I want to thank the International Journal of Therapeutic Massage and Bodywork for their open access policy permitting free use with proper attribution in noncommercial settings, which--along with the fair use principle--permits us to engage with the text of this article in depth.
Entries in the IJTMB are governed stylistically and ethically by the publication guidelines of the International Committee of Medical Journal Editors' (ICMJE), Uniform Requirements for Manuscripts Submitted to Biomedical Journals. Published articles are licensed under the Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 license. Accordingly, copyright retention by authors, first publication rights for the journal, free use with proper attribution in noncommercial settings, and prohibition of derivative works are all ensured.
Full disclosure: Rosemary Chunco has been a supporter of the ideas behind POEM since the day I first mentioned the idea to her, and she has donated countless volunteer hours of technical and massage content expertise to bring it to fruition, as well as providing emotional support when I needed it along the way.
You should always read critically, and think about whether what you read makes sense, and that is especially true in this article, because I have a personal connection to the author.
It is my job to connect the dots and build my case to evaluate whether or not what she writes is correct, totally separate from the high esteem I personally hold her in.
Then, it is your job to read what I have written, and decide whether I was really successful in separating my evaluation of her work from what I think of her personally, or whether I am permitting my very high positive regard for her to bias what I write here about her work.
I hope you let me know in the comments whether or not I have succeeded at that task.
"The Ethical Implications of Research and Education in the Massage Therapy Profession", by Rosemary Chunco, LMT, BA, MSc, Owner (Private Practice), Shamrock Therapeutics LLC, Plano, TX, USA, International Journal of Therapeutic Massage and Bodywork, 2008:3(3).
Chunco sets the stage for the ethical and knowledge claims she will make in this article by grounding it in her practical experience of running her own massage practice for a number of years:
As a therapist operating my own practice, I am constantly reminded of the ethical aspects of my work in dealing with situations involving clients and the everyday running of my business. Professional boundaries and ethical practices are recognized within our profession as an important aspect of our work, as evidenced by mandatory classes on ethics in most U.S. states and also by the clearly stated ethical codes and practices set out by our professional organizations. The reasoning behind these measures is clear. Ethical declarations and a thorough understanding of them and their application are needed. They set standards of integrity. They help to define massage therapy as a profession and have significant repercussions on how massage therapists are perceived by the public.
From this foundation, she sets out to explore the connections between research, education, and ethics, and the meaning of those connections in everyday MT practice.
By drawing on specific points in the ethical code of each of MT's 2 major professional organizations in the US, as well as that of the NCBTMB certification board, she avoids partisanship, and focuses on what all of us--at least, those who subscribe to the ethical code of either professional organization--have in common with each other.
Whether it's ABMP's
I shall actively participate in educating the public regarding the actual benefits of massage, bodywork, somatic therapies and skin care.
I shall not make false claims regarding the potential benefits of the techniques rendered.
[practitioners shall] be truthful in advertising and marketing, and refrain from misrepresenting his or her services, charges for services, credentials, training, experience, ability or results.
Chunco correctly emphasizes what they have in common with each other and with other professions' codes of ethics: actual benefits, not making false claims, being truthful and refraining from misrepresentations.
As she observes, this ethical value of veracity--truthfulness, accurately representing the facts--is core to the mission of a healthcare profession such as MT aspires to be.
But how do we gain that veracity about massage? She proposes:
Considering the increasing quantity—and importance—of research in our profession, and applying our understanding of professional ethics, it is apparent that keeping up to date with research findings could be viewed as an ethical responsibility. New research findings may uncover therapeutic benefits that we never learned in school. Conversely, some things we were taught in massage school have been overturned by the latest research. For example, many of us may have been taught that massage helps to release lactic acid from muscle tissue after exercise; research refutes that claim.
In this way, she grounds knowledge in empirical research findings, as well as describing the problem of outdated and ungrounded information that is taught in massage schools as fact.
She is touching on a huge problem here. You don't need to assume any bad intentions at all on the part of massage schools and educators in this situation--it makes perfect sense that the situation has developed because reality changed out from under us faster than we were prepared to keep up.
There was a time in the past when those explanations were the best we had for trying to figure out what was going on in the world around us.
But knowledge has moved on since then, and we were not prepared for that. So now, schools and their owners face tremendous sunk costs--costs already spent, that will never be recovered--as well as tremendous need for investment to bring the new knowledge on board, at exactly the time when the economy does not support such investment.
It is a huge problem, and you can really feel for the plight that educators find themselves in.
And yet, as difficult as the situation is, Chunco is correct: practicing MTs must, every day, confront the fact that what they were taught in school was insufficient, or even wrong, and to pass along that misinformation is to directly contradict the ethical codes of both of our major professional organizations, and of the board that certifies and attests to the integrity of our education.
Integrity means doing the right thing, not when it's easy and anyone can do it, but precisely when--although it would be easier to take the path of lesser integrity instead--you do the right thing anyway, even at greater cost. Chunco is correct in identifying that right thing as "a restructuring of existing knowledge, and that knowledge will continually evolve".
This integration of research findings into our profession’s training programs should be considered an ethical necessity.
"Ethical necessity" is a very strong term--and yet, entirely accurate and appropriate here. We must address the situation; to deny or ignore it is an ethical failure.
She ties that ethical necessity into what is required to actually carry it out. Our responsibilities to understand and integrate research findings run far deeper than just finding a source that says what we like, and slapping a citation onto our claims. Chunco refers to the established biomedical research literature, where others before us have encountered this challenge, to identify weaknesses in our relationship to massage research:
causism, a “tendency to imply a causal relationship where none has been established” (that is, the data are insufficient to support the claim), and data dropping...These, along with misrepresentation of findings, instances of poor research design, and an assortment of weaknesses in methodology can result in low-quality research. It follows that an uncritical acceptance of research by the massage community, and most of all by massage therapists, is a mistake, and that awareness of the ethical and methodologic issues common to any subfield of research is imperative.
But it's not all one-sided responsibility and burden, as she points out--there are professional benefits from being part of the biomedical healthcare team that shares a common body of translational client/patient-centered healthcare knowledge.
By sharing and communicating better with other members of the team, and by communicating a unified message to the client/patient (as she mentions with educating the public about massage), research literacy benefits us as well as putting higher expectations on us.
She deals compassionately and with integrity to common objections raised to changing practice in response to research findings:
When adherents of a specific modality are confronted with research findings showing that that modality has no therapeutic effect, I have often heard or read these three objections:
“More research is needed.”
“If the public wants it, and they believe it works, then we should supply it.”
“If I see results in my practice, then that’s all I need. All I want to do is help my clients.”
Although we frequently deal with these concerns here at POEM, she has said it in her article better and more concisely than I could do myself--I recommend you follow the link to her article and read her responses to these objections for yourself.
Chunco is clear on what needs to be done, yet she is compassionate and empathetic to the practitioners, teachers, and students who find themselves confronted with this new reality:
Having invested time, energy, and money to be trained in a modality and then being confronted with new information showing that that modality may have no therapeutic effect is undoubtedly an unpleasant and uncomfortable situation. The attachment to the modality could even go so far as to be an emotional one. Of course, the power of choice will always lie with the therapist. It is my hope that the ethical core of the therapist will make the right choice and that our profession will accept what good science is showing us; for in doing so, we are using science to raise our own levels of integrity and the universal integrity of the profession. Each of us has a role to play, and we should not view ourselves as detached. The decision that each therapist makes will affect the profession as a whole.
To conclude, it is reasonable to deduce that the link between research, education, and professional ethics is strong. Examination of our ethical codes indicates that it is our responsibility to keep up to date with research findings and to apply them in our work. The decisions that we make as a profession—from every angle and by every participant, whether it be researchers, policymakers, educators, or therapists in practice—will have a significant influence on the true ethical barometer of our field.
Chunco has written a very good and convincing review of the issues and a call for ethical action in integrating the volume of massage research going on into our educational system and our daily practices. As she points out, we're all in this together, and history will record the outcomes for the practice of massage from how individual therapists choose to face our common challenge.