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A Question of Ethics
Recently, after I had finished teaching a class on ethics, I  read a blog post on the AAAOM
website regarding "gainful employment." The published information made me reflect on what I had just discussed with the students — the acupuncturists' ethical responsibility to the patient, the profession and the public.

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My View From Here

By Ralph Stephens, BS, LMT, NCBTMB

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Debunking the Myth: Is Massage Licensing Necessary?

What is the purpose of professional licensing? In virtually all state laws across the country that have established licensing requirements for professions, you’ll find the key phrase, “To protect the public health, safety and welfare.” That sounds noble, but does it really hold up under scrutiny? Let’s look at our mainstream health care delivery system, which operates on a foundation of licensed professionals (including physicians, nurses, pharmacists and a host of others) and accredited hospitals.


A 2016 study from the Johns Hopkins University School of Medicine revealed that there are 250,000 deaths per year from medical errors. It’s the third leading cause of death in our country.1 On top of that, more than 100,000 people die each year, and 1.3 million are injured from prescription drugs that have been given the official designation, “generally recognized as safe” by the U.S. Food & Drug Administration.2

With this many people being killed or harmed by the screw-ups of regulated providers, hospitals and drug companies, the entire structure of laws and rules has failed. The legislative mandate of protecting the public health, safety and welfare has been usurped by a health care system that first and foremost looks after its financial well-being. That, my dear colleagues, is the real reason why professional licensing was established, and why it persists in the face of such damning evidence. Follow the money, not the safety net.

Debunking the Myth: Is Massage Licensing Necessary? - Copyright – Stock Photo / Register Mark WHERE IS THE THREAT?

In stark contrast, the practice of massage therapy and bodywork poses virtually no threat to public safety. The incidence of actual harm occurring from these treatments is minuscule. That’s remarkable, in light of more than 150 million hands-on sessions given to clients each year.

If you wondered how a licensed massage therapist can buy a year’s worth of malpractice insurance for just $96, it’s because there is so little risk for the insurance companies. Low payouts for injury equals low premiums.

Despite this fact, massage therapy advocates have gone into state legislatures over the past two decades lobbying for new license laws to be passed. They were motivated by the desire to get massage out of the draconian city and county ordinances regulating adult entertainment, and to upgrade the status of massage to a full-fledged profession.

In each state, they had to convince lawmakers that the unlicensed practice of massage therapy would pose a danger to the public. But in the absence of real data, these advocates (assisted in most places by AMTA) presented anecdotal stories and raised the prospect of harm.

While their hearts may have been in the right place, myths were put forth as truth. It was none other than Joseph Goebbels who said, “If you tell a lie big enough and keep repeating it, people will eventually come to believe it.”

Believe it they did. As a result of these efforts, we have an entire regulatory structure for the massage therapy field built upon a false premise. Nowhere is this clearer than the homepage of the Federation of State Massage Therapy Boards, where they trumpet in bold headline letters, “FSMTB is focused on public protection.”


Well, the big lie was finally debunked in Vermont. As one of the few remaining states without a massage law in place, AMTA joined forces with ABMP to lobby for legislation there in 2010. In a rare show of unity, both organizations made their most fervent pleas.

Individual practitioners tried to make the case that the public was being harmed by massage therapists and needed to be protected — yet they provided no verifiable evidence. The result can be found in the sunrise application review, published in December 2010 by the Vermont Office of Professional Regulation. Here’s their summary, in plain English:

“Under the sunrise criteria, harm to the public must be real and recognizable, and preventable by regulation. The proponents of regulation have not demonstrated harm or a need to protect the public if the profession remains unregulated. They have not demonstrated that the public will benefit from regulation. Other legal protections and market forces are sufficient to protect the public. Therefore, licensure is not appropriate. The Office of Professional Regulation recommends that Massage Therapists not be subject to professional regulation in the State of Vermont.”3

Legislators in Vermont followed this objective recommendation, and opted not to pass a licensure bill. There was very little coverage about this action in the massage press, since the specter of “potential harm from the unlicensed practice of massage” was still being perpetuated by FSMTB, state massage boards and our membership associations.

No one likes those inconvenient truths! Since then, several more states have enacted massage laws. Is Vermont that much smarter, or is the big lie just too well-etched?


Since public protection is not the real issue here, are there other purposes served by state massage licensure that justify its continuance? Or should all these laws get repealed with the field going back to its former unregulated status? These are the fundamental questions our organizational leaders must take up.

It’s time to shift from the harm-based paradigm to the “provision of good.” Without a doubt, massage therapy is a highly effective health care service, and the public benefits greatly from access to ethical practitioners who provide competent treatment.

License laws support that, and have also created a clear delineation between the business of massage therapy and the use of the term “massage” as a cover for other activities provided by the sex-for-hire industry.

Licensure creates more opportunities for massage to be accepted into medical venues such as hospitals, hospice services, clinics, interdisciplinary practices, and for those who seek it — access to insurance reimbursement. This all benefits the public good.


Continuing education requirements for license renewal, which have been shown to provide no benefit in public safety by the Pew Research Foundation — do translate into better skills, awareness, knowledge and thus to better quality of care provided to the public. This is especially true in a field like ours with such a low entry level of education.

State massage boards should use their statutory authority to crack down on the illegal use of the term “massage” in adult entertainment, and to assist law enforcement agencies in their efforts to address human trafficking. These direct actions will promote the public welfare, and will preserve the integrity of our field.

That’s the key: moving quietly away from a false “public protection” rationale, and shifting state boards’ emphasis to professional development and enforcement of the regulations against unlicensed and unethical practice.


Further, our massage boards should be working with the regulatory boards of other licensed professions to promote interdisciplinary cooperation in ways to facilitate public good. As it is, each discipline fights to protect its professional “turf.”

For too long, the focus of health care has been on the financial benefit of providers at the expense of consumers. It is time for state massage regulation, better yet all professional healthcare regulation, to serve the true interests of the public. Let’s start something good.


  1. McMains V. “Johns Hopkins study suggests medical errors are third-leading cause of death in U.S.” Johns Hopkins University, 2016.
  2. U.S. Food & Drug Administration (FDA). “Medication Error Reports.” U.S. Department of Health and Human Services, 2016.3. Vermont Secretary of State Office of Professional Regulation. Sunrise Application Review, 2010. Docket Number: MT-01-0710.
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