imstandinghere

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Location: Berkeley, CA, United States

Friday, October 10, 2008

Many thanks to Steve Eabry for being a mentor, friend, and editor and contributor to the defunct 'The Rub'. This piece, for the most part could have been written yesterday.

Beware the Robes of Science

Steve Eabry

We are a peculiar people, we European/North Americans. We often demand to know why and how something works before we ask if it does. It isn't enough for us to experience something and to accept it. We can't accept something of value until we are convinced that it is logical, that the system fits within some preconceived mechanism or that it has been "proven" (by someone else) to work. We have even developed a unique system, the scientific method, to prove things. Science has become one of the special religions of our culture: it both regulates and comforts us.

Our adherence to the religion of science contrasts with the attitude of most of the world's peoples, who are generally content to know that what they do works and are not interested in the how or why. Bodywork, both here and throughout the world, has been accepted and utilized because it works. People know that. Now, with the desire to be eligible for third party reimbursement, our profession is being challenged to scientifically prove the how and why of what we do, as well as that it works.

In many ways, this is good for us and for our consumers. Not only will it help to support and refine what we do, and give comfort to the people who don't now know the benefits of massage and bodywork, but it will help to establish our niche within the religion. I criticize and poke fun at science, but belief in it is a fact of life in our society. Also, I have worked within the profession of science for the past 35 years. Perhaps it is this experience which allows me to see through the incense and beyond the altar and the robes and to be concerned about the imposition of science upon bodywork.

Don't get me wrong. I am very happy that the National Institutes of Health has gotten involved in the study of alternative forms of health care, including the sponsoring of research. I also am very happy with the recent report that Americans utilize alternative therapies (including massage) to a greater extent than Western medicine, and spend more on it than hospital care.

However, I am bothered when Chinese medicine and ayurvedic techniques (both thousands of years old) and the various forms of bodywork are labeled as "unconventional," "non-traditional," "unorthodox" (isn't that a religious word!), and "alternative," in contrast to modern medicine, which is less than 200 years old. This is only a game of semantics being imposed upon us by the high priests.

Of real concern to me, however, is the imposition of standards by which we must demonstrate the efficacy of our work, particularly when these standards are not equally applied to Western medicine. There is a call now for scientific studies of alternative therapies. While I support this concept, I caution our profession to be vigilant, to keep science as a tool, not a religion. Let's prevent another AMA witchhunt of the 1930s and 1940s that resulted in the outlawing of many important therapies labeled as "quackery," only because they threatened the ruling priests. Many of these have only recently become available again, e.g., ultrasound, the many color and magnetic therapies, and many disease-fighting nutritional systems. Now, however, they are available only underthe robes of mainstream medicine and at very high cost.

While "modern" medicine parades under the religion of science, for the most part it is not scientific. Most therapies applied daily in doctors' offices and hospitals throughout the country have never been tested by the scientific method; their efficacy is unknown. Dr. Richard Smith, editor of the British Medical Journal, recently published an article in the Journal of Medical Ethics challenging the science of medicine. Dr. Smith says, "I want to argue here that the scientific base of medicine is weak and that it would be better for everyone is that fact were more widely recognized." He reviewed the medical literature, concluding that the scientific evidence in it is poor. He cites a Canadian study which evaluated 4,000 recent medical papers. The study applied 28 basic criteria that should be met in scientific studies to these papers. The authors of that survey concluded that only one percent of the papers met all the criteria. They found that only one in 10 papers published on internal medicine were scientifically reliable, one in 20 for general medicine and only one in 25 in the specialty journals were scientifically reliable. Dr. Smith cites other studies which find that only "about 15 percent of medical interventions are supported by solid scientific evidence.....Often statements were notsupported by any evidence at all -- recommendations were grossly oversimplified; the rationale contained logical errors; and some recommendations were actually refuted by this very evidence." Dr. Smith concludes that "doctors wanttobelieve that they know more than they do, both because it feels good andbecause knowledge is power. And the public likes the idea that doctors will cure them or even keep them from death."

The scientific method involves posing a question and designing a protocol within which we collect data to answer the question. We have libraries full of"scientific" studies which ask the wrong question and/or have a faulty protocol. In fact, science often intentionally asks inappropriate questions because we can't design an economical study to address our real concerns. Even when the scientific method is applied appropriately, we must be very cautious. While science assumes that the whole of reality can be analyzed in terms of data points, each with a separate existence, the space between the points if often ofequal or greater importance than the point measured. Additionally, anything that can be seen or heard or measured or handled by scientific instruments is in itself an abstraction, unfolding and isolated from the system or process.

All this is not so much to argue against the science of medicine, or to restrict the scientific testing of the efficacy of bodywork. It is, however,intended to erect a large warning sign for our profession to be very wary of the people approaching us now, wearing the robes of science. We must not accept a standard which isn't applied to the therapies with which we are being compared. Let us understand science well enough so that we can learn what we would like to know about our work and not what others would like to say about us. Let us use science as appropriate and for our needs. Let's not allow our profession to be used by science.

Wednesday, October 01, 2008

Comments #1 : This piece appeared first, in the November/December 1996 issue of Massage Magazine and then a 1997 issue of The Rub, my defunct hard copy newsletter. There really is nothing new under the sun. April 2005, and the battles still rage with Amta beating up on the trade with one successful licensing drive after another.

Comments #2: With the passing of CA-SB731, on September 27, 2008, California has once again avoided the yoke of licensing. The voluntary system and the length of time it will be in place will, hopefully, give rise and incentive to those opposed to licensing ala the Amta machine to organize and pave a different way for California.

I have moved from being opposed to the exclusionary licensing suggested by Amta and her allies to inclusive licensing as suggested here: http://massage.meetup.com/307/about/ Massage and touch are art forms worthy of payment that can be taught outside of massage schools.


The Tragedy of Skilled Touch and Movement in the United States
Don Schwartz, Ph.D.

I am deeply troubled by what is happening overall in the field of skilled touch and movement. There is endless strife in the area of professional regulation which has been, is, and will continue to divide the field. The divisions created make it difficult--if not impossible--to create authentic, broad-based coalitions that can truly support the field in actualizing its potential of service to the people of the United States.



Our field is roughly split into two camps: those who identify skilled touch and movement as therapy/treatment to be conducted within the context of our established health care system; and those who hold other models of the> function, purpose and values of skilled touch and movement -- such as educational, recreational personal service or art.



Those who hold the therapeutic model are furthering their agenda by working toward state licensure of skilled touch and movement. They are well-organized, and have recently accelerated their efforts. Even with their best intentions, the right to practice is being threatened by legislative actions. Those who hold other models are mostly unorganized, and are not working toward any one agenda. Some are concerned, speaking, up, acting up; others are passive.

Author/lawyer/reflexologist Raymond Beck gave us the answer in his groundbreaking article on the Florida state massage laws (MASSAGE Magazine,"What's in a Name -- Title Registration vs. Practice Act," Issue #57, Sept./Oct. 1995). There are two categories of legislative acts: practice and title registration. Practice acts state who can practice what, and title registration acts govern who may use what title.

If the field of skilled touch and movement came to a consensus on the positive value of title registration, we could move toward a credentialing system that would offer a credential to those who want it, but not restrict the right to practice for those who don't. It is possible, under this system, that "professionals" and "non-professionals" could begin to recognize and support each other, and all would benefit from this mutual support. The benefit I'm looking forward to the most, in addition to a reduction of strife, is the possibility that the field of skilled touch and movement can begin to address issues other than professional regulation.

I think the move toward licensure is regrettable. I believe licensure creates state-sanctioned monopolies with the explicit goal of "protecting the public,' but with the real effect of protecting those who hold the monopolies' respective entitlements, reducing information to the public, and restricting competition.

Licensure is associated with our health care system, which is rife with incompetency, corruption, abuse and carelessness. The United States is the only nation in the world that allows profiteering from health care products and services. To the objective observer it appears that the motives and actions of the field of skilled touch and movement are self-serving.

Just because I prefer forms of professional regulation other than licensure does not mean that I do not stand for high educational and practice standards. I would like to see a solid 3,000-hour educational standard for those who choose to be in our established health care system.

With that standard in place I would more confidently know that our peers are able to communicate well with physicians, nurses, physical therapists, administrators, public and private insurance organizations. These high standards will enable us to be more a part of the solution rather than a part of the problem.

Licensure is the dominant form of professional regulation in our health care> system. The steam-rolling nature of skilled touch and movement's initiatives toward licensure are deeply entrenched. Do we recognize that we are jumping into an arena characterized by deep, constant conflict regarding who gets how much money, with what credentials, for what kind of sessions, for what length of sessions, for what diagnoses, for what frequency of sessions, and under which plans? Those who want to play this endless game know its nature, and simply will go for all they can get. Our field has become conflicted in its approach to the health care system, and we will find ourselves in more and greater conflicts as we enter the morass of the health care system.

To reduce conflict within our field, we need to develop mutual recognition, respect and support. The tone of communication on the topic of professional regulation tends to be absolute; disagreement is met with anger and entrenchment. We all need to consider each others' perspectives much more than we are doing now. We need to really consider the impact of our actions on our peers in the field. With respect to entering the health care world, we do know that when someone is ill, the more skilled (and nurturing) touch and movement they receive, the better their recovery. The potential is that as skilled touch and movement practitioners enter into our health care system, positive change in that system can be accomplished.

I believe skilled touch and movement deserves to be virtually everywhere in our world, and that ultimately includes the health care system. While I would like those who are going for licensure to stop, look and listen, I want to support them in achieving a positive impact in our health care system. And I want to support those who practice under different models, in different contexts, and who do not want health care credentialing. Imagine what would happen in, instead of ignoring or fighting with each other, we found ways of supporting each other in being where we each want to be with our work!

Public education is the key to the field's realization of its potential of service to the world. Rather than depend on private and public health plans to market our work, we could pool our resources and develop a comprehensive plan to reach out and promote the value of touch to all Americans. Not just our touch, but touch as a natural part of life, as a human value. Whatever we do in the way of public educations, it is critical that we be accurately perceived as promoting positive values independent of our interests.

Most of us have seen and heard the phrase, "Got Milk?" countless times. It is the keynote of a wildly successful campaign by the Milk Advisory Board to promote the consumption of milk. Skilled touch also needs promotion, and there are those who have the expertise to develop graceful and effective public education campaign. As people begin to appreciate the value of touch, they will begin to ask more questions, to look around, and to take steps in maximizing touch in their lives. Our presence as practitioners will be recognized, valued and utilized.

Until we really begin to connect with each other, to find our commonalities, to respectfully explore our differences, and to find ways we can work together that most benefit all of us, our energies will be focused on conflict--between peers within the field, and between the field and the worlds of professional health care and prostitution. I call on everyone in our field to soften their views on professional regulations, to consider what all sides are saying, and to be open to creative, unanticipated ways we can address regulation while developing a community spirit based not on shared strategies,but shared values and visions.

Don Schwartz, Ph.D.,was the administrative director for The Trager Institute> for 17 years, and was a founding representative to The Federation of Therapeutic Massage, Bodywork and Somatic Practice Organizations. He has been receiving skilled touch and movement sessions since 1972.