Ontario Ministry of Health concludes that chiropractors

should be theprimary caregiversofpatients

with low-backpain.' Mangaandassociates,theauthors

of thereport,comedownstronglyonthe sideof

thechiropractorandwarnphysiciansthatsocietyexpects

bettercareatalowercost.

Controllingexpensesassociated with thedelivery

ofmedical servicesappearstobe thehighest priorityin

thiseraof fiscal restraint.Thus,it isnotsurprisingthat

the mediaemphasizesstories relatedto costcontainment

inhealthcare.TheMangareportreceived muchattention

without having undergonetherigour ofpeerreview

before publication.Inthis editorialIpointoutthe main

shortcomings of thereportandsuggestthat bettercare

forlow-back painmeansnotmorespinalmanipulations

but, rather, bettermanagementof the patientas awhole

asopposedtoadisease-orientedapproach.

NodoubtMangaand associateshavestrongopinions

aboutourhealthcaresystem.Onpage14 of their

report,inthe introduction, theycommentontheneed for

healthcarereform, stating that "ourhabitofcomparing

ourselves[Canada's system]toanobviouslyinferior

Americansystemhasmadeussomewhat complacent

about theshortcomings ofour ownsystem."Although

mostofus areproudofthe accessibilitytohealthcarein

Canada I know of fewmedical practitioners who feel

that thequalityofcarein Canada issuperiortothatin

the United States. Thisdivergence of opinion between

the authors and healthcareprofessionals possiblyexplains

whynophysician, clinicianorchiropractorwas

seeminglyinvitedtoparticipatein theresearch leading

tothereport.