Author: Richard H. Adler

The newly released Manga Report (August 1993) commissioned by the government of Ontario, Canada, finds that chiropractic management is superior to medical management for patients with low back pain in the areas of safety, scientific evidence of effectiveness, cost-effectiveness, and patient satisfaction.

This report gives the chiropractic profession a completely new quality of evidence: that which is truly independent, conducted by leading health economic experts, commissioned, and funded by the government, and not the chiropractic profession.

The findings and recommendations contained in the Manga Report are significant:

"Finding 1: ...spinal manipulation applied by chiropractors is shown to be more effective than alternative treatments for low back pain. Many medical therapies are of questionable validity or are clearly inadequate."

"Finding 2: ...Our reading of the literature suggests that chiropractic manipulation is safer than medical management of low back pain."

"Finding 3: ...the much greater need for clinical evidence of the validity of medical management of low back pain... Spinal manipulations are less safe and effective when performed by non-chiropractic professionals."

"Finding 4: There is an overwhelming body of evidence indicating that chiropractic management of low back pain is more cost-effective than medical management..."

"Finding 5: There would be highly significant cost savings if more management of low back pain was transferred from physicians to chiropractors..."

"Finding 6: There is good empirical evidence that patients are very satisfied with chiropractic management of low back pain and considerably less satisfied with physician management..."

"Finding 7: Despite the official medical disapproval and economic dis-incentive to patients (higher private, out-of-pocket cost), the use of chiropractic has grown steadily over the years..."

"Finding 8: In our view, the constellation of evidence of:

a) the effectiveness and cost-effectiveness of chiropractic management of low back pain;
b) the untested, questionable or harmful nature of many current medical therapies;
c) the economic efficiency of chiropractic care for low back pain compared with medical care;
d) the safety of chiropractic care; and
e) the higher satisfaction levels expressed by patients of chiropractors,

together offers an overwhelming case in favor of much greater use of chiropractic services in the management of low back pain."

"Recommendation 1. ...There should be a shift in policy to encourage and prefer chiropractic services for most patients with low back pain."

"Recommendation 2. Chiropractic services should be fully insured under the Ontario Health Insurance Plan, removing the economic dis-incentive for patients and referring health care providers..."

"Recommendation 3. Chiropractic services should be fully integrated into the health care system..."

"Recommendation 4. Chiropractors should be employed by tertiary hospitals in Ontario..."

"Recommendation 5. Hospital privileges should be extended to all chiropractors for the purposes of treatment of their own patients who have been hospitalized for other reasons, and for access to diagnostic facilities relevant to their scope of practice and patients' needs." ...

"Recommendation 7. Since low back pain is of such significant concern to workers' compensation, chiropractors should be engaged at a senior level by Workers' Compensation Board to assess policy, procedures, and treatment of workers with low back injuries..."

"Recommendation 8. The government should make the requisite research funds and resources available for further clinical evaluation of chiropractic management of low back pain..." ...

"Recommendation 10. Finally, the government should take all reasonable steps to actively encourage cooperation between providers, particularly the chiropractic, medical and physiotherapy professions..."

The uses and implications of the Manga Report are substantial for larger institutions and governments wrestling with issues of health care reform, effectiveness, and cost effectiveness of low back care. For the treating chiropractor, the Manga Report can be used in several ways.

1. Patient Education: Let your patients and prospective patients know of this report. Leave a copy in the reception room. Also, incorporate the findings and recommendations into your patient education classes.


2. Interprofessional Relationships: Order several copies of this report and forward them to medical doctors and health care insurers. Invite the medical doctors and administrative officers of insurers to your office or to lunch and discuss how you can work together, how you manage low back pain patients, and why you want his/her referrals.


3. Reasonableness and Necessity of Care: When an insurer challenges the reasonableness and necessity of chiropractic care via paper peer review, IME, or cross-examination by the insurer's attorney at arbitration or trial, you can use this independent report to respond to falsehoods that chiropractic is inappropriate or merely palliative.

To order a copy of the Manga Report, mail your written request and $19.00 check (includes copying and shipping) to Professor P. Manga/Faculty of Administration/University of Ottawa/136 Jean-Jacques Lussier/P.O. Box 450, Station A/Ottawa, Ontario K1N 6N5/CANADA.

Very truly yours,
ADLER GIERSCH, P.S.

Richard H. Adler
Attorney at Law