An Interview with Paul Ingraham

A few years ago, I came across a website that has become one of my favorites. It’s at www.PainScience.com, and the writer behind it is Paul Ingraham.

Ingraham is a former Registered Massage Therapist from Vancouver, Canada. He practiced for ten years in downtown Vancouver, taking as many difficult chronic pain cases as he could. Since 2009, he has been the assistant editor for ScienceBasedMedicine.org. I recently had the chance to ask him a few questions about his life and work:

LA: Paul, one of the reasons I find you so interesting is because we share the circumstance of formerly being into energy work, and all sorts of things along those lines that we no longer embrace. Was there a defining moment when you decided to leave that behind and become the skeptic you are today?

PI: It was a series of defining moments, a gradual process, many things chipping away at my faith. For instance, I had a colleague who I shared some beliefs with. We both did energy work and talked shop about it. For me it was more like art and poetry, while for him it was much more literal and real, like he thought he was a Jedi in training or something, and he shredded his credibility with increasingly bizarre belief and overconfidence — like healing over the phone — until I one day I thought, “Wow, way too far. That is just not quality thinking!”

There were many more little disappointments like that over the years. Some were bigger. I remember a workshop taught by someone I greatly admired. I went in beaming, but came out rolling my eyes — a whole day of fringe science and sloppy, self-serving “logic.”

When I started questioning this stuff publicly, I got hate mail, even about stuff I thought was no big deal to question. And that finished the job. Seeing a steady stream of incoherent arguments from unhinged true believers — never calm, never gracious, never “balanced” — finally turned me into an actual card-carrying skeptic. It took about a decade to go from true believer to doubter to curmudgeonly skeptical gadfly.

LA: For years, your website was known as SaveYourself.ca. What precipitated your recent name change?

PI: PainScience.com is more serious and dignified. And just more descriptive of what I do.

I never really cared for the connotations of “save.” Some people immediately think of Jesus when they think of being saved. And I didn’t want to imply that anything I write can “save” anyone — it smacks of the same kind of unethical over-promising that I often criticize in health care.

PainScience fits great. It feels like putting on a nice suit after years of doing business in a Hawaiian shirt.
LA: I’ve seen a few snarky comments from people on the Internet concerning the fact that you’re not a scientist, but you write about science. What are your qualifications, and what do you say to your critics?

PI: Yes, that comes up a lot. And they’re half right: I am not a scientist! But of course hardly any science news and reporting comes directly from scientists, and it can’t, because scientists are busy doing their jobs. And hardly anyone outside of science actually reads scientific papers (least of all the kinds of people who complain that I’m not a scientist).

I am a writer, and my job is to understand and translate science as well as I possibly can — to be a liaison between scientists and clinicians and patients. It’s a tough job, but I care deeply about it and work my hind end off to do it right.

Information about the implications of science can and should only be judged on its own merits. It doesn’t matter who wrote it. Is it good? Is it reasonable and referenced?
LA: One thing I have always admired about your writing is that you provide footnotes for everything. How much time do you spend researching and preparing an article?

PI: It never ends! I never stop editing and upgrading articles, because science is a moving target. They need to change. This is a distinctive thing about PainScience.com: I don’t publish stuff and then just leave it there to rot on the server forever.

But a first draft of a typical 2500-word delve into a topic is usually about a 40-hour project, assuming I’m really going for it. The main way to distinguish yourself online these days is quality. You can’t just write a lot — you’ve got to write well. Serious polish. So I really get into making an article as good as I can possibly make it. It’s not unusual to thoroughly edit at least five or six times.
LA: Like my own blog, some of your articles have generated controversy and even gotten you some hate mail. Is there an article that stands out in your mind for that?

PI: By far the most hate-mail generating article I’ve ever published is Does Chiropractic Work? The modern version of it is more diplomatic and generates much less hate mail, while the original was somewhat snarky and made a lot of heads explode. But I still stand behind any statement I ever made there.

But the most interesting hate mail generator is this one: Trigger Point Doubts. It doesn’t generate a lot of hate mail, but some people just go bonkers when they think they’ve caught me in a contradiction. That is, criticizing “trigger points” while also selling a book about trigger points. Even though the article tackles this so-called contradiction head on. And of course it’s very intellectually healthy to question your own ideas. But I get mail from people who are just furious with me: they take me for a trigger point guru and then freak out when they find out I have concerns about trigger point science being half-assed.

LA: Painscience.com gets about 30,000 hits a day. I notice there’s no advertising on your site, but my guess is you’ve been offered plenty of deals; is that so? What’s your reason for running an ad-free site?

PI: I just like it better. Classier. Different than most of the rest of the internet. And I can generate enough revenue with e-book sales.

LA: You’ve written quite a few e-books. What is the focus of those?

PI: So far I have written eight books about eight musculoskeletal pain problems that are often puzzling and stubborn, like patellofemoral pain or chronic low back pain. The goal of the books is to explore the puzzle with the reader, who can be a patient or a professional: to dive into the interesting mysteries and try to figure out what works, what doesn’t, and why. My goal is to simply teach the reader as much as I possibly can about the condition. In the absence of proven treatments, good information is the next best thing.

LA: What’s the most gratifying thing about what you do?

PI: Oh, that’s easy: email from people who like my sense of humour! Best people in the world! Or librarians who recognize the mad genius of my bibliography.

But seriously, of course it’s the readers who feel that something they learned from me has really helped them. I do love that. That’s the whole point.

LA: Is there anything you haven’t accomplished yet that you plan to do? What’s next for Paul Ingraham?

PI: Lots! It’s taken me a few years to get PainScience.com going and prove that it can pay the bills. I’ve had to do a lot of technology work to get it to that point, which often distracted me from writing in a big way. Now it’s time to get back to the writing, and lots of it, both professional and personal. I’d like to get going on my first novel. And some other technology business projects with a genius buddy of mine, for the diversification and fun of it. Going to be a busy couple decades!


Is AMTA Passé?

Maybe or maybe not. But their method of selecting members and officers for the National Board of Directors sure is.

AMTA’s annual online election process just wrapped up on November 30. According to their official report, the number of members who voted during the month-long window hit an all-time low of 2.53%, or just 1,398 out of 55,276 members. That’s down from a whopping 2.66% participation rate in the 2013 and 2012 elections, and 2.83% in 2011.

These numbers sound pathetic, but how to they stack up in comparison to other organizations? In a 2012 study conducted by Votenet Soutions of election and voting trends in 239 non-profit professional and trade associations, the average voter turnout was 32%. That’s more than ten times the involvement of AMTA members over the past four years.

You might think this is a case of “Who cares about these positions–it’s just a bunch of massage people who like to get free trips to out-of-town hotels where they have meetings and party and get to feel important.” Well, AMTA is the largest non-profit in our field, and their Board of Directors controls an annual budget of more than $14 Million Dollars. That’s a lot of green that can  benefit the profession if it is spent wisely. Or, it can continue to be used (as most of it has gone) to keep sending elected officers and committee chairs to national and state meetings where little gets done.

The decline in the voting for AMTA elections is just a symptom of a larger problem. The bottom line is that AMTA is stuck in an old social-welfare model that resists change, while most of the people in our profession have moved into the social media age. Chapters and meetings are less important, strong brand identity and consistent delivery of needed services trumps all. That’s why ABMP has beat the pants off AMTA in the membership race.

From its origins as a small rebel organization in 1988, ABMP pulled up even with AMTA’s numbers sometime around 2005, and has left them in the dust since then. ABMP now has more than 80,000 members, without the burden of a state chapter system or the complexity of holding conventions. AMTA is hovering below 60,000 members, and can’t seem to get much traction.

In my last blog, I wrote about the elections mess created by some of AMTA’s own officials who couldn’t hold to a clearly-stated policy around not making the whole thing a partisan affair. Since President-Elect Jeff Smoot (who was not up for election this round) felt compelled to publish his own candidate endorsements, the AMTA Commissioner of Elections (which is a position appointed by the President-Elect) threw the doors open for all state and national officers to get into the partisan parade. This is further evidence that AMTA needs to make a major shift in how it selects its governing board.

Since the participation rate in national elections is moving towards zero, AMTA should amend its Bylaws to chuck the election process for the Board of Directors in favor of a leadership development model. The focus would shift to an expanded Commission on Candidacy, which would function like an executive search firm. A call for candidates would be put out in each cycle, and the Commission would be responsible for interviewing and selecting the most qualified individuals to serve on the National Board.

Annually, when a new Board is configured, the members themselves would elect a President, Vice-President and Treasurer. Other changes that need to be made include term limits, and mandatory time-outs after serving, so that the same people do not keep recycling back around.

There are a lot of talented and committed people who belong to AMTA, and I bet that more of them would be willing to step forward to serve in key leadership positions if the old clique system was banished. We need to grow up our profession, and AMTA should be part of the solution, not the problem.


AMTA Election: A Social Media Storm

It’s time for AMTA National elections, and so far, it’s a hot mess. The ruckus all started when Presdident-Elect Jeff Smoot made a post on Facebook announcing his own choices among the candidates.

I have known Smoot for a few years through the association, and I sent him a private message that I thought he was making a tactical error. We had a little back-and-forth but the post remained; he felt it was okay to have posted it and his post said that the Commission on Candidacy Chair and the Chair of Elections have determined that his FB post falls under the realm of “personal conversation.”  As of today, he has 665 FB friends–a lot more than some, a lot less than others, but that’s a relatively good-sized personal conversation.

Some other officers, present and former, and interested readers (including me) weighed in with concerns about the legality and ethics of the post–including some who have gotten in trouble for lesser social media offenses before. And as several people pointed out, other national health care organizations do not allow their board members to endorse candidates who are running for office in their organizations. Others stated they were glad to see it and felt it was overdue for the organization to join the 21st century and get with the social media program. Although I haven’t seen anyone say it publicly on FB, I’ve received a few private messages suggesting that he should resign, and barring that, that the organization should remove him from office.

I personally emailed current President Nancy Porambo and Executive Director Bill Brown about the situation. Porambo was nice enough to call me, and stated that Smoot’s post wasn’t a violation, but she was aware there were some perception problems with it.

However, AMTA’s own Policy Manual seems to be a confusing train wreck on this issue. Under  “Campaigning” (Section XII), Item 4 states

Candidates may:Utilize social networks to inform people of their candidacy, position, or issues, and respond to questions.

Directly under that, Item G states

Volunteers shall not use their current AMTA position to promote a candidate.

Item H goes on to further state

Violations of this section, Campaigning, may result in the removal of a candidate from the ballot, making them ineligible for election.

Obviously, someone is confused. Technically, Smoot’s announcing his choice of candidates could be considered a “position.” But Item G looks pretty cut and dried to me. I think AMTA needs to go back to the table and fix this mess, which was, according to the date on the policy, just revised barely more than a week ago on October 29.

It’s all moot to me. I dropped my own membership in AMTA this past August after more than a decade of being a member. I didn’t like the fact that The Wizard of Oz was hired for a fortune to be the keynote speaker at the national convention, and the chapter fee fiasco is still sticking in my craw. But the main clincher, when I called them on that, was that it was done by the BOD in executive session, without knowledge of the chapter presidents, because “the competition was in the room” (meaning ABMP.) Well, guess what…ABMP is always in the room during the Board meeting at the national convention; at least they have been at the 10 conventions I have attended. That’s mighty convenient for casting aside transparency. I attended the chapter meetings in three different states soon after that change came to light, and it had substantially affected the budgets of all of them negatively; not to mention the fact the budgets  had already been done for the coming year and had to be done again to take the fee losses into consideration. Yes, there are people who will continue to support their chapters, but just as many will probably not pay anything they don’t have to. It’s my opinion that the chapters and the Massage Therapy Foundation are going to suffer from this policy, and I hope it is revisited.

I have always loved participating in my state chapter and have taught classes in many AMTA chapters, and I have loved them all. I wish the organization well, but they need to clean this up immediately.

 

 

 


Deal, or No Deal?

In my last blog, The Good, the Bad and the Ugly, I reported that the only good thing that came out of the recent FSMTB Annual Meeting was the announcement that NCBTMB and FSMTB had reached an agreement on licensing exams, which promised to spell the end of the long “exam wars”. FSMTB trumpeted this news in their October 3rd press release, which stated:

“FSMTB and the NCBTMB have worked cooperatively to reach an agreement that the NCBTMB will no longer provide examinations for licensure purposes and will now focus exclusively on delivering quality certification programs. This supports the common goal of the FSMTB, Associated Bodywork and Massage Professionals (ABMP), American Massage Therapy Association (AMTA) and the Alliance for Massage Therapy Education (AFMTE), for the Massage & Bodywork Licensing Examination (MBLEx) to be utilized as the sole licensure exam for the profession, thus facilitating licensure portability for therapists.”

Too bad that we really can’t celebrate this news because the so-called “agreement” did not include the Approved Continuing Education Provider Program operated by NCBTMB (which 27 state massage boards use in one way or another). Like rubbing salt in the wound, the FSMTB turned right around and passed a resolution to create their very own CE approval program–as if NCBTMB didn’t exist.

It actually gets worse. I received word that at last week’s Florida Board of Massage Therapy meeting in Orlando, it was stated publicly that there was really only a “letter of intention” between the two organizations that was signed before the FSMTB Annual Meeting, and that the details of this letter would be worked out later in a formal agreement.

Now I’m no attorney, but a letter of intention is NOT the same thing as a legally-binding agreement. It’s more like putting a small deposit down on a house to get the process started, with the purchase contract and the mortgage money to come later. A lot can happen between those two steps.

So I’m confused here… is there a deal, or is it no deal? For the FSMTB to send out a national press release with the subject line “FSMTB AND NCBTMB REACH AGREEMENT” when no final document appears to have been signed, raises all kinds of red flags and ethical questions.

We never needed two competing licensing exams, and we sure as blazes don’t need two competing national CE approval programs. Looks like it’s time for the heads of these two organizations to get back to the negotiating table and work out the rest of this deal, for the benefit of the CE community and the profession as a whole.  And don’t come out until you get it settled!


The Good, the Bad, and the Ugly

With apologies to Clint Eastwood, I’m using the title of his classic Western to talk about three major announcements from the Federation of State Massage Therapy Boards, and what they mean to the rest of the profession. This all came down at the recent FSMTB Annual Meeting, held in Tucson on October 3-4.

The Good: FSMTB and NCBTMB reach an agreement on licensing exams.
Woo hoo! Praise the Lord and pass me the MBLEx! After six years of costly and damaging “exam wars” between the two organizations, NCB was unable to keep its market share of the entry-level testing business. As FSMTB’s exam revenue grew each year, NCB’s declined. NCB finally saw the handwriting on the wall and agreed to stop offering its national certification exams for state licensure as of November 1, 2014 – in exchange for an unspecified amount of money.

This is a huge benefit for the profession, as we can finally move towards having a single licensing exam that is under the direct oversight of state massage boards. (Only Hawaii and New York are still hanging on to their own state exams.) It means less confusion for students and massage schools, and a boon to portability of licensure in the future. This has been a long and painful struggle between FSMTB and NCB, and I for one am thrilled to see it come to a peaceful end.

The Bad: FSMTB adopts CE standards and license renewal recommendations.
Two years ago, FSMTB proposed a radical shift to the continuing education landscape, as outlined in their Maintenance of Core Competency proposal. The MOCC was slammed by organizations, schools, CE providers and individual therapists alike – and yet, the worst of it has made its way into FSMTB’s new continuing education and license renewal standards.

This is a classic case of “If it ain’t broke, then don’t try to fix it.” Overall, our existing CE system works reasonably well, so the last thing we need is yet another organization coming in with an agenda to transform and/or grab control of it. Last year, we suffered through an attempt by NCB to do just that. After a massive grassroots effort, NCB toned down most of the unacceptable changes they were trying to force on providers and sponsors of continuing education. They’ve been behaving themselves since then, and their CE approval processes have been operating more smoothly, although personally some of the classes they have approved are still an issue with me. I’d like to see some sort of designation for those of us who don’t practice or teach pseudoscience and don’t want to be lumped in the same category as those who do.

Now we have the FSMTB trying to flex its muscles. It’s like we just got King Kong calmed down, and now we have to do the same with Godzilla!

At the recent FSMTB Annual Meeting, state board reps passed a resolution from their CE Task Force to “implement a program that provides reliable, unbiased and appropriate vetting of continuing education providers and the classes offered to the consuming public.” That sounds high and mighty, but there is no reference to NCB and their existing national Approved CE Provider program in the resolution, and there was no mention of NCB when this resolution and the license renewal standards were presented to the Delegate Assembly for consideration. Did they think that no one would notice this sin of omission?
The LAST thing we need is another CE approval program! FSMTB could have easily solved their delegation of authority issue by entering into a partnership agreement with NCB to use their existing program. This should have gotten rolled into the exam deal between the two organizations, so that CE approvals could be consolidated.

It’s hard to believe, but the resolution was passed without any details on how FSMTB actually plans to vet CE providers and classes. Why should we trust that FSMTB can do this in an effective manner? They’ve been offering the MBLEx for six years now, and they still don’t have an online practice exam and exam study guide for massage students. The very worst of it is that FSMTB’s plan for CE and license renewal centers on “public safety”, while minimizing the role of CE for “professional development”. The problem is that there is no evidence that we have a widespread “public safety” crisis in our profession, so there’s no factual basis for what FSMTB is trying to do. (There are a lot of specific flaws in the CE standards and license renewal recommendations FSMTB has adopted. I’ll detail those in a future blog.)

What I can see from all this is a major threat to the existing CE provider and sponsor system in our field. FSMTB’s proposal is so completely out-of-synch with how CE is organized and delivered, and FSMTB stands to consolidate even more money and power if this model is adopted by state massage boards. We’re just coming out of a period where NCB tried to dominate the field. Now FSMTB is acting like they’ve picked up the NCB playbook and are trying to run with it.

The Ugly: FSMTB publishes the Model Massage Therapy Practice Act (MPA).
As I wrote about in my previous blog, the MPA was released after three years of behind-the-scenes work and two rounds of public comment. Most of its content is the kind of standard stuff found in all templates for occupational licensure. However, FSMTB really blew it in a number of key areas, and the final version contains both technical errors and some awful policy decisions. As FSMTB’s leaders had final say, the responsibility for correcting these fatal flaws rests on them.

Judging from how few comments were made on the three blogs I posted about the MPA, it looks like it doesn’t register as all that important. Wake up people! A model practice act is one of the bedrock components of a profession. It contains the Scope of Practice definition and other essential elements that influence both education and practice. If you haven’t taken time to read our new MPA, I urge you to get familiar with it and keep up the pressure on FSMTB to fix it. Remember that it doesn’t become law unless it’s adopted by a state legislature.

Let’s celebrate the Good, and get to work on the Bad and the Ugly!


Final Draft of Model Practice Act Released

The Model Practice Act was released in its final draft this week, after more than three years of work on it and two periods of public comment. The introduction does state that it will be an evolving document as changing times and circumstances dictate, but as of now, it still has many of the school owners on my social media pages up in arms.

The language requiring accreditation from previous drafts (Section 103(B) ) was modified to say “Approved Massage Therapy Education Program means a school or educational program that meets the criteria established in rule by the Board, at a minimum includes 625 Clock Hours, and is both authorized in the jurisdiction in which it is located and that reflects a curriculum acceptable to an accrediting body recognized by the U.S. Department of Education…” While the requirement has been downgraded to a suggestion, the comment section makes it clear that the eventual goal is required accreditation for one and all.

Personally, I have some mixed feelings on this. Accreditation is a process of quality control–to a point. (Disclosure: I am a peer reviewer for COMTA). Obtaining accreditation is not cheap, it’s rigorous and it’s time-consuming. It sends the message that you have voluntarily gone over and above what the state requires. Other health care professions require it. And therein lies the clincher.

There are no other health professions that I am aware of accrediting programs that teach psuedoscience, and many massage school programs, including those accredited by COMTA and other accrediting bodies–and in the case of community colleges, even the regional accrediting bodies–do. So what does that really mean? Is it really a hallmark of excellence when we accredit things that have no basis in fact, just because it’s tradition, and been around for a long time, even though it’s been shot down by science?

I am not a school owner, but if I was, I wouldn’t be hitting the panic button just yet. The FSMTB has no power of legislation and they can’t lobby. In order for accreditation to become the law of the land, that’s what will have to happen: it will have to become the law of the land, literally, through legislative changes. There may be some FSMTB member states who are gung-ho to see it happen, but remember, state boards can’t lobby, either. That is the domain of the professional associations. In my state, our AMTA chapter has paid a lobbyist for many years. Since the chapter fees are now optional, I have heard that he volunteered to continue working at a lesser fee, but I bet some of the state chapters have lost their lobbyist altogether, if they had one to start with. The wheels of government don’t turn that quickly unless they’re greased.

The MPA is a template for the states. It isn’t the law and it may never be. For the few unregulated states, should they finally get out of the Dark Ages and decide to regulate, this will be very time-saving for them. It isn’t perfect; nothing is. Obviously a lot of work went into it. Only time will tell what effect it is really going to have.


NCBTMB and FSMTB: Long-awaited Collaboration in the Works

The NCBTMB and the FSMTB made a joint announcement this morning that I have long been hoping for. Leena Guptha, Chair of the NCBTMB, confirmed to me that the NCB will sign a letter of intent to withdraw completely from licensing examinations, which will mean the MBLEx will be the only licensing exam in the US, excepting New York and Hawaii, which both have their own state exams. This change is taking place November 1.

The FSMTB will support Board Certification, according to Guptha. “We are getting back to the roots of certification,” she stated, “honoring our original purpose.” Further details will be forthcoming soon, but for now, Guptha expressed to me that she hopes that the other massage organizations and the profession at large will support this action. I hope they do, too.

 


To the Edge and Back

I’ve been quiet for the past few weeks because I’ve been ill. On August 17, I wasn’t feeling too well, not really full-blown sick, but on the puny side, and I told my husband Champ I wanted him to cover our office the next day and let me stay home. I felt a little worse on Tuesday, and stayed home again. I had terrible diarrhea all night and was constantly thirsty. On Wednesday morning, I woke up in a state of extreme illness and confusion. Champ asked me if I knew the signs of a stroke. Of course I do, but I looked at him blankly and said “no.” He asked if I knew who he was. That was another “no.” He asked if I knew who I was. When I answered “no” to that, he took me to the ER.

After a few blood tests, x-rays and the like, a doctor came in and informed me I was being admitted with a severe urinary tract infection, which I had not had any of the usual symptoms of, and that it had gone systemic. I also had pneumonia in both lungs–something I just went though in March of 2013. They admitted me to the hospital and started pumping me full of antibiotics. The diarrhea lasted four more days to the point where I was reduced to wearing a diaper in the hospital. That’s a rather humbling experience. A friend of ours who is a pharmacist told Champ that another day or two without the antibiotics and IV fluids, and I would have died.

I was released after a week in the hospital, which included two days in the ICU. My mom came to take care of me. She is 75 and I could never in a million years have had a better mother than what she has been to me. I turned 55 while I was sick. She was wiping my butt just like I was baby, so was Champ, and for all intents and purposes, I was one. She made me some homemade soup the day after I came home. I ate a half a bowl (it was delicious vegetable soup). About an hour later, my stomach got very bloated and hard. I was vomiting, and the next morning, I told Champ I thought I had better go to the ER.

Low and behold, another x-ray revealed that I was full of gall stones. They admitted me again and  took out my gall bladder early the next morning. After another week in the hospital, I came home again last Thursday.

My hormones and electrolytes were screwy in the hospital, and I had to go to the doctor for a checkup yesterday. I also spent last night at the Sleep Center–not a restful place at all. I haven’t gotten those results yet, but I had been placed on a BiPap in the hospital because I was retaining too much carbon dioxide. They woke me up in the middle of the night and put me on a CPAP. I expect I’ll hear all about it later today.

On my birthday, all I could say was “55 and still alive.”

I have been overwhelmed at the outpouring of love and compassion from everybody. FB friends I have never even met sent me cards and gifts. Several people sent me money in amounts from $5 to $500, which just made me cry in gratitude and disbelief at the kindness. People sent flowers and fruit baskets. Local people have delivered food to my house. Restaurant owners have refused to take any money when Champ went to get takeout.

Since I’m known for pissing people off with some of my commentaries, I might as well not pass up this opportunity to say thank God for Obamacare. Last year, when I was stricken with pneumonia the first time, we had given up our health insurance. It had gone to over $600 a month. Champ was not working much, our business was struggling in our local economy, which is still very depressed, and we simply couldn’t pay for it anymore. It was either give that up or give up eating. We also had a $5000 deductible. My hospital bill was over $10,000, which I am still working to pay off. On January 1, I got us signed up for Obamacare. We are now insured with a $500 deductible, not $5000, and we are paying $235 a month. My prescriptions have cost me $5 each. The nebulizer I had to get to take breathing treatments at home four times a day was free. Before anyone jumps on taxpayers subsidizing that, let me say that I got my first job at the age of 13, and I have worked every day of my life since, so I have paid my share in taxes and I continue to do so. It feels good to me not to have to worry that I am going to lose my home or my business over healthcare expenses. So there. I appreciate it whether anyone else does or not.

Champ’s social security kicks in this month, so we can breathe a little easier on that front, as well. I am taking a few weeks off from work to gain my strength back. I am sapped. I have seen some of my FB friends spreading the suggestion that people buy my books in order to help my finances, and I really appreciate that more than I can say, along with everything else people have done for me during this time. So in a fit of shameless self-promotion, I will list them here in case you are led to purchase one.

The first one is one I finished last year while I was in the hospital with the first round of pneumonia. It’s about death and dying and the wonderful Nina McIntosh, author of The Educated Heart. I watched Nina get her affairs in order while she was suffering from ALS. When I was in the hospital, I had the thought that I might not be leaving there alive, and that I needed to get my own affairs in order. We all do, while we’re able to, instead of leaving it for our grief-stricken family to do. The last part of the book walks you through that. It’s called The Days Still Left.

My most recent book is Excuse me, exactly how does that work? Hocus Pocus in Holistic Health Care. I didn’t question anything I was taught in massage school, and I should have. Part memoir, partly an examination of some of the things that are heavily marketed to massage therapists, who then turn around and market to the unknowing public. Yes, it will step on a few toes, but my hope is that it makes people THINK.

Massage is my second career. In my first life, I cooked for the public for more than 20 years. My little cook book is full of great Southern recipes and funny stories that happened to me in the restaurant business. Nothin’ Fancy, Good Food and a Few Funny Stories.

In 2012, The Massage Nerd, aka Ryan Hoyme, and I collaborated on the Manual for Massage Therapy Educators. This is NOT meant to be a textbook. We were both unceremoniously foisted onto our first class of massage students, and this is just the practical advice of the things we wish we had known when we started out and what we’ve learned along the way.

The Plain and Simple Guide to Therapeutic Massage & Bodywork Examinations 2nd ed.   Get ready to pass the MBLEx or NCBTMB exams. The inside cover has a scratch-off password to a website filled with practice questions and learning games.  Great teacher ancillaries, too. I am very proud to say this book is sold in hundreds of massage schools.

One Year to a Successful Massage Therapy Practice is full of low-cost and no-cost ways to get your practice off the ground or revitalize an older one.

I’m proud of this book because I didn’t try to sell it to LWW; they asked me to write it, and I was happy to oblige. The inside cover has a password for a website with dozens of useful forms. It covers everything from your business plan to retirement and in between.             A Massage Therapist’s guide to Business also has great instructor ancillaries.

That’s it, although I do have a few more in the works. Thank you for your support.


Model Practice Act Causing an Uproar

Disclosure: I am a peer reviewer for COMTA.

I have complained a lot about massage therapists sitting on their hands, not having any interest or involvement in governance, and not caring or being informed about what is going on until it’s too late to do anything about it. I can’t make that complaint about massage school owners in the past couple of weeks. I’ve never seen such a hue and cry over any other issue.

The Model Practice Act is on its second period of public comments, and I’m pretty sure the FSMTB is hearing from a lot of upset people. I had a few issues with the first draft, and I hear it got about 1300 comments. I’m willing to bet this one will get twice that, caused by a one-word change in the following definition, found in Section 103(B):

Approved Massage Therapy Education Program means a school or educational program that meets the criteria established in rule by the Board, at a minimum includes 625 clock hours and is both authorized in the jurisdiction in which it is located and is accredited by an accrediting body recognized by the US Department of Education. Education received outside of the United States must be substantially equivalent to the criteria of this Act and must be recognized by the jurisdiction in which it is located.

In the first MPA draft, this requirement for schools was stated as state authorization AND/OR accreditation. The removal of just one word here makes a world of difference, which has set the massage education community into a tizzy.

My Facebook is buzzing with comments from school owners, teachers, and other interested parties. Overwhelmingly, the feeling is that this is going to put a lot of schools out of business. There are also people that feel that we have about twice as many massage schools in the US as what are really needed, and that this has led to churning out too many graduates, which has led to a glut in the job market, and contributed to the proliferation of franchised massage (or maybe it’s because of franchised massage).

Rick Rosen is the co-owner of Body Therapy Institute in Siler City, NC, one of only two schools in our state that are accredited by COMTA, shared some of his comments on it with me:

There are two primary reasons this accreditation requirement is inappropriate and potentially damaging: First is the fact that about half of all massage schools in the U.S. are not accredited. In general, these are smaller proprietary institutions that only offer massage programs. It is doubtful that most of these schools could qualify for accreditation even if they wanted it, because of the lack of financial resources. Smaller schools that are undercapitalized are unlikely to be able to meet the financial ratio requirements of COMTA and the other accreditors, not to mention the initial and ongoing costs of accreditation.

These massage-only institutions embody the lineage of massage therapy and the healing arts, as contrasted with for-profit career colleges and publicly-funded community colleges where massage is one program among dozens (if not hundreds). Mandatory accreditation WILL cause many of these smaller schools to close, which would be a tremendous loss for our field.

Second, COMTA is the only specialized accreditor in the massage therapy field, and the only agency with competency-based curriculum standards. Institutional accreditation by the other six vocational accreditors and the seven regional higher education accreditors fails to provide a meaningful measure of quality assurance for the massage program itself.

Therefore, it makes no sense for FSMTB to include an institutional accreditation requirement in its Model Practice Act when such accreditation (in the case of non-COMTA-accredited schools) ignores the elements that are critical to producing a well-trained massage therapist. It is the integrity of the program’s curriculum, the competency of the instructors and the consistent application of admissions criteria that are the critical elements that make a sound massage therapy program — far more so than the financial and operational standards that comprise the bulk of institutional accreditation.

So, if roughly half the massage schools in the U.S. cannot qualify for accreditation, and the other half (minus the 67 schools and branch campuses that are under COMTA accreditation) are accredited under institutional standards that do not reliably produce skilled and employable massage therapists who last more than two years in practice — where does that leave us?

We need a regulatory structure for schools that can satisfy the minimum requirements of state massage statues for protection of the public, while preserving the ability of our smaller massage schools to exist. In addition, we need a mechanism to bring all massage programs under single set of programmatic standards to establish consistency of entry-level training that is impossible to achieve within the current system.

Rosen’s solution is for COMTA to add a non-accreditation level program approval to its scope, which would require the blessing of the USDE. In addition, all massage schools with institutional accreditation from other agencies would also need to seek programmatic accreditation from COMTA – a structure that is common in other regulated professions. The language in Section 103(B) of the MPA would then need to be changed to include programmatic accreditation OR approval by COMTA – along with approval or licensure by the educational authority in the jurisdiction in which the school operates.

There are a lot of other school owners out there that don’t feel any accreditation should be required at all, particularly owners of small schools who have long-standing, successful programs that have lasted for decades without accreditation. Accreditation is not cheap. It’s time-consuming to initially obtain, and time-consuming and expensive to renew. While I have heard many small school owners talk about the expense as a deterrent to getting accreditation, I’ve heard as many others say “I’m not going to have anyone telling me how I have to run my school.”

Sandy Fritz, who has owned a school (not accredited) for more than 30 years and is a well-known author and advocate for massage education, stated on her blog that accreditation was a good thing–and then it moved away from a process to determine excellence and became a hurdle to jump across to access the cash cow of financial aid.

Actually, institutional accreditation has always been about being a financial gateway rather than a hallmark of excellence. When COMTA came on the scene, it was the first accreditor to offer programmatic standards that were meaningful to massage education. Unfortunately, they’re also the smallest player on the accreditation field and have no real ability to affect the whole.

I can’t speak to the other accrediting agencies, for my experience as a peer reviewer for COMTA is that a school that seeks the accreditation is sending a powerful message: “I do more than the state requires me to do.” Accreditation involves an in-depth self-study, and documentation, documentation, documentation. If it isn’t in writing, it doesn’t exist. But that’s a good thing. It ensures that policies and procedures are in place that are for the good of the student, the good of the school, and the good of the profession.

COMTA has been criticized for including pseudoscience (energy work) amongst the things that are acceptable for curricula in accredited schools. Without have read the standards of the other accrediting agencies, my guess is that they do, as well. The NCBTMB condones it, the AMTA and ABMP both condone it, the FSMTB condones it, so COMTA is hardly the lone ranger. It just goes to show, once again, that massage therapy accreditation is not being held to the same standards as medical professions do with their accreditation, which is why we’re still a vocation and not a profession.

The period of public comment ends on August 15. If you want your voice to be heard, you should seize the opportunity by clicking here.

 


Report from the World Massage Festival

Champ and I spent last week in Las Vegas at the World Massage Festival. This was our fifth year there, and the biggest and best one yet. Almost 700 people at this one…9 years ago when Mike Hinkle started the Festival, 20 people were in attendance.There were people from every state and 7 or 8 foreign countries. A whole contingent came from Trinidad.

The World Massage Festival is a unique event. Mike and Cindy bend over backwards to make the Festival affordable to everyone. Instead of a $189 hotel, we were in the Tuscany, an all-suite hotel, for the magnificent price of $59. And they are nice rooms! The staff at the Tuscany was very nice and helpful, the food was good, and in general it was just a good experience to stay there.

Over $50,000 in door prizes and scholarships were given away. I got to do a lot of the name-drawing and I had some real fun helping make people’s day with cash prizes, diamond jewelry, and other goodies.

On opening night, I was the keynote speaker. It was a humbling experience to look out at the room and see so many dedicated colleagues, many of whom have been doing massage for many more years than I have. During the awards ceremony, Irene Smith was honored with the Lifetime Achievement Award. I have to confess that I was not familiar with her work until Sunday night. She started the first project in the US to massage AIDS patients and has been doing Hospice work since the 1970s. Her entire career has been based on selfless giving. She is an example of the finest massage has to offer.

Since the beginning, one of the purposes of the Festival has been to recognize those who have made significant contributions to massage, through the Hall of Fame. Judi Calvert is always the host for this occasion and as usual did a beautiful job. I spent some time talking with several of this year’s inductees, all genuinely nice people who leave their ego at the door in spite of some of their amazing accomplishments. I spent an hour visiting with Mark Beck, who wrote the textbook I learned from in massage school, which was a real treat for me.

Lots of friends were in attendance at karaoke night, and we have got some talented singers in massage therapy. People had a blast singing and dancing.

Quality education, as always, was a highlight of the Festival. Champ took a class in Thai Massage from Mukti Michael Buck and really enjoyed it. I taught two classes, participated on a student panel, helped out with registration and karaoke night, and kept busy visiting with people. Glad to see Allissa Haines, Andrea Lipomi, Ryan Hoyme, Jake Flatt, Gina Smith, Thomas Liberto, Vivian Madison-Mahoney, Enid Whittaker, Michael McGillicuddy, Cherie Sohnen-Moe, Leena Guptha, and so many more. The WMF is always like a family reunion. I also got some great bodywork from Karen Kowal. Darcy Neibaur raised over $2000 in the Sweet Serenity booth to benefit the Greenville SC Shriner’s Children’s Hospital.

I also enjoyed having Sally Hacking and Mary O’Reilly of the FSMTB come into my student class and answer questions about the MBLEx for students.

Pualani Gillespie took Champ and I out for a fabulous dinner at Mario Batali’s restaurant, Carnevino, and we had a great visit with her.

Next year, the tenth anniversary, is going to be held in Michigan City, Indiana, and I expect it to be even better. I appreciate Mike and Cindy and everything they do. I hope to see you there!