In a study entitled "The Manga Report", prominent health economists Pran Manga and Douglas Angus of the University of Ottawa, Canada, found chiropractic management to be the best choice of health care for patients with low back pain - in terms of safety, scientific evidence of effectiveness, evidence of cost effectiveness and patient satisfaction. Commissioned by the Ontario Ministry of Health in response to that province's staggering public deficit of the early 1990's, this landmark document represents the largest existing analysis of the scientific literature on low back pain to date.

The Report's primary focus was to determine the most cost-effective health care service available for the treatment of low back pain. In an attempt to address the Ontario government's cost saving concerns, the Report concentrated on comparing the value of chiropractic and medical management of this socially and economically crippling condition. The findings of the Report were based on a review of randomized controlled trials, case control/cohort studies, descriptive studies and meta-analysis/literature reviews - in total, over 400 references concerning both chiropractic and medical treatment methods.

The following are the key findings of this study:

1. On the evidence, particularly the most scientifically valid clinical studies, spinal manipulation applied by chiropractors is shown to be more effective than alternative treatments for low back pain (LBP).

2. There is no clinical or case-control study that demonstrates or even implies chiropractic spinal manipulation is unsafe in the treatment of LBP. Their interpretation of the literature suggests that chiropractic manipulation is safer than medical management of LBP.

3. Indeed, several current medical therapies of LBP are generally contraindicated on the basis of the existing clinical trials. There is also evidence in the literature to suggest spinal manipulation is less safe and less effective when performed by non-chiropractic professionals.

4. There is an over-whelming body of evidence indicating that chiropractic management of LBP is more cost-effective than medical management.

5. There would be highly significant cost savings if more management of LBP was transferred from physicians to chiropractic doctors. Evidence from Canada and other countries suggests potential savings of many hundreds of millions of dollars annually.

6. Workers' compensation studies report that injured workers with the same specific diagnosis of LBP returned to work much sooner when treated by chiropractors than by physicians.

7. There is good empirical evidence patients are very satisfied with chiropractic management of LBP and considerably less satisfied with physician management.

8. The use of chiropractic has grown steadily over the years. Chiropractic is now accepted as a legitimate healing profession by the public and an increasing number of physicians.