Via the magic of Legislative Alchemy, once again, states are considering licensing reflexologists as health care practitioners, just like medical doctors and nurses. To add insult to injury, some proposed legislation expands licensing to other alternative medicine practices, like Ayurvedic and energy healing.
Legislative Alchemy playbook
Briefly, Legislative Alchemy is the incorporation of pseudoscience into the law. One widespread example is the chiropractic “vertebral subluxation”, “an asymptomatic and undetectable ‘joint dysfunction’… alleged to affect organ system function and general health.” There is no credible evidence that these subluxations exist, yet Congress mandates that Medicare pay chiropractors for manual manipulation of the spine to correct them. More to the point of our post today, chiropractors are licensed health care practitioners in all 50 states, their scope of practice defined by law as the detection and correction of these mythical subluxations.
Following what I call the Legislative Alchemy playbook, chiropractors have created, and control, organizations such as chiropractic schools, the Council on Chiropractic Education (which accredits the schools), and the National Board of Chiropractic Examiners (which administers their licensing exam). State legislators incorporate these organizations into licensing legislation as guarantors of chiropractors’ fitness to practice, ensuring that chiropractors alone are in control of what they learn and their practice standards. To prevent outsiders from meddling in their affairs, a regulatory board controlled by chiropractors is placed in charge of rule-making and discipline.
Superficially, it looks a lot like licensing for medical doctors. And if you don’t actually read the practice act, you’ll have no idea that it’s all based on pseudoscience.
(For a more complete discussion of health care licensing and the elements of a typical practice act, see here.)
Reflexology
Reflexology is in something of a regulatory limbo, with some states regarding it as a type of massage and therefore requiring a massage therapy license to practice. Other states specifically exempt reflexology from massage licensing requirements, leaving it either unregulated or giving reflexologists their own practice act.
The American Reflexology Certification Board (ARCB) pushes for the latter via legislation and, toward that end, came up with this definition, suitable, they feel, for inclusion in licensing bills:
‘Reflexology’ means a protocol of manual techniques… that are applied to specific reflex areas predominantly on the feet and hands of an individual who is fully clothed, except for footwear. The protocol stimulates the complex neural pathways linking body systems and supports the body’s efforts to function optimally. Reflexology does not include the diagnosis of or treatment for specific diseases, or joint manipulations.
The ARCB further “explains” that the “primary intent” of reflexology is “to support the health of the body’s internal systems” by focusing on “reflexes corresponding to stressed organs and glands”. Thus, in their view, reflexology can “safely help people of all ages restore homeostasis, optimize physiological functions and address system imbalances and weaknesses”.
Or, as I less credulously summarized their claims in a previous post:
In other words, these manufactured ‘reflex areas’ (illustrated in the above foot chart), are somehow connected by ‘complex neural pathways’ (so complex they are apparently incapable of explanation by medical science) to the body’s organs and other ‘body systems’. ‘Manual techniques’ applied to the “reflex areas” activates something or other in these ‘complex neural pathways’ and this, in turn, positively affects ‘stressed organs and glands’ in some unspecified manner, thereby bringing about suitably vague effects like ‘optimizing physiological function’ and allowing the reflexologist plenty of room to claim that reflexology can benefit all manner of conditions and diseases.
Following the typical Legislative Alchemy playbook, which has been wildly successful for chiropractors, naturopaths, and acupuncturists, reflexologists have created schools, a proto-accrediting agency, a credentialing agency (the ARCB), and a professional organization, all run by reflexologists. These organizations stand at the ready to be incorporated, if needed, into a proposed practice act, along with a scope of practice (which they’ve defined as above) and a regulatory board, on which they hold a majority of seats.
With that, let’s turn to proposed legislation regulating reflexology and see how practitioners are following the Legislative Alchemy playbook.
North Carolina
The “North Carolina Healing Arts Act” (House Bill 122) would regulate reflexologists under the auspices of a newly created Healing Arts Commission, tasked with protecting the public from “unqualified persons” and ensuring “the highest degree of professional services” by issuing “healing arts” practitioner licenses. “Healing arts” are expansively defined as
allopathic, complementary, or alternative approaches to the art and science of medicine for the prevention, identification, and treatment of human physical or mental conditions, diseases, ailments, illnesses, infirmities, pain, defects, or injuries and promotion and restoration of health and wellness.
Note that this definition specifically endorses alternative medicine, generally understood as the use of unproven practices instead of “conventional” medicine.
Initially, only reflexologists and music therapists are eligible for licensing, but the Act anticipates further “healing arts professions” being added by future legislation, leaving the door open for all sorts of licensed quackery.
(The American Music Therapy Association defines music therapy as “clinical & evidence-based”. I’ve not looked into their claims, but my discussion of this bill is concerned only with reflexology and other potential quackery, not music therapy.)
Each “healing arts profession” has its own Advisory Committee, consisting of two practitioners and one public member. The Commission itself is also composed of practitioners, thereby ensuring a double layer of foxes guarding the proverbial henhouse.
Reflexology is defined in the bill as
A protocol of manual techniques… applied to specific reflex areas predominantly on the feet and hands and that stimulate complex neural pathways linking body systems and support the body’s efforts to function optimally.
Notably, it excludes the ARCB definition’s prohibition against the diagnosis and treatment of specific diseases.
In fact, taken together with the generous definition of “healing arts” quoted above, reflexologists would be able to “stimulate” these illusory “complex neural pathways linking the body systems” to treat any patient of any age with any disease or condition.
Qualifications for this immense responsibility are—to be generous—modest. Reflexologists would have to be all of 18 years old, “of good moral character”, and—adhering closely to the Legislative Alchemy playbook—hold a certification awarded by the ARCB.
ARCB actually offers two certifications: feet and hands. Each requires a high school diploma (or “equivalent”) and a 200-hour reflexology course (either in-person or hybrid in-person and online), including 30 hours (thus, less than a typical workweek) of “practical instruction”.
Applicants for certification can choose the foot exam, the hand exam, or a combination. To ensure that everyone is marching in step and not confused by other charts showing a different array of targeted body parts,
The ARCB utilizes the American Standard Reflexology Foot and Hand Maps. Please base your documentation and exam prep on these charts.
Applicants must also “successfully complete the ARCB SOAP [presumably, Subjective, Objective, Assessment and Plan] Note”. You can see a blank SOAP note form and find a link to a completed example here. Note how, in the latter, the reflexologist presumes to have diagnosed clinically significant abnormalities in the client’s feet and to have located “reflex points” for various body parts she deems clinically significant based on the client’s symptoms. Building on the late, great Dr. Harriet Hall’s “Tooth Fairy Science”, we could call this “Tooth Fairy Clinical Practice”.
The ARCB doesn’t require, or endorse, completion of any particular reflexology school to apply for certification. Rather, it lists topics one’s curriculum should cover, including, paradoxically, both “Critical Thinking” and “Foot Reflexes and Maps”. It does refer candidates to the National Council for Reflexology Educators, which aims to develop national standards for reflexology education. As might be expected, these “standards” include teaching nonsensical reflexology maps and how to locate “reflexes”, as well as marketing.
Under the proposed Act, continuing education (12 hours every 2 years) is also farmed out to the ARCB, leaving it to decide which CE providers can sell their courses to NC reflexologists.
A competing North Carolina bill, House Bill 99, the “Reflexologists Right to Work Act”, would simply remove reflexologists from the jurisdiction of the Board of Massage and Bodywork Therapy and allow them to practice with no regulatory oversight, as long as they are “ARCB-certified”. The bill uses the same science-free definition of reflexology as House Bill 122.
Massachusetts
Massachusetts Senate Bill 261 is entitled “An act regulating alternative [that word again] healing therapies”. The proposed law replaces the massage therapy board with a “board of registration of massage therapy and alternative healing therapies.” Naturally, massage therapy and alternative healing practitioners themselves would make up a majority of board members and would decide, aided by an advisory council composed solely of alternative medicine practitioners, what their scopes of practice and qualifications for licensing should be.
Per the bill, serving as a perfect example of the Legislative Alchemy process, standards for professional and ethical conduct and education should reflect “acceptable national, state, or other recognized professional organization or certification standards of each discipline”.
The foxes could not have asked for better.
This is a truly frightening bill. “Alternative healing therapies” include:
Asian bodywork therapy, bodywork, reflexology, structural integration or Rolfing, and energy and somatic health practices as identified by the advisory council [made up of alternative therapy practitioners] . . .
In addition to reflexology, a few practices are specifically defined. For example, Asian bodywork therapy is the treatment of
the human body/spirit/mind, including the electromagnetic or energetic field, which surrounds, infuses and brings that body to life.
Sounds like someone read, or watched, Frankenstein.
“Energy and somatic healing practices” are to be further defined by the advisory council, and may include, but are not limited to:
The Feldenkrais Method; the Trager Approach; Ayurvedic Therapies; Polarity or Polarity Therapy; Qi Gong [caution: typically credulous NCCIH explanation]; Body/Mind Centering; and Reiki, levels II and above.
In sum, the bill would license all manner of quackery, limited only by the imagination of the advisory council and board.
The board would have the authority to investigate complaints
for fraudulent, deceptive, or professionally incompetent and unsafe practices.
If one assumes, based on established science, that telling a client his electromagnetic field is out of whack, and charging to fix it, is deceptive and fraudulent, then this provision has the potential to wipe out a lot of practitioners. I’ll wager that is not the intent.
Iowa
Finally, Iowa House File 2178 would allow practitioners to use the term “certified reflexologist” if they met certain educational requirements, although the bill eschewed naming a particular educational or certifying organization. Practitioners would operate under the jurisdiction of the board of medicine. The bill uses the reflexologist-approved definition of their practice, including the prohibition against diagnosis and treatment of disease.
No matter the fate of any particular bill this year, reflexologists and other alternative medicine practitioners appear determined to become licensed health care professionals, so they’ll be back, year after year, with ready-made practice acts in hand.
