Your Letter to the Editor (which appeared in Massage Magazine. Sept/Oct 1998) took issue with my Guest Editorial Massage therapists do not harm people (in Massage Magazine. Sept/Oct. 1998.
The main point of my Guest Editorial, as the title clearly indicates, is that massage therapists don't harm people. My editorial also points out the important difference between actual harm, which is harm that has actually occurred and potential harm which is harm that may or may not occur.
Your Letter did not address the main point of my Guest Editorial because you did not present any well-documented evidence that massage therapists - unregulated or regulated - have actually harmed people. Instead, you focused on potential harm.
My more detailed report (in the Massage Law Newsletter. 5(2):1-12, 1998) expands my Guest Editorial. This report includes some of my research on harm over a period of several years. The title of the report is: Research shows that massage does not cause harm. Where adequate research was done, no harm was found and no state regulation was enacted. There's no need for state regulation to protect the public from harm, or for any other reason.
I hope this report will clarify my position on harm and the alleged need to protect the public from harm.
I would appreciate your clarifying your position by providing certain information that was not in your Letter. The information I am asking for is well-documented data on the morbidity (harm) associated with massage. The term "data" refers to the number of people actually harmed. This is how the incidence of harm is customarily reported in epidemiology.
Medical statistics tell us the incidence of each contraindication in the population at large. However, these statistics are not morbidity data which tell us how many people, with each contraindication, have actually been harmed by massage.
The term contraindications refers to conditions which predispose people to harm by massage. Contraindications in and of themselves do not invariably cause harm. They are conditions for which massage may be potentially harmful.
This means that people with contraindications may or may not be harmed by massage. Moreover, if only one individual with a contra-indication is harmed by massage, that in and of itself does not necessarily mean that the contraindication was directly responsible for the harm. To setablish a direct cause-effect relationship requires a significant number of cases of harm.
I have clearly indicated, in the following paragraphs, where the data, which I request, refer to harm that has actually occurred and where the data refer to potential harm.Where I ask about actual harm, please give me information about harm for which there is a well-documented direct cause-effect relationship with massage; that is, where the harm was definitely caused by massage. I am not interested in anecdotal harm for which the etiology has not been conclusively established.
Questions on harm
which has actually occurred
1. You ended your Letter with the allegation: "Massage therapy performed by unregulated individuals is not" safe. If that is so, why didn't you provide data on people who have been harmed by unregulated individuals?
2. Many unregulated individuals have been treating many people for many years. What data do you have on people, with and without contraindications, who have been harmed by unregulated massage practitioners, before and after regulation was enacted in Ontario?
3 If you have no data on people who have been harmed by unregulated individuals, why isn't it justifiable to conclude:
(a) Unregulated individuals have caused little or no harm.
(b) "Massage therapy performed by unregulated individuals is," safe.
(c) Regulation is not needed to protect the public from harm.
4. How do you justify the alleged need to regulate massage to protect the public from harm in Ontario, when the neighboring Province of Quebec does not regulate massage because its two-year research project (1990 - 1991) discovered no harm?
5. I assume you will agree that the incidence of potential harm (contraindications) is about the same in Ontario and Quebec. If so, how do you explain why two years of well-designed research failed to uncover any harm in Quebec where massage therapists vary considerably in their training? Isn't it logical to conclude that no harm was discovered because no harm had occurred?
6. What research on the occurrence of harm - comparable to the two-year research conducted in Quebec - has any agency in Ontario conducted?
Questions about potential harm
7. Why is potential harm used to justify regulating massage to allegedly protect the public from harm? So much potential harm (contr-indications) has been with us for so many years, during which so many massages have been given by so many massage therapists, regulated and unregulated. But there is little, if any, data on harm which actually occurred as a direct result of massage.
8. What data, in terms of harm that has actually occurred, do you have which show that the risk of potential harm is a serious threat to the safety and welfare of people, with and without contra-indications, who are treated by unregulated individuals?
9. The Schwartz Commission evaluated the risk of potential harm and eight other criteria in order to decide which health care professions should be regulated to protect the public from harm.
(a) If no harm has occurred and if the risk of potential harm is insufficient to justify regulating a particular profession, aren't the other eight criteria for regulation irrelevant?
(b) If the other eight criteria for regulation are not irrelevant, what professions, that pose little if any risk of potential harm, have been regulated to protect the public from harm, because they met the other eight other criteria?
10. Did the Schwartz Commission use potential harm as the criterion of risk of harm because there was little if any harm which had actually occurred? If that isn't the reason, what is?
What does "quite safe" mean?
11. The penultimate sentence in your Letter, which refers to regulated massage therapists, reads, "Massage therapy performed by massage therapists is quite safe." What does the qualifying adverb "quite" mean? Does it mean that massage is safe most of the time, but not always? If massage is not always safe, what harm have regulated massage therapists caused which justifies your qualified statement that, "Massage therapy performed by massage therapists is" [only] "quite safe."
Why is massage regulated in Ontario?
12. If massage by regulated practitioners in only quite safe, isn't massage by unregulated practitioners just as safe because there are no data that reveal a higher incidence of harm associated with unregulated individuals compared to regulated practitioners? If not, why not?
13. If so, how do you justify regulation of massage to protect the public from harm, in Ontario?
Questions on competence
14. How is the competence (in terms of on-the-job performance) of regulated massage therapists objectively (i.e, quantitatively) evaluated in Ontario?
15. What well-documented evidence do you have that Ontario's 2,200-hour training produces more competent massage therapists, in terms of on-the-job performance, than a 1000-hour training would produce?
If there are any inaccuracies in this report, please let me know and I shall publish corrections.I would appreciate your giving me permission to publish your reply in the Massage Law News-letter.