In 1993 the Ontario Ministry of Health published the Manga Report:
This was a review of literature on the most effective and cost-effective treatments for low back pain. After reviewing all available international evidence, the researchers concluded that chiropractic is "greatly superior to medical treatment in terms of scientific validity, safety, cost effectiveness, and patient satisfaction." In fact this study also concluded that chiropractic care would save hundreds of millions of dollars annually with regard to work disability payments and direct health care costs.
In 1994 the Agency for Health Care Policy and Research (AHCPR) released guidelines for the management of lower-back pain:
The guidelines, which were intended to assist primary-care physicians, were developed by a panel of 23 professionals, including medical doctors, chiropractic doctors, nurses, experts in spinal research, and physical therapists. The panel concluded, among other things, that chiropractic treatment (specifically, spinal manipulation) is recommended for acute low-back problems in adults and should be pursued (in most cases) before pharmaceutical or surgical treatments.
The AHCPR also notes that the chiropractic profession is now the third largest group of doctoral-level providers in the United States (after medical doctors and dentists).
