consumers who purchase the massages they provide. Moreover, the consumers are satisfied with the services they pay for. Consumer Protection Agencies are not lobbying state legislators to regulate massage therapists to protect the public from harm.
Why is the Arizona Coalition on a crusade to protect the public from harm? Is the state regulation it wants a Trojan Horse? Is it a wolf in sheep's clothing?
"THE KING IS NAKED."
"THE EMPEROR HAS NO CLOTHES."
Since there is no need for state regulation of massage therapists to protect the public from harm in Arizona, why does the Arizona Coalition want licensure? Are certain schools the engines that run the Arizona Coalition? If so, which schools are doing that, and why? What's in it for them? To find out, we should read "Follow the money train to find out why scare tactics tell us secular massage is harmful."6
How will the state regulation, which the Arizona Coalition wants, affect those whom Susan Pomfret1 considers "poorly trained therapists" who "flood the market ... in some areas"? Will state regulation put them out of business unless they pay massage schools considerable sums of money for additional training which they obviously don't need?
There is no well documented evidence that massage therapists (who are required to take that additional training) become more competent, provide better quality service, and have clients who are more satisfied after they have had that additional training. But massage schools make a lot of money because they get paid for providing that additional training.
This raises questions. Is state regulation a Trojan Horse? Is it the proverbial wolf in sheep's clothing?
Beware of false prophets which come to you in sheep's clothing but inwardly they are ravening wolves. (Matthew7:15)
Having eyes, see ye not? and having ears, hear ye not? and do ye not remember? (Jer. 5:21)
The Arizona Coalition can
play a positive role
The Arizona Coalition can play a positive role by promoting legislation similar to the Minnesota Alternative Health Care Freedom of Access Act17 or the self-regulation, which the Canadian Provinces of Ontario and British Columbia have.14 Minnesota and these provinces do not have monopoly control. Anybody may call herself a massage therapist and do massage without complying with any state regulatory requirements as long as she does not use a protected title. This serves the public very well in Minnesota and the Canadian provinces. It will serve the public equally well in Arizona.
1. Schatz, A. Arizona does not need to regulate massage therapists to protect the public from harm. Massage Law Newsletter. 15(4)1-9. 2000.
2. Minutes of the September 9, 2000, meeting of the Council of Massage Therapy Educators at Apollo College in Phoenix, AZ.
3. Review of Senate Bill 300 Which Proposes to Regulate Massage Therapists. Georgia Occupational Regulation Review Council. October, 1997.
4. Schatz, A., and Tillotson. A. From licensure of massage to licensure of shopping carts. Massage Humor. 1(1):1-4. 1997.
5. Schatz, A. Massage should be deregulated because it does not cause harm. Massage Law Newsletter. 5(2):1-18. 1998.
6. Schatz. A. Follow the money train to find out why scare tactics tell us secular massage is harmful. Journal of Spiritual Bodywork. Special Issue No. 4. 1997.
7. Urgo. J. L. Study: Injuries on rides are increasing. Philadelphia Inquirer. Aug. 5, 2000.
8. Greenberg, B., and Dale, M. At playgrounds, risky conditions still lurk. Philadelphia Inquirer. June 16, 2000.
9. Ho, David. As scooter fad takes off in U.S., injuries skyrocket. Philadelphia Inquirer. September 6, 2000.
10. Villarosa, L. Cheerleading changes and injuries increase. New York Times. October , 2000
11. Collins, H. 5,000 people a year are killed by something they ate. Philadelphia Inquirer. September 14,1999.
12. Nullis, C. Before WHO, tobacco firms admit dangers of cigarettes. Philadelphia Inquirer. October 13, 2000
13. Journal of the American Medical Association. Vol. 284: July 26, 2000. (Reported in Dr. Jospeh Mercola's Optimal Wellness Center Newsletter. Issue 164. July 30, 2000)
14.. Schatz, A. Should the Tucson, Arizona, Committee of Massage Examiners be abolished? Massage Law Newsletter. 4(1):1-9.1998.
15. Schatz, A., York, B., and Brewster, M. Minnesota does not need Bill 685 to regulate massage therapists because they don't harm people. House Bill 685 does not comply with relevant laws. We need freedom of choice for consumers and freedom to practice for practitioners. Alternatives for House Bill 685. State regulation of massage therapists makes no sense. Massage Law Newsletter. 7(1):1-12. 1999.
16. Schatz, A. Does PA Senate Bill 1171 violate laws that protect freedom of speech, and freedom of the press; and prohibit discrimination and arbitrary governmental; interference, restraint of trade, monopolies, and unfair trade practices? Massage Law Newsletter. 4(2):1-3. 1998.
17. Thomas, J. Minnesota law supports unlicensed practitioners. Massage Magazine. page 172,
18. Werner, W., and Benjamin, B. E. A Massage Therapist's Guide to Pathology." Williams & Wilkins. Baltimore., MD. 1998.
19. Schatz, A. Potential risk. Letter to the Editor. Massage Therapy Journal. 39(1):16 & 18. Spring. 2000.
20. Schatz, A. Tuberculosis. The Great White Plague. How you can protect your self and help others. Massage Therapy Journal. Vol. 33. pages 30-32. Spring. 1994.
21. What is a research scientist doing with massage? Massage Therapy Journal. Vol. 33. pages 32-33. Spring. 1994.