The Massage Politics Sheet
No Hype — No
Cheerleading — No
Hidden Details
Bringing you hard facts & clear analysis since 2002
27 October 2003
A Moment of Silence and Support
Given the extent of the southern California wildfires, I just wanted to offer up a moment of silent reflection and emotional support to our friends and colleagues who may have homes and offices threatened or lost.
The Boards Must be Crazy
In regarding reports of actions or proposals by various state massage boards, I'm reminded of the confusion a single Coke bottle created in the classic movie The Gods Must be Crazy. Why would those supposedly knowledgeable and supportive of massage be acting in ways with such negative impacts on unifying massage into a coherent profession? Have the boards gone crazy?
The November issue of the trade newspaper Massage Today reports that Mississippi has apparently decided that Craniosacral is beyond the scope of massage because it manipulates osseous tissues. What seems lost on the board is the concept of technique. If the law really says you can't move bones, then the law says you can't move phalanges, femurs, a humerus or two, clavicles, and scapulae. And if you should do a torso stretch, you are undoubtedly moving spinal vertebrae and an innominant or two. And if you should hold a wrist and rotate a bit, you're manipulating the radius/ulna relationship. If the MS massage law forbids manipulation of bones, and if they are going to interpret it as independent of technique, may the gods forbid that we do more than jostle a bit of soft tissue with the joints all standing still and with the client moving themselves to flip like a pancake when done on one side. Now if the MS board wants to interpret the law to mean that we don't use high velocity thrust to manipulate bones by gapping joints, then I'd be the first to agree. But Craniosacral isn't doing high thrust techniques to begin with. Give some people a licensing law and they start feeling they have to do something to assert their presence.
In another proposal of ill-merit, Maryland seems bent on allowing only COMTA accredited massage schools. There's a chicken and egg problem with a state requiring education at a school accredited by an agency recognized by the Department of Education as a condition of licensing. Accreditation has preconditions requiring the program in question to have graduated two classes prior to application and to have been offered for two years prior to accreditation. Unless one is able to offer such programs gratis, that precludes offering a new entry-level program. Few students will be willing to pay for entry-level education worthless in obtaining licensing. Nevertheless, that seems to be what the Maryland board, amid its other regulatory faults, is now contemplating.
Thanks to Jeff Shevell for bringing New Jersey to my attention and finding a link to their proposed regulations. The "winner" of the slam the profession award goes undeniably to the NJ Nursing Board. Didn't anyone ask them what they thought about massage before placing regulation in their hands? The proposal regulations, up for comment until December 19th, ban anything that could be considered as treatment. Beyond that, they outlaw lymphatic drainage in total — even for something as simple as a facial. The micro-managed sanitation requirements go far beyond normal considerations of environmental hygiene. I doubt that you could run a hotel or motel under them, even though the skin exposure would be similar. They even have a rule that specifies what agency must have approved your required disinfectant soap.
The NJ proposal also contains a rather invasive notation of what's allowed with a spouse.
these rules shall not prevent a certificant from rendering massage, bodywork or somatic therapy to a spouse, provided such therapy is consistent with accepted standards and is not used to exploit the spouse for the sexual arousal or sexual gratification of the certificant.
To the best of my knowledge, occupational regulation is supposed to regulate services provided for compensation — (to go back to the Clinton impeachment hearings) that there is a quid pro quo. The anticipation by a regulatory board that massage for spouses and family will be done for compensation makes one wonder about the board's knowledge of human relationships. What's done apart from compensation is none of a regulatory board's business. Of course, such language also did creep into the current version of California's AB 1388, and was among those items that I flagged.
Finally, don't try to transport your training from a private massage school in California into New Jersey. In another inspired moment of micro-management, the rules specify that a school has to be approved by a state's Department of Education rather than just state approved. In California, private postsecondary and vocational education schools are approved by a Bureau under the Department of Consumer Affairs.
The actions of massage licensing boards are beginning to make returning a Coke bottle from the depths of the Kalahari appear to be a sane and simple proposition.
24 October 2003
The Veil of Tiers
I've already written a good deal about how I believe the requirements in California's AB 1388 for a second tier should be changed to require experience or that the extra tier should be removed. In perusing the letter from Beverly May to Michael Miiler, Christine Kehoe's chief of staff, I noted the following statement:
We believe that market forces will probably allow Tier II therapists to charge more, and will help maintain the respectability of massage.
This is a curious statement in that the second half implies that the first tier, the tier on which exemption from local regulation is to be based, is not quite respectable enough. This is after requiring 250 hours from a school approved by the BPPVE and setting up a board to monitor the profession. It isn't clear how a second voluntary tier adds respectability. It's also not clear whether this is a remainder of some less than inclusive large organization attitudes. As a note, the greater education of medical doctors, chiropractors, and psychologists has shown little ability to dissuade misconduct and disreputable behavior —an extra 250 hours can't be expected to do much apart from the board supervision already created.
The first half of the quote above is also interesting. It evidences that, to a goodly extent, the purpose of the second tier is simply an attempt to embody a marketing distinction into regulatory code. This is all the more reason that a second tier should require experience or be removed. My own experience as a massage instructor has convinced me that the greatest gains after 250 training hours come not from adding more training but by carrying the training already accomplished into practice. Especially if the consumer or employer is to be charged more, they should get more than the second tier currently offers. One more thing to "write home" about.
23 October 2003
Inteview of Judith McKinnon by Open Exchange Magazine
The McKinnon Institute has up a reprint of a recent interview of Judith McKinnon by Open Exchange Magazine. The interview, appearing in the current issue, covers Could Touch Become Illegal? The Massage Licensing Debate.
20 October 2003
Clarifying the Upcoming California Legislative Schedule
Via a brief conversation with California legislative staff today, I was able to clarify a couple of important points in next year's calendar.
AB 1388 is currently under review by the Assembly Committe on Business and Professions. If it survives the sunrise review there, AB 1388 has to make it out of the State Assembly by January 31, 2004 or it's a dead bill. If it does make it through the Assembly, it has until August 31, 2004 to make it through the Senate, starting in the Senate Business and Professions Committee.
Since, according to CAMBS sources, AB 1388 can't be amended again until January, the implication is that there isn't going to be any time for review and iterations. There's probably one more shot at ammendments in the Assembly. I was also advised that waiting until January to provide input is too late to have much affect. So again, if you have any opinions on the fate or content of AB 1388, it's high time to make them known.
19 October 2003
Tiering my Care Out
The current version of California's AB 1388 contains both a 250 hour practice act tier and an additional 500 hour tier. Important questions remain on what the second tier currently represents and also what it should and might represent. Could it do a lot more both for interstate portability and for consumer guidance?
Currently, the second tier can be obtained by those with 500 hours of training or 250 hours of training plus 750 hours of experience, or some prorating of these two options. I've previously offered my belief that simply having 250 extra hours of training, without a day of experience in actual practice, is not enough motivation to warrant a second tier. From the state viewpoint, the motivation for regulation is a clear public benefit. As written, there is no clear statement of public benefit from the extra tier nor does it guide a consumer necessarily to an experienced practitioner. To base a second tier solely on the extra hours of unspecific training simply reeks of one-upsmanship. If that's the end of the story, the reasonable options are to remove the second tier or to squash the bill.
Perhaps, however, those adding in the second tier were considering the concept of portability between states. If this is the case, they certainly missed an opportunity to declare so in the bill. If this is the case, then a revision in another direction would be of benefit both to consumers and practitioners.
I've already written that a second tier would constitute some benefit to consumers if it required 500 hours of training plus 250 hours of experience; 250 hours of training plus 750 hours of experience (this hasn't changed); or some prorating of the two. A consumer using the second tier to seek a seasoned practitioner would at least gain some guidance. There may also be substantial benefits to interstate portability in taking this route.
Most state occupational regulation laws contain some phrase accepting those licensed in states with "equivalent requirements". Equivalent does not necessarily mean the same, but it often implies that something must be equated to something else. Now some states require 500 hours plus some type of psychometrically valid certification exam. Some states require 600 or 700 hours. All such states could be considered to have the form of 500 hours plus something more. Looked at from this perspective, 500 hours plus 250 hours of experience could open a world of portability that would otherwise be closed. The formula 500 plus 250 would give a second tier that had something to equate without adding anything that a serious practitioner wouldn't want to accomplish anyway. So 500+250 or squash is one more bit to convey to your assemblymember and to the members of the Assembly Committe on Business & Professions. As noted in a fire safety engineering course, training plus experience equals competence.
As a footnote, I'll also note the additional requirement that a state massage board not be allowed the freedom to change eligibility requirements, but only to implement and enforce requirements explicitly set by the legislature. I believe that this is already in the language of AB 1388, but anyone determining otherwise please let me know. Multiple sets of eyes do a much more thorough job of review than just a single pair.
14 October 2003
Could ya Spare a Letter? One Way or the Other, It's Time to Voice an Opinion on AB 1388
Both the ABMP and the AMTA have sent out information to their members urging support for licensing and in particular support for AB 1388. While the bill is much improved over its original introduction, we are now about at the point at which I believe the bill should have been before it was introduced. As it is, I still have some major objections, both practical and philosophical. Since we have entered the letter writing campaign as it stands, however, here's my take.
My largest objection on the practical side is the stipulation that education be counted only in increments of 100 hours or greater. That the bill writers forget about the concept of loose change in trying to get to either 250 or 500 hours could require schools to needless have to change the length of programs, a process requiring approval from the state BPPVE. The McKinnon Institute, for example has 100 hour and 142 hour entry level certificate programs. Taken together, these add up to 242 hours. The current bill would require a student to take another 100 hours minimum to add eight hours. I don't buy it.
For a second tier, I also object to the 100 hour increment limit on the philosophical side. I feel that after 250 hours, a student should be able to direct their own learning, studying, for example with Whitney Lowe for orthopedic massage or Upledger for Cranial sacral or Lymphatic drainage. Increments from the notable experts in an area don't always come in such neat bundles. I also don't like the implications of the 100 hour limitation for those who, like I did, accomplish much of their training taking vacation from another job.
Also on the philosophical level, I object to a second tier that does nothing for the student or the consumer. Adding the second tier doesn't do anything more about exempting practitioners from local regulation than does the first tier. It also doesn't require that a second tier practitioner have been in prior practice even for a single day. It would elevate someone who was fresh out of the classroom above a practitioner who might have 500 hours of experience. If that's not confusing enough to the consumer, AB 1388 would also remove the consumer information requirements that currently exist under SB 577.
So, I would urge you, like my counterparts are doing, to write to the Assembly Committee on Business and Professions, Chris Gallardo, the consultant to the committee, and to the bill author, Assemblymember Christine Kehoe.
To help you along, here's a one page letter template in Word and PDF formats. To simplify things still further, here's a PDF file with #10 envelopes to everyone above. Please take the letter as a base and personalize it to express your own feelings and thoughts.
29 September 2003
The Powerful and Obnoxious Odor of Mendacity
Two recent peer-reviewed articles investigated massage safety as characterized in the medical literature. Both effectively concluded that while injury from massage is possible, it is a true rarity. Being the author of one of the articles, I can attest to reported serious injuries tending to be singular events out of the millions of medical case reports indexed over a good 40 year span of time.
- Ernst E, 2003: The safety of massage therapy. Rheumatology, 42 (9), 1101–1106.
- Grant KE, 2003, Massage safety: injuries reported in Medline relating to the practice of therapeutic massage — 1965–2003. Journal of Bodywork and Movement Therapies, 7(4), 207-212.
Despite the rarity of such injury events and a further thread in both papers that they bear very limited connection to the entry-level practice of Swedish Massage, there appear to be those who are willing to further themselves by conveying a highly exaggerated sense of likelihood of injury to the public.
I believe that it is of questionable ethics to talk about the reports of injury from massage without also mentioning their infrequency, yet, in a news release (Massage Injuries— Rebecca Somach) bearing the signatures of the AMTA and NCTMB, this appears to be exactly what was done. No explicit lies are told, but there is still the odor of mendacity. What gets conveyed to the public is an exaggerated sense of danger from massage with the implicit closing suggestion of how this can be avoided by consulting those associated with the above organizations. Given that I've seen a previous such release a couple of months ago to another TV news venue (Beware your Massage), this seems a purposeful marketing strategy. There's too much good to promote about massage without resorting to half-truths.
What's that smell in this room? Didn't you notice it, Brick? Didn't you notice the powerful and obnoxious odor of mendacity in this room? — Tennessee Williams (Cat on a Hot Tin Roof, 1958)
27 September 2003
Another Take on Massage by Exam
The last several days, Massage Today has been running a poll on whether massage practitioners believe that the National Certification Examination for Therapeutic Massage and Bodywork (NCETMB) is a reliable tool to evaluate the knowledge and skill of a massage therapist. As of tonight, with 836 responding, the poll is running at just over 80 percent on the negative side. The comments made are well worth a scan through.
Even those who feel that the NCE successfully tests knowledge are dubious of its capability to test skill. If we look at knowledge simply as the ability to remember separate facts, then the NCE does to a fair extent test knowledge. However, what's missing is the large jump towards connecting the bits and pieces so that the store of knowledge has an impact upon practice. Without the context of experience, remembering knowledge does not make one knowledgeable, but only an imperfect substitute for a good reference book. Knowledge becomes meaningful when it is coordinated with use while learning, giving rise to the observation by Brown, Seely, and Duguid that learning is situated. From this context, the emphasis and time spent focused on a test without immediate applicability, is simply replacing the development of deeper understanding with practice at memorization. What's been missed is that massage is not a practice built on rules and facts but on skills of use. Connections are the crucial element. I would much rather be worked on by a practitioner who knows less but can apply more than the converse.
23 September 2003
Boundary Issues
Recently, AMTA sent out an email about protecting trademarks.
As you know, AMTA was established 60 years ago and is incorporated as a not-for-profit whose purpose is to lead the massage therapy profession. We have all worked hard to establish our name and reputation. The AMTA name is trademarked and we have also received and/or applied for other trademarks, service marks and certification marks associated with AMTA. One of the names we protect is the Commission on Massage Therapy Accreditation (COMTA).
There are laws regarding certification marks and other trademarks. These laws enable organizations to avoid public confusion regarding the origin of goods and services (such as the accreditation service that COMTA provides) and to protect their name and reputation. If a massage therapy organization uses names similar to the protected names and trademarks owned by AMTA and COMTA it can cause public confusion. In some cases, such efforts may be deliberate and intended to confuse the public for a financial advantage.
The only thing wrong with this scenario is that, under Department of Education rules for accrediting agencies, COMTA is supposed to be functioning as a separate and independent agency. The statement above, strongly implies that the AMTA is managing COMTA's legal interests. Of course, COMTA can hire any legal representation it chooses, but AMTA is not a law firm, it's a membership organization.
If you are concerned by the strong overlap implied by the AMTA mailing, send your comments to the National Advisory Committee on Institutional Quality and Integrity (NACIQI). While the September 18th deadline for written comments for their December meeting has passed, the federal register notice does state that comments received will be acted upon. As with our private practices, concern for ethical handling of boundary issues is important in the structuring of our organizations.
Unseemly Happenings in Simi Valley
Recent news reports note an unseemly push for harsher massage regulation in California's Simi Valley. Local therapists are opposing regulations not appropriately recognizing massage as small business, personal care, and health care. Yes, you've seen this discussion of reminding local agencies about these elements of massage in previous discussions on Thinking Business and on regulation in Contra Costa County.
If you have the time, take a look at the city council agendas and minutes. You can send email to the various council members by following the links from the main council page. Politely but firmly, let them know about the benefits of massage and that California's estimated 25,000 massage practitioners are watching.
16 September 2003
AB 1388 Amended
Last week, the pending California massage bill AB 1388 was amended.
The bill is a practice act that follows the input developed at an ABMP "coalition" meeting. It could have easily been done as a title act -- there's some language to that effect, but there's also some that restricts massage practice and advertising to the licensed. Given that massage involves none of the acts restricted under SB577 or under the British Health Professions Council's list of reserved acts, there's no justification for use of a practice act in terms of protecting consumers from harm. AB 1388, in this respect, is unlike the current Naturopathic Doctor Act (SB 907), which pursues licensing to obtain access to reserved acts while protecting the unfettered use of all other practices under SB 577. It is, I believe, the malformed nature of creating practice acts removed from the needs of risk containment, that have led to the arguments in Florida on whether Reiki should be restricted to licensed massage practitioners. The problem is not with the decision yes or no, but with trying to define the restriction by the context rather than by the act itself.
The new version of AB 1388 is basically a level one practice act with a second level title act pasted on. The second level adds nothing to consumer protection from mal practice and basically makes the bill somewhat more cumbersome and more vulnerable to challenge as to meeting sunrise questionnaire provisions. Even in terms of consumer guidance, the second tier is a weak sister, being based solely on education without any requirement for practical experience. The bill allows moving to the second tier via 750 hours of experience. As written the bill states that three hours of education will equal one hour of experience, but almost certainly the reverse was meant.
The writers would have done much better in consumer guidance to require 500 hours education plus 250 hours experience or 750 hours experience or a prorating thereof. These considerations may be particularly pertinent to legislative consideration of the bill in that Section 4600 starts out with motivating the bill by the need for the public to identify qualified practitioners. Qualified is an arbitrary decision. As a profession, we have not developed guidelines for effective practice. The closest document that I've seen approaching this is the CAMBS hours analysis, which tops out at 250 hours. I simply can't see the consumer benefit in creating an "advanced tier" without a thought to requiring a modicum of experience. Go figure.
The bill sets up funding for a board via licensing fees, but does not address the source of startup costs, prior to the capability to collect such fees. Based on a prior bill analysis, initial funding could be a big consideration in the legislative committees. Section 4602.10(f) requires the board established by the bill to hire sufficient staff to carry out its duties. There also is a $100 limit (Section 4605) to licensing fees and a need for the legislature to appropriate use of funds for every year beyond initiation. It's not clear that these considerations will be mutually compatible given inspection duties defined in Section 4602.10.
The bill requires that a record of proceedings be kept for distribution to those licensed, but does not require specifically that such proceedings have electronic availability. Given that even the Florida board has their minutes on the web, I think we could do better than this. Public accountability is a very important concept..
The aspect of only counting education in 100+ hour increments is problematic for a 250 hour requirement. There are a number of schools that have multiple 120 hour programs or, like McKinnon Institute, a 100 hour and a 140 hour program for entry levels. Some idea of entry program statistics is available on the CAMBS site. There seems to be no good way to move from say 240 hours to 250 hours. The bill needs the concept of "accepting loose change" for some part of the requirement to avoid forcing schools into an expensive reapproval process. I've also always viewed the "100 hour" increment thing as unnecessarily limiting those such as myself that stage our learning during vacation time from other professions. This aspect gets a very definite thumbs down from me.
Right now, AB 1388 reserves the generic term "bodyworker" for use by the upper tier. It strikes me as a bit or arrogance to attempt to protect a term already in widespread use for diverse bodywork methods. There a a lot of different methods out there, even by a simple catalog.
Section 4604.10(2) limits grandfathering to those who have practiced "at least 100 hours within the previous 18 months". This stipulation could be problematic for those who for maternity and child-rearing reasons or for health reasons have taken a break in active practice.
There's an item in Section 4606 exempting those massaging their immediate family. This is a bit strange in that such persons would only be affected by the law if they were massaging their immediate family for compensation. Am I missing something? What about extended family? The same section exempts those working on sports teams on tour, but misses other touring likelies such as dance troupes and performing arts.
What we see is a very late effort at writing a bill worth critiquing, but one still with a number of warts and some definite vulnerabilities under the considerations of the sunrise questionnaire.
01 September 2003
Massage Politics Entries for July and August Archived
The MPS entries for July and August have been moved into their own archive file. There's also a link to the archive index page on the navigation bar to your left.
For the first time since the East Coast power outage, Bloglet also seems to be functioning for email notification. The change in the file name in the earlier links in this feed will cause them to reissue.
