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Legislative Alchemy, the incorporation of pseudoscience into state and federal law, has allowed chiropractors, acupuncturists, naturopaths, and other practitioners of quackery to join science-based professions like medicine and nursing in the pantheon of state-regulated health care professionals. This bestows the imprimatur of legitimacy on pseudoscience, implies a false equivalency, and gives the public the illusion it is being protected from harm. In some cases, it also forces all of us to participate in the financing of quackery via government-mandated insurance coverage.

Continuing in this tradition, a bill pending in the New York legislature (A3425) would license the “profession of reflexology”, as the bill calls it. A Nebraska bill (LB 211) would allow reflexologists to become registered professionals, a less regulated means of state recognition and sometimes a step on the ladder to full licensing. If the bills pass, New York and Nebraska will join North Dakota, Tennessee, New Hampshire, and Washington state in making reflexology a regulated health care profession. Over thirty other states indirectly recognize “the profession of reflexology” by exempting reflexologists from their massage practice acts, although not specifically making it a regulated health care profession.

Before we get to the pending bills and existing licensing laws, let’s briefly review reflexology, a topic we’ve covered here on SBM several times (see here and here), including Mark Crislip’s memorably titled “Reflexology: Insert Nancy Sinatra Reference Here”, a nod to what we might call reflexology’s foot fetish. We’ll also take a look at how reflexology is taking a page from the playbooks of chiropractic, naturopathy, and acupuncture to achieve its goal of licensing in all 50 states.

Like their fellow practitioners of pseudoscience, reflexologists have created an infrastructure to serve as a foundation for their legitimization: schools, a professional association, certification boards. Conveniently, the states can blindly incorporate the “standards” for reflexology education, training, and practice concocted by these organizations into state law, thereby entrusting the reflexologists themselves to determine their qualifications (such as they are) and scope of practice. This is the same system that gives us naturopathic “physicians” and chiropractic “primary care”.

You can see this plan at work in the Reflexology Association of America’s attempt to come up with a definition of reflexology suitable for licensing laws, where, ironically enough, pseudoscience can be something of a disadvantage. Once the parameters of science are tossed in favor of fabricated systems of anatomy, physiology, and the like, how do you settle on a description of your practice with sufficient detail to make it into the statute books, but with enough elasticity to ensure that future fabrications and additional iterations can be shoehorned into the legal definition of your scope of practice?

Toward this end, the Reflexology Association of America recently joined two other organizations gunning for legitimization via state regulation, the American Reflexology Certification Board and the National Council for Reflexology Educators, to create what they believe is a standardized, statute-worthy definition of reflexology. The American Reflexology Certification Board requires a minimum of 110 hours (that is, less than three 40-hour workweeks) of education and training, including all of 10 hours of clinical work, for certification. The National Council for Reflexology Educators prescribes a 120-hour, somewhat standardized curriculum.

Reflexology should be legally defined, according to them, as

a protocol of manual techniques, such as thumb- and finger-walking, hook and backup and rotating-on-a-point, applied to specific reflex areas predominantly on the feet and hands. These techniques stimulate the complex neural pathways linking body systems, supporting the body’s efforts to function optimally.

The effectiveness of reflexology is recognized worldwide by various national health institutions and the public at large as a distinct complementary practice within the holistic health field.

(For ease of reference, we’ll refer to this as the “reflexology consortium’s definition”.)

As an American Reflexology Certification Board article further “explains”, distinguishing reflexology from mere foot massage,

Although the benefits of reflexology include relaxation of mind and musculature, the primary intent is to support the health of the body’s internal systems . . . Reflexology typically focuses on reflexes corresponding to stressed organs and glands. . . [It can] safely help people of all ages restore homeostasis, optimize physiological functions and address system imbalances and weaknesses . . .

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. (And they do, as you’ll see.)

Nicely done! Science-wise, this is gobbledegook, but that’s no impediment to becoming state law, as we shall soon find out.

Of course, the medical profession should step in at this point and warn the public that this is all nonsense and intervene to prevent further exploitation of vulnerable patients by alerting state legislators to the reflexologists’ scheme.

But they don’t. To ensure that the public is kept reliably ignorant, presumably responsible medical sources like the Mayo Clinic and WebMD pretend they don’t know any better, acting as if reflexology’s fabulations are perfectly reasonable. Thus, from the Mayo Clinic:

The theory behind reflexology is that areas of the foot correspond to organs and systems of the body. Pressure applied to the foot is believed to bring relaxation and healing to the corresponding area of the body. Reflexologists use foot charts to guide them as they apply pressure to specific areas.

And, from WebMD,

There are different theories about the exact way that reflexology works, but the main concept of all is that different areas of the feet are linked to specific body parts, and that putting pressure on one area of the foot can have an effect on the organ that it corresponds with. . . Still another theory suggests that your body contains “vital energy” that is affected by stress. If you don’t work to relieve the stress, your body may not work as well as it should, which may lead to aches or illness. Reflexology is thought to help you maintain the flow of vital energy through your body.

Theory. You keep using that word. I do not think it means what you think it means.

And finally, from the NIH’s National Center for Complementary and Integrative Health:

Reflexology is a practice in which different amounts of pressure are applied to specific points on the feet or hands. These points are believed to match up with certain other parts of the body. Reflexology is claimed to cause relaxation and healing in those parts of the body, but this has not been proven.

“Not been proven”? How about “scientifically implausible to the point of impossibility”?

If the esteemed physicians at the Mayo Clinic, WebMD, and the venerable National Institutes of Health are willing to toss basic anatomy and physiology out the window, is it any wonder that mere state legislators would be willing to legitimize reflexologists by making them licensed health care professionals?

The road to legitimacy, one state at a time

As noted, North Dakota already licenses reflexologists, giving them their own regulatory board, consisting of three reflexologists appointed by the governor. This board determines licensing qualifications, including education and examination, and oversees discipline, just like a state medical board. North Dakota’s definition of reflexology tracks that of the reflexology consortium’s, although it describes only the method of reflexology (“finger walking” and such at “reflex points”), omitting the alleged purpose of all this (stimulating “optimal functioning” and the like).

Licensed reflexologists “may not diagnose or treat for specific diseases”, although presumably that leaves plenty of wiggle room for “restoring homeostasis” and “addressing system imbalances”. They are also prohibited from “false or deceptive advertising”. How that could possibly be enforced without wiping them all out is beyond me.

Tennessee law creates “registered certified reflexologists”, who must have 200 hours of education and training. Reflexology is defined simply as the “application of specific pressures to reflex points in the hands and feet only”, omitting any “theory” of operation or its purpose. Like North Dakota, reflexologists cannot “diagnose or treat for specific diseases” or engage in false or deceptive advertising.

Washington state “certifies” reflexologists, who practice under the state massage board. Certification requires 200 hours of instruction, which must include a “map of reflexes as they are anatomically reflected on the feet, hands and outer ears” and “how the reflexes are affected by stimulation to the feet, hands and outer ears”, thereby ensuring a thorough indoctrination in reflexology pseudoscience via the force of law. The state defaults to the American Reflexology Certification Board exam to determine if reflexologists are qualified to practice.

New Hampshire also licenses reflexologists, defining reflexology as the “use of alternating pressure applied to the reflexes within the reflex maps of the body located on the feet, hands, and outer ears” and likewise defaults to the American Reflexology Certification Board exam.

To briefly address the notion that state regulation somehow protects the public, let’s look at one example of a “registered certified reflexologist” from Tennessee, who advertises that

Reflexology is helpful to…

  • Improve blood circulation and energy in body by stimulating pressure points.
  • Give relief in Stress and helps in Stress Management.
  • Help relieve Back Pain, Neck Pain, Neck Stiffness, Shoulder Tension, Headache, Toothache, etc.
  • Help improve digestion functioning and reduce Stomach problems such as Acidity, Ulcer, Chest burn, Gas.
  • Remove craving for food and balance appetite and reduce amount of wastes.
  • Help relieve Depression, Nausea and other mental disorders.
  • Minimize Sinus Congestion and Nasal Problems.
  • Reduce Nasal pain and to get rid of Runny or Stuffy Nose.
  • Give relief in lung issues.
  • Relieve Ankle Pain, Knee Pain, Elbow Pain, etc.
  • Help improve Skin tone and heal skin disorders.
  • Help to improve Eyesight through massaging points.
  • Help to relieve cold, cough, constipation, Arthritis, Dizziness and Sore throat.
  • Help to Improve memory.
  • Help to reduce Menstrual Disorders in women.
  • Help to reduce emotional challenges of irritability, anger and frustration.
  • Minimize addictions to tobacco, smoking, etc. by stimulating some pressure points.
  • Improve healing from sports injuries.
  • Give Relaxation to the body.

So much for Tennessee’s prohibitions against treating disease and false advertising.

With that, let’s turn to the latest attempts at legitimization via legislation, the bills pending in New York and Nebraska.

New York A3425 would permit “licensed reflexologists”, who would be regulated by the state massage board, with one seat added for a reflexologist. According to the bill’s “Introduction”,

The effectiveness of reflexology is recognized worldwide by various national health institutions and the public at large as a distinct complementary practice within the holistic health field.

Sound familiar? It should. It’s straight from the reflexology consortium’s definition. Not only that, but the bill adopts, word for word, the rest of the consortium’s definition of reflexology (“stimulate the complex neural pathways linking body systems” etc.) as the legal definition of the practice of reflexology. There is no prohibition against diagnosing and treating disease. Reflexologists must have a high school education as well as reflexology training and pass an exam approved by the education department. Given the reflexology consortium’s obvious hand in drafting this bill, one can assume they will successfully influence the department to adopt their approved curricula and certification exam.

Nebraska LB 211 would register reflexologists, who would also practice under the jurisdiction of the state massage board. Reflexology is defined as “the application of specific pressure . . . to the soft tissue of the hands, feet, and outer ears . . . not designated or implied to be massage or massage therapy”. No specific training is required, only passing the examination given by the American Reflexology Certification Board or the Reflexology Certification Board, a different certification organization with its own education requirements (200 hours) and exam.

Reflexologists are following the well-trodden path of legitimization laid before them by chiropractors, naturopaths, and other practitioners of pseudoscience. (Ayurveda recently entered this sweepstakes as well.) It may take decades, but licensing in all 50 states is their goal and, given the support from certain quarters of the medical profession and Legislative Alchemy’s proven track record, “the profession of reflexology” has every chance of getting there.

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Posted by Jann Bellamy

Jann J. Bellamy is a Florida attorney and lives in Tallahassee. She is one of the founders and Board members of the Society for Science-Based Medicine (SfSBM) dedicated to providing accurate information about CAM and advocating for state and federal laws that incorporate a science-based standard for all health care practitioners. She tracks state and federal bills that would allow pseudoscience in health care for the SfSBM website.  Her posts are archived here.