Please Decriminalize Massage and Touch In Berkeley

An open letter to the Berkeley City Council and the Chief of Police

Dear Berkeley City Council Members and Chief of Police Hambleton,

First, I want to thank Berkeley's Chief of Police, Douglas Hambleton, for bringing the issue of the licensing of massage back to the table. Doing so has opened the door for setting things straight so many who are working off the radar, in Berkeley, could be given a chance to come in out of the cold. I know what that is like, having done it for so many years myself. Being licensed not only feels better, but allows me to truly become active from within the system without the fear of being chastised for not being in compliance with the law.

There is a lot more to touch than sex, violence and massage therapy. By this I am suggesting Berkeley become the bellwether citystate for creating a licensing system that is accepting of all folk providing touch for income, no matter the level their training, so long as they are in a training leading to at least the old standard set, in Berkeley, of 70 hours. (Let's not forget CA is unique in the State surrendered the power for the licensing of massage to cities and counties in the 1970's)

The permit would be available to all looking to do touch anywhere, at any time with any consenting adult, in Berkeley, FOR INCOME. Those with permanent structures (aka parlors or offices using massage as part of their operation) are to be held accountable that a person has that license or the permit being put forth by the state level CAMTC noted in the newly proposed ordinance. Hitting here will take you to a letter I wrote to Senator Oropeza (via fax) and the Assembly Committee on Business and Professions with a similar suggestion for the state level.

This link will take you to an ongoing public discussion related to the politics of massage. The list reflects the varied opinions hardly heard because of their being only one truly organized lobbying group in the massage profession, the 501(c)6 AMTA, with the expressed goal of "fair and consistent" licensing throughout the land. Unfortunately the fair and consistent licensing much more benifits schools and other industry players and not those receiving or giving the work.

This link will take you to a blog discussing some of the potential problems for the organization you are looking to institute as the only way of entry for providing touch, for income, in the City of Berkeley.

In closing I ask you merely tweak the existing ordinance especially removing the following:

B. "Bona fide massage therapy school" means an institution, school, or training center providing a course of training in bodywork, healing arts, massage, or touch therapy and issuing a diploma or certificate upon completion of at least five hundred (500) hours of classroom instruction.

C. "Massage" means any method of pressure on or friction against, or stroking, kneading, rubbing, tapping, pounding, vibrating or stimulating of the exterior of the body with or without the aid of any devices, appliances, tools, or topical preparations such as lotions, rubbing alcohol, or creams.

Removing those two items would make it much more inclusive for those who have very adequate trainings of less than 500 hours from different arenas able to provide touch for income, in Berkeley, legally. The upcoming CAMTC governance would make it much easier for those who choose to be employees of chain operations requiring working in different municipalites.

If the links in this mailing do not work, working links may be found at http://iscaaty.blogspot.com/

Sincerely,

Robert Flammia

Berkeley LMT

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.

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.

People have always known massage "works". As noted in the first introduction to Massage, Manipulation and Traction by Dr. Sidney Licht, even MD's did massage in the past. Massage was put aside by the medicos in favor of pharmaceuticals.

Massage, Manipulation and Traction, edited by Sidney Licht, M.D.

Preface to 1976 Reprint

In the second half of the twentieth century most books on therapy of such age are considered obsolescent, and often, justifiably so. This book claims exception because the methods described have not changed during the life of this book, and in many cases for much longer.

During this period there has been such a renewed interest in the subject of pain, that journals and societies dedicated to the control of pain have appeared. Pain has become a specialty and although new surgical, pharmaceutical and electrical approaches have claimed success, massage, manipulation and traction still enjoy the gratitude OF those who suffer from certain musculoskeletal complaints.

Of greatest interest to readers of this book is the recent development of theories concerning the cause and relief of pain. Much of this has been summarized in a book which we recommend: Pain Relief by Dr. John G. Hannington-Kiff (William Heinemann Medical Books, Ltd., London, 1974). Most of what we discuss in this addendum is discussed and documented in the Hannington-Kiff book.

In 1959, a Dutch surgeon, W. Noordenbos, advanced a concept of pain mechanisms based on the properties of peripheral nerve sensory fibers. He suggested that there were at least two different kinds of fibers: small diameter, which conduct skin and visceral pain impulses to the spinal cord at slow conduction rates and large-diameter fibers which inhibit transmission of impulses travelling the fast route to the brain.

Six years later, Ronald Melzack, a Montreal psychologist and Patrick D. Wall, a London surgeon, proposed the Gate-Control Theory of Pain which has since been faulted by a few reviewers but which remains attractive and useful, especially to those of us who believe empirically that massage can and does offer relief to some patients for whom other approaches are less satisfying. The Melzack-Wall gate-control theory proposes that there is a "gate" or monitor in the substantia gelatinosa of the dorsal horn of the spinal cord in the form of transmission (T) cells. There are thick and thin fibers from the periphery along which impulses travel at different speeds; fast for the thick, slow for the thin. Pleasant stimulus impulses travel faster along the thick fibers than do pain stimuli along the thin. when the pleasant stimuli reach the T cells they influence them to "close the gate" against pain stimuli which may arrive later. If the pain stimuli arrive in great abundance or intensity they can "crash" the gate, and the pain impulses will continue cephalad to cerebral pain centers.

There are also, fibers from the brain which send messages to the T cells from above which may modulate the flow of impulses, inhibition or facilitation. The thin fibers (called A-delta and C) may have a strong influence on the T cells and "open the gate" to pain stimuli allowing impulses to continue upward individually or by summation, or, by permitting spread of pain impulses involving larger areas than subserved by the original site of pain. This is a simplified view of the important contribution of Melzack and Wall, first enunciated in the journal Science in 1965.

This unifying theory of pain is applicable to massage. The stroking of the skin can initiate different stimuli which run the gamut from sensual pleasure (gentle stroking) to pain (hacking, connective tissue massage). Gentle striking is so pleasant that the stimuli it sends along large-diameter fibers arrive at the T cells in the spinal cord before the painful stimuli. The T cells often respond by "closing the gate". Thus effleurage can inhibit the transmission of painful stimuli to higher centers for varying periods of time. Of course, eventually, painful stimuli by their intensity or cumulative effect may "crash the gate". This is one reason the sedating effect of massage may last only an hour or two. Even relief of short duration may break the "vicious cycle" of pain and thus offer longer relief.

What is important about the new theory is that there is now an explanation which lends respectability to the likely reasons why in so many instances massage "works". Of course, previous theories about massage are still viable, for example, improved circulation and thus evacuation of local accumulation in painful tissues of katabolites, and so on.

Sidney Licht, M.D. June, 1976

From one of my favorite bibles(4), Massage, Manipulation and Traction, a compilation of physical medicine techniques by Sidney Licht, MD, comes this preface. I believe the preface to be one of the best explanations as to why massage fell by the wayside until the Human Potential Movement. The HPM contributed to the resurrection of many of the healing arts long pooh-poohed by western medicine.

Preface

The subjects treated in this book share several things in common. Each concerns the application of mechanical forms of treatment, and all rank high on the list of therapeutic procedures that have occasioned extravagant claims, assault, and rejection.

Virtually anyone can give massage, and almost everyone has. the mother who rubs the bumped head of her child is giving massage; the dog who licks his broken leg is massaging himself. There is probably no older analgesic than massage; yet, massage, which was lauded by Hippocrates and applauded by Galen, was ignored by physicians for centuries. Since its medical reacceptance in the middle of the nineteenth century, there have been as many detractors as enthusiasts. During the early years of the twentieth century, medical educators, particularly in the United States, refused even to condemn it lest by mouthing the word massage they might give it even a negative recognition. Most physicians are not against massage; in fact, they may be found among those who make appointments for a "rubdown" at a club (beach, country, or "health"). Many physicians who are against massage are opposed to certain operators rather than to the method, for there have always been and will probably always be masseurs who will continue to "prescribe" and make claims for massage that are not in accord with established medical practice.

Massage is more than the laying on of hands or bodily contact; it is personal contact. Each masseur uses, in addition to his hands, his voice, his assessment of the person massaged (sometimes called "psychology" by masseur and subject), and a knowledge or supposition of fold medicine. We may group masseurs into three classes: the untrained, the trained, and the educated. the untrained are those who may be found in vacation resorts or attached to athletic teams. They learn massage by watching other "rubbers" give massage. They work hard at looking industrious; they make extravagant sweeps of the hand and slapping noises. they use generous amounts of lubricants, sometimes of a "secret formula". These people are often likable extroverts who radiate health-imparting confidence. They are frequently consulted for opinions on health and disease, especially of the muscoloskeletal system. In general, they do no harm medically since they recognize their limitations and will not venture opinions beyond that of folklore medicine (admittedly an occasional danger).

In the second classification are those persons who have taken a few weeks or months of training, during which they have been taught all about massage, anatomy, physiology, disease--in short (very short)--medicine. These people are usually awarded a certificate, sometimes a very impressive-appearing certificate. They usually set up a private practice to fill the prescriptions of referring physicians. Many states now require licensure for private (and even public) massage administration, but such licensure may be based on an inadequate examination given to persons with an inadequate education. In other words,state licensure in itself may not guarantee ethical conduct since, in addition to liberal requirements, inspection and enforcement are too costly to be carried out fully. For example, a masseur who is questioned closely and asked to produce a prescription for a patient may say that he was given the order over the telephone as an emergency and the physician died before he was able to send it. Many of the referrals received by these masseurs are from grateful patients, but a large number are from accredited physicians who for personal reasons, or because they are not well informed on the subject, persist in this practice.

The third class of persons who give massage is limited to qualified physical therapists who have been graduated from schools of physical therapy approved by a national medical association or health ministry. In the United States, such persons are "registered' by the American Registry of Physical Therapy founded by the American congress of Physical Medicine; in Great Britain they are "chartered" by the Chartered Society of Physiotherapists. In the United States, membership in the American Physical Therapy Association is as acceptable as registration since the standards of that association are desirably high. For the most part, registered or chartered physical therapists (as differentiated from licensed) are educated at hospital schools or universities where the program, or a great part of it, is under the direction of a physician. Most qualified therapists work in hospitals, clinics, or the offices of physicians. We have yet to meet a registered therapist in private practice who has gained such complete cooperation from all referring physicians that he is able to prove that each patient admitted to treatment came to him with a written prescription, but this remains a theoretical possibility. Nevertheless, such therapists have had prolonged drill in medical ethics and have remained under the close ethical supervision of other therapists and physicians for two or more years; very few of them breach the ethical code.

Why does massage thrive if, as some physicians content, it does no good? There are several reasons, among which we may cite (a) it feels good, especially when given skillfully, (b) it is a more tangible treatment than advice, and (c) it is a positive and immediate approach in an attempt to relieve symptoms--usually the first concern of many patients.

There was a time--less than a century ago--when some physicians personally massaged their patients. When massage is limited to a five-minute session, this is practicable, but, since many patients asked for longer sessions, physicians employed masseurs or trained their own. The physician who has not himself been massaged and has not learned enough about massage to administer it himself has neglected the art. We question whether such a physician has the right to prescribe massage, for he can assess the technique of his masseurs only by knowing as much about massage as it is possible for him to learn.

Many books and articles have been written about massage; perhaps more than half of these have been by physicians. These writings have seldom been sufficiently objective to be classified as scientific; massage is largely not scientific. In this book, we do not pretend to treat massage from the scientific viewpoint alone since the result would be inadequate for clinical purposes. We do feel that we have presented the subject in a more informative and restrained fashion than is customary. In this book, the history of massage is treated more fully than elsewhere in the English language. The physiologic effects and classic techniques re discussed by physicians who have had long and broad experience in these fields. All chapters in this book have been written by physicians--a distinct departure from recent practice.

There are several forms of massage that are very popular in the countries of their recent origin yet are scarcely known in America. We present these as fully as possible and, in most cases, by the physicians who introduced them or are currently considered leaders in that aspect of massage. Dr. Irmgard Seeberger Bischof has become the editor of the Dicke book on connective tissue massage since the latter's death. This book has been reprinted three times in four years. Dr. Maurice Fuchs introduced syncardial massage, and Dr. W. Ritchie Russell restored vibration to a medially acceptable level. The name of Cyriax is probably more closely associated with medically prescribed massage than that of any other living physician. The inclusion in this book of newer forms of massage does not imply an endorsement upon the part of the editor or any contributors to this or previous volumes of Physical Medicine Library. Some people will question the propriety of including such discussions in a medical book since they have not been proven scientifically, that is, accepted by organized American medicine. What could be less scientific than to deny American physicians the opportunity to learn the rationale and methods advocated? The decision to try or to reject without trial is up to the reader. Surely, methods that are widely used with claimed success should not be condemned before they are examined. The way of liberals is to place the pain of patients above prejudice. In editing each contribution we have tried to emphasize methods, not results.

Manipulation remains an ugly word in many medical and surgical clinics. When applied improperly it may be dangerous, conceivably fatal when dealing with rotation of cervical vertebrae. If manipulation is performed by an informed physician, the hazard should be no greater than with most valuable therapeutic agents.

Manipulations and most other operations requiring the use of the hands are difficult to teach by the printed word or even the printed picture. This book does not presume to make a masseur or a manipulator of anyone without previous knowledge or ability to acquire training from an experienced operator; however, for those who have had or may have the opportunity to watch a skilled worker, this book should serve as a useful reference.

Many physicians prescribe stretching. There are some conditions for which there is no other rewarding approach at the time of this writing; yet, there is little written about the subject. We believe a discussion of stretching belongs in this book since it is performed largely by manually applied forces. We have placed stretching in the section on manipulation since it is probably more closely related to it than to massage or traction. We have reserved methods that employ apparatus for the section on traction. We might say it another way: stretching is manual traction.

Traction is almost as old as massage, yet it is a word which is seldom encountered in ancient writings. The subject was usually discussed in writings on fractures and dislocations. The word traction is lost among description of pulleys, ropes, axles and winches. The traction which is of ancient origin has been used continuously throughout the ages for traumatic bony pathology. As used in this book, traction is concerned largely with minor displacements or pathology not visible on X-ray and in this sense is relatively new--a product of the twentieth century.

For the chapters on manipulation and traction we invited physical medicine specialists rather than orthopedic surgeons. We did this to differentiate surgical from physiatric procedures to the extent feasible and to present to physical medicine specialists the experience of other physical medicine specialists in these ares.

No volume of Physical Medicine Library would have reached book form without the help of many persons, and this volume is no exception. Drs. Michael Carpendale of the University of Alberta in Canada and Roland Harris of Buxton, England must be mentioned first since their help was of the highest order in reviewing parts of the manuscript. Miss Mildred Elson of New York City is mentioned next because of her valued assistance with the chapter on connective tissue massage, not only as a student of the subject, but as an editor of long and appreciated experience.

Portions of the text were critically appraised by our good and able friends, Dr. Alfred Ebel of New York, Drs. Lewis L. Levy and Donald B. Alderman of New Haven, and Professor Michael MacConaill of Cork, Ireland. Ideas and figures of historical interest were graciously offered by Dr. P. Hume Kendall of London and Mr. Frederick G. Kilgour, Librarian of the Yale Medical Library. As has been the custom, Physical Medicine Library material is used in the teaching of residents at the Yale university School of Medicine, and many improvements are suggested during seminars, especially by my colleagues, Dr. Thomas F. Hines, Dr. Robcliff V. Jones, Jr., Lee Greene and Frederick E. Dugdale. Gratitude is also due Miss Edith Nyman of New Haven for editorial assistance. To Mr. Norvell E. Miller, III, and his associates at the Waverly Press, we extend thanks for all their help in the mechanical details of structuring a book. We ask forgiveness of those who helped but whose names are beyond our aging memory.

Sidney Licht, M.D.
New Haven, Connecticut
December 1, 1959

We need a lobbyist to serve OUR interests. My letter to the Business and Professions Committee may be falling on deaf or shut off ears.

Dear Senator Oropeza (via fax) and Assembly Committee on Business and Professions:

SB731, as it is written, is not good for consumers or future providers of touch.

I have written extensively (see links below) in opposition to the state level licensing or certification of massage aka massage therapy. Now I want to suggest a licensing program that would be good for all, rather than for the benefit of those providing programs of 250 hours or more of training in a state approved program.

Albeit reluctantly, I agree ALL those providing massage or touch for income should be licensed by the state for the following reasons:

• It is too easy in an unlicensed environment for activity outside of straightforward massage to be provided by folk involved in illegal activities. Fingerprinting and an application would immediately criminalize those not willing to go through a simple process.
• A very large pool of folk from all levels of training would reduce the expense of the basic requirements of licensing which I believe should be comparable to those for operating a motor vehicle.
• It would be beneficial to legitimate professionals because of having an easily acquired ID they could use on a statewide basis.
• It would be beneficial to employers who could use the system for background checks. Hospitals, insurance providers, Chiros and other licensed healthcare providers could be mandated to employ only those with certain levels of training.
• Licensing would be beneficial to cities and counties because of having a resource for a background check for those looking to work in their community. It would be beneficial to consumers who bother to ask for credentials.

An online resource comparable to that of the Ohio massage board could be a resource for the public. http://www.med.ohio.gov/MTlicexam.htm Rather than being only medical, the board would be broader.

Following are opening suggestions for state licensing:

First, one needs to acquire a learners permit... Fingerprinting, background check and proof one has agreed to learn from a Registered Class A license holder for at least one hour of formal training or is registering at an approved institution. A test could be created that would test a persons knowledge of the law, very much like the test given to folk wanting to drive a motor vehicle:

• 1-99 hours of formal training gets a Class C license... Holder is free to market themselves as a Class C provider of touch.
• 100-499 hours of formal training at a state approved institution gets a Class B license... Holder is free to market themselves as a Class B provider of touch
• 500 hours of training or more at a state approved institution gets a Class A license... Holder is free to market themselves as a Massage Therapist

I choose the word provider as opposed to practitioner because I do not believe many practice doing massage. One provides massage at all kinds of levels of expertise. Medical folk practice medicine.

In closing, California is the home of the Human Potential Movement which began in the 1960's at Esalen. California has been a bellwether state in many arenas. Make California a bellwether state keeping the field of touch/massage wide open to all that wish to indulge rather than just to those laying out large amounts of money that would benefit the coffers of schools and other industry segments. I have been providing touch since 1986.

My initial training was 100 hours. The training has yet to end.

POLITICS: Only two individuals oppose licensing or certification in CA.


There has been a bit of activity on the bodywork politics list. The writings are public and can be read at http://tinyurl.com/25qfqo To post you must join the group.

To fully understand the context of the excerpts, start with http://tinyurl.com/yof83f. The following excerpts come from http://tinyurl.com/3yy48h

I wrote, "It is pretty evil for the Amta, against all the resistance and pleas for compromise to have gone to the government in so many states imposing unnecessary regulations on those who would touch for income. The analogy of Shreks evil brother fits, especially when one considers the innocence and niavete of many that get into this line of work."

Amta-CA law and legislation co-chair Beverly May Shultz wrote, "Beyond you & Carl (Brown), there has been very little pleas and resistance in CA -mostly increasing expressions of support. Why do you think ABMP is fullyinvolved? And only a couple of schools do not support the bill - eitherbecause they want more hours or less. Meanwhile, cities and counties arepassing new ordinances all over on their own, and none of them are pretty."

Unfortunately, because of the lack of an organized resistance, it sometimes feels that way. CA is a lobbyist state and those working with lobbyists have the power. The only way to overwhelm that power is too inundate the legislators with an incredibly large number of letters of oppostion. Now is the time to start doing that. To find your CA state assembly person or senate member, go too: http://www.leginfo.ca.gov/yourleg.html

Also, in an effort to create an organized opposition to Amta efforts in CA, I have set up a site where you can put your money where your mouth is if in opposition. Check it out at: http://massage.meetup.com/307/?gj=sj6 All proceeds beyond $72 will be donated to the Florida Touch Institute if the effort fails. Stating that does not imply any connection to the FTI.

Following is a post from James Nally, ND regarding SB731. James is one of the school owners alluded to by Beverly May Shultz.

SB 731

SB 731 passed the State Senate yesterday with 29 votes in favor and 4 votes opposed. It is now going to the State Assembly to be heard by various Assembly committees then by the entire Assembly. It looks like it is on a fast track to passing this year. I think the best opportunity to make any changes to the bill will be when it comes before the Assembly Business and Professions Committee.

SB 731 is the reincarnation of SB 412 which died in the last legislative session. While statewide registration of massage practitioners may have some benefits, there are problems with some of the provisions in SB 731. The biggest concern is with the phasing out of the 250 hour massage practitioner tier in 2013. This will require that anyone entering the profession after that will need a minimum of 500 hours of education to get started.

Phasing out the 250 hour tier would greatly increase the cost of entering the massage profession. This would effectively close the door to people who want to do massage avocationally, part -time, or just to help family and friends. The increased cost of training would also have a negative impact on the number of therapists who would do volunteer work with hospice organizations, etc.

Phasing out the 250 hour tier would negatively affect the smaller massage schools. The larger career schools would be better situated to offer 500 hour programs, but because they are not focused on massage therapy they will not have the diverse selection of classes that a massage school would. Without financial aid programs and the economy of scale it will be very hard for the massage schools to compete. The net result will be a lower quality of education, less diversity of training, and fewer continuing education choices for therapists.

Around 60% of California massage schools offer programs of less than 500 hours. These schools serve the needs of a highly diverse California population, including those transferring from other professions, those learning while meeting family and community responsibilities, and those of ethnic, non-English, or poor backgrounds working hard to fulfill their potential. For these groups, the 250 hour tiers meets an important and continuing economic need for rapid entry to massage practice so that their career dreams can continue.

Low-income students need to begin earning an income as soon as possible, and those who have other responsibilities such as family and job but who want to take advantage of this educational and economic opportunity might not even be able to even enter the field if required to begin with 500 hours. Many don't qualify for education grants, and student loans simply increase their economic burden. The national trend toward requiring a minimum of 500 hours of training would close the door of opportunity for these disadvantaged people if it became the standard in California.

Senate Bill 731, on the face, creates a voluntary certification. However, when combined with local regulations, it can be anticipated to have the effect of a practice act in that it would be mandatory in many urban regions. Where the state leads, the cities and counties will follow. It is likely that any standard set by the state will be adopted by the cities and counties, which means that a one-size fits all law could mean the beginning of the end of the great diversity of massage practice in California.

To see the language of the bill please go to: http://tinyurl.com/2htqbd

All politics are based on the indifference of the majority.
~ James Reston

Come join the minority!!!

Following are two letters in opposition to CA-SB731. One is from Will Green, founding President of the International Massage Association and one from yours truly. You too can write the committee with your thoughts and opinions. Go here to find out who to write.


Dear (Committee Members)

I am the founding president of the International Massage Association, based in Washington DC, representing over 72,000 members across America with over 6000 in California. I am writing concerning CA S.B. No.731, this bill does not do much for the people that are members of my organization or the general public but does much to advance a monopoly of schools and other segments of the massage industry.

When states deliberate whether or not to regulate, or how to regulate massage, I strongly recommend thoughtful consideration to the economic impact of doing so. In spite of the licensure requirements that continue to put proficient massage professionals out of business, the industry is worth nearly four-billion dollars a year in taxable income, as reported a while back in the New York Times.

Massage is an ideal career, vocation or avocation that can be practiced by everyone through cost-effective avenues such as apprenticeships, video correspondence courses and internships. It is empowering and adaptable to: segments of the work force that experience periodic furloughs, massive layoffs, displacement through industry decline; to single parents, welfare-to-work candidates, and to occupational therapy programs.

Regulation creates monopolies in the name of “protecting the public”, with no harm ever being proven by those advocating this protection. The public, our clientele, is becoming more savy and discerning as to the types of service and modalities it wants to experience.

Licensing and regulation have never guaranteed competency. Poor performers do not do well in the massage business. Because they cannot sustain a consistent repeat clientele base they would be driven out of the business by the law of supply and demand.

We know many talented and gifted practitioners, who had extremely successful practices, who are prevented from practicing because they do not conform to the definition and requirements of massage therapy licensure. Further there are skilled immigrants – some with 20-40 years of massage experience, some being “Doctors or Nurses of massage” in other countries that cannot practice their trade because they have not attended an “accredited” US school or attained the minimum hours. Thus we have a skilled work force unable to work, constituting restraint of trade, unfair trade practices and discrimination.

Unfortunately, cities and states knowingly or unknowingly are complicit to the monopoly that massage licensure laws have created.

I would be pleased and honored to participate with legislative and law enforcement authorities to promulgate thoughtful laws and ordinances and address problems and challenges to our trade.

Sincerely,

Will Green
President
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Dear Senator.Ridley-Thomas,Please let SB731 die and continue to oppose any bill governing massage or touch, for practitioners, at the state level under the umbrella title of massage therapy. Govern "Massage Therapy," maybe.

Taken directly from materials from an AMTA membership packet is this: Massage Therapy is a "profession" in which the practitioner applies manual techniques and may apply adjunctive therapies, with the intention of positively affecting the health and well-being of the client.

Massage Therapy is a "profession" created by the AMTA. Massage Therapist is a title yet to be completely defined as an occupation. This bill is a foot in the door for the proponents of licensing and a foot in the door for imposing unnecessary requirements on those looking to provide touch or massage as a service.

In the realm of government our country has three distinct branches - the Legislative, Judicial and Executive. In the realm of massage and touch, there are at least three branches. There could be a "profession" which regulation could be placed in the hands of a group such as AMTA, their AMTA Council of Schools or COMTA the AMTA spawned Commission on Massage Therapy Accreditation, accredited by the Federal Department of Education for accrediting schools desiring to teach 'Massage Therapy'. Completing high numbered hours of training at one fell swoop at one of their schools would entitle those desiring to be referred to as a Massage Therapist the right to do so.

Beyond a "profession", there is the 2nd and 3rd branches of trade and service involving people who desire to do massage or touch or integrating a short massage training into other body oriented practices they may already be involved in. The three branches of massage/touch are understood to be "professional" as all are worthy of payment for services rendered.

Any act written without interchanging the words massage or touch with Massage Therapy to satisfy those feeling the need for state recognition could be an option. Words implying a Massage Therapist is anything more than a title in a realm with many optional titles not needing standards set for the title Massage Therapist or Massage Therapy is more damaging than good for the vast majority of givers and those receiving the work.

Licensing CPA's did not kill accountants and bookkeepers, freelance or employees. Skilled touch and massage should remain unscathed. Rubbing is also a profession. Massage Therapists would be allowed to rub. By visiting this site you will be lead to definitions of masseur, masseuse and rubber, long established and connected to massage. These definitions are being drawn from and placed into a "new" occupation of "Massage Therapist."

The major difference between masseur/masseuse and rubber trainings and "massage therapy" trainings is all the responsibilities of the masseur/masseuse and rubber titles are lumped into one very expensive training more beneficial to the schools and industry than for those looking to provide touch as a service for income.

Thank you for listening.

Robert Flammia,
Former Amta member
Holistic Bodywork Therapist and Health Educator and expired NCTMB
Berkeley CA