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Massage Today
March, 2001, Vol. 01, Issue 03

Medical Massage II

By Cliff Korn, BS, LMT, NCTMB

Last month, I shared some of my thoughts and observations on massage therapy sharing space with managed care. This month, I'd like to delve into the "care" aspects of massage and medicine, rather than the payment areas.

I am writing this while attending a symposium on complementary and integrative medicine titled, "Clinical Update and Implications for Practice," sponsored by the Harvard Medical School Department of Continuing Education.

The course director is David M. Eisenberg, MD, whose published findings in the early '90s on the public's usage of alternative therapies are credited with opening the eyes of the medical community to the dollars being spent on health solutions, outside the sphere of contemporary allopathic care. My attendance here in Boston gives insights I might not get in the course of my normal daily routine as a practicing massage therapist. The 400+ attendees are mostly physicians, but my fellow attendees include general internists; family practitioners; nurses; pharmacists; pediatricians; oncologists; OB/GYNs; chiropractors; acupuncturists; bodyworkers; naturopaths; psychiatrists; psychologists; licensed social workers; managed care executives; health benefits administrators; and other complementary care providers (even three veterinarians - go figure!).

Complementary and integrative medical therapies are used by an estimated 42% of the U.S. population. Visits to complementary care practitioners exceed visits to primary care physicians by over 200 million visits per year. Americans spend an estimated $30 billion a year on these services, the majority of which nonreimbursed.1 The symposium brochure states, "There is a growing body of literature that is helping to distinguish useful from useless and safe from unsafe therapies. In light of ongoing evidence that most complementary and integrative therapies are neither disclosed to nor discussed with medical doctors, 1,2 there is an urgent need for professional education and improved patient-provider communication in this provocative area."

The symposium is covering many areas of interest to physicians, and several of particular interest to readers of Massage Today. I am delighted to be entering into the discussions and interacting with course faculty in reviewing prevalence, costs, and patterns of use of commonly used complementary and integrative medical therapies; reviewing the theory, practice, safety and efficacy of:

  • chiropractic and spinal manipulation;
  • homeopathy;
  • massage/bodywork;
  • acupuncture;
  • mindfulness meditation;
  • herbal therapies and dietary supplements;
  • naturopathy; and
  • nutritional medicine.

While at the symposium, I will also be taking part in as much of the following as possible:

  • reviewing current information regarding clinically significant drug-herb and drug-supplement interactions;
  • participation in academic case conferences involving patients who have benefited from, or experienced adverse effects related to, complementary therapies;
  • participation in breakout sessions involving demonstrations and clinical applications in chiropractic, acupuncture, massage, homeopathy and herbal therapies;
  • reviewing clinical evidence for complimentary medical therapies for cancer, coronary disease, women's health, and other common medical problems;
  • discussing strategies to responsibly advise adult and pediatric patients who use or seek complementary medical therapies;
  • discussing legal, ethical and financial aspects of caring for patients who use complimentary therapy, including issues of reimbursement; credentialing; licensure; and malpractice liability;
  • reviewing models of integrative medical care within conventional health delivery systems;
  • identifying and examining suitable resources and reference materials;
  • identifying and discussing specific methodological challenges impacting complementary and integrative medicine research;
  • receiving updated information from the NIH National Center for Complementary and Alternative Medicine and the White House Commission on Complimentary and Alternative Medicine Policy; and
  • participating in question-and-answer periods involving investigators, practitioners, educational directors and policy-makers. This is really fun!

Specific to massage therapy, one of the breakout sessions was facilitated by Nancy Dail, owner/director of the Downeast School of Massage, Waldoboro, ME. Nancy did a great job of demonstrating the practical aspects of massage to an audience of physicians and surgeons. She provided both lecture and interactive demonstration stressing that massage therapy meets needs of health care today, evidenced by massage therapy's ability to offer tangible benefits to the average person who wants conservative, cost-effective ways to have optimum health. She pressed home the point that massage therapy generally encourages the individual to take responsibility for oneself, and that massage therapy is a companion to health care, working with the health care system to benefit the individual. The medically oriented audience was attentive as Nancy reviewed the current state of massage education and credentialing, indications/contraindications, and opportunities for referrals.

Another breakout session entitled "Massage Research - Evidence for Meaningful Integration" was led by Janet Kahn, PhD, a past president of the AMTA Foundation, and a senior research scientist for the Wellesley Center for Research on Women, housed at Wellesley College. Janet gave a nicely detailed presentation covering definitions, limitations of research, suggestions stemming from available research and suggestions for ongoing research efforts. She covered aspects of the difficulty (impossibility?) of double-blind randomized control studies that are commonplace in medicine today. She offered that existing research suggests that massage may introduce relaxation; enhance one's sense of well-being; decrease pain; provide noticeable short and long-term relief from low back pain; ease post-mastectomy lymphedema; enhance immune function; and promote development in premature infants.

Although not on the symposium faculty, AMTA President Steve Olson hosted a luncheon networking session providing information to the group of massage therapists who attended. Also present were AMTA President-elect Carolyn Talley, and John Balletto, President of the AMTA Foundation. It was a great opportunity to socialize a bit with the 30 to 40 massage therapists attending the symposium.

The message I took away from the symposium was that those massage therapists (or Asian bodyworkers, herbalists, acupuncturists, homeopaths, naturopaths, etc.) wishing to integrate their practices into the health care system need to pay particular care to evidence-based integration, and support continued research. Dr. Eisenberg stressed that in advising patients, safety will always trump efficacy; and real or potential dangers associated with unscientifically explained or non-reproduced results severely limit the ability to refer. Along this line, a lawyer presented a legal/legislative update covering topics such as a physician's liability in referring to complementary and alternative medicine (CAM) providers. He stressed that physicians have to address questions such as what liability exists when a referral to a chiropractor, acupuncturist or massage therapist occurs and the patient's condition deteriorates. This tied directly to a conversation on credentialing and ties to insurance and referral networks. He also revealed that referring physicians conceivably could be liable for aiding and abetting unlicensed medical practice!

I would encourage Massage Today readers who work or hope to work in concert with other caregivers and/or health care practitioners to take advantage of symposiums such as this one. The perspective gained from attending with others from multidimensional disciplines is vast! The knowledge and perspectives of the physicians present was also aided by the presence of massage therapists. Even if they choose to reject referrals to massage therapists until they become comfortable with further study results, they learn more about what we do, how we do it, and why. As a wise person once said, you must understand that which you choose to reject.

References:

  1. Eisenberg DM, Kessler RC, Foster C, Norlock, FE, Calkins DR, Delbanco TC. Unconventional medicine in the United States - prevalence, cost and patterns of use: results of a national survey. N Engl J Med 1993: 328:246-252.
  2. Druss BG, Rosenbeck RA. Association between use of unconventional medical therapies and conventional medical services. JAMA 1999; 282:651:656

Massage Today encourages letters to the editor to discuss matters relating to the publication's content. Letters may be published in a future issue of Massage Today. Please send all correspondence by e-mail to , or by regular mail to the address listed below:

Massage Today
P.O. Box 6070
Huntington Beach, CA 92615-6070


Former editor of Massage Today, Cliff is owner of Windham Health Center Neuromuscular Therapy LLC. He is nationally certified in therapeutic massage & bodywork and is licensed as a massage therapist by the states of New Hampshire and Florida. Cliff is a member of the International Association of Healthcare Practitioners; a professional member and past president of the New Hampshire chapter of the American Massage Therapy Association; a certified member of the Associated Bodywork & Massage Professionals, Inc.; and a past chairman of the board of directors of the National Certification Board for Therapeutic Massage & Bodywork.

 

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